A literature review on the benefits of serious games to the literacy process of children with disabilities and learning difficulties

Abstract

BACKGROUND:

Many studies have been developed to explore and better understand the interaction between individuals and technological resources in the context of special education.

These studies show that Information and Communication Technologies, and more specifically digital games, have the potential to improve the learning process of children with disabilities.

OBJECTIVE:

The main purpose of this paper was to develop a literature review in order to identify the benefits of the use of Serious Games (SG) to the literacy process of children with disabilities and learning difficulties.

METHODS:

Previous studies related to the use of Serious Games (SG) in the literacy process of children with disabilities and learning difficulties were identified and analyzed. Considering the expressions, keywords and criteria used to select the papers, the sample was comprised of 25 studies.

RESULTS:

The main results show that SG, when used as assistive technologies, contribute to the literacy process, since children usually feel motivated to play the games and learn. Moreover, we identified that to benefit the literacy process, games need to be easy to use, challenging, enjoyable and include feedback, reinforcements and interactive resources.

CONCLUSIONS:

The literature indicates that the use of SG can stimulate engagement and that interactive activities can contribute to the literacy process of children with disabilities and learning difficulties.

Keywords

Serious games information technology disability special education literacy

1. Introduction

Information and Communication Technologies (ICTs) have been increasingly used to support people in their daily activities. In the field of education, the use of ICTs also has grown exponentially [1]. ICTs resources become particularly interesting due to the possibility of combining visual forms with educational settings, using, for example, immersive multimedia, virtual reality and 3D animation [2]. Additionally, using mobile devices, technological resources gain mobility and ubiquitous access [3].

The benefits related to ICTs for education include since the use of internet by teachers as a support material up to the use of games with educational purposes [1], which is the case of Serious Games (SG). SG can increase the motivation and engagement of students, explore creativity and improve self-confidence [2], presenting a positive outcome in the learning process. The contribution of SG becomes more effective when the experience involves multi-sensory features [4]. Moreover, through RFID systems that is a resource related to the Internet of Things (IoT), the interaction can integrate real and digital elements [1], facilitating the engagement of children when playing for educational purposes.

SG also gained prominence in the context of special education, since they have an important role in assisting the learning process of individuals with disabilities ([2, 5]) and enhance experiences ([6]), even in distance learning through telepractice [7]. However, most of the studies on educational games is usually focused on children with typical development characteristics [2], which indicates opportunities to new research about the use of SG for children with disabilities and learning difficulties.

One of the most important skills that children need to develop in early years is reading [8], that usually is learned at school [9]. Literacy skills are relevant for individuals at (and after) school ([9, 10]), but for individuals with some types of disability and learning difficulties, the literacy process may be challenging, requiring the use of different strategies.

Previous studies show that SG may help children with disabilities in their literacy process ([2, 9]), but the design of interactive experiences is different for individuals with typical development characteristics and individuals with disabilities; depending on the disability, the design may require specific characteristics for communication and interaction [1]. Games usability also deserves an additional attention when they are developed for children with disabilities [11].

Considering this context and the role of ICTs, and specifically of SG, to the learning process, the main purpose of this paper was to develop a literature review in order to identify the benefits of the use of Serious Games (SG) to the literacy process of children with disabilities and learning difficulties. Following the criteria presented in the next section, we identified 25 different studies involving a set of technological resources that support the literacy process. These studies highlight the important role that serious games play in the special education, especially when it allows autonomous training.

The development of a literature review in the field of technology and special education can motivate new studies in the area and has the potential to reveal new issues that could be addressed by new research. Technology is constantly receiving improvements, for example, through new resources, new devices, and new forms of interaction. This paper identified studies using cutting-edge technologies, such as augmented reality, RFID, artificial intelligence, and mobile applications. These improvements can be used in the future development of games aimed at special education.

2. Method

In order to identify the studies to be analyzed, we conducted some rounds of online searches at DePaul Library. Table 1 shows the keywords used in the searches and the number of studies identified in each round. It is important to note that some studies were identified in more than one round.

Table 1
Number of studies according to the keywords

Keywords	Number of studies
“Serious Games”, Literacy, Disability, Write, Read.	316
“Serious Games”, “Literacy skills”, Blind.	6
“Serious Games”, “Literacy skills”, Deaf.	5
“Serious Games”, “Literacy skills”, Autism.	23

These searches were made considering the period from January 2015 to January 2021 (since the data were collected in February 2021). The following databases were considered during the online search: IngentaConnect; Social Science Premium Collection; Directory of Open Access Journals; Education Database; Academic Search Complete; Education Research Complete; ABI/INFORM Collection; OmniFile Full Text Select (H.W. Wilson); SpringerLink Contemporary (1997-present); Professional Development Collection; Springer for R&D – Telecommunications; Springer for R&D – IT & Software; SpringerLink Contemporary (CARLI); Computers & Applied Sciences Complete; Single Journals; PubMed Central; Springer for R&D – Finance, Business & Banking; Springer for R&D – Electronics; Business Source Complete; JSTOR Archive Collection.

After identifying the studies, we read the title and the abstract to analyze their adherence to the purpose of this research. The criteria for inclusion of the papers for review was that they should address the use of games in the literacy process of children with disabilities or with learning difficulties in the educational environment or in clinical interventions. Only studies published in English and in academic Journals were selected. Literature reviews were excluded. The sample of studies was then analyzed by other researcher in order to confirm the adherence to this research. Following these steps, the initial sample was comprised of 28 papers. Then, we read the papers to identify the type of disability that they have addressed, the name and attributes of the game (or games) that they have tested or developed and the benefits provided by the games to the literacy process of children with disabilities or with learning difficulties. In this stage we have excluded three papers that did not meet the inclusion criteria. So, the final sample was comprised of 25 papers.

The disabilities/learning difficulties explored by the studies were: Autism Spectrum Disorders; Complex Communication Needs; Dyslexia; Hearing Impairments/Deafness; Intellectual Disabilities; Language Disorders; Reading Difficulties; Visual Impairments. The next section presents these studies categorized by type of disability: Learning Difficulties; Intellectual Disabilities and Autism Spectrum Disorders; Hearing and Visual Impairments. For each of these categories we presented the previous studies and the main benefits of SG.

3. Results

3.1 Games for children with learning difficulties

Intervention programs can present a positive outcome to facilitate the acquisition of reading and fluency skills [8]. Therefore, it would be helpful to identify children that would present reading difficulties. Hautala et al. [12] explored this issue using a computerized game-based assessment (GBA) system in order to identify students with reading difficulties. The study sample was comprised of 723 students. Reading skills were evaluated based on five tasks: word reading and spelling, pseudoword reading and spelling, and sentence reading comprehension [12]. The main results indicated that GBA tasks help in identifying primary school students with reading difficulties. Borleffs et al. [13] highlight that by identifying those children that are at risk of developing reading difficulties at an early stage and by using additional learning tools like GraphoGame, it is possible to minimize the sequelae of reading disabilities.

Even with efforts to provide reading instruction for children, some of them do not acquire reading skills [10]. The combination of different pathways to literacy acquisition is explored by Moses et al. [10], since the authors investigate the use of visual-based language (in this case, the American Sign Language – ASL) and sound-based approaches to teach hearing children. The study considered a sample with 77 preschool participants. An educational video in ASL, with 40-min., was used with and without sound. Following such design, three groups of comparison were considered: a group who viewed the ASL video with sound; a group who viewed the ASL video without sound; and a control group who did not view the video. The authors observed that hearing children can be benefited by the incorporation of ASL into educational videos, representing an alternative route of the literacy process of hearing children [10].

Ronimus et al. [14] investigated the contribution of a digital game, called GraphoLearn, to support children with difficulties in acquiring reading skills. This game was “designed specifically for children who have a risk for dyslexia” ([14, p. 640]) and has a child-friendly interface, so the individual does not need to present any reading skill to use it. Engagement in the game is supported through the use of an avatar and a labyrinth-like fantasy [14]. The study sample was comprised of 37 participants during the intervention of 6 weeks (intervention group: 17 participants; control group: 20 participants). Two groups were considered in the analysis: a group with that used the GraphoLearn in addition to support from school and a group that did not use GraphoLearn, only the support from school. Participants who used the game presented better reading skills when compared to the other group. According to the authors:

“Serious games could offer an alternative method of practice for these students [students with learning difficulties] because these games can provide individually adaptive training on specific skills and experiences of success in tasks which these students would likely fail to achieve in a conventional classroom education.” ([14, p. 640]).

El Kah and Lakhouaja [4] evaluated a set of five games designed to children with dyslexia and dysgraphia. They conducted the evaluation based on two exams: one before and one after the use of the games. These exams contain two kinds of tests: reading and spelling, divided into three subparts: letters, words and sentences. A high level of motivation was observed among the participants when using the games. The main results showed that the participants enhanced their reading and spelling skills after using the games [4].

Still in the context of literacy skills, Connor [15] analyzed an Assessment-2-Instruction (A2i) technology, designed to support literacy instruction. The author also presented the Word Knowledge e-Book (WKe-Book), that can improve the word learning and monitor/repair the comprehension of unfamiliar words. These resources allow a more personalized instruction, improving student outcomes and prevent reading disabilities [15].

GraphoGame represents a technology-based intervention that teach basic literacy skills and can support children with reading difficulties [16]. The authors highlight that the relevance of GraphoGame goes beyond practicing basic literacy skills, having the potential to impact the education sector at a country level. Ojanen et al. [16] also provide an overview of GraphoGame activities in four countries: Zambia, Kenya, Tanzania, and Namibia.

Franceschini et al. [17] observed improvements in word reading and in phonological decoding speed for English-speaking children with dyslexia. The game used by the authors was “Rayman Raving Rabbids”, where single mini-games were selected, played during two weeks, segregated in 9 sections of 80 minutes [17]. Participants were tested in two different moments: first, before starting the treatment (between 3 to 5 days before); secondly, after ending the treatment (between 1 and 3 days after) [17].

Grünke et al. [8] evaluated the contribution of racetrack games to the reading skills of children with learning disabilities. Four children, with special needs, from elementary school participated of the experiment, that occurred during three weeks. As the main results, the authors observed that the treatment can support students with learning disabilities to improve skills related to sight words and reading fluency.

Vasalou et al. [18] examined a game called Words Matter, designed for children with dyslexia. They observed the kind of social interactions between students and students, and between students and tutors. Words Matter can support world decoding, spelling and fluency among children and consider evidence-based pedagogical principles. The sample was comprised of 8 children with dyslexia, that played the game during ten weeks. Observing the main result of their study, Vasalou et al. highlight that the context “is critical in shaping the nature of engagement and learning” ([18, p. 190]). Therefore, engagement occurs also by social motives, and game features can gain meaning in social interaction [18].

Disabilities related to speech and language can affect the individuals’ skill to understand and to be understood by others [19]. Rocha et al. [19] created a mobile application that can assist training pronunciation for people with speech and language impairments. One remarkable advantage presented by the authors is that individuals can use the app at any time. Rocha et al. [19] also highlight that, in the context of special education, a solution that allows daily autonomous training generates value. Their empirical analysis is based on 35 children (15 with speech and language impairments and 20 with no impairments), three speech therapists and three usability experts. The authors observed that the app can encourage children to perform the activities, and positive feedback was also obtained in relation to its efficiency, effectiveness and satisfaction. It can also be used in therapy sessions [19].

Lorusso et al. [11] presented a system to improve semantic competence and structural knowledge of children with language impairments. To recognize the toys, the authors used NFC tags and, when necessary, a micro HDMI port. The app, with educational purposes, is installed in a Tablet and contains a set of activities (such as story, picture, puzzle, song …) which are activated through the interaction between the Tablet (using a NFC reader) and plastic animals (that contain NFC tag stickers). Some activities, such as “information” and “story”, can be read or listened. Lorusso et al. [11] observed that the device can contribute to both educational and rehabilitation contexts, supporting communication skills; children were shown to be engaged and motivated when using it.

Overall, the studies presented above highlight and reinforce the contribution of serious games to develop and improve the reading skills of children with learning difficulties. These results become more relevant when we also observe previous research pointing the importance of reading skills for individuals in the society ([6, 8, 9, 10]).

3.2 Hearing and visual impairments

Hearing impaired children do not access the language sound, which affects their literacy process [3]. In this regard, special education programs play an important role [3]. Yaman et al. [3] created and evaluated a Mobile Reading Comprehension Package, involving two mobile applications: “storybook” and “story map”. During the empirical analysis the authors observed increased attention and motivation of hearing impaired children, when using the applications.

Bouzid et al. [2] proposed a game to contribute to the vocabulary acquisition for Deaf and Hard of Hearing (DHH) individuals. The game, called MemoSign, contains an avatar based system, namely, a 3D human character. In their study, MemoSign was evaluated by students, who gave their opinion about its usability. The study sample was comprised of 9 deaf learners that evaluated the game in three sessions [2]. The data of the experiment were collected using a qualitative approach, including observations and interviews. A questionnaire was also employed to collect data, and the Technology Acceptance Model ([20]) was considered to support this stage. Other constructs were also included, so the questionnaire contains four main dimensions: Usefulness, Ease of Use, Satisfaction and Ease to Learning, where the responses consider a Likert scale ranging from 1 to 3 [2]. The main results indicate that participants presented a positive attitude toward using the SG, especially for the constructs: Usefulness, Ease of Use and Ease to Learning. As pointed out by the authors, this SG offers an innovative approach to learn and a useful tool for teaching vocabularies [2].

Cano et al. [1] analyzed two kinds for interactive experiences through non-traditional interaction. In the analysis, they consider children that have cochlear implants. According to the authors. these children must learn to identify the sounds that make up the words. The first proposal, Phonomagic, is a physical board which includes non-traditional interaction through IoT resources. Its design follows an ear anatomy, it has levels and sub-levels represented by colors and the interaction is done though cards (with RFID tag) and the Tablet. Therefore, it requires a RFID sensor that is an IoT-related resource [1]. The second proposal, Caseto, supports children with cochlear implants in learning music [1, p. 9]. Its design follows an interactive piano and each color represents a musical note; so, when a given note is pressed, its respective color is projected. The feedback when the children press a button is given by RBG LED diodes and speakers. In the paper, Cano et al. [1] also highlighted (and illustrated) how IoT is transforming interactions; they also shown how tangible interfaces promote interactivity.

Cano et al. [21], using the information search process, analyzed a set of serious games designed for children with hearing impairment. Children with hearing impairments and literacy problems were evaluated. The authors identified 20 SG that could be used only with a Tablet device and evaluated five of them. They observed that the information search process was useful to identify relevant needs related to teachers and deaf children [21].

Information technology also has promising resources for interventions or consultations at a distance, through telepractice [7]. The telepractice service model becomes more prominent for children with hearing loss due to the low number of qualified service providers for in-person treatment [7]. Considering this context, Lee et al. [7] evaluated the intervention through telepractice for children with hearing loss. Their interventions were provided twice a week, during 12 weeks. In the telepractice group, children received intervention using a computer and amplification systems. Their results indicated that teleptactice can improve phonological awareness skills for children with hearing loss [7]. Moreover, the authors observed that in-person interventions and the telepractice service delivery model were equivalent in terms of effectiveness.

Edirisinghe et al. [6] pointed out the relevance of reading and visualizing to the learning process of children. However, the benefits from picture books are lost for visually impaired children, since their acquisition of representations is different when compared to visually sound children. Considering this scenario, the authors evaluated an improved version of a book, “Alice and Her Friend”, that has interactive elements based on touch, sounds, and smells. The study was conducted with 10 educations and 25 children (with visual impairment), considering both qualitative and quantitative approaches. A high level of enjoyment and engagement of the children was observed by the authors for the multi-sensory interactions [6].

The primary literacy medium for individuals who are blind is braille [22]. A tool to support the literacy skill of beginning braille readers in the absence of teachers would be invaluable [22]. McCarthy et al. [22] evaluated the usability and effectiveness of an Internet-based tool (Braille Tutor) to reinforce instruction. Braille Tutor uses adaptive computer instruction, which represents a form of artificial intelligence [22]. They found that Braille Tutor can support visually impaired students in acquiring braille proficiency.

Based on these previous studies we note the relevance of the development of games considering the specific needs of children with hearing impairments and with visual impairments. The design of games for children with hearing impairments must consider their difficulty, or in some cases impossibility, of accessing the languages’ sounds. Thus, the use of visual resources is very important for these individuals. In the case of visual impaired children, multisensory tools may contribute to their learning process.

3.3 Intellectual disabilities and autism spectrum disorder

We found four initiatives addressing the context of individuals with Autism Spectrum Disorders (ASD). Caron et al. [5] investigated the inclusion of Transition to Literacy (T2L) features in an augmentative and alternative communication (AAC) software. Participants of the study include individuals with autism. The authors observed that such integration can generate improvements in sight-word reading, according to the results of the study. They highlight that the study:

provides preliminary evidence that redesigning AAC apps to include T2L features may positively impact the sight-word reading of individuals with ASD and complex communication needs. […]. All of the participants demonstrated gains in reading the target sight-words, suggesting that incorporating T2L features into AAC apps to support sight-word learning may be effective for individuals with complex communication needs even when they are unable to decode words ([5, p. 150]).

Novack et al. [23] evaluated a mobile application to teach receptive language skills for children with Autism Spectrum Disorder. The application, called Camp Discovery, was designed to teach receptive language targets using different lessons and a gameplay format. After four weeks of interaction and with a sample comprised of 28 participants, the authors observed gains in the treatment group.

In a more specific context, Serret et al. [9] developed a serious game, SEMA-TIC, to support the learning of literacy skills for children with Autism Spectrum Disorder that are minimally verbal. The authors also evaluated the usability of the game for the acquisition of literacy skills. The sample was comprised of 25 children, and two groups were considered for analysis: a training group that received treatment during 23 weeks (12 participants) and the other group, that did not receive training (13 participants). SEMA-TIC presented an adequate level of usability (in terms of adaptability, efficiency and effectiveness). Moreover, the group that received training presented better levels of literacy skills, indicating that the development of literacy skills by children with ASD is not necessarily linked to spoken language [9].

Ahlgrim-Delzell et al. [24] created a phonics-based reading curriculum for students with developmental disabilities. This intervention was called Early Reading Skills Builder (ERSB), that was designed with different levels (8 levels) and different lessons (5 lessons per level). iPads were used by the students to indicate the response, pressing buttons [24]. Three ERSB skills were considered by the authors as dependent variables: phoneme identification (25 items); blending sounds to identify words (41 items); decoding for picture-word-matching (40 items). The study sample was comprised of 31 students (treatment $=$ 17; control $=$ 14) with autism, developmental delay, or intellectual disability. According to the main results, for two skills (phoneme identification; decoding for picture-word-matching), students that received treatment presented better performance when compared to the students in the group of control [24].

Regarding children with intellectual disabilities, Guarnieri et al. [25] explored a test-retest reliability of a VR game, called MoviLetrando. The game has different phases and levels of difficulty, and considers alphabet, numbers, and sets. Guarnieri et al. [25] also investigated the feasibility of the game considering its usefulness for literacy. The study sample was comprised of 88 individuals with intellectual disabilities. Their results indicated that participants with intellectual disabilities, through the use of a computer-based game, can practice spelling and improve vocabulary acquisition.

Caro et al. [26] evaluated a gesture-based videogame, BeeSmart, which can support eye-hand coordination and pre-literacy skills. BeeSmart starts with a short animated video and contains different levels, themes and items to be use for playing. The levels to be played are decided by a therapist, considering the cognitive and motor functioning levels. The sessions played by each child also can be viewed by the therapists. Caro et al. [26] conducted their study using a sample with seven children with Down syndrome during a period of ten weeks. Two psychotherapists also participate in the research. Based on the qualitative and quantitative analysis, the authors observed that the game has many benefits for children with Down syndrome; moreover, it represents an educational tool to support and practice eye-hand coordination, as well as pre-literacy skills [26].

The literacy process can be particularly challenging for children with intellectual disabilities. The literature shows that the use of games can contribute to the development of literary skills of these individuals, assisting them in the acquisition of vocabulary and pre-literacy skills. Regarding individuals with autism, studies point that serious games can contribute to the development of their language and reading skills.

Table 2
The benefits and some characteristics of the SGs analyzed in this paper

Author	Disability/learning difficult	Serious games characteristics	Benefits
Ahlgrim-Delzell et al. [24]	Developmental disabilities	iPad-based app with Early Literacy Skills Builder (ELSB) curriculum	Allows children to learn phonics skills
Borleffs et al. [13]	Reading difficulties	GraphoGame SI: has playful activities with grapheme-phoneme coupling	Allows children to train reading skills and help to minimize the sequelae of reading disabilities
Bouzid et al. [2]	Hearing impairments	MemoSign: useful, enjoyable and easy to use	It stimulates the students’ interest in learning sign language
Cano, Flórez-Aristizábal, Collazos, Fardaoun, and Alghazzawi [1]	Hearing impairments (children with cochlear implant)	Phonomagic and Caseto: interactive games that contains real objects that can be manipulated and explored by the children	The games support the teaching-learning process and motivate children, by allowing them to learn in a collaborative manner
Cano, Alghazzawi, Arteaga, Fardoun, Collazos, and Amador [21]	Hearing impairments	Seven games were evaluated and a prototype of a serious game was proposed	After identifying limitations of existing applications, the authors proposed a serious game that includes aspects that can motivate children’s learning such as fantasy, challenge, feedback, surprise, etc.
Caro et al. [26]	Down syndrome	BeeSmart: it is a gesture-based videogame	It has potential to improve eye-hand coordination and pre-literacy skills
Caron et al. [5]	Autism spectrum disorders and complex communication needs	Dynamic Text in an Augmentative and Alternative Communication app	The game presented a positive impact in sight-word reading
Connor [15]	Reading difficulties	Assessment-2-Instruction (A2i) technology; Word Knowledge e-Book	Help teachers to become more effective in using assessment data to give more personalized instruction, and prevent reading problems as well the sequelae of reading disabilities
Edirisinghe et al. [6]	Visual impairments	Alice and Her Friend: A picture book with multi-sensory interactive experiences	The book is engaging for both teachers and children
El Kah and Lakhouaja [4]	Dyslexia and dysgraphia	Five games were evaluated	The games are efficient and play an important role in improving the learning process
Franceschini et al. [17]	Dyslexia	Single mini-games from “Rayman Raving Rabbids’	The games enhance the visuo-spatial attention, the phonological working memory and the visual-to-auditory attentional shifting
Grünke et al. [8]	Children with learning difficulties	A Racetrack Game	The tool can support children in building sight words and improve their reading fluency
Guarnieri et al. [25]	Individuals with intellectual disability	MoviLetrando: an augmented reality game	The game improves vocabulary acquisition
Hautala et al. [12]	Children with reading difficulties	A computerized game-based assessment system	It is a reliably and cost-efficient way to assess children reading skills
Lee et al. [7]	Speech and hearing disorders	Telepractice intervention with various games	It is ffective to improve phonological awareness skills of young children in the same way of in-person intervention
Lorusso et al. [11]	Children with language disorders	A Near Field Communication-based Application: It is engaging, rewarding, and easy to use	The game keeps childrens’ attention and motivation
McCarthy et al. [22]	Visual impairments	Internet-based Braille Tutor tha uses Artificial Intelligence	It improves proficiency in braille literacy
Moses et al. [10]	Hearing children with reading difficulties	An educational video with ASL (American Sign Language)	It helps hearing children to acquire both ASL and literacy skills
Novack et al. [23]	Autism spectrum disorder	Camp Discovery: mobile application; includes reinforcements, feedback and interactive minigames to motivate children	The app effectively teaches Receptive Language Skills

Table 2, continued
Author	Disability/learning difficult	Serious games characteristics	Benefits
Ojanen et al. [16]	Children with reading difficulties	GraphoGame: web-based game. Is is adaptative, challenger, enjoyable and has feedback	It improves children’s reading performance
Rocha et al. [19]	Speech and language impairments	AppVox: mobile app with audio stimulus to train the pronunciation of words	It improves language and speech capabilities, which can contribute to the development of literacy skills
Ronimus et al. [14]	Difficulties with acquiring reading skills	GraphoLearn: the game has a child-friendly interface.	It provides gains in reading fluency
Serret et al. [9]	Autism spectrum disorders	SEMA-TIC: includes 10 Games with progressive and adapted learning activities based on nonverbal cognitive skills. The games provide reinforcements, feedback and nonverbal instructions	It improves Literacy Skills
Vasalou et al. [18]	Dyslexia	Words Matter: Highly structured approach, graphical representations, reinforcements and allows generalization	It encourgaes social engagement, creating new opportunities for learning
Yaman et al. [3]	Hearing impaired children	Storybook and Storymap: mobile applications with enriched instructional environments	The games significantly increase children attention and motivation

4. Discussion

After the analysis of the 25 studies, we elaborated Table 2 in order to summarize the main benefits of the SG. The table also indicates the disability/learning difficult addressed by each study, as well as the main characteristics of the SG.

Based on the studies of the sample it was possible to identify some features that games must have to benefit the literacy process of children with disabilities or with learning difficulties. Games need to be easy to use, enjoyable and include fantasy, interactive and playful resources. Feedback and reinforcements are also important feature of the games. Moreover, games need to be challenging (with multiple difficulty levels). Finally, games must be interactive, allowing children to explore and manipulate objects in the virtual environment. In a general way, serious games with these characteristics have a positive impact in the literacy process because they help children in the development of their reading skills, by engaging and motivating them to learn. During the analysis we also identified cutting-edge resources that can be used to improve the learning process of children such as virtual and augmented reality, artificial intelligence, mobile applications, Tablets, Leap Motion and Kinect-like devices.

It is important to note that for the development of serious games as an assistive technology for special education, the particularities and limitations of individuals with each type of disability must be considered. For hearing impaired children, for example, the use of visual based resources and interfaces that involve sign language are essential. Visual-graphical aspects are also relevant for children with autism and complex communication needs. Multi-sensory resources that involve touch, sounds, and smells may enhance the learning process of visual impaired children, Finally, for children with intellectual disabilities, realistic virtual environments with daily life activities are very important.

5. Conclusions, limitations and future studies

The literature review conducted in this paper shows the relevance of technologies for the learning process of individuals with disabilities and learning difficulties. It is important that the interventions start in an early stage and with a suitable technology, according to the characteristics of the user. ICTs provide different tools to stimulate engagement and can generate significant experiences among learners. These tools attract users’ attention, so they can learn, for example, while playing a game. Motivation was also presented by many studies as an advantage generated by Serious Games (SG) use with educational purpose.

We can observe some initiatives to identify students that potentially will have reading difficulties and studies that highlight the relevance of using different resources in the literacy process (visual-based, sound-based or multisensory resources, depending on the disability). Incorporating new features in existing apps also can generate gains in terms of literacy skills acquisition. Prior research also shows that literacy skills of individuals with disabilities and learning difficulties were positively affected by the use of educational games.

The results of this study become especially relevant when we observe previous research pointing that there are few initiatives related to the development of Serious Games focused on people with hearing impairment. This figure is also valid to other disabilities. Therefore, this research can contribute to the development of new studies in this field.

The study identified important characteristics that games must include to benefit the learning process of individuals with disabilities. These characteristics could be considered for the development of future solutions. Moreover, according to Ronimus et al. [14], the process of reading acquisition is different among different languages. Therefore, it is important to develop studies considering also regional characteristics, the particularities of each language and country culture.

This study has some limitations. The first limitation is related to the criteria used to select the studies to be analyzed, since only papers in English were considered. Moreover, the sample of this study only includes papers published during the period of analysis, following the keywords presented in the methods section. Further analysis considering other databases, periods, and other languages can expand the results achieved in this study. We also recommend for further research an analysis considering the use of SG during the period of pandemics, where the contact between teachers and students is naturally limited to avoid COVID-19 contagion. During these periods, maybe the interaction of students with disabilities with technology is affected and new studies can fill this gap and propose alternatives to help users with the interaction of SG, especially those games that require the mediation of the teacher to be used.

Author contributions

The authors contributed equally to the study.

Ethical considerations

This study, as a literature review, is exempt from Institutional Review Board approval.

Footnotes

Acknowledgments

The authors would like to thank the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) for its support through the project n ${}^{\circ}$ APQ-00417-14.

Conflict of interest

The authors have no conflicts of interest to report.

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A literature review on the benefits of serious games to the literacy process of children with disabilities and learning difficulties

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Method

Table 1 Number of studies according to the keywords

3.1 Games for children with learning difficulties

3.2 Hearing and visual impairments

3.3 Intellectual disabilities and autism spectrum disorder

Table 2 The benefits and some characteristics of the SGs analyzed in this paper

5. Conclusions, limitations and future studies

Author contributions

Ethical considerations

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Number of studies according to the keywords

Table 2
The benefits and some characteristics of the SGs analyzed in this paper