據研究報導顯示5歲以下兒童發展遲緩率高達10-15%，好發於學齡前兒童身上。發展遲緩會使孩童的語言理解、粗細動作與生活自理技能等能力出現落後的表現，其中視知覺能力的缺陷是發展遲緩兒童最常見的的病症之一。視知覺能力無論在學習、遊戲技巧或日常生活中都扮演著重要的角色，而現今臨床訓練主流採用傳統紙本訓練。此訓練形式枯燥乏味且缺乏互動性，使兒童出現缺乏訓練動機、注意力不集中等狀況。而遊戲訓練應用於兒童醫療上已有一定的研究基礎，互動遊戲訓練對於提升兒童的訓練動機有良好的效果。然而對於發展遲緩兒童狀況不同。遊戲除了具有互動之外，系統介面設計也將影響訓練的難易度與可用性，因此介面設計與圖型呈現方式對發展遲緩兒童最為合適仍需多加探討。
本研究旨為設計一款適合發展遲緩兒童使用的視知覺遊戲訓練系統，並探討他們對介面設計的偏好與可用性，從而設計出高滿意度的訓練系統。我們招募了16名學齡前發展遲緩兒童（年齡4-7歲，平均年齡5.5歲）參與介面偏好實驗。在實驗過程中使用眼動儀觀察兒童閱讀模式。結果表明，指定圖型擺放的位置對兒童的正確答題數有顯著影響（t=2.764, p=0.007<0.05）。有獎勵機制且指定圖型擺在畫面中央的介面能有助於兒童的答題表現。透過熱點圖的觀察發現，在本系統中表現佳的兒童關注較集中，主要關注於指定圖型與正確答案，而表現差的兒童關注度較分散。基於上述實驗結果和專家啟發式評估的建議，我們對系統進行優化與修正。最後，招募了50名（發展遲緩兒童和典型發展兒童各25名）學齡前兒童進行系統易用型評估測試與滿意度調查。結果表明兩個族群的易用性等級都達到B級（分別為80.8分與85.7分），滿意度為4.48分與4.84分，滿分為5分。數據表明本系統無論對發展遲緩兒童或典型發展兒童都是簡單容易操作的。本研究結果可為發展遲緩兒童視知覺遊戲開發研究以及兒童數位遊戲研究提供參考。

According to research reports, the rate of developmental delay in children under the age of 5 is as high as 10-15%, and it tends to occur in preschool children. Developmental delays cause children to lag in language comprehension, gross motor, and self-care skills, with visual impairment being one of the most common conditions in children with developmental delays. Visual perceptual skills play an essential role in learning, gaming skills, and daily life, and today's training methods are mainly based on traditional paper-based training. Visual perceptual skills are important in learning, gaming skills, and daily life, and today's training methods are mainly based on traditional paper-based training. This method is tedious and needs more interaction, which makes children lack motivation to train and inattentiveness. The application of game training to children's medical care has been studied to a certain extent, and interactive game training has effectively enhanced children's motivation to train. However, the situation is different for children with developmental delays. In addition to the game's interactive nature, the system interface design will also affect the hard and usability of the training, so the how kind of design that is most suitable for children with developmental delays still needs to be explored.
This study aims to design a visual-perceptual game training system for children with developmental delays and investigate their preferences for interface design and usability to design a highly satisfying training system. This study recruited 16 children with preschool developmental delays (aged 4-7 years, mean age 5.5 years) to participate in an interface preference experiment. An eye-tracking device was used to observe the children's reading patterns during the experiment. The results of this study are: the position of the specified pattern placement significantly affected the number of correct answers of the children (t=2.764, p=0.007<0.05). Furthermore, an interface with a reward mechanism and a specified pattern in the center of the screen can help children's performance. T Through the observation of the heat map, it was found that the children performing well in this system were more focused on the specified patterns and correct answers. In contrast, the children performing poorly were more scattered in their attention. Based on the above experimental results and the recommendations of the heuristic evaluation, the system was optimized and modified. Finally, 50 preschoolers (25 children with developmental delays and 25 children with typical development)were recruited for the system usability (SUS) and satisfaction surveys. The results show that both groups achieved a usability grade of B (80.8 and 85.7 for each), with a satisfaction rating of 4.48 and 4.84 out of 5. The results show that the system is simple and easy for children with developmental delays and typically developing children. The results of this study can be used as a reference for research on visual-perceptual games development for children with developmental delays and digital games for children.

Ahn, S. N. (2021). Combined Effects of Virtual Reality and Computer Game- Based Cognitive Therapy on the Development of Visual-Motor Integration in Children with Intellectual Disabilities: A Pilot Study. Occupational Therapy International, 2021, Article 6696779. https://doi.org/10.1155/2021/6696779
Bailes, A. F., Reder, R., & Burch, C. (2008). Development of Guidelines For Determining Frequency of Therapy Services in a Pediatric Medical Setting. Pediatric Physical Therapy, 20(2), 194-198.
Berry, K. E., & Buktenica, N. A. (1967). Developmental test of visual-motor integration. Chicago: Follett.
Bernard, M., Mills, M., Frank, T., & McKown, J. (2001). Which fonts do children prefer to read online. Usability News, 3(1), 2001.
Brooke, J. (1996). SUS: a quick and dirty usability scale. Usability evaluation in industry, 189(194), 4-7.
Bruckman, A., Bandlow, A., Dimond, J., & Forte, A. (2012). Human–computer interaction for kids. In Human Computer Interaction Handbook (pp. 841-861). CRC Press.
Caro, K., Tentori, M., Martinez-Garcia, A. I., & Zavala-Ibarra, I. (2017). FroggyBobby: An exergame to support children with motor problems practicing motor coordination exercises during therapeutic interventions. Computers in Human Behavior, 71, 479-498.
Case-Smith, J., & O'Brien, J. C. (2013). Occupational therapy for children-E-Book. Elsevier Health Sciences.
Chen, Y. N., Lin, C. K., Wei, T. S., Liu, C. H., & Wuang, Y. P. (2013). The effectiveness of multimedia visual perceptual training groups for the preschool children with developmental delay. Research in developmental disabilities, 34(12), 4447-4454.
Chen, W.-H. (2016). The study on the influence of the visual picture prompt teaching for attention in child with special needs
Chen, Y. (2013). The Effectiveness of The Intervention of Systematic Multimedia Visual-Perceptual Training Group for Children With Developmental Delay between 4 to 6 years old National Taichung University of Education. Taichung.
Huang, C.-L. (2017). The effectiveness of interactive kinetic game on visual perceptual functions in children with developmental disabilities- A randomized controlled trial Kaohsiung Medical University. Kaohsiung.
Choo, Y. Y., Agarwal, P., How, C. H., & Yeleswarapu, S. P. (2019). Developmental delay: identification and management at primary care level. Singapore medical journal, 60(3), 119.
Colarusso, R. P., & Hammill, D. D. (2015). Motor-Free Visual Perception Test-4. Academic Therapy Publications.
Fotaris, P., Mastoras, T., Leinfellner, R., & Rosunally, Y. (2016). Climbing up the leaderboard: An empirical study of applying gamification techniques to a computer programming class. Electronic Journal of e-learning, 14(2), 94-110.
Frostig, M., Lefever, W., & Whittlesey, J. (1963). Disturbances in visual perception. The Journal of Educational Research, 57(3), 160-162.
Gottschalk, F. (2019). Impacts of technology use on children: Exploring literature on the brain, cognition and well-being.
Inkpen, K. M. (2001). Drag-and-drop versus point-and-click mouse interaction styles for children. ACM Transactions on Computer-Human Interaction (TOCHI), 8(1), 1-33.
Hamari, J., Shernoff, D. J., Rowe, E., Coller, B., Asbell-Clarke, J., & Edwards, T. (2016). Challenging games help students learn: An empirical study on engagement, flow and immersion in game-based learning. Computers in human behavior, 54, 170-179.
Hammill, D. D., Pearson, N. A., & Voress, J. K. (2014). DTVP-3: Developmental test of visual perception. Austin: Pro-Ed.[Google Scholar].
Ho, L. P., & Lee, Y. C. (2022). Prevalence of developmental delay among children: A national study based on administrative database of the single‐payer National Health Insurance System in Taiwan. Child: Care, Health and Development, 48(2), 324-335.
Johnson, S. P. (2011). Development of visual perception. Wiley Interdisciplinary Reviews: Cognitive Science, 2(5), 515-528.
Kafai, Y., & Bates, M. J. (1997). Internet Web-searching instruction in the elementary classroom: Building a foundation for information literacy. School Library Media Quarterly, 25(2), 103-11.
Kamaruzaman, M. F., Rani, N. M., Nor, H. M., & Azahari, M. H. H. (2016). Developing user interface design application for children with autism. Procedia-Social and Behavioral Sciences, 217, 887-894.
Katz, S. E., & Breed, F. S. (1922). The Color Preferences of Children. Journal of Applied Psychology, 6(3), 255.
Khan, I., & Leventhal, B. L. (2021). Developmental Delay. StatPearls. Treasure Island, FL: StatPearls Publishing.
Kılıç, A. O., Sari, E., Yucel, H., Oğuz, M. M., Polat, E., Acoglu, E. A., & Senel, S. (2019). Exposure to and use of mobile devices in children aged 1–60 months. European journal of pediatrics, 178, 221-227.
Levy, Y. (2018). ‘Developmental delay’reconsidered: the critical role of age-dependent, co-variant development. Frontiers in psychology, 9, 503.
Ho, P. C., Chung, S. M., & Lin, Y. H. (2012). Influences on children's visual cognition capabilities through playing ‘intelligent matrix’developed by the augmented virtual reality technology. International Journal of Humanities and Arts Computing, 6(1-2), 160-171.
Lai, D.-C., & Huang, J.-N. (2018). Screening and Referral of Children with Developmental Delays. Family Medicine and Primary Care, 334-339.
Lin, Y.-H. (2010). Influences on Children’s Visual Cognition Capabilities through Playing“Intelligent Matrix” Developed by the Augmented Virtual RealityTechnology (in Chinese).
Lin, H. C., Chiu, Y. H., Chen, Y. J., Wuang, Y. P., Chen, C. P., Wang, C. C., Huang, C. L., Wu, T. M., & Ho, W. H. (2017). Continued use of an interactive computer game-based visual perception learning system in children with developmental delay. International Journal of Medical Informatics, 107, 76-87. https://doi.org/10.1016/j.ijmedinf.2017.09.003
Linehan, C., Waddington, J., Hodgson, T. L., Hicks, K., & Banks, R. (2014). Designing games for the rehabilitation of functional vision for children with cerebral visual impairment. In CHI'14 Extended Abstracts on Human Factors in Computing Systems (pp. 1207-1212).
Lissauer, T., & Carroll, W. (2017). Illustrated Textbook of Paediatrics 5th Edition (5th ed.).
Majnemer, A. (1998, March). Benefits of early intervention for children with developmental disabilities. In Seminars in pediatric neurology (Vol. 5, No. 1, pp. 62-69). WB Saunders.
Majnemer, A., & Shevell, M. I. (1995). Diagnostic yield of the neurologic assessment of the developmentally delayed child. The Journal of pediatrics, 127(2), 193-199.
Martin, N. A., & Gardner, M. F. (2006). Test of visual perceptual skills. Novato, CA: Academic Therapy Publications.
Masood, M., & Thigambaram, M. (2015). The usability of mobile applications for pre-schoolers. Procedia-Social and Behavioral Sciences, 197, 1818-1826.
Mitchell, A., & Savill-Smith, C. (2004). The use of computer and video games for learning. A review of the literature, 88(10), 1397-1399.
Mithyantha, R., Kneen, R., McCann, E., & Gladstone, M. (2017). Current evidence-based recommendations on investigating children with global developmental delay. Archives of disease in childhood, 102(11), 1071-1076.
Nielsen, J. (1994). Heuristic evaluation. Usability Inspection Mehods.
Nielsen, J. (1996). Usability metrics: tracking interface improvements. IEEE Software, 13(6), 1-2.
Nielsen, J. (2010). Children’s websites: Usability issues in designing for kids. Jakob Nielsen’s Alertbox.
Noor, H. A. M., Shahbodin, F., Ananta, G. P., Mohd, C., Razali, S. N., Khalid, M. S., & Baharum, Z. (2017). A prototype development of visual perception diagnosis games for autism children. International Journal of Advanced and Applied Sciences, 4(3), 68-72.
Northway, N., & Dutton, G. (2009). Undetected visual problems in adults with literacy difficulties. Glasgow Caledonia University: Glasgow (unpublished doctoral dissertation).
Pavlov, N. (2014). User interface for people with autism spectrum disorders. Journal of Software Engineering and Applications, 2014.
Pellas, N., Fotaris, P., Kazanidis, I., & Wells, D. (2019). Augmenting the learning experience in primary and secondary school education: A systematic review of recent trends in augmented reality game-based learning. Virtual Reality, 23(4), 329-346.
Read, J. C., & Markopoulos, P. (2013). Child–computer interaction. International Journal of Child-Computer Interaction, 1(1), 2-6.
Rezae, M., Chen, N., McMeekin, D., Tan, T., Krishna, A., & Lee, H. (2020). The evaluation of a mobile user interface for people on the autism spectrum: An eye movement study. International Journal of Human-Computer Studies, 142, 102462.
Durand-Rivera, J. A., & Martínez-González, C. L. (2020). Usability evaluation of a tangible user interface and serious game for identification of cognitive deficiencies in preschool children. International Journal of Advanced Computer Science and Applications, 11(6).
Sanchez-Morales, A., Durand-Rivera, J. A., & Martinez-Gonzalez, C. L. (2020). Usability Evaluation of a Tangible User Interface and Serious Game for Identification of Cognitive Deficiencies in Preschool Children. International Journal of Advanced Computer Science and Applications, 11(6), 486-493. <Go to ISI>://WOS:000568849400061
Schall, A., & Bergstrom, J. R. (2014). The future of eye tracking and user experience. In Eye Tracking in User Experience Design (pp. 351-360). Morgan Kaufmann.
Schneck, C. M., & Case-Smith, J. (2005). Visual Perception. Occupational therapy for children.
Sim, G., & Bond, R. (2021). Eye tracking in child computer interaction: Challenges and opportunities. International Journal of Child-Computer Interaction, 30, 100345.
Taiwan Ministry of Health and Walfare, Taiwan, ROC. (2021). Overview of Case Reports on the Development of Early Childhood Care Services for Children with Delays. Retrived from https://crc.sfaa.gov.tw/Statistics/Detail/125
Vitrikas, K., Savard, D., & Bucaj, M. (2017). Developmental delay: when and how to screen. American family physician, 96(1), 36-43.
Warmington, M., Hitch, G. J., & Gathercole, S. E. (2013). Improving word learning in children using an errorless technique. Journal of Experimental Child Psychology, 114(3), 456-465.
Warren, M. (1993). A hierarchical model for evaluation and treatment of visual perceptual dysfunction in adult acquired brain injury, part 1. The American Journal of Occupational Therapy, 47(1), 42-54.
Wuang, Y. P., Chiu, Y. H., Chen, Y. J., Chen, C. P., Wang, C. C., Huang, C. L., ... & Ho, W. H. (2018). Game-Based Auxiliary Training System for improving visual perceptual dysfunction in children with developmental disabilities: A proposed design and evaluation. Computers & Education, 124, 27-36.
Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., ... & Boyle, C. A. (2019). Prevalence and trends of developmental disabilities among children in the United States: 2009–2017. Pediatrics, 144(4).