Artificial Intelligence-Supported Digital Game and Exercise Applications in Children With Autism and Typically Developing Children

This study will examine the effects of artificial intelligence-supported digital game and exercise applications on children with autism spectrum disorder and typically developing children using a holistic approach. The study will include 60 children aged 6 to 10 years, including 30 children with autism spectrum disorder and 30 typically developing children.

Participants will be assigned to intervention and control groups. The intervention group will include 15 children with autism spectrum disorder and 15 typically developing children. The control group will include 15 children with autism spectrum disorder and 15 typically developing children. Children in the intervention group will participate in artificial intelligence-supported digital game and exercise activities, while children in the control group will not receive this intervention.

The study will examine changes in motor skills, repetitive behaviors, working memory, and brain activity. Quantitative assessments will include standardized measures and electroencephalography (EEG). Qualitative information will also be collected from parents to provide a broader understanding of children's experiences and development.

• Movement-Based Digital Game Intervention (Behavioral): The intervention consists of a 10-week movement-based digital game program specifically developed for children aged 6-10 years. Participants in the intervention groups will attend two sessions per week, with each session lasting approximately 60 minutes. Sessions include warm-up, movement-based digital game activities, and cool-down. The digital games are delivered using an interactive projection system and require children to perform active body movements in response to visual and game-based tasks. Activities progressively target balance, coordination, locomotor skills, object control, hand-eye coordination, bilateral coordination, rhythm, reaching, jumping, changing direction, body awareness, and target-directed movements. Game difficulty and movement demands are progressively adjusted throughout the intervention period.

Primary outcomes

• Motor Skill Performance [Baseline and immediately after the 10-week intervention]: Motor proficiency in the 30 children with autism spectrum disorder and 30 typically developing children will be assessed using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Short Form (BOT-2 SF). The BOT-2 SF consists of 12 items representing eight motor skill areas: Fine Motor Precision, Fine Motor Integration, Manual Dexterity, Bilateral Coordination, Balance, Running Speed and Agility, Upper-Limb Coordination, and Strength. Raw performance scores for individual items are converted to point scores according to the BOT-2 scoring procedures and summed to obtain a Total Point Score. The BOT-2 SF Total Point Score ranges from 0 to 88. Higher scores indicate better overall motor proficiency, whereas lower scores indicate poorer motor proficiency.
• Repetitive Behaviors Assessed With the TEDÖ-R-TV [Baseline and immediately after the 10-week intervention]: Repetitive behaviors in the 30 children with autism spectrum disorder will be assessed using the Repetitive Behavior Scale-Revised-Turkish Version (RBS-R-TV). The scale consists of 43 items covering six domains of repetitive behavior: Stereotyped Behavior, Self-Injurious Behavior, Compulsive Behavior, Ritualistic Behavior, Sameness Behavior, and Restricted Behavior. Each item is rated on a 4-point scale from 0 to 3. The total score ranges from 0 to 129. Higher scores indicate greater severity of repetitive behaviors and, therefore, a worse outcome, whereas lower scores indicate less severe repetitive behaviors.
• Working Memory Assessed With the Working Memory Scale (ÇBÖ) [Baseline and immediately after the 10-week intervention]: Working memory will be assessed using the Working Memory Scale (ÇBÖ) developed by Ergül, Özgür-Yılmaz, and Demir. The Working Memory Scale for Children Aged 5-10 Years will be used to assess working memory performance in children with autism spectrum disorder and typically developing children. The scale consists of nine subtests grouped into four dimensions: Verbal Short-Term Memory (Digit Recall, Word Recall, and Nonword Recall), Visual Short-Term Memory (Pattern Matrix and Block Recall), Verbal Working Memory (Backward Digit Recall and First-Word Recall), and Visual Working Memory (Odd-One-Out and Spatial Discrimination). Each item includes two trials, and one point is awarded for each sequence correctly recalled or identified in the required order. The total raw score ranges from 0 to 86, with higher scores indicating better working memory performance.
• Brain Activity Assessed With Electroencephalography (EEG) [Baseline and immediately after the 10-week intervention]: Brain activity will be assessed using electroencephalography (EEG) before and after the intervention. EEG recordings will be used to evaluate changes in brain activity associated with the artificial intelligence-supported digital game and exercise intervention.

Sex: All, ages: 6 Years to 10 Years, accepts healthy volunteers

Inclusion Criteria:

* Children aged 6-10 years.
* Written informed consent from a parent or legal guardian.
* Ability to understand and follow simple verbal instructions.
* Ability to stand independently and perform basic locomotor movements.
* For participants in the ASD groups: a physician-confirmed diagnosis of autism -spectrum disorder (ASD) with mild to moderate severity.
* For typically developing participants: typical development without a diagnosis of ASD or another neurodevelopmental disorder.
* For typically developing participants: no known neurological, orthopedic, or cardiovascular condition that would interfere with participation in the study activities.

Exclusion Criteria:

* Orthopedic surgery within the previous 6 months.
* Presence of a neurological, orthopedic, or cardiovascular condition that may limit participation in movement-based activities.
* An acute health condition that prevents participation in physical activity.
* For typically developing participants: presence of a diagnosed neurodevelopmental disorder.
* Inability to complete the planned assessments or participate safely in the study activities.
* For participants assigned to an intervention group: expected attendance of less than 80% of the planned intervention sessions.