Brief Report: A Pilot Study of the Use of a Virtual Reality Headset in Autism Populations

Toward a strengths-based model for designing virtual reality learning experiences for autistic users

LAY ABSTRACT

Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences.

The Need for Technology-Aided Instruction and Intervention Policy for Autistic Youth

This paper examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support or hinder the delivery of these interventions. Specifically, we focus on policies that might influence the delivery of TAII to autistic TAY. After a careful review of the literature, we observed that postsecondary policy guiding the delivery of TAII designed to support autistic TAY is lacking. TAII have demonstrated effectiveness, usability, sustainability, and cost-effectiveness, particularly with this population. We suggest possibilities for future policies to support the development, implementation, and evaluation of TAII for autistic TAY.

Using Virtual Reality Interventions to Promote Social and Emotional Learning for Children and Adolescents: A Systematic Review and Meta-Analysis

This study provides a comprehensive review of the application of virtual reality (VR) in social and emotional learning (SEL) for children and adolescents over the past decade (January 2013-May 2023), with a specific interest in the relations between their technological and instructional design features. A search in Web of Science resulted in 32 relevant articles that were then manually screened. Coding analysis was conducted from four perspectives: participant characteristics, research design, technological features, and instructional design. The analysis provides insights into the VR literature regarding publication trends, target populations, technological features, instructional scenarios, and tasks. To test the effectiveness of VR interventions for promoting SEL, a meta-analysis was also conducted, which revealed an overall medium effect size and significant moderating effects of SEL disorder type and instructional task. Finally, based on the research results, the practical implications of and future research directions for applying VR in SEL were discussed.

Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions

Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.

On the Evaluation of Engagement in Immersive Applications When Users Are on the Autism Spectrum

New generation wearable devices allow for the development of interactive environments tailored for Virtual Reality (VR)- and Augmented Reality (AR)-based treatment of Autism Spectrum Disorders (ASD). Experts agree on their potential; however, there is lack of consensus on how to perform trials and the need arises for evaluation frameworks, methods, and techniques appropriate for the ASD population. In this paper, we report on a study conducted with high-functioning ASD people in the 21-23 age range, with the objectives of (1) evaluating the engagement of two headsets offering distinct immersive experiences, (2) reasoning on the interpretation of engagement factors in the case of ASD people, and (3) translating results into general guidelines for the development of VR/AR-based ASD treatment. To this aim, we (1) designed two engagement evaluation frameworks based on behavioral observation measures, (2) set up two packages of reference immersive scenarios, (3) defined the association between metrics and scenarios, and (4) administered the scenarios in distinct sessions for the investigated headsets. Results show that the immersive experiences are engaging and that the apparent lack of success of some evaluation factors can become potential advantages within the framework of VR/AR-based ASD treatment design.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.

Measuring Social Modulation of Gaze in Autism Spectrum Condition With Virtual Reality Interviews

Gaze behavior in dyadic conversations can indicate active listening and attention. However, gaze behavior that is different from the engagement expected during neurotypical social interaction cues may be interpreted as uninterested or inattentive, which can be problematic in both personal and professional situations. Neurodivergent individuals, such as those with autism spectrum conditions, often exhibit social communication differences broadly including via gaze behavior. This project aims to support situational social gaze practice through a virtual reality (VR) mock job interview practice using the HTC Vive Pro Eye VR headset. We show how gaze behavior varies in the mock job interview between neurodivergent and neurotypical participants. We also investigate the social modulation of gaze behavior based on conversational role (speaking and listening). Our three main contributions are: (i) a system for fully-automatic analysis of social modulation of gaze behavior using a portable VR headset with a novel realistic mock job interview, (ii) a signal processing pipeline, which employs Kalman filtering and spatial-temporal density-based clustering techniques, that can improve the accuracy of the headset's built-in eye-tracker, and (iii) being the first to investigate social modulation of gaze behavior among neurotypical/divergent individuals in the realm of immersive VR.

Two sides of the same coin: accessibility practices and neurodivergent users' experience of extended reality

Purpose

This paper explores the accessibility barriers faced by neurodivergent individuals regarding the use of Extended Reality (XR) technologies and the difficulties faced by developers in creating neurodivergent inclusive XR experiences.

Design/methodology/approach

The authors carried out a survey with neurodivergent participants, and a series of semi-structured interviews with neurodivergent adults and XR developers.

Findings

Neurodivergent individuals experience sensory overload when using XR technologies; these negative experiences are exacerbated by excessive multisensory stimulation. Allowing for the customization of sensory settings was seen as the only way to potentially limit negative experiences. The authors found that XR developers lacked awareness of accessibility requirements and struggled to integrate them in current software development practices.

Social implications

Accessibility understanding regarding neurodivergence is increasingly available and the time has come to bring computing and information services within the reach of all neurodivergent individuals. The power in the design of XR, which is crucial, is decentralized from neurotypical XR developing practices to avoid artificial barriers that decrease the quality of life.

Originality/value

There is a lack of studies exploring how neurodivergent individuals experience XR considering their different sensory processing patterns. There is also no research exploring XR developers' awareness of accessibility needs of neurodivergent individuals. This paper presents an account of the challenges faced by neurodivergent XR users, the difficulties faced by XR developers to integrate neurodivergent accessibility requirements, and proposes specific strategies to overcome challenges.

Virtual Reality Technology as an Educational and Intervention Tool for Children with Autism Spectrum Disorder: Current Perspectives and Future Directions

The worldwide rising trend of autism spectrum disorder (ASD) calls for innovative and efficacious techniques for assessment and treatment. Virtual reality (VR) technology gains theoretical support from rehabilitation and pedagogical theories and offers a variety of capabilities in educational and interventional contexts with affordable products. VR is attracting increasing attention in the medical and healthcare industry, as it provides fully interactive three-dimensional simulations of real-world settings and social situations, which are particularly suitable for cognitive and performance training, including social and interaction skills. This review article offers a summary of current perspectives and evidence-based VR applications for children with ASD, with a primary focus on social communication, including social functioning, emotion recognition, and speech and language. Technology- and design-related limitations, as well as disputes over the application of VR to autism research and therapy, are discussed, and future directions of this emerging field are highlighted with regards to application expansion and improvement, technology enhancement, linguistic diversity, and the development of theoretical models and brain-based research.

Are Extended Reality Interventions Effective in Helping Autistic Children to Enhance Their Social Skills? A Systematic Review

Autistic children’s social skills do not always align with those of their neurotypical peers and research suggests that this can negatively impact quality of life. This review aimed to assess the effectiveness of extended reality (XR) interventions in helping autistic children to enhance their social skills. Five electronic databases were systematically searched and seventeen studies were identified. The majority targeted social-emotional reciprocity and were of relatively low quality. There was insufficient evidence to determine whether effects were generalisable, sustained or important to autistic people. Research in this field is in its infancy and evidence of effectiveness should be viewed with caution. Future studies should aim for high-quality, theory-driven research, and involve autistic people to ensure meaningful outcomes.

PROSPERO ID: CRD42021229442

Using immersive virtual reality with autistic pupils: moving towards greater inclusion and co-participation through ethical practices

Purpose

The potential of head mounted displays based virtual reality (HMD-based VR) for autistic groups has been well documented. However, the deployment and application of this technology, especially in schools, has been extremely limited. One of the main criticisms in this field has been the lack of involvement from practitioners in research on educational approaches for autistic populations and the gap between research and practice in real-life settings.

Design/methodology/approach

This conceptual article focuses on our research in a UK-based special needs school that sought to examine the effects and potential use of VR-HMDs, while seeking to establish best practices for safe and ethical application using this technology. This draws upon ethical and participatory research guidance, including British Educational Research Association and Autism Participatory Research.

Findings

The authors make recommendations on planning and implementing a participatory, safe and ethical approach to researching the use of VR-HMDs in special needs schools and engaging with the priorities of autistic children and young people and their teachers.

Originality/value

This conceptual article provides an initial first consideration of ways we can better include autistic people and their views in research that is with and about them. The value in this will mean we are able to better support autistic groups moving ahead using VR HMD-based technologies. Without this paradigm shift and including autistic people (and their stakeholders) the field might continue to build initiatives around medical-based models of disabilities rather that what the community need/want.

Extended Reality Guidelines for Supporting Autism Interventions Based on Stakeholders' Needs

While Extended Reality (XR) autism research, ranging from Augmented to Virtual Reality, focuses on socio-emotional abilities and autistic children requiring low support, common interventions address the entire spectrum and focus on other abilities, including perceptual abilities. Based on these observations, this paper first addresses common practitioners' interventions, and then suggests XR use cases and guidelines to better support them. To do so, 34 interviews were conducted with stakeholders, mainly including practitioners, and then analyzed. Emerging XR use cases were compared with the findings from two former systematic literature reviews, and emerging design guidelines were compared with the findings from a literature survey that we conducted. Findings suggest that collaborative XR sensory-based and mediation approaches could benefit the entire spectrum.

Not perfect but good enough: a primer for creating spherical video-based virtual reality for autistic users

Purpose

Previous research provides promising insights to the role of spherical video-based virtual reality (SVVR) applied with and for autistic users. Work already conducted in this area suggests that SVVR delivered via a range of head-mounted displays (HMDs) are useable, acceptable, can enable skill acquisition, can be relevant for delivering training, can help to reduce discomfort and promote skills generalization. However, to date very little research articulates methods or approaches to the design and development of SVVR. Here, the authors share the experiences of working in this space and designing SVVR content with and for autistic groups.

Design/methodology/approach

The authors draw upon two case studies/projects that were previous worked on with the intention to extrapolate key parts of the production process of SVVR development. The authors also outline key theoretical contexts as related to SVVR development in this field.

Findings

The goal of this primer on SVVR is to provide researchers and practitioners with an overview of using this technology. The authors provide a set of recommendations that should inform others in creating their own content and developing SVVR for/with/by autistic people.

Originality/value

This work combines and outlines theoretical, conceptual and practical considerations for practitioners and stakeholders seeking to build and deploy SVVR content; aspects not reported in previous research.

Focusing on cybersickness: pervasiveness, latent trajectories, susceptibility, and effects on the virtual reality experience

Although virtual reality (VR) usage has become widespread in the last decade, its adoption has been hampered by experiences of user discomfort known as cybersickness. The present study, in line with the "2020 cybersickness R&D agenda", sought to provide a broad examination of the cybersickness phenomenon, assessing its pervasiveness, latent trajectories, impacts on the VR experience, and predictor variables. The study was composed of 92 participants living in the Dominican Republic with ages ranging from 18 to 52 years (M = 26.22), who experienced a 10-min VR immersion in two environments designed for psychotherapy. The results indicated that cybersickness was pervasive, with 65.2% of the participants experiencing it, and 23.9% severely. Additionally, the latent trajectories of cybersickness were positive and curvilinear, with large heterogeneity across individuals. Cybersickness also had a substantive negative impact on the user experience and the intentions to adopt the VR technology. Finally, motion sickness susceptibility, cognitive stress, and recent headaches uniquely predicted greater severity of cybersickness, while age was negatively related. These combined results highlight the critical role that cybersickness plays on the VR experience and underscore the importance of finding solutions to the problems, such as technological advancements or special usage protocols for the more susceptible individuals.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10055-022-00636-4.

Using virtual reality to treat aggressive behavior problems in children: A feasibility study

Evidence-based cognitive behavioral therapies (CBTs) for children with aggressive behavior problems have only modest effects. Research is needed into new methods to enhance CBT effectiveness. The aims of the present study were to (1) examine whether interactive virtual reality is a feasible treatment method for children with aggressive behavior problems; (2) investigate children's appreciation of the method; and (3) explore whether children's aggression decreased during the ten-session treatment. Six boys (8-12 years) participated at two clinical centers in the Netherlands. Newly developed weekly reports were collected on treatment feasibility (therapist-report), treatment appreciation (child report), and children's aggression (child/parent report). Results supported treatment feasibility: therapists delivered on average 98% of the session content, provided more than the recommended practice time in virtual reality, experienced few technical issues, and were satisfied with their treatment delivery. Children highly appreciated the treatment. Parents reported decreases in children's aggression over the treatment period (i.e., between week 1 and week 10), but children did not. The promising findings of this feasibility study warrant randomized controlled trials to determine whether interactive virtual reality enhances CBT effectiveness for children with aggressive behavior problems.

A study of the use of virtual reality headsets in Chinese adolescents with intellectual disability

Background: Virtual reality technologies (VRTs) present many characteristics that can facilitate learning, especially in individuals with intellectual disabilities (ID). The VRT head-mounted display (HMD) has recently shown significant technological improvement. This study aims to prove the suitability of the newer commercially available VRT HMDs used in interventions for adolescents with ID in China. To this end, we explored the acceptance, immersion, and negative effects for adolescents with ID in a series of virtual environments. Methods: Forty-nine adolescents with ID (33 boys and 16 girls, IQ < 70), aged 11 to 21, from three special schools participated in this study. Questionnaires, observations, and interviews were used to investigate their views while using a VR HMD. Results: Our analysis found that most participants narrated a pleasant experience using HMD and a series of VR experiences and experienced a high level of immersion accompanied by low negative effects. In addition, our study found that the gender variable was independent of the acceptance of HMDs and the immersion experience. Conclusions: Overall, this study suggests that the HMD is accepted by most Chinese adolescents with ID; thus, its application has great potential in China.

Vocational Training in Virtual Environments for People With Neurodevelopmental Disorders: A Systematic Review

People with neurodevelopmental disorders are often considered unsuitable or incapable of working in open employment. When employment is available, tasks are often limited, and opportunities for career development are restricted. Policy and funding constraints leave people with disabilities without an opportunity to develop skills due to the additional time and costs for employers. To overcome these barriers, virtual environments have been proposed as a safe and reliable solution for training. An important prerequisite for a wider uptake of training in virtual environments are demonstrations that the training leads to improved performance in the real world. This is particularly true for people with neurodevelopmental disorders, as transferring learnings from one context to another can be challenging. A systematic review was conducted to assess whether training in virtual environments can be used to improve real-world vocational skills in people with neurodevelopmental disorders. After a systematic search in six databases, eight out of the initially identified 1,806 articles met the inclusion criteria. The findings from these eight studies demonstrate that people with neurodevelopmental disorders can transfer vocational skills from virtual environments to real-world settings. With substantial technological improvements, a surge in accessibility, and improved affordability, there is a need to build upon the promising results identified in this review.

Technology-Based Assessments and Treatments of Anxiety in Autistic Individuals: Systematic Review and Narrative Synthesis

This systematic review (Prospero Registration Number: CRD42019142910) aimed to narratively synthesise technology-aided assessments and treatments of anxiety in individuals with autism spectrum disorder (ASD) for the first time. Sixteen studies were identified: 5 assessment studies and 11 treatment studies. Assessment studies targeted state anxiety using ecological momentary assessment, wearables, or computerised tasks. Treatment studies targeted specific fears/phobias using electronic screen media or transdiagnostic anxiety using telemedicine. Broadly, results indicated technology-aided assessments and treatments may be feasible and effective at targeting anxiety in ASD, except treatments involving social scripts or peer modelling. Assessment results further indicated that state anxiety in ASD has a distinct psychophysiological signature and is evoked by idiosyncratic triggers. However, larger scale studies with representative samples are needed.

Piloting an adaptive skills virtual reality intervention for adults with autism: findings from user-centered formative design and evaluation

Purpose

The purpose of this paper is to present evaluation findings from a proof-of-concept virtual reality adaptive skills intervention called Virtuoso, designed for adults with autism spectrum disorders.

Design/methodology/approach

A user-centric usage test was conducted to investigate the acceptability, feasibility, ease-of-use and relevance of Virtuoso to the unique needs of participants, as well as the nature of participants’ user experiences. Findings are presented from the perspectives of expert testers and participant testers with autism.

Findings

This paper offers findings that suggest Virtuoso is feasible and relevant to the unique needs of the target population, and that user experience was largely positive. Anecdotal evidence of skills transfer is also discussed.

Research limitations/implications

The research was conducted in limited settings and with a small number of participants. Multiple VR hardware systems were used, and some experienced instability. This could be accounted for in future research by deploying across multiple settings and with a larger number of participants. Some evidence of cybersickness was observed. Future research must carefully consider the trade-offs between VR-based training and cybersickness for this vulnerable population.

Originality/value

This paper reports on cutting-edge design and development in areas that are under-represented and poorly understood in the literature on virtual reality for individuals with autism.

Personalized Virtual Reality Human-Computer Interaction for Psychiatric and Neurological Illnesses: A Dynamically Adaptive Virtual Reality Environment That Changes According to Real-Time Feedback From Electrophysiological Signal Responses

Virtual reality (VR) constitutes an alternative, effective, and increasingly utilized treatment option for people suffering from psychiatric and neurological illnesses. However, the currently available VR simulations provide a predetermined simulative framework that does not take into account the unique personality traits of each individual; this could result in inaccurate, extreme, or unpredictable responses driven by patients who may be overly exposed and in an abrupt manner to the predetermined stimuli, or result in indifferent, almost non-existing, reactions when the stimuli do not affect the patients adequately and thus stronger stimuli are recommended. In this study, we present a VR system that can recognize the individual differences and readjust the VR scenarios during the simulation according to the treatment aims. To investigate and present this dynamically adaptive VR system we employ an Anxiety Disorder condition as a case study, namely arachnophobia. This system consists of distinct anxiety states, aiming to dynamically modify the VR environment in such a way that it can keep the individual within a controlled, and appropriate for the therapy needs, anxiety state, which will be called "desired states" for the study. This happens by adjusting the VR stimulus, in real-time, according to the electrophysiological responses of each individual. These electrophysiological responses are collected by an external electrodermal activity biosensor that serves as a tracker of physiological changes. Thirty-six diagnosed arachnophobic individuals participated in a one-session trial. Participants were divided into two groups, the Experimental Group which was exposed to the proposed real-time adaptive virtual simulation, and the Control Group which was exposed to a pre-recorded static virtual simulation as proposed in the literature. These results demonstrate the proposed system's ability to continuously construct an updated and adapted virtual environment that keeps the users within the appropriately chosen state (higher or lower intensity) for approximately twice the time compared to the pre-recorded static virtual simulation. Thus, such a system can increase the efficiency of VR stimulations for the treatment of central nervous system dysfunctions, as it provides numerically more controlled sessions without unexpected variations.

The possibility and importance of immersive technologies during COVID-19 for autistic people

Purpose

The purpose of this paper is to identify three key areas where autistic people may find themselves impacted through COVID-19, namely, education; employment; and anxiety.

Design/methodology/approach

This paper provides some views based on the extensive experience of using immersive technologies for the utilisation and application with autistic groups during COVID-19.

Findings

This paper offers some examples of immersive technology application that might be helpful for practitioners, services and others to consider in overcoming possible challenges faced by people with autism.

Originality/value

This opinion piece offers expert insights to the role immersive technologies and virtual reality might play during COVID-19 in the lives of autistic groups.

Short report: Evaluating the safety and usability of head-mounted virtual reality compared to monitor-displayed video for children with autism spectrum disorder

LAY ABSTRACT

This study investigated the safety and usability of a virtual reality experience for children with autism spectrum disorder in a laboratory setting. In our study, the negative effects of head-mounted display-virtual reality were similar to monitor-displayed video watching. At the same time, the participants indicated that the head-mounted display-virtual reality experience provided improved realism and sense of presence. This study is a first step in understanding the impact of head-mounted display on children with autism spectrum disorder.

Application of virtual reality in people with ASD from 1996 to 2019

Purpose

Diversity is one of the main characteristics of modern societies. To be teachers and trainers, it is necessary to use all the tools to respond to students with diversified needs. Therefore, the main aim of this study is to review the scientific production in Web of Science (WOS) and SCOPUS of 1996-2019 on the application of Virtual reality in people with Autism Spectrum Disoders (ASD) for the improvement of social skills.

Design/methodology/approach

For this purpose, two databases have been used: The Web of Science (WOS) and SCOPUS from the advanced search tab. After applying the search terms, 267 documents were obtained which were analysed according to a series of indicators.

Findings

The results indicate that the period 2016-2019 was the most productive and that SCOPUS has a focus on conferences and WOS is intended for journals. Furthermore, in SCOPUS, there are journals with higher quartiles (Q1) than in WOS. The study shows the great importance of virtual reality in people with ASD and its recent dissemination.

Originality/value

Currently, to the best of the authors’ knowledge, there are no studies on the use of virtual reality in people with ASD using bibliometric indicators. The study allows us to know which databases publish higher quality research. Likewise, information can be obtained about the most productive centres and the most important authors on the subject.

SoundFields: A Virtual Reality Game Designed to Address Auditory Hypersensitivity in Individuals with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) are characterised as having impairments in social-emotional interaction and communication, alongside displaying repetitive behaviours and interests. Additionally, they can frequently experience difficulties in processing sensory information with particular prevalence in the auditory domain. Often triggered by everyday environmental sounds, auditory hypersensitivity can provoke self-regulatory fear responses such as crying and isolation from sounds. This paper presents SoundFields, an interactive virtual reality game designed to address this area by integrating exposure based therapy techniques into game mechanics and delivering target auditory stimuli to the player rendered via binaural based spatial audio. A pilot study was conducted with six participants diagnosed with ASD who displayed hypersensitivity to specific sounds to evaluate the use of SoundFields as a tool to reduce levels of anxiety associated with identified problematic sounds. During the course of the investigation participants played the game weekly over four weeks and all participants actively engaged with the virtual reality (VR) environment and enjoyed playing the game. Following this period, a comparison of pre- and post-study measurements showed a significant decrease in anxiety linked to target auditory stimuli. The study results therefore suggest that SoundFields could be an effective tool for helping individuals with autism manage auditory hypersensitivity.

Data-Driven Discovery of Predictors of Virtual Reality Safety and Sense of Presence for Children With Autism Spectrum Disorder: A Pilot Study

Virtual reality (VR) offers children with autism spectrum disorder (ASD) an inexpensive and motivating medium to learn and practice skills in a personalized, controlled, and safe setting; however, outcomes of VR interventions can vary widely. In particular, there is a need to understand the predictors of VR experience in children with ASD to inform the design of these interventions. To address this gap, a sample of children with ASD (n=35, mean age: 13.0 ± 2.6 years; 10 female) participated in a pilot study involving an immersive VR experience delivered through a head-mounted display. A data-driven approach was used to discover predictors of VR safety and sense of presence among a range of demographic and phenotypic user characteristics. Our results suggest that IQ may be a key predictor of VR sense of presence and that anxiety may modify the association between IQ and sense of presence. In particular, in low-anxiety participants, IQ was linearly related to experienced spatial presence and engagement, whereas, in high-anxiety participants, this association followed a quadratic form. The results of this pilot study, when replicated in larger samples, will inform the design of future studies on VR interventions for children with ASD.

Active View and Passive View in Virtual Reality Have Different Impacts on Memory and Impression

Virtual reality (VR) through a head-mounted display (HMD) can provide new experiences. However, it remains unclear how the characteristics of HMDs affect users’ memory. To use HMDs more effectively and appropriately in several applied fields, including education, it is necessary to clarify what characteristics of HMDs affect users’ memory. A head-tracking function mounted on an HMD helps to detect the user’s head direction to enable a simulation experience akin to the real world. When we experience a simulation on an HMD, we actively perceive the visual world. In this study, we assessed how active/passive viewing affects users’ memory of VR content. We conducted a psychological experiment in which participants watched a movie on an HMD. In the active viewing condition, the presented view changed depending on the participant’s head direction. In the passive viewing condition, the presented view was a recorded movie that was shown to the participants in the active viewing condition. All participants took a memory test about the content presented in the movie on the day of viewing and 2 weeks later. The results showed that performance on the memory test in the active viewing condition was significantly lower than that in the passive viewing condition after 2 weeks. This result indicated that active viewing in VR inhibited users’ memory compared to passive viewing. The current study contributes to the development of new VR techniques, such as educational learning.

Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study

BACKGROUND

Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor.

OBJECTIVE

The primary objective of this pilot study was to explore the feasibility of using Floreo's Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention.

METHODS

A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks.

RESULTS

No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4% (126/132) of the time participants tolerated the headset, 95.4% (126/132) of the time participants seemed to enjoy using Floreo's platform, and 95.5% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions.

CONCLUSIONS

The study results suggest that Floreo's Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills.

Using Virtual Reality Head-Mounted Displays in Schools with Autistic Children: Views, Experiences, and Future Directions

This article seeks to place children on the autism spectrum at the center of a study examining the potential of virtual reality (VR) head-mounted displays (HMDs) used in classrooms. In doing so, we provide data that address 3 important and often overlooked research questions in the field of autism and technology, working in school-based settings with 31 autistic children from 6 to 16 years of age. First, what type of VR HMD device (and experiences therein) are preferred by children on the autism spectrum using HMDs (given possible sensory concerns). Second, how do children on the autism spectrum report the physical experience, enjoyment, and potential of VR HMDs in their classrooms? Finally, we were interested in exploring what children on the autism spectrum would like to use VR in schools for? Through a mixed methods approach, we found that costly and technologically advanced HMDs were preferred (namely: HTC Vive). In addition, HMDs were reported as being enjoyable, physically and visually comfortable, easy to use, and exciting, and children wanted to use them again. They identified several potential usages for HMDs, including relaxing/feeling calm, being able to explore somewhere virtually before visiting in the real world, and to develop learning opportunities in school. We discuss these findings in the context of VR in classrooms, in addition to considering limitations and implication of our findings.

iSenseVR: bringing VR exposure therapy outside the laboratory

Purpose

The purpose of this paper is to present the preliminary outcomes of a research which takes gradual exposure in virtual reality (VR) outside the laboratory to empower people with “hidden disabilities” breaking down their barriers towards independent living. It explores the use of VR through smartphones to practically apply gradual exposure to environment stressors that are typically found in busy spaces from one’s own safe environment.

Design/methodology/approach

Aberdeen International Airport has kindly accepted to take part to this research as a case study. Following a participatory design and usability testing, a semi-controlled seven-day study was conducted among seven individuals with hidden disabilities to assess user acceptance.

Findings

Results showed undeniable participants’ engagement and enthusiasm for the proposed approach, although further research is needed to increase the presence and improve the overall user experience.

Research limitations/implications

The proposed research has been conducted on small cohort of participants outside of a clinical setting. Further engagement with individuals with hidden disabilities is required in order to determine the effectiveness of the proposed approach.

Originality/value

This research presents a methodological and technological framework which contributes effectively to the practicality of VR exposure therapy outside of the laboratory setting, from one’s own safe place.

A Virtual Reality System for Practicing Conversation Skills for Children with Autism

We describe a virtual reality environment, Bob’s Fish Shop, which provides a system where users diagnosed with Autism Spectrum Disorder (ASD) can practice social interactions in a safe and controlled environment. A case study is presented which suggests such an environment can provide the opportunity for users to build the skills necessary to carry out a conversation without the fear of negative social consequences present in the physical world. Through the repetition and analysis of these virtual interactions, users can improve social and conversational understanding.

The State of Virtual and Augmented Reality Therapy for Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition affecting a growing number of individuals across the lifespan. It is characterized by observable impairments in social communication, as well as repetitive behaviors and restricted patterns of interests. Early, intensive behavioral interventions improve long-term outcomes in ASD, but are often expensive and hard to administer consistently. This chapter describes a new approach to autism intervention, using highly motivating virtual reality (VR) and augmented reality (AR) technologies that could soon support traditional autism therapies across ages and ability levels. The chapter begins by reviewing the ASD phenotype, followed by a review of the current landscape of research on VR and AR in ASD. A discussion of ASD-specific benefits and risks is followed by a presentation of new, harnessed immersive VR technology from Floreo, Inc. Finally, we propose a series of future research directions.

Safety and Lack of Negative Effects of Wearable Augmented-Reality Social Communication Aid for Children and Adults with Autism

There is a growing interest in the use of augmented reality (AR) to assist children and adults with autism spectrum disorders (ASD); however, little investigation has been conducted into the safety of AR devices, such as smartglasses. The objective of this report was to assess the safety and potential negative effects of the Empowered Brain system, a novel AR smartglasses-based social communication aid for people with ASD. The version of the Empowered Brain in this report utilized Google Glass (Google, Mountain View, CA, USA) as its hardware platform. A sequential series of 18 children and adults, aged 4.4 to 21.5 years (mean 12.2 years), with clinically diagnosed ASD of varying severity used the system. Users and caregivers were interviewed about the perceived negative effects and design concerns. Most users were able to wear and use the Empowered Brain (n = 16/18, 89%), with most of them reporting no negative effects (n = 14/16, 87.5%). Caregivers observed no negative effects in users (n = 16/16, 100%). Most users (77.8%) and caregivers (88.9%) had no design concerns. This report found no major negative effects in using an AR smartglasses-based social communication aid across a wide age and severity range of people with ASD. Further research is needed to explore longer-term effects of using AR smartglasses in this population.

Autism and virtual reality head-mounted displays: a state of the art systematic review

Purpose

The use of virtual reality (VR) technologies in the education of autistic children has been a focus of research for over two decades. It is argued that this form of technology can provide authentic “real world” contexts that target social and life skills training in safe, controllable and repeatable virtual environments. The development of affordable VR head-mounted displays (HMD), such as Google cardboard and Oculus Rift, has seen a renewed interest in their use for a wide range of applications, including the education of autistic individuals. The paper aims to discuss these issues.

Design/methodology/approach

A systematic search of electronic databases focussing on empirical studies on the use of VR-HMD for children and adults on the autism spectrum was undertaken.

Findings

A review of the literature identified a limited number of studies in this field characterised by differences in the type of application, technology used and participant characteristics.

Research limitations/implications

Whilst there are some grounds for optimism, more research is needed on the use of this technology within educational settings to ensure robust recommendations can be made on the implementation, use and sustainability of this approach.

Originality/value

This paper is the first to consider the evidence base for the use of VR-HMD technology to support the needs of the autistic population.

Virtual Reality in Pediatric Psychology

Virtual reality (VR) technologies allow for controlled simulations of affectively engaging background narratives. These virtual environments offer promise for enhancing emotionally relevant experiences and social interactions. Within this context, VR can allow instructors, therapists, neuropsychologists, and service providers to offer safe, repeatable, and diversifiable interventions that can benefit assessments and learning in both typically developing children and children with disabilities. Research has also pointed to VR's capacity to reduce children's experience of aversive stimuli and reduce anxiety levels. Although there are a number of purported advantages of VR technologies, challenges have emerged. One challenge for this field of study is the lack of consensus on how to do trials. A related issue is the need for establishing the psychometric properties of VR assessments and interventions. This review investigates the advantages and challenges inherent in the application of VR technologies to pediatric assessments and interventions.

HTC Vive MeVisLab integration via OpenVR for medical applications

Virtual Reality, an immersive technology that replicates an environment via computer-simulated reality, gets a lot of attention in the entertainment industry. However, VR has also great potential in other areas, like the medical domain, Examples are intervention planning, training and simulation. This is especially of use in medical operations, where an aesthetic outcome is important, like for facial surgeries. Alas, importing medical data into Virtual Reality devices is not necessarily trivial, in particular, when a direct connection to a proprietary application is desired. Moreover, most researcher do not build their medical applications from scratch, but rather leverage platforms like MeVisLab, MITK, OsiriX or 3D Slicer. These platforms have in common that they use libraries like ITK and VTK, and provide a convenient graphical interface. However, ITK and VTK do not support Virtual Reality directly. In this study, the usage of a Virtual Reality device for medical data under the MeVisLab platform is presented. The OpenVR library is integrated into the MeVisLab platform, allowing a direct and uncomplicated usage of the head mounted display HTC Vive inside the MeVisLab platform. Medical data coming from other MeVisLab modules can directly be connected per drag-and-drop to the Virtual Reality module, rendering the data inside the HTC Vive for immersive virtual reality inspection.