SIGNIFICANCE: One can hardly overstate the impact of impairments on the lives of individuals with autism spectrum disorder (ASD). After reaching adulthood, most individuals with ASD are not employed, do not get married, or do not achieve enough independence to live alone. This problem reflects an important societal need; is important to clients, families, practitioners, and policy makers; and needs to be better addressed by occupational therapy. Executive function (EF) and motor deficits have been consistently documented in studies of individuals with ASD that limit their participation in many activities.

INNOVATION: Identification of effective, interesting, and motivating interventions is important to provide optimal therapeutic impact for children with ASD. Sometimes resistance to intervention limits the potential for addressing some of these areas. The format of the Makoto Arena has been shown to be generally attractive and motivating to potential participants in the pilot study, which gives it more potential for reduced client resistance than more traditional intervention approaches to these problem areas. The whole area of exergaming offers an interesting and potentially effective medium for addressing a range of occupational therapy goals. This research leads the way for occupational therapists to better understand and utilize this developing group of intervention tools. To date, there are no studies that specifically look at how EF and motor skills can be affected by participation in an exergame in children with ASD. This type of intervention has potential for use in driving programs for youths with ASD and for addressing EF and motor skills in other populations.

APPROACH: This study investigated the effects of a pilot 30-session Makoto Arena training intervention—a light-and-sound, speed-based exergame (computerized game involving exercise)—on response speed, EF, and motor skills in high-functioning, school-age children with ASD. The study attempted to answer the following research question: Does participation in a light-and-sound exergame affect performance in response time, motor proficiency, and EF in children with ASD?

METHOD: This study used a single-group, pretest–posttest research design that was completed in two area schools. Seventeen high-functioning children with a diagnosis of ASD participated in the pilot study. Each participant completed the Makoto Arena protocol for 30 sessions, with a total of approximately 1,800 attempts to strike the targets. The Behavior Rating Inventory of Executive Function and the Bruininks–Oseretsky Test of Motor Proficiency—Second Edition were used to measure EF and motor skills.

RESULTS AND CONCLUSIONS: Participants had increases in average reaction speed, most areas of EF, and motor skills.

This pilot study provides initial evidence suggesting that exergaming—specifically, use of the Makoto Arena—may be useful for improving EF and motor skills for children with ASD. Use of exergames in therapy has the potential to provide effective, interesting, and motivating interventions. Study weaknesses include use of a convenience sample, no control group, and no measure of sustained impact on academic skills. Studies to further understand and possibly increase the benefits of various types of exergaming on individuals with ASD will be valuable steps toward best practice.