Addressing Cognitive Bias in Adolescents with Neurodevelopmental Disorders Using 3-D Animated Serious Games.
A 10-session animated game flips negative thinking in most autistic teens, yet mood scores stay flat.
01Research in Context
What this study did
Stewart et al. (2025) tested a 10-episode 3-D cartoon game called Minds Online.
The game teaches teens with autism, ADHD, or developmental delay to spot negative thoughts and flip them.
Kids played the game at school while researchers tracked their thinking before and after each session.
What they found
Seven out of eight teens started picking more positive endings to short stories.
Standard mood and anxiety scores barely moved.
Daily check-ins showed mixed results—some kids felt better, some did not.
How this fits with other research
Dembo et al. (2023) also used a 3-D game with autistic teens and saw social gains, but Stewart looked at thinking style instead of social skills.
Yerkibayeva et al. (2025) got big, fast gains with a tooth-brushing game, while Stewart found smaller, slower change—likely because brushing is a simple habit and bias is a deep thinking pattern.
Bauminger-Zviely et al. (2013) mixed computer tasks with CBT for social concepts a decade earlier; Stewart updates that idea by wrapping the lesson inside a full cartoon story.
Why it matters
You can add a short, game-based bias module to your middle-school sessions without pulling kids out of class.
Expect quicker thought-shift data, not quick mood scores—track story-completion choices instead of anxiety scales.
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02At a glance
03Original abstract
Objective: This study sought to evaluate the effectiveness of a serious game, that embeds cognitive bias modification for interpretation (CBM-I), in altering the negative interpretive bias of early aged adolescents diagnosed with Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Specific Learning Disorders. The difficulties that adolescents with neurodevelopmental disorders (NDDs) experience navigating the social nuances of everyday environments make them prone to the cognitive biases that lead to the development of negative thought patterns. Directly tackling the biased interpretive processes that give rise to negative thinking may be effective in reducing negative bias and mental health problems. Method: Minds Online, a 10-episode 3-D animated serious game that embeds CBM-I was introduced using a three-phase multiple baseline design in a school setting. Eight adolescents diagnosed with an NDD completed the 10 episodes. Results: Real-time data revealed that seven of the eight adolescents altered their negative interpretive bias to a benign bias. However, pre- and post-test standardized measures revealed non-significant changes in the desired direction for mental health. Visual analyses of 308 daily self-reported ratings about worry about schoolwork, worry about peer relationships, and feelings of loneliness did not demonstrate a replicated intervention effect. However, when these interrupted time series data were analyzed statistically, significant individual improvements were evident. Engagement with Minds Online was excellent, as was adherence to daily data collection. Conclusions: Minds Online seems to be highly effective in altering the negative interpretive biases of adolescents with NDDs, which is promising because such cognitive biases are involved in the onset and maintenance of psychopathology.
Pediatric Reports, 2025 · doi:10.3390/pediatric17020028