Table 2.

Summary of the iterative process of game development.

Phase	Approach	Games	Learnings	Impact on game development
Phase 1 – Game conceptualization	Expert consultation and rapid review of cognitive and gaming literature	N/A	Identified memory, reasoning, response inhibition, divided attention, visual form perception and visual integration as domains of cognition integral to learning Numerous games testing individual cognitive domains are available off-the-shelf and have a wide range of front-end graphics, music and user interfaces	Identified off-the-shelf games that primarily assess each of these domains. Multiple games testing the same cognitive domain were identified to enable characterization of front end features that are attractive/distracting to children
Phase 2 – Formative visits	Household visits stage 1 (N = 10)	Off-the-shelf games targeting the domains identified during conceptualization	Children were easily engaged by tablet-based games for 20–30 minutes Tapping on tablets came naturally, drag-and-drop is a tougher gesture Identified elements of game interface that were conducive or distracting for gameplay Identified the importance of use of narrative, music and positive reinforcement	Designed game to be 20–30 minutes long Administered tapping games first followed by drag-and-drop games Used elements of game design that were conducive for game play Integrated an upbeat musical soundtrack and confetti/applause as positive feedback; brainstormed potential narratives that would engage children
	Household visits stage 2 (N = 10)	Alpha versions of game being developed in this study	Some games showed saturation of child performance while others were too difficult Children enjoyed the preliminary narrative tested	Number and order of difficulty levels in each game and their timers determined Independent games integrated into a first-person narrative
Phase 3 – Pilot study	Household visits (N = 100)	Beta version of game being developed in this study	Number of children playing game levels decreases as difficulty increases Accuracy decreases as difficulty increases Completion time increases as difficulty increases	DEvelopmental Assessment on an E-Platform (DEEP) ready for validation against a gold standard measure of development