Virtual and Augmented Reality in Social Skills Interventions for Individuals with Autism Spectrum Disorder: A Scoping Review

Effect of immersive virtual reality-based training on cognitive, social, and emotional skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomized controlled trials

BACKGROUND

Virtual Reality (VR) based diagnostic and therapeutic interventions have opened up new possibilities for addressing the challenges in identifying and treating individuals with Autism Spectrum Disorders (ASD).

AIM

To conduct a systematic review and meta-analysis of Randomized Controlled Trials to investigate the impact of Immersive VR techniques on the cognitive, social, and emotional skills of under-18 children and adolescents with ASD.

METHODS AND PROCEDURES

Four databases were systematically searched as per "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines and assessed six RCTs for further analysis. The Cochrane Risk of Bias tool was used to assess the methodological quality of the studies.

OUTCOMES

Pooled results favoured VR and reported significant differences between experimental and control groups concerning social skills (SMD:1.43; 95 % CI: 0.01-2.84; P: 0.05), emotional skills (SMD: 2.45; 95 % CI: 0.21-4.18; P: 0.03) and cognitive skills.

CONCLUSION

VR offers an array of benefits that make it a promising tool for children and adolescents with ASD to improve their cognitive, social and emotional skills in a safe and supportive setting. However, accessibility, affordability, customization, and cost are also significant aspects to consider when developing and implementing VR-based interventions for ASD.

Self-Guided DMT: Exploring a Novel Paradigm of Dance Movement Therapy in Mixed Reality for Children with ASD

Children diagnosed with Autism Spectrum Disorder (ASD) often exhibit motor disorders. Dance Movement Therapy (DMT) has shown great potential for improving the motor control ability of children with ASD. However, traditional DMT methods often lack vividness and are difficult to implement effectively. To address this issue, we propose a Mixed Reality DMT approach, utilizing interactive virtual agents. This approach offers immersive training content and multi-sensory feedback. To improve the training performance of children with ASD, we introduce a novel training paradigm featuring a self-guided mode. This paradigm enables the rapid creation of a virtual twin agent of the child with ASD using a single photo to embody oneself, which can then guide oneself during training. We conducted an experiment with the participation of 24 children diagnosed with ASD (or ASD propensity), recording their training performance under various experimental conditions. Through expert rating, behavior coding of training sessions, and statistical analysis, our findings revealed that the use of the twin agent for self-guidance resulted in noticeable improvements in the training performance of children with ASD. These improvements were particularly evident in terms of enhancing movement quality and refining overall target-related responses. Our study holds clinical potential in the field of medical treatment and rehabilitation for children with ASD.

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.

A Scoping Review of the Use of Robotics Technologies for Supporting Social-Emotional Learning in Children with Autism

This scoping review synthesises the current research into robotics technologies for promoting social-emotional learning in children with autism spectrum disorder. It examines the types of robotics technologies employed, their applications, and the gaps in the existing literature. Our scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines. The systematic search of relevant databases allowed us to identify studies that use robotics technologies for fostering social, emotional, and cognitive skills in young children with autism. Our review has revealed that various robots, such as Nao, Kaspar, and Zeno, have been used to support the development of social and emotional skills through imitation games, turn-taking, joint attention, emotional recognition, and conversation. As most of these studies were conducted in clinical settings, there is a need for further research in classroom and community-based environments. Additionally, the literature calls for more high-quality longitudinal studies to assess the long-term effectiveness and sustainability of robot-assisted therapy and to assess adaptive and personalised interventions tailored to individual needs. More emphasis is recommended on professional development for educators, parents, and health professionals to incorporate robotics technologies as evidence-based interventions as a pathway for creating inclusive learning environments for children with autism.

On effectively predicting autism spectrum disorder therapy using an ensemble of classifiers

An ensemble of classifiers combines several single classifiers to deliver a final prediction or classification decision. An increasingly provoking question is whether such an ensemble can outperform the single best classifier. If so, what form of ensemble learning system (also known as multiple classifier learning systems) yields the most significant benefits in the size or diversity of the ensemble? In this paper, the ability of ensemble learning to predict and identify factors that influence or contribute to autism spectrum disorder therapy (ASDT) for intervention purposes is investigated. Given that most interventions are typically short-term in nature, henceforth, developing a robotic system that will provide the best outcome and measurement of ASDT therapy has never been so critical. In this paper, the performance of five single classifiers against several multiple classifier learning systems in exploring and predicting ASDT is investigated using a dataset of behavioural data and robot-enhanced therapy against standard human treatment based on 3000 sessions and 300 h, recorded from 61 autistic children. Experimental results show statistically significant differences in performance among the single classifiers for ASDT prediction with decision trees as the more accurate classifier. The results further show multiple classifier learning systems (MCLS) achieving better performance for ASDT prediction (especially those ensembles with three core classifiers). Additionally, the results show bagging and boosting ensemble learning as robust when predicting ASDT with multi-stage design as the most dominant architecture. It also appears that eye contact and social interaction are the most critical contributing factors to the ASDT problem among children.

Virtual Reality Technology to Enhance Conventional Rehabilitation Program: Results of a Single-Blind, Randomized, Controlled Pilot Study in Patients with Global Developmental Delay

Global developmental delay (GDD) is a complex disorder that requires multimodal treatment involving different developmental skills. The objective of this single-blind, randomized, controlled pilot study is to evaluate the feasibility and effectiveness of conventional rehabilitation programs integrated with the BTs-Nirvana virtual reality system. Patients with GDD aged 12 to 66 months were enrolled and treated for a 48-session cycle. Patients were randomized into two groups, (1) conventional treatment and (2) conventional treatment supplemented with the use of BTs-Nirvana, in a 1:1 ratio. Before and after treatments, areas of global development were tested with the Griffiths-III Mental Developmental Scale and the clinical indicator of global improvement were measured with the Clinical Global Impressions-Improvement (CGI-I). Feasibility was confirmed by the high retention rate. The experimental group presented a significantly improvement in General Quotient (GQ) after treatment (GQ, p = 0.02), and the effect of the two treatments was significantly different in both the GQ (t =2.44; p = 0.02) and the Foundations of Learning subscale (t =3.66; p < 0.01). The overall improvement was also confirmed by the CGI-I (p = 0.03). According to these preliminary data, virtual reality can be considered a useful complementary tool to boost the effectiveness of conventional therapy in children with GDD.

Current development of biosensing technologies towards diagnosis of mental diseases

The biosensor is an instrument that converts the concentration of biomarkers into electrical signals for detection. Biosensing technology is non-invasive, lightweight, automated, and biocompatible in nature. These features have significantly advanced medical diagnosis, particularly in the diagnosis of mental disorder in recent years. The traditional method of diagnosing mental disorders is time-intensive, expensive, and subject to individual interpretation. It involves a combination of the clinical experience by the psychiatrist and the physical symptoms and self-reported scales provided by the patient. Biosensors on the other hand can objectively and continually detect disease states by monitoring abnormal data in biomarkers. Hence, this paper reviews the application of biosensors in the detection of mental diseases, and the diagnostic methods are divided into five sub-themes of biosensors based on vision, EEG signal, EOG signal, and multi-signal. A prospective application in clinical diagnosis is also discussed.

Effects of Adaptive Prompts in Virtual Reality-Based Social Skills Training for Children with Autism

The purpose of this single-case experimental design (SCED) study is to investigate how adaptive prompts in virtual reality (VR)-based social skills training affect the social skills performance of autistic children. Adaptive prompts are driven by autistic children's emotional states. To integrate adaptive prompts in VR-based training, we conducted speech data mining and endorsed micro-adaptivity design. We recruited four autistic children (12-13 years) for the SCED study. We carried out alternating treatments design to evaluate the impacts of adaptive and non-adaptive prompting conditions throughout a series of VR-based social skills training sessions. Using mixed-method data collection and analyses, we found that adaptive prompts can foster autistic children's desirable social skills performance in VR-based training. Based on the study findings, we also describe design implications and limitations for future research.

Global trends and hotspots in the digital therapeutics of autism spectrum disorders: a bibliometric analysis from 2002 to 2022

Introduction

Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder that has become a major cause of disability in children. Digital therapeutics (DTx) delivers evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. This study objectively analyzed the current research status of global DTx in ASD from 2002 to 2022, aiming to explore the current global research status and trends in the field.

Methods

The Web of Science database was searched for articles about DTx in ASD from January 2002 to October 2022. CiteSpace was used to analyze the co-occurrence of keywords in literature, partnerships between authors, institutions, and countries, the sudden occurrence of keywords, clustering of keywords over time, and analysis of references, cited authors, and cited journals.

Results

A total of 509 articles were included. The most productive country and institution were the United States and Vanderbilt University. The largest contributing authors were Warren, Zachary, and Sarkar, Nilanjan. The most-cited journal was the Journal of Autism and Developmental Disorders. The most-cited and co-cited articles were Brian Scarselati (Robots for Use in Autism Research, 2012) and Ralph Adolphs (Abnormal processing of social information from faces in autism, 2001). "Artificial Intelligence," "machine learning," "Virtual Reality," and "eye tracking" were common new and cutting-edge trends in research on DTx in ASD.

Discussion

The use of DTx in ASD is developing rapidly and gaining the attention of researchers worldwide. The publications in this field have increased year by year, mainly concentrated in the developed countries, especially in the United States. Both Vanderbilt University and Yale University are very important institutions in the field. The researcher from Vanderbilt University, Warren and Zachary, his dynamics or achievements in the field is also more worth our attention. The application of new technologies such as virtual reality, machine learning, and eye-tracking in this field has driven the development of DTx on ASD and is currently a popular research topic. More cross-regional and cross-disciplinary collaborations are recommended to advance the development and availability of DTx.

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.

Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions.

MATERIAL AND METHODS

A thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022.

RESULTS

Of 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental.

CONCLUSION

Using suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.

Development of a social skills training programme to target social isolation using virtual reality technology in primary mental health care

Introduction

People with severe mental illness often have a small or no network of friends and limited contact with their family and live social isolated lives. We developed a social skills training programme to be administered by public mental health professionals in helping those with mental illness to overcome their social isolation.

Methods

The programme was developed over 3 years in close collaboration among psychologists, service users, municipal mental health professionals, mental health service researchers and a local firm providing virtual reality (VR) training. We started with the simplest available equipment, that is, a cardboard headset combined with a smartphone, then we used Oculus Quest and now Oculus Quest 2.

Results

The resulting programme is comprised of eight steps from: 1) identify service user's primary and secondary goals to 8) three-month follow-up.

Conclusion

Several factors made adoption and implementation of VR technology possible in a relatively short timeframe: namely, the municipality and service users were involved from the beginning of the development process, efforts were made to introduce VR to mental health professionals and allow them to reflect on its usability, solutions were low-tech and low cost, and the long-term research collaboration was established without municipal financial obligations.

Feasibility of Using Multiplayer Game-Based Dual-Task Training with Augmented Reality and Personal Health Record on Social Skills and Cognitive Function in Children with Autism

The purpose of this preliminary study was to evaluate the feasibility of multiplayer game contents with dual-task exercises using augmented reality (AR) and a personal health record (PHR) system for social skills and cognitive function in children with autism. The present study used a single group pretest-posttest study design with fourteen children diagnosed with autism and aged 6-16 years. The intervention consisted of various game contents designed specifically with cognitive and motor tasks, performed for 30 min per session, twice a week, for three weeks. Outcome measures were conducted before and after the intervention and included social skills and cognitive function. A satisfactory survey was conducted post-intervention to assess the usability of the performed games. As result, statistically significant improvements were observed in all subscales of the social skills and cognitive function expected in two subscales of each measured outcome. Parents and children appreciated the overall game program, and no risk of injury and dizziness were mentioned. This preliminary study found that multiplayer game-based dual-task training using AR and PHR was feasible and has a promising efficacy for children with autism. However, there is the need to conduct a randomized control study with a large sample size.

The application of augmented reality in the learning of autistic students: a systematic and thematic review in 1996–2020

Purpose

More and more diversity is present in our classrooms. As teachers, we must be able to respond to the different levels of learning presented by our students. Therefore, it is necessary to use the new emerging technologies as elements of response. Thus, the purpose of this paper is to develop a systematic and thematic review of the application of augmented reality (AR) in the learning of autistic students in the educational setting during the period 1996–2020 using the Web of Science and Scopus databases.

Design/methodology/approach

For this purpose, one of the bibliometric techniques called systematic and thematic review has been used. This technique is supported by the preferred reporting items for systematic reviews methodology, and it uses a quantitative and qualitative approach. The thematic analysis will be carried out on 28 documents based on a series of indicators, including sample size, hardware devices, way of storing the information and findings obtained in the research.

Findings

The results of the work indicate that the average size of the sample is three participants, and that the most worked area has been social skills using tablets. In addition, bookmarks are often used as an element of information storage in AR.

Originality/value

The main contribution of this work focuses on the establishment of a series of thematic variables that will serve for the later development of an action protocol for the creation of AR activities for autistic students.

What is Significant in Modern Augmented Reality: A Systematic Analysis of Existing Reviews

Augmented reality (AR) is a field of technology that has evolved drastically during the last decades, due to its vast range of applications in everyday life. The aim of this paper is to provide researchers with an overview of what has been surveyed since 2010 in terms of AR application areas as well as in terms of its technical aspects, and to discuss the extent to which both application areas and technical aspects have been covered, as well as to examine whether one can extract useful evidence of what aspects have not been covered adequately and whether it is possible to define common taxonomy criteria for performing AR reviews in the future. To this end, a search with inclusion and exclusion criteria has been performed in the Scopus database, producing a representative set of 47 reviews, covering the years from 2010 onwards. A proper taxonomy of the results is introduced, and the findings reveal, among others, the lack of AR application reviews covering all suggested criteria.

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.

The Efficacy of Head-Mounted-Display Virtual Reality Intervention to Improve Life Skills of Individuals with Autism Spectrum Disorders: A Systematic Review

Challenges in life skills in individuals with autism spectrum disorders (ASD) are associated with dependency on others and increased isolation from peers. In recent years, interventions using virtual reality (VR) technology have been proposed to improve life skills in ASD populations. This systematic review seeks to evaluate the efficacy of employing VR interventions mediated via head-mounted displays (HMD) for the improvement of life skills in individuals with ASD. Several databases were searched and a narrative synthesis was conducted to examine the findings of the included studies. Eight studies including a total of 58 participants were deemed relevant for this systematic review. The methodological quality of the included studies was assessed via the use of critical appraisal tools. Results were generally positive, with one study reporting statistically significant results, and one study not reporting any change in abilities. The remaining six studies reported varying degrees of life skill improvement. The studies were characterized by methodological issues, such as very low sample sizes. The findings of this systematic review indicate some potential for HMD VR interventions in the improvement of life skills in individuals with ASD. However, this review also highlights the current lack of methodologically strong study designs, which prohibits any firm conclusions. Findings are discussed regarding methodological recommendations for further research as well as practical implications for life skills interventions for individuals with ASD.