Effects of immersive virtual reality training on the adaptive skills of children and adolescents with high...

Autism Spectrum Disorder (ASD) is characterized by social deficits and restricted, repetitive behaviors, with fewer than 10% achieving independent adulthood. Immersive virtual reality (IVR) provides a novel training approach through interactive and realistic environments. This study developed an IVR system to enhance adaptive skills in children and adolescents with high-functioning ASD.

Thirty-three individuals with high-functioning ASD (ages 8-18) were enrolled based on clinical diagnoses confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and Autism Diagnostic Interview-Revised (ADI-R), with an intelligence quotient ≥ 80. The study employed a single-arm, within-subject pre-post design. Participants received weekly one-hour IVR training sessions, requiring 6-10 sessions to complete 36 tasks twice. Primary outcomes included changes in IVR task scores and completion times, while secondary outcomes assessed parent-reported questionnaires - Adaptive Behavior Assessment System-Second Edition (ABAS-II), Autism Behavior Checklist (ABC), and Behavior Rating Inventory of Executive Function (BRIEF) - neuropsychological tests (Go/No-Go, 0-back, 1-back, and emotional face recognition tasks), and semi-structured interviews. Usability was evaluated via self-reported comfort levels, willingness to continue and device-related questions. Generalized Estimating Equation models analyzed changes across all measures.

The IVR training demonstrated high usability, with an 87.9% completion rate and no severe adverse effects. Some participants reported mild discomforts, including dizziness (28.6%) and fatigue (25.0%), as well as device-related issues such as unsteady walking (34.5%) and headset discomfort (31.0%). However, comfort levels increased over time (adjusted P = 0.026), indicating gradual adaptation to the system. IVR task scores improved by 5.5% (adjusted P = 0.034), and completion times decreased by 29.59% (adjusted P < 0.001). Parent-reported measures showed a 43.22% reduction in ABC Relating subscale scores (adjusted P = 0.006) and moderate reductions in BRIEF Behavioral Regulation and Metacognition indices (adjusted P = 0.020, 0.019). Reaction times for the 1-back and emotional face recognition tasks decreased by 14.81% and 14.14% respectively (adjusted P = 0.012, 0.014). Qualitative feedback indicated improvements in social interaction, emotional regulation, repetitive behaviors, attention, and daily living skills.

This pilot study supports IVR training as a feasible and potentially effective training method for improving adaptive skills in children and adolescents with high functioning ASD.