Virtual Reality Air Travel Training with Children on the Autism Spectrum: A Preliminary Report

The Application of Extended Reality in Treating Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder in children, characterized by social interaction, communication difficulties, and repetitive and stereotyped behaviors. Existing intervention methods have limitations, such as requiring long treatment periods and needing to be more convenient to implement. Extended Reality (XR) technology offers a virtual environment to enhance children's social, communication, and self-regulation skills. This paper compares XR theoretical models, application examples, and intervention effects. The study reveals that XR intervention therapy is mainly based on cognitive rehabilitation, teaching, and social-emotional learning theories. It utilizes algorithms, models, artificial intelligence (AI), eye-tracking, and other technologies for interaction, achieving diverse intervention outcomes. Participants showed effective improvement in competency barriers using XR-based multimodal interactive platforms. However, Mixed Reality (MR) technology still requires further development. Future research should explore multimsodal interaction technologies combining XR and AI, optimize models, prioritize the development of MR intervention scenarios, and sustain an optimal intervention level.

Virtual Reality Utilized for Safety Skills Training for Autistic Individuals: A Review

In recent years, virtual reality technology, which is able to simulate real-life environments, has been widely used in the field of intervention for individuals with autism and has demonstrated distinct advantages. This review aimed to evaluate the impact of virtual reality technology on safety skills intervention for individuals with autism. After searching and screening three databases, a total of 20 pertinent articles were included. There were six articles dedicated to the VR training of street-crossing skills for individuals with autism, nine articles focusing on the training of driving skills for individuals with ASD, and three studies examining the training of bus riding for individuals with ASD. Furthermore, there were two studies on the training of air travel skills for individuals with ASD. First, we found that training in some complex skills (e.g., driving skills) should be selected for older, high-functioning individuals with ASD, to determine their capacity to participate in the training using scales or questionnaires before the intervention; VR devices with higher levels of immersion are not suitable for younger individuals with ASD. Second, VR is effective in training safety skills for ASD, but there is not enough evidence to determine the relationship between the level of VR immersion and intervention effects. Although the degree of virtual reality involvement has an impact on the ability of ASD to be generalized to the real world, it is important to ensure that future virtual reality settings are realistic and lifelike. Again, adaptive models that provide personalized training to individuals with ASD in VR environments are very promising, and future research should continue in this direction. This paper also discusses the limitations of these studies, as well as potential future research directions.

Learning Experience Design and Unpacking Sociocultural, Technological, and Pedagogical Design Considerations of Spherical Video-Based Virtual Reality Systems for Autistic Learners: A Systematic Literature Review

This systematic literature review discusses the use of spherical video-based virtual reality (SVVR) as a training and therapy intervention for autistic individuals. The authors emphasize the need for an evidence-based framework with guidelines and design considerations to help developers and educators tailor SVVR to the diverse needs of autistic learners. The paper highlights the unique benefits of SVVR, such as being relatively easier to develop compared to other VR technologies and high compatibility with various devices, making it more affordable for educational settings. The authors also discuss the importance of the STP (Sociotechnical-Pedagogical) framework for evaluating and designing social aspects of SVVR interventions for autistic individuals.

My Lovely Granny's Farm: An immersive virtual reality training system for children with autism spectrum disorder

One of the biggest difficulties faced by children with Autism Spectrum Disorder during their learning process and general life, is communication and social interaction. In recent years, researchers and practitioners have invested in different approaches to improving aspects of their communication and learning. However, there is still no consolidated approach and the community is still looking for new approaches that can meet this need. Addressing this challenge, in this article we propose a novelty approach (i.e., an Adaptive Immersive Virtual Reality Training System), aiming to enrich social interaction and communication skills for children with Autism Spectrum Disorder. In this adaptive system (called My Lovely Granny's Farm), the behavior of the virtual trainer changes depending on the mood and actions of the users (i.e., patients/learners). Additionally, we conducted an initial observational study by monitoring the behavior of children with autism in a virtual environment. In the initial study, the system was offered to users with a high degree of interactivity so that they might practice various social situations in a safe and controlled environment. The results demonstrate that the use of the system can allow patients who needed treatment to receive therapy without leaving home. Our approach is the first experience of treating children with autism in Kazakhstan and can contribute to improving the communication and social interaction of children with Autism Spectrum Disorder. We contribute to the community of educational technologies and mental health by providing a system that can improve communication among children with autism and providing insights on how to design this kind of system.

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.

Applications of virtual reality (VR) in autism research: current trends and taxonomy of definitions

Purpose

Recent work could further improve the use of VR technology by advocating the use of psychological theories in task design and highlighting certain properties of VR configurations and human – VR interactions. The variety of VR technology used in the trials prevents us from establishing a systematic relationship between the technology type and its effectiveness. As such, more research is needed to study this link, and our piece is an attempt to shed a spotlight on the issue.

Design/methodology/approach

To explore recent developments in the field, the authors followed the procedures of scoping review by Savickaite et al. (2022) and included publications from 2021 to 2022.

Findings

In this updated analysis, it was clear that the research themes emerging over the last two years were similar to those identified previously. Social training and intervention work still dominates the research area, in spite of recent calls from the autism community to broaden the scientific understanding of neurodivergent experiences and daily living behaviours. Although, autism is often characterised by difficulties with social interactions, it is just one part of the presentation. Sensory differences, motor difficulties and repetitive behaviours are also important facets of the condition, as well as various wider aspects of health, wellbeing and quality of life. However, many of these topics appear to be understudied in research on VR applications for autism.

Originality/value

VR stands out from other representational technologies because of its immersion, presence and interactivity and has grown into its own niche. The question of what constitutes a truly immersive experience has resurfaced. We can no longer deny that VR has established itself in autism research. As the number of studies continues to grow, it is a perfect time to reconsider and update our notion of definitions of immersion and its reliance on hardware.

The Relevance of Virtual-Assisted Early Childhood Education and Occupational Psychotherapy Based on Emotional Interaction

This paper presents an in-depth study and analysis of the relevance of early childhood education to occupational psychotherapy using a virtual-assisted affective interaction approach. Starting from the educational theory of interactive cognitive psychology, the theoretical basis for parent-child picture book education for interactive learning is explored, as well as the theoretical development after the introduction of AR technology. Firstly, the analysis of young children's emotions involves massive image processing, and the use of cloud computing architecture leads to high latency, while young children's safety is a latency-sensitive service. Secondly, face recognition accuracy based on static images is not high due to problems such as inconspicuous facial features of toddlers and low-quality kindergarten surveillance videos. In this paper, a face identity correction model based on location features is proposed and the superiority of the model is demonstrated through experiments. Finally, this paper analyzes and mines the emotional data of young children. The level of kindergarten teachers' awareness of early childhood mental health education generally showed an upward trend as their titles rose, and there were significant differences in the seven dimensions of early childhood mental health, the purpose and meaning of early childhood mental health education, implementers, targets, content, pathways, and effects; significant differences existed between teachers of different kindergarten natures, and there were significant differences in the purpose and meaning of early childhood mental health education, implementers, targets, content, pathways, effects, and mental health education for young children. Therefore, this paper proposes a face identity correction model based on position information, which considers both the correlation between pixel values in the spatial domain and the correlation between frames in the temporal domain. This paper has developed an emotion analysis system for kindergartens and put it into use in kindergartens to meet the needs of monitoring the safety of young children and evaluating early childhood education and has received good feedback from users, demonstrating the effectiveness of the system.

Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies

World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.

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 structure of the superior and inferior parietal lobes predicts inter-individual suitability for virtual reality

The global virtual reality (VR) market is significantly expanding and being challenged with an increased demand owing to COVID-19. Unfortunately, VR is not useful for everyone due to large interindividual variability existing in VR suitability. To understand the neurobiological basis of this variability, we obtained neural structural and functional data from the participants using 3T magnetic resonance imaging. The participants completed one of two tasks (sports training or cognitive task) using VR, which differed in the time scale (months/minutes) and domain (motor learning/attention task). Behavioral results showed that some participants improved their motor skills in the real world after 1-month training in the virtual space or obtained high scores in the 3D attention task (high suitability for VR), whereas others did not (low suitability for VR). Brain structure analysis revealed that the structural properties of the superior and inferior parietal lobes contain information that can predict an individual’s suitability for VR.

Evaluation of a rail-travel simulator for elderly adults with cognitive disorders. The Grand-Via Project, a travel therapy pilot study

BACKGROUND AND PURPOSE

Travel therapy can reduce anxiety symptoms in elderly adults with cognitive disorders. The objective of this pilot study was to evaluate the use of a rail-travel simulator in this purpose.

MATERIALS AND METHODS

The study was a prospective, single centre cohort survey. Our study population consisted of persons either from the nursing home, the cognitive and behavioural unit or the day-care centre of our university hospital. Participants were accompanied on a virtual trip using a film projection in a replica of train compartment. Participants were interviewed before and after each session using a short questionnaire developed by a multi-disciplinary team.

RESULTS

Forty-two participants performed sessions. While only 58.3% of the participants reported being relaxed before the session, this rate increased significantly to 87.5% by the end of the trip. A majority of participants gave their personal impressions and half of the group reported memories evoked by the experience.

CONCLUSION

The majority of elderly persons who completed the virtual trip replied positively about the experience. We need now to confirm the efficacy of our simulator using a randomised controlled trial.

Effectiveness of Virtual/Augmented Reality-Based Therapeutic Interventions on Individuals With Autism Spectrum Disorder: A Comprehensive Meta-Analysis

In recent years, the application of virtual reality (VR) for therapeutic purposes has escalated dramatically. Favorable properties of VR for engaging patients with autism, in particular, have motivated an enormous body of investigations targeting autism-related disabilities with this technology. This study aims to provide a comprehensive meta-analysis for evaluating the effectiveness of VR on the rehabilitation and training of individuals diagnosed with an autism spectrum disorder. Accordingly, we conducted a systematic search of related databases and, after screening for inclusion criteria, reviewed 33 studies for more detailed analysis. Results revealed that individuals undergoing VR training have remarkable improvements with a relatively large effect size with Hedges g of 0.74. Furthermore, the results of the analysis of different skills indicated diverse effectiveness. The strongest effect was observed for daily living skills (g = 1.15). This effect was moderate for other skills: g = 0.45 for cognitive skills, g = 0.46 for emotion regulation and recognition skills, and g = 0.69 for social and communication skills. Moreover, five studies that had used augmented reality also showed promising efficacy (g = 0.92) that calls for more research on this tool. In conclusion, the application of VR-based settings in clinical practice is highly encouraged, although their standardization and customization need more research.

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.

Virtual reality and naturalistic developmental behavioral interventions for children with autism spectrum disorder

BACKGROUND

Naturalistic Developmental Behavioral Interventions (NDBI) have been evaluated as the most promising interventions for children with autism spectrum disorder. In recent years, a growing body of literature suggests that technological advancements such as Virtual Reality (VR) are promising intervention tools. However, to the best of our knowledge no studies have combined evidence-based practice with such tools.

AIM

This article aims to review the current literature combining NDBI and VR, and provide suggestions on merging NDBI-approaches with VR.

METHODS

This article is divided into two parts, where we first conduct a review mapping the research applying NDBI-approaches in VR. In the second part we argue how to apply the common features of NDBI into VR-technology.

RESULTS

Our findings show that no VR-studies explicitly rely on NDBI-approaches, but some utilize elements in their interventions that are considered to be common features to NDBI.

CONCLUSIONS AND IMPLICATIONS

As the results show, to date, no VR-based studies have utilized NDBI in their intervention. We therefore, in the second part of this article, suggests ways to merge VR and NDBI and introduce the term Virtual Naturalistic Developmental Behavioral Interventions (VNDBI). VNDBI is an innovative way of implementing NDBI which will contribute in making interventions more accessible in central as well as remote locations, while reducing unwanted variation between service sites. VNDBI will advance the possibilities of individually tailoring and widen the area of interventions. In addition, VNDBI can provide the field with new knowledge on effective components enhancing the accuracy in the intervention packages and thus move forward the research field and clinical practice.

Electroencephalographic Correlate of Mexican Spanish Emotional Speech Processing in Autism Spectrum Disorder: To a Social Story and Robot-Based Intervention

Socio-emotional impairments are key symptoms of Autism Spectrum Disorders. This work proposes to analyze the neuronal activity related to the discrimination of emotional prosodies in autistic children (aged 9 to 11-year-old) as follows. Firstly, a database for single words uttered in Mexican Spanish by males, females, and children will be created. Then, optimal acoustic features for emotion characterization will be extracted, followed of a cubic kernel function Support Vector Machine (SVM) in order to validate the speech corpus. As a result, human-specific acoustic properties of emotional voice signals will be identified. Secondly, those identified acoustic properties will be modified to synthesize the recorded human emotional voices. Thirdly, both human and synthesized utterances will be used to study the electroencephalographic correlate of affective prosody processing in typically developed and autistic children. Finally, and on the basis of the outcomes, synthesized voice-enhanced environments will be created to develop an intervention based on social-robot and Social Story^TM for autistic children to improve affective prosodies discrimination. This protocol has been registered at BioMed Central under the following number: ISRCTN18117434.

Virtual Reality Air Travel Training Using Apple iPhone X and Google Cardboard: A Feasibility Report with Autistic Adolescents and Adults

Rapid rises in autism diagnoses are increasing the demand for effective services and straining service providers. When individuals on the autism spectrum turn 18, they are faced with even greater barriers to services, since many services are delivered in school settings. Thus, there is a need for more accessible tools that teach daily life and communication skills to autistic adolescents and young adults. The current project reports findings from a pilot study using virtual reality (VR) to teach air travel skills to autistic young adults. The authors repurposed a virtual airport environment previously used to treat fear of flying for this study. Seven participants on the autism spectrum viewed a 5-minute virtual airport simulation with an overlaid narrative script using an iPhone X^® and Google Cardboard^® device once per week for 3 weeks. Researchers collected measures of attentiveness, language function, activity comprehension, and clinical observations on how participants interacted with the technology. Analyses revealed improvements in attentiveness, certain language functions such as labeling vocabulary, and activity comprehension in most participants. Clinical observations revealed acceptability of this technology and its capability to serve as an appealing media to deliver interventions. Thus, it is feasible to apply mobile VR trainings with autistic adolescents and young adults. We discuss ways to improve the pedagogical approach of VR-enhanced interventions in light of these findings. In the future, we plan to develop and test more virtual environments that address the needs of young adults on the autism spectrum, such as interview training and independent living skills.

Lay summary

Why was this virtual reality air travel training program developed?: Each year, more and more people travel via airplane. Long lines, unexpected changes and other stressors can make air travel overwhelming and difficult, particularly for autistic people. Our goal was to develop and pilot test a program to help autistic adults learn air travel skills without needing to physically enter an airport.What does the virtual reality air travel training program do?: Our virtual reality air travel training (VR-ATT) program presents a virtual simulation of the steps that travelers go through in an airport. It guides users through entering, checking in, navigating security, waiting at the departure gate, and boarding. VR-ATT also contains a narrative to guide users by highlighting important information such as: "Look, there's the ticket counter. Let's check in with the attendant." This script was based on social stories, which are often used to help individuals on the autism spectrum learn communication and social interaction strategies. Seven autistic adolescents and adults participated in our program. They watched the VR-ATT simulation on an iPhone X^® and Google Cardboard^® two to three times over the course of 3 weeks. Google Cardboard is an inexpensive virtual reality (VR) headset.How did the researchers evaluate the VR-ATT program?: We evaluated the program in three ways. First, we asked each participant to retell the sequence of events of the simulation. In other research studies, participants who retold what they watched showed a greater ability to apply the skill to the real world. Second, we tracked how and what types of language participants used. Third, we measured if participants could independently view the VR-ATT simulation without side effects such as dizziness or cybersickness (common side effects of VR viewing). This helps us understand the feasibility and acceptability of using VR with autistic individuals.What were the early findings?: Early findings suggest that autistic individuals are accepting of the iPhone and Google Cardboard VR viewing method. They also provide preliminary support for the ability of the program to promote improvements in functional language skills such as labeling vocabulary, which helps individuals interact and navigate busy environments, such as an airport. Finally, the findings suggest that participants can accurately retell the sequence of events in the virtual simulation.What were the weaknesses of this project?: One weakness was that researchers could not test how participants transferred the skills they learned in the virtual training to a real-world airport. Another weakness is the small sample of participants. Finally, not every participant completed all three training sessions, making it difficult to draw precise conclusions about the program's acceptability and success.What are the next steps?: Future studies should include a larger number of participants, a real-world test, changes to the virtual simulation to encourage more language use and interaction with virtual characters, and use more accurate measurement materials.How will this work help autistic adults now or in the future?: This air travel program may someday help autistic people learn what to expect and how to communicate in a busy airport setting. This program also highlights that new technology, such as VR, could potentially improve access to services and help more people in need in the future.