Effectiveness of Virtual Reality for Children and Adolescents with Autism Spectrum Disorder: An Evidence-Based Systematic Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills. ASD has a high prevalence in children, affecting 1 in 160 subjects. Virtual reality (VR) has emerged as an effective tool for intervention in the health field. Different recent papers have reviewed the VR-based treatments in ASD, but they have an important limitation because they only use clinical databases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank. To our knowledge, this is the first contribution that has carried out an evidence-based systematic review including both clinical and technical databases about the effectiveness of VR-based intervention in ASD. The initial search identified a total of 450 records. After the exclusion of the papers that are not studies, duplicated articles, and the screening of the abstract and full text, 31 articles met the PICO (Population, Intervention, Comparison and Outcomes) criteria and were selected for analysis. The studies examined suggest moderate evidence about the effectiveness of VR-based treatments in ASD. VR can add many advantages to the treatment of ASD symptomatology, but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments.

[1]  José-Antonio Lozano-Quilis,et al.  The Effect of Balance Training on Postural Control in Patients with Parkinson’s Disease Using a Virtual Rehabilitation System , 2017, Methods of Information in Medicine.

[2]  Horace Ho-Shing Ip,et al.  Virtual Reality Enabled Training for Social Adaptation in Inclusive Education Settings for School-Aged Children with Autism Spectrum Disorder (ASD) , 2016, ICBL.

[3]  Morgan Rouprêt,et al.  Outcomes of a virtual‐reality simulator‐training programme on basic surgical skills in robot‐assisted laparoscopic surgery , 2017, The international journal of medical robotics + computer assisted surgery : MRCAS.

[4]  F. D. Rose,et al.  The use of virtual reality in memory rehabilitation: current findings and future directions. , 2003, NeuroRehabilitation.

[5]  John Morgan,et al.  Emulation of Physician Tasks in Eye-Tracked Virtual Reality for Remote Diagnosis of Neurodegenerative Disease , 2017, IEEE Transactions on Visualization and Computer Graphics.

[6]  Zhen Bai,et al.  Using Augmented Reality to Elicit Pretend Play for Children with Autism , 2015, IEEE Transactions on Visualization and Computer Graphics.

[7]  Chien-Hsu Chen,et al.  Augmented reality-based video-modeling storybook of nonverbal facial cues for children with autism spectrum disorder to improve their perceptions and judgments of facial expressions and emotions , 2016, Comput. Hum. Behav..

[8]  Heleen Riper,et al.  Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis , 2017, Front. Psychiatry.

[9]  Lizbeth Escobedo,et al.  Using Augmented Reality to Help Children with Autism Stay Focused , 2014, IEEE Pervasive Computing.

[10]  Zachary Wartell,et al.  Evaluation of the exertion and motivation factors of a virtual reality exercise game for children with autism , 2013, 2013 1st Workshop on Virtual and Augmented Assistive Technology (VAAT).

[11]  Stefania Serafin,et al.  Daily Living Skills Training in Virtual Reality to Help Children with Autism Spectrum Disorder in a Real Shopping Scenario , 2017, 2017 IEEE International Symposium on Mixed and Augmented Reality (ISMAR-Adjunct).

[12]  E. Pietrzak,et al.  Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. , 2014, Games for health journal.

[13]  Jorge Pomares,et al.  Inclusion of immersive virtual learning environments and visual control systems to support the learning of students with Asperger syndrome , 2013, Comput. Educ..

[14]  Yufang Cheng,et al.  Using a 3D Immersive Virtual Environment System to Enhance Social Understanding and Social Skills for Children With Autism Spectrum Disorders , 2015 .

[15]  Sarah Parsons,et al.  Authenticity in virtual reality for assessment and intervention in Autism: a conceptual review , 2016 .

[16]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[17]  Kwanguk Kim,et al.  A Virtual Joy-Stick Study of Emotional Responses and Social Motivation in Children with Autism Spectrum Disorder , 2015, Journal of autism and developmental disorders.

[18]  Damiaan Denys,et al.  Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review , 2017, Front. Psychiatry.

[19]  Ho Ming Lau,et al.  Embodied Conversational Agents in Clinical Psychology: A Scoping Review , 2017, Journal of medical Internet research.

[20]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[21]  Fengfeng Ke,et al.  Virtual reality based collaborative design by children with high-functioning autism: design-based flexibility, identity, and norm construction , 2016, Interact. Learn. Environ..

[22]  Christopher Frauenberger,et al.  Social Communication between Virtual Characters and Children with Autism , 2011, AIED.

[23]  Nilanjan Sarkar,et al.  Understanding How Adolescents with Autism Respond to Facial Expressions in Virtual Reality Environments , 2013, IEEE Transactions on Visualization and Computer Graphics.

[24]  Jorge Pomares,et al.  Design and application of an immersive virtual reality system to enhance emotional skills for children with autism spectrum disorders , 2016, Comput. Educ..

[25]  M. Ma,et al.  Effectiveness of Immersive Virtual Reality in Surgical Training-A Randomized Control Trial. , 2017, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[26]  Sara Bernardini,et al.  Designing an Intelligent Virtual Agent for Social Communication in Autism , 2013, AIIDE.

[27]  Fengfeng Ke,et al.  Virtual-Reality-Based Social Interaction Training for Children with High-Functioning Autism , 2013 .

[28]  James Laffey,et al.  iSocial: Delivering the Social Competence Intervention for Adolescents (SCI-A) in a 3D Virtual Learning Environment for Youth with High Functioning Autism , 2013, Journal of Autism and Developmental Disorders.

[29]  Jing Fan,et al.  Multimodal adaptive social interaction in virtual environment (MASI-VR) for children with Autism spectrum disorders (ASD) , 2016, 2016 IEEE Virtual Reality (VR).

[30]  R. Baños,et al.  Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy , 2015, The Clinical journal of pain.

[31]  J. Bailenson,et al.  Social Attention in a Virtual Public Speaking Task in Higher Functioning Children With Autism , 2013, Autism research : official journal of the International Society for Autism Research.

[32]  Wenbing Zhao,et al.  Technology-Facilitated Diagnosis and Treatment of Individuals with Autism Spectrum Disorder: An Engineering Perspective , 2017 .

[33]  Denise Reid,et al.  Using the Virtual Reality-Cognitive Rehabilitation Approach to Improve Contextual Processing in Children with Autism , 2013, TheScientificWorldJournal.

[34]  P. Sterkenburg,et al.  Self-controlled technologies to support skill attainment in persons with an autism spectrum disorder and/or an intellectual disability: a systematic literature review , 2015, Disability and rehabilitation. Assistive technology.

[35]  DidehbaniNyaz,et al.  Virtual Reality Social Cognition Training for children with high functioning autism , 2016 .

[36]  Sarah Parsons,et al.  Learning to work together: Designing a multi-user virtual reality game for social collaboration and perspective-taking for children with autism , 2015, Int. J. Child Comput. Interact..

[37]  Taryadi,et al.  The improvement of autism spectrum disorders on children communication ability with PECS method Multimedia Augmented Reality-Based , 2018 .

[38]  Todd A. MacKenzie,et al.  Effect of an Immersive Preoperative Virtual Reality Experience on Patient Reported Outcomes: A Randomized Controlled Trial , 2017, Annals of surgery.

[39]  Jayasree Santhosh,et al.  Efficacy of Collaborative Virtual Environment Intervention Programs in Emotion Expression of Children with Autism. , 2013 .

[40]  Jianmin Zheng,et al.  Design and Development of a Virtual Dolphinarium for Children With Autism , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[41]  W. Mandy,et al.  What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. , 2017, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  Trent W. Lewis,et al.  Development of a virtual agent based social tutor for children with autism spectrum disorders , 2010, The 2010 International Joint Conference on Neural Networks (IJCNN).

[43]  Nilanjan Sarkar,et al.  Assessing the Utility of a Virtual Environment for Enhancing Facial Affect Recognition in Adolescents with Autism , 2014, Journal of autism and developmental disorders.

[44]  Mariano Alcañiz Raya,et al.  Clinical Validation of a Virtual Environment Test for Safe Street Crossing in the Assessment of Acquired Brain Injury Patients with and without Neglect , 2011, INTERACT.

[45]  H. McConachie,et al.  Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention , 2014, PloS one.

[46]  K Lane,et al.  A Randomized Controlled Trial Investigating the Efficacy of Virtual Reality in Inpatient Stroke Rehabilitation , 2017 .

[47]  Evelyne Klinger,et al.  Using a virtual supermarket to promote independent functioning among adolescents with Autism Spectrum Disorder , 2017, 2017 International Conference on Virtual Rehabilitation (ICVR).

[48]  Celestino Rodríguez,et al.  Efficacy of a Continuous Performance Test Based on Virtual Reality in the Diagnosis of ADHD and Its Clinical Presentations , 2018, Journal of attention disorders.

[49]  C. V. van Heugten,et al.  Novel insights into the rehabilitation of memory post acquired brain injury: a systematic review , 2014, Front. Hum. Neurosci..

[50]  Horace Ho-Shing Ip,et al.  Enhance emotional and social adaptation skills for children with autism spectrum disorder: A virtual reality enabled approach , 2018, Comput. Educ..

[51]  C. Colombi,et al.  Neuropsychological Characteristics of Children with Mixed Autism and ADHD , 2017, Autism research and treatment.

[52]  G. Reger,et al.  Review of Virtual Reality Treatment in Psychiatry: Evidence Versus Current Diffusion and Use , 2017, Current Psychiatry Reports.

[53]  Jing Fan,et al.  A Gaze-Contingent Adaptive Virtual Reality Driving Environment for Intervention in Individuals with Autism Spectrum Disorders , 2016, ACM Trans. Interact. Intell. Syst..

[54]  Chien-Hsu Chen,et al.  Augmented reality-based self-facial modeling to promote the emotional expression and social skills of adolescents with autism spectrum disorders. , 2015, Research in developmental disabilities.

[55]  Daniel C. Krawczyk,et al.  Virtual Reality Social Cognition Training for children with high functioning autism , 2016, Comput. Hum. Behav..

[56]  S. Padmavathi,et al.  A Rehabilitation Therapy for Autism Spectrum Disorder Using Virtual Reality , 2017 .