About the author: Grant Meredith is a lecturer of Computer Games and Multimedia within the School of Science Information Technology and Engineering (SITE) at the University of Ballarat, Australia. Grant is also the discipline coordinator for the Games, AI and Multimedia programs. Additionally, Grant is the programme leader for the Technologies for Empowering People for Participation in Society (TEPPS) Programme. TEPPS envisages, designs, tests and implements assertive technologies for people in need. Grant has research interests in assertive technologies, cyber ethics, social justice and information systems. Grant is a member of the SITE IT/educational research team that is currently investigating issues of student retention, assistance novice programmers and perceptions of plagiarism. Grant is an active publisher and has presented his work globally. By the way..he stutters.

The theme of this year’s the International Stuttering Awareness Day (ISAD) Online Conference is “People Who Stutter Supporting Each Other”. The theme has led me to think about how people who stutter (PWS) do/can indeed support each other. The obvious ways come to mind ranging from lending an ear to a chat, to participating actively within a support group through to pointing PWS towards accepted treatment methods. But of course, we are all individuals with different opinions, interests and talents. So there may be many other ways in which we can support each other. In my case as the research leader for Technologies for Empowering People for Participation in Society (TEPPS) programme (http://tinyurl.com/tepps) I lean personally towards creating, evaluating and rolling out technologies that may help my fellow PWS. I love to share ideas, discuss ideas and collaborate on ideas. In this paper I intend to present some ideas with the aim of inspiring parents and speech language pathologists (SLPs) into further discussion revolving around the development of treatment for children who stutter (CWS) in different ways than are conventionally used at the moment.

Computer games are no longer only the domain of children as they once were.  Video games are a serious business and it may shock some readers to know that globally the games industry yearly earns more money than Hollywood (Stuart, 2011) and has continued to do so since from at least 2008. Video gaming is being taken very seriously in terms of its overall effect on global culture, as an evolving art form and as the source for serious academic focus. Recent surveys on gamers have opened up many people’s eyes to how far video gaming has spread from smoky 70’s arcades and through to the technologies and culture of modern families.

For example the Entertainment Software Association reported that in 2012 (Entertainment Software Association, 2012):

• The average age of a gamer was 30;
• Male gamers only slightly outnumber female gamers;
• 62% of gamers play games online with other people;
• 40% of gaming adults regularly play games with their children;

Yes, 40% of adults who game also regularly play games with their children. Another survey conducted by Bond University in 2011 indicated that 92% of Australian households had at least one device used for playing games. The report also highlighted a high degree of parent/child gaming interactions indicating that a 88% percentage of parents who gamed (83%) played games regularly with their children (Brand, 2011). This indicates a large amount of family unit gaming interactions and firmly sets gaming as a family affair in many modern households. So it makes me think hard. We know that many people and children play video games, and together. But why have speech and language pathologists not considered video gaming as a method to assist therapy in a serious fashion? For parents of CWS who may be reading this article consider these thoughts: How many hours do your children put into gaming per day and how many times have you perhaps told your kids off for spending too many hours gaming? But what if these CWS were playing games that were assisting them with therapy, treatment or social confidence? I would then think that you would most likely be encouraging more hours for them behind the gaming screen. The aim of this paper is to propose two different games-based ways for people to consider in terms of the future treatment and support of children who stutter. These methods are by directly using video games as tools of support and/or by using the process of “gamification” to make therapy and treatment more appealing to children. To begin with I will discuss the use of video games as enablers of therapy and support. The first decision we must make is whether to develop a video games or to use existing games which are already out on the market and on the store shelf. Initially it may make sense to use games which have already been developed to appeal to the general gamer market. This would be a much cheaper and quicker option than developing games specifically only for speech therapy.  Of course you should keep in mind the content and appropriateness of a game before considering exposing your child to it. Let’s consider the use of the well-known games like “Cooking Mama” in which players prepare and cook meals through a series of mini-games or a point and click adventure game like “Sam & Max” with its rich comical storylines. Games like these could so easily be included within therapy with parents observing or playing with their children while at the same time encouraging the use of learnt speech techniques. It would be so easy to develop narrative discussions around the game play and interactions within. This would add a great fun element to clinical and home based treatments. This could very well encourage children to be more interested in therapy and encouraged them to practice.

Now let’s consider the creation of games for children who stutter. In my mind this is a tricky one because why would you reinvent the wheel for? So many games already exist on the market on the shelf in which we could easily include within therapy in some form. But what if the aim of the game was not directly therapy related, but was more concerned with social confidence and self-esteem? My approach to creating games for kids would then be different and go beyond peer interactions. I would consider creating a video game that could assist therapy, but would more importantly have a strong lead character who stutters. The child could then more readily identify with the character and play them out through the stories within the game itself. A computerised stuttering positive role model, whether it be a private investigator, a swamp frog or even a galactic ranger saving the universe. An avatar which is accepted within their virtual world, faces challenges and overcomes them, while in fact stuttering openly all along the way. Even better, we could design a game in which the child could customize the lead character to resemble themselves, in turn truly placing themselves within the game world. I would think that parents of children who stutter the world over would gladly encourage their children to spend hours and hours interacting and playing such games. Alternatively the narrative of the game may be more akin to real life in which there at times may be negative feedback from peers and strangers. It would be great for children and families to be able to work through, discuss and educate the child about such situations. This educational experience could occur within a comfortable, caring and supportive home-based environment. These types of games in my mind could be heavily complementary to existing therapy techniques and support services. These types of games if marketed and designed correctly could also have a strong ability to spread awareness of stuttering on a global scale and appeal to a much wider market.

Another consideration for SLPs could be the “gamification” of therapy for children. Gamification is a not a new term or concept but perhaps many readers may not have heard of it. Gamification is becoming a focus of some serious academic attention with studies being conducted across different disciplines and is hard to give justice to in a small paper. The process of gamification at its core revolves around using game mechanics and techniques to encourage, motivate and excite participation, learning and collaboration in non-gaming contexts. This may sound daunting to some people. How in the world would I “gamify” therapy? Well perhaps some of you are already doing it without knowing it. Actually once explained in terms for an SLP you might well begin to see elements of it everywhere throughout normal everyday life. Why not play on the natural desires and expectations of a generation which have grown up with video games?

Gamification can revolve successfully around a sense of community. A community could revolve around an SLP clinic, via a stuttering organisation of support groups. Within the community you could gamify therapy and support with a little thought quite easily. Groups could even have virtual portals and websites to assist with this and cater for a more widespread, if not global audience.

For example when combining a website together with conventional therapies and support environments to encourage the gamification of supporting children who stutter you could give the ability of children to create avatars to represent themselves. These avatars could range from being realistic in appearance through to more animal forms. Children love to create virtual characters and identities. You may even allow the child to name their avatar. This avatar would represent the child through the following list of possible interactions and game elements.

To encourage a child to focus hard on therapy a sense of reward and progression represented through their avatar could occur. Imagine being able to grant a child some form of virtual achievements for various tasks set by the SLP and family. For example a child may have consistently practiced their learnt techniques for a week for the SLP may award them a virtual ribbon, badge or perhaps virtual currency. With the virtual currency perhaps the child could buy additional clothes and items for their avatar. Or perhaps if a partnership was struck with some local businesses them the virtual currency may translate into store credits of some form. Reward could also take the shape of progression bar and leveling up. A child could then easily gauge their progression through therapy and aim to level up. The result of leveling can itself allow certain allocations of rewards and incentives.

Earlier, I alluded to the fact the gamification can revolve around a sense of community and this is true. Imagine a website on which many different children can register and join with the help of their parents. All these children are represented by avatars and are all undergoing therapy. It would not be difficult to implement some form of competition amongst avatars. You could allow leader boards of achieved points or levels to be public amongst members. These could revolve around a site-wide reward system that all associated SLPs inform and enforce. Like adults, children may also be driven by such a sense of achievement and also competition.

To aid with gaining achievements and scaling the leader board SLPs may be able to give children a series of quests or goals to achieve. These tasks can be allocated in a progressive order and paced to match the progress of the individual child. Many popular children games revolve around the  completion of quests and missions. Some missions may revolve around the practicing of techniques consistently or perhaps specified speaking tasks. Some examples may be making a phone call querying a shop or giving a “show & tell” presentation at school. Again via the quests the child could level their avatar up higher or be given some form of virtual achievement.

Finally it would be possible to build into the online community some form of multiplayer cooperation or role playing. In a more complex system different children could log on and team up at the same time with perhaps the aim of role playing a scenario. For example they may create a play within a virtual theatre, run a virtual shop or interview each other on a virtual radio station. These role playing meetings could be run and times by the therapist or the families of children to supervise and guide the interactions in a playful and constructive manner. With carefully thought out processes you may also allow the registered children themselves to chat to each other and socialize with the aim of peer-lead support. Through a web-based environment this could be facilitated globally and a child would grow very aware that they are not alone in regards to stuttering.

To complete this paper I just wish to reiterate that I think it is time that the speech and language profession starts to seriously consider how to implement both video games and the process of gamification into conventional therapies. The careful design and evaluation of these processes may tap into the modern gaming mentality and make therapy more fun for children. In turn hopefully leading to more successful therapy-based outcomes for all involved.

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References

Brand, J. (2011). Digital Australia 2012. Eveleigh, NSW: School of Communication and Media, Bond University.

Entertainment Software Association. (2012). Essential Facts about the Computer and Video Game Industry: 2010 sales, demographic and usage data. Retrieved from http://www.theesa.com/facts/pdfs/esa_ef_2012.pdf

Stuart, K. (2011). Video games: Where to now for the UK industry?   Retrieved 28th August, 2013, from http://www.theguardian.com/media/2011/mar/14/video-games-industry-uk-struggle