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Research Article

Understanding experiences and interactions of children with Asperger’s syndrome in Virtual Reality-based learning systems

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Received 02 Jan 2024, Accepted 27 May 2024, Published online: 01 Jul 2024

ABSTRACT

Asperger’s syndrome is part of the large group of Autism Spectrum Disorders. Children with Asperger’s syndrome suffer from communication difficulties, which leads to disabilities related to social skills and learning. One of the novel suggested approaches to help in their social interaction and learning has been the use of Virtual Reality environments. Following this path, in this long-term study, we explored the social interaction and communication of children with Asperger’s syndrome within a Virtual Reality-based learning system. Children with Asperger’s syndrome used the system in a controlled environment for three months. By conducting a qualitative study based on Constructivist Grounded Theory methods and the Experimental Analysis of Behavior, involving the children, their teachers and mental health experts, we perceived that after initially demonstrating discomfort with the system’s characters, children interacted with the characters of the VR system, facing their communication difficulties, and expressing emotional states (e.g. fear, shyness, and probable suicidal desire). Based on the results, we provide novel insights related to the perception of children with Asperger’s syndrome regarding the use of Virtual Reality-based learning systems.

1. Introduction

According to International Classification of Diseases-10 criteria, Asperger’s syndrome is a disorder of undefined nosology characterized by the same qualitative abnormalities in social interactions as those characteristics of autism, combined with restricted, stereotyped, monotonous interests and activities (ICD List, Citation2023). Asperger’s disorder manifests in early childhood and determines all subsequent human development (Autism Statistics and Facts & Autism Speaks, Citation2023; Hosseini & Molla, Citation2023). This syndrome is characterized by communication impairment, an under-recognition of reality, and a limited and peculiar stereotyped range of interests that distinguishes these children from their peers (Huang et al., Citation2022; Javaheripour et al., Citation2023; Motlani et al., Citation2022), and such barriers tend to hinder children’s learning process (Hassan et al., Citation2021).

There are striking similarities and overlaps between Autism Spectrum Disorder (ASD) and Asperger’s syndrome, with underlying impairments in socialization, communication and imagination recognized as fundamental and universal in both cases (Huang et al., Citation2022; ICD List, Citation2023). Asperger’s syndrome is characterized by significant impairment in social interaction, as well as the development of a limited set of repetitive behaviors and interests, which in turn may affect the disruption of other important areas of functioning (Huang et al., Citation2022). Although Asperger’s syndrome is classified as an ASD, there are still no specific statistics on children with Asperger’s syndrome (Aane, Citation2022). However, approximately 1 in 36 children worldwide are currently diagnosed with ASD (Data and Statistics on Autism Spectrum Disorder & CDC, Citation2023).

One of the main problems related to Asperger’s syndrome is the dysfunction in social interaction (Chasson & Jarosiewicz, Citation2014), which can manifest in: (i) an inability to interact with peers (interaction with peers is possible, but is not attractive, meaningful, or highly valued), and (ii) social and emotional inadequacy of communication (Elder et al., Citation2006; Javaheripour et al., Citation2023; Motlani et al., Citation2022). At the same time, communication with peers is essential for children’s and adolescent’s learning (Bagwell et al., Citation1998; Hosseini & Molla, Citation2023), and friendship builds emotional contact, develops communication skills, and teaches empathy for others (Bagwell et al., Citation1998; Hosseini & Molla, Citation2023).

In recent years, Virtual Reality (VR) has emerged as a multimodal technology that immerses users in an environment and allows them to interact with it using specialized software and hardware (Deng et al., Citation2023; Dincelli & Yayla, Citation2022; Oigara, Citation2018), integrated with equipment including head-mounted displays (HMDs), motion-sensing or haptic gloves, and VR game controllers (Carreon et al., Citation2020; Oigara, Citation2018). It has further been recognized as a technology capable of helping people to face some problems related to mental health (Usmani et al., Citation2022), and interventions using immersive VR systems can be especially useful for acquiring knowledge and skills for students with disabilities (Freina & Ott, Citation2015; Wang et al., Citation2023).

Feeling fully immersed in VR can improve the learning process by increasing learners’ concentration and engagement (Freina & Ott, Citation2015; Hidayat & Wardat, Citation2023; Sánchez et al., Citation2022). VR can allow the simulation of a range of real-life situations, offering a safe circumstance to practice social situations that children with ASD can explore in a controlled and safe environment (Lorenzo et al., Citation2019). The research based on the use of VR for children with ASD indicates that individuals have been able to perceive, use and respond appropriately to the virtual environment, and can also transfer these skills to real life (Chen et al., Citation2022; Frolli et al., Citation2022; Ip et al., Citation2022). Integrating VR technology into learning has great potential as it helps students retain their attention, as well as making learning more engaging and interesting (Lee & Hwang, Citation2022; Macey et al., Citation2023; Wohlgenannt et al., Citation2020).

However, although the results related to the use of VR in the treatment of Asperger’s syndrome are still incipient (Honorato et al., Citation2023; Karami et al., Citation2021), the perception, experience and behavior of children with Asperger’s syndrome regarding the use of VR systems is still unknown (Mak & Zhao, Citation2023). Addressing this current challenge, in this study we explored the communication and social skills of children diagnosed with Asperger’s syndrome while using a VR-based learning system, asking the research question: How do children with Asperger’s syndrome experience and interact with VR-based learning systems?

To answer this RQ, we employed a qualitative study based on Constructivist Grounded Theory methods and Experimental Analysis of Behavior involving three children with a clinical diagnosis of Asperger’s syndrome, their teachers and mental health experts over three months in a controlled environment. Children demonstrated interest in exploring the VR system, despite experiencing difficulties in communication during the system usage, and explicitly expressed emotional states (e.g. fear, shyness, and probable suicidal desire), which can help us to understand the tendencies of children with Asperger’s syndrome to improve their learning process. Based on the results, we contribute to the fields of learning technologies by providing novel insights related to the perception of children with Asperger’s syndrome regarding the use of VR-based learning systems.

2. Background

In this section, we present the main topic addressed in this study (i.e. the use of VR with children with Asperger’s syndrome). We also present an overview of recent related work.

2.1. Implementing Virtual Reality for children with Asperger’s syndrome

The concept of Asperger’s syndrome was introduced by psychiatrist Lorna Wing after the Austrian psychiatrist Hans Asperger’s described autistic behaviors in children (Gillberg, Citation2015). Asperger’s referred to the disorder described as autistic psychopathies (Wing, Citation1981). The syndrome is more common in boys than in girls (Data and Statistics on Autism Spectrum Disorder & CDC, Citation2023; Tremolada et al., Citation2023; Werling & Geschwind, Citation2013). According to the DSM-IV Diagnostic Criteria, symptoms should appear before the age of 3, although the diagnosis is made, on average, several years later (Hosseini & Molla, Citation2023; Schnur, Citation2005). Asperger’s syndrome became a part of the diagnosis of ASD in 2013 (Autism Statistics and Facts & Autism Speaks, Citation2023), and recent reports estimate that ASD is identified in approximately 1 in 36 children (Data and Statistics on Autism Spectrum Disorder & CDC, Citation2023; Tremolada et al., Citation2023).

In contrast to other cases of autism, there is no significant delay in speech and cognitive development in Asperger’s syndrome (Hosseini & Molla, Citation2023; Mirkovic & Gérardin, Citation2019). Intelligence is often normal (overall IQ of at least 70 with better verbal and worse non-verbal intelligence), or higher than normal (Hosseini & Molla, Citation2023; ICD List, Citation2023; Schnur, Citation2005). An individual may be surprisingly successful at one thing and unsuccessful at another, for example, being fluent in language, but demonstrating difficulty adjusting to social contexts and different forms of listening (Hosseini & Molla, Citation2023; Wing, Citation1981). Children with Asperger’s syndrome have an excellent memory and are intensely interested in one or two subjects such as astronomy, geology, prehistoric monsters, and other things (Hosseini & Molla, Citation2023; Wing, Citation1981).

At the same time, individuals with Asperger’s Syndrome have impaired communicative function of speech, where speech is formal, pedantic, dull, poor in intonation, unusually modulated, and peculiar in melody and rhythm (Hosseini & Molla, Citation2023; Klin, Citation2006; Valle et al., Citation2021). Children also have problems with nonverbal communication, and features such as an inability to use gestures, clumsiness, limited facial expression, and a stiff and peculiar gaze are also noted (Hosseini & Molla, Citation2023; Valle et al., Citation2021).

The exact causes of Asperger’s syndrome are unknown, but they are thought to be similar to those of other autism spectrum disorders (ICD List, Citation2023; Motlani et al., Citation2022). Research suggests that genetic factors play a greater role in Asperger’s syndrome than in ASD (Foster & King, Citation2003; Rinehart et al., Citation2002; Schnur, Citation2005). Scientists also suggest causes such as environmental pollutants, antibiotic use, allergies, vaccines, and viral diseases in utero (Ratajczak, Citation2011; Schnur, Citation2005; Wing & Potter, Citation2002).

At the same time, VR refers to immersive multimodal technologies (Bowman & McMahan, Citation2007; Deng et al., Citation2023), and are technical devices and software that create the illusion of human presence in an artificial world, and in some cases allows you to manipulate its objects (Berg & Vance, Citation2017; Gopalan et al., Citation2023; Jerald, Citation2016). VR can be characterized based on three important properties: (i) presence, (ii) interactivity, and (iii) immersion (Wohlgenannt et al., Citation2020). Presence refers to a feeling of being “there” in the computer-generated world, which means not in the place where the user actually is (Sanchez-Vives & Slater, Citation2005; Wohlgenannt et al., Citation2020). According to other research, presence is also defined as the user’s response to visual stimuli in the same way as if they were exposed to equal, real-world incentives (Nordahl & Nilsson, Citation2014; Slater, Citation2003). Interactivity refers to the ability to interact with the virtual world in real-time (Steuer, Citation1992; Wohlgenannt et al., Citation2020). Finally, immersion refers to the perception that is created by surrounding the system with virtual images, sounds, or other effects that create an immersive environment of the surrounding space (Dincelli & Yayla, Citation2022; Wohlgenannt et al., Citation2020).

Nowadays, VR technology is rapidly growing and becoming one of the important tools in many fields (Pyun et al., Citation2022; Wohlgenannt et al., Citation2020). Advanced VR technologies include head-mounted displays (HMDs), headphones and controllers for haptic sensations, gloves and suits, multidimensional treadmills, or other hardware that enhances the immersive experience (Hamad & Jia, Citation2022; Pyun et al., Citation2022; Wohlgenannt et al., Citation2020). VR is widely used in education, for example, to train engineers, mechanics, pilots, field workers, military personnel, and technicians in the manufacturing, oil and gas sectors (Gopalan et al., Citation2023; Hidayat & Wardat, Citation2023; Kavanagh et al., Citation2017; Sánchez et al., Citation2022; Tan et al., Citation2022). In addition to educational and training purposes, VR is also broadly used for other industries (Berg & Vance, Citation2017).

VR allows users to meet in a shared immersive virtual environment, and interact with virtual versions of people, improve communication, and engage in collaborative work (Deng et al., Citation2023). Commercial social VR applications are becoming increasingly common in a variety of fields, including employment, education, counseling, and entertainment (Bujić et al., Citation2021). VR exposure technology is also used to treat people with mental health problems (Berg & Vance, Citation2017). This technology allows engineers to experiment with design and construction at the concept stage, before proceeding with expensive prototypes (Mobach, Citation2008). Using this technology in architecture helps in decision-making and visualization of the results of proposed urban planning projects and architectural plans (Delgado et al., Citation2020; Mobach, Citation2008; Portman et al., Citation2015).

In the same way, VR applications offer a safe and ecologically digital environment for experience, practice, learning and improving skills for students with disabilities (Chițu et al., Citation2023; Lorenzo et al., Citation2013; Yakubova et al., Citation2021). Thus, VR provides cost-effective and affordable solutions that can be made available in the classroom to support the academic, behavioral and social skills of children with ASD (Lorenzo et al., Citation2013; Carreon et al., Citation2020; Dechsling et al., Citation2021), possibly increasing the motivation, attention and focus of participants with ASD (Zhang et al., Citation2022).

Taking into account the individual characteristics and severity of the disability, students with ASD require careful planning for educational success (Williams, Citation2006), and the use of VR technology has the important advantage of helping to contribute significantly to the long-term support for those with ASD (Ke & Im, Citation2013; Zhang et al., Citation2022). Also, this technology is useful for educators working in special education for children with ASD (Zhang et al., Citation2022), and research has demonstrated the effectiveness of VR training in increasing affective expression and social reciprocity in school-aged children with ASD (Ip et al., Citation2022). Interventions using VR technology provide repetitive practice and exposure, which is a key element of the treatment of ASD individuals (Ke & Im, Citation2013; Zhang et al., Citation2022).

One notable characteristic of VR lies in its ability to create a tailored sensory environment (Macey et al., Citation2023), a feature particularly advantageous for teaching children with Asperger’s syndrome (Zhang et al., Citation2022). Children with Asperger’s often experience sensory sensitivities (Hosseini & Molla, Citation2023), and traditional learning environments may pose challenges for them (Soltiyeva et al., Citation2023). VR allows educators to customize the sensory input, controlling factors such as visual stimuli, auditory cues, and tactile feedback (Chițu et al., Citation2023; Soltiyeva et al., Citation2023; Yakubova et al., Citation2021). This adaptability can enable the creation of a controlled and predictable space, providing a comfortable and less overwhelming setting for children with Asperger’s (Zhang et al., Citation2022).

As a further consideration, VR offers a unique avenue for teaching and enhancing social skills, which is seen as a crucial area of development for children with Asperger’s syndrome (Howard & Gutworth, Citation2020). One of the challenges faced by these children is navigating social interactions, interpreting social cues, and understanding the nuances of interpersonal communication (Hosseini & Molla, Citation2023). VR is expected to simulate various social scenarios, allowing children to practice and refine their social skills in a controlled and safe environment (Chițu et al., Citation2023; Soltiyeva et al., Citation2023; Yakubova et al., Citation2021). Through interactive virtual scenarios, children can engage in role-playing exercises, practice making eye contact, and learn appropriate social responses (Chițu et al., Citation2023; Soltiyeva et al., Citation2023; Yakubova et al., Citation2021).

2.2. Related work

The special condition of children with ASD must be considered to meet their learning needs (Didehbani et al., Citation2016; Ip et al., Citation2016; Zhao et al., Citation2018). Because of the low cost and greater degree of interaction, computer-based interventions are one of the most effective ways of training children with ASD (Zhao et al., Citation2018). Specially, immersive VR-based systems are helpful in teaching children about different life situations (Rahmadiva et al., Citation2019; Wade et al., Citation2014). Accordingly, in recent years, researchers have invested in using VR-based systems with children with ASD.

One of the proposed VR-related approaches is the use of VR-based games to improve the social interaction and communication skills of children with Asperger’s syndrome (Honorato et al., Citation2023). VR-based games are usually designed to help children with ASD train their focus, improve social skills, and meet each child’s individual needs (Ke & Im, Citation2013; Rahmadiva et al., Citation2019). In VR-based games, ASD children can complete social interaction scenarios, recognizing the body gestures and facial expressions of a virtual communication partner (Ke & Im, Citation2013), and maintaining their interaction with characters (Ke & Im, Citation2013; Rahmadiva et al., Citation2019).

Another VR-related approach is using VR-enabled training systems to facilitate the social adaptation of learning (Didehbani et al., Citation2016; Ip et al., Citation2016). In this kind of application, participants interact with the virtual environment using body gestures and communication with the trainer, and in turn, the trainer controls the entire process of training (Didehbani et al., Citation2016; Ip et al., Citation2016).

Another novel VR-related approach is based on collaborative systems. In this case, the idea is to enhance communication and cooperation with peers for children with ASD (Zhao et al., Citation2018). VR collaborative systems for ASD children aim to allow the interaction of virtual objects and players simultaneously, including gaze and voice-based touch in real-time within the gameplay (Zhao et al., Citation2018). In we present a comparison of technical aspects featured in the related work discussed.

Table 1. Related work comparison.

In summary: recent studies aim to teach children with ASD using VR technologies, advancing the understanding of how VR-based learning systems can be used with ASD children, and raising new challenges for future studies. However, there is still a lack of studies analyzing the experience and overall interactions of children with Asperger’s syndrome in VR-based learning systems. As far as we know, we are the first to explore the experiences and interactions of children with Asperger’s syndrome in VR-based learning systems.

3. Study design

The study’s main aim is to explore the experiences and interactions of children with Asperger’s syndrome in VR-based learning systems. Our goal is not to analyze the effects between variables, but rather to freely explore children’s perception, experience and behavior, thus providing insights into how the children experienced the VR-based learning system. To effectively achieve this goal, we conducted a qualitative study based on Constructive Grounded Theory methods and Experimental Analysis of Behavior, aiming to answer the research question: How do children with Asperger’s syndrome experience and interact with VR-based learning systems?

3.1. VR training system description

In the study, we used the VR training system called My Lovely Granny’s Farm. In this system, users can explore a farm with domesticated animals, farm vehicles, plants, trees, and virtual characters. During the training, participants are given the opportunity to interact with a virtual farmer and a little boy to improve their communication skills (Alimanova et al., Citation2022; Soltiyeva et al., Citation2023). Children can develop their skills and practice in a safe environment, in addition to repeating tasks to reinforce social interaction skills. We specifically chose a farm for this virtual environment because earlier research works have found that human-animal relationships can provide many health benefits for children with ASD (Habri, Citation2020), and at the same time, are among the most used graphic objects in gameful systems (including VR-based gameful systems) used in the education and general treatment of autistic children (Honorato et al., Citation2023). Also, this system has previously been used and analyzed with autistic children (Soltiyeva et al., Citation2023). In this way, we ensure a generalist VR system previously used with autistic children, that uses commonly used graphic elements, and thus avoids biases related to the system’s generalization and interpretation. shows the system diagram. The virtual characters, both the farmer and little boy, and the virtual farm are shown in and .

Figure 1. System diagram (adapted from Soltiyeva et al. [Citation2023]).

Figure 1. System diagram (adapted from Soltiyeva et al. [Citation2023]).

Figure 2. Virtual characters example.

Figure 2. Virtual characters example.

Figure 3. Virtual farm example.

Figure 3. Virtual farm example.

3.2. Case study environment

The study was conducted in a rehabilitation center for children with ASD called [removed for anonymous review]. The center is visited by children with special educational needs and diagnoses such as ASD, intellectual disability with autistic manifestations, Down syndrome, and other conditions. Every month, 80–100 children participate in the rehabilitation course. The duration of the course varies from 6 to 12 months. Most of the children attending the center are children with ASD of varying severity, including children with Asperger’s syndrome.

We have signed a memorandum of mutual cooperation with this center. Following the ethical standards established by the center, parents of ASD children were familiarized with the purpose, objectives, and the way of conducting the study. Their permission was obtained to participate in the training of their children, and to use the collected material for further analysis. Before starting the assignment, each participant was asked if they wanted to wear VR glasses. Each participant was accompanied by a personal mentor (teacher) and an expert (in mental health) at the center. Everyone involved in the study participated voluntarily.

3.3. Method

The study was organized in three different steps: (i) familiarization and instruction, (ii) immersive VR training, and (iii) data analysis and processing. In the first step, we provided general information about the VR glasses and the virtual scene inside the headset to the children, teachers and specialists in the rehabilitation center. Before starting the training, approximately 15–20 min was allowed for adaptation and becoming familiar with the new equipment. Afterward, we started the training process (second step).

In the second step, participants began to explore the virtual farm and become familiar with its inhabitants (which lasted for an average of 15–20 min for each child). During the training, participants-initiated interactions with the virtual farmer and the boy and completed tasks. The tasks in the system aimed to make children interact with the characters and scenery, while also carrying out some basic day-to-day activities such as counting objects. The activities had been previously analyzed by Soltiyeva et al. (Citation2023) to avoid bias related to the children’s behavior when carrying out the tasks. The duration of the training was three months (with weekly interventions).

The third step involved analyzing the data obtained during training using qualitative research (based on Grounded Theory and Experimental Analysis of Behavior) and interpreting the results to obtain a model of children’s behavior when using the system (see Subsection 3.5). The described steps of the research are illustrated in . The description of the tasks is presented in .

Figure 4. Stages of the study.

Figure 4. Stages of the study.

Table 2. Description of the tasks.

3.4. Participants

In this study, the participants were three children (male) aged seven years with an Asperger’s syndrome diagnosis. The participants are from affluent families with good socio-economic status, and the parents’ financial state is above the national average. The children have significant difficulties with social interaction, but their cognitive development allows them to understand what is happening and they have sufficient verbal skills to describe their feelings, answer questions, and complete tasks. Furthermore, we chose 7-year-old children in this study because at this age they start attending an elementary school. Key participant characteristics are summarized in . presents examples of the children participating in the study.

Figure 5. Children with Asperger’s syndrome participating in the study.

Figure 5. Children with Asperger’s syndrome participating in the study.

Table 3. Characteristics of participants.

3.5. Data collection, analysis and interpretation

For data collection, the entire training process (presented in Subsection 3.3) was filmed on two cameras. The first was a static camera and the second was a smartphone camera. The first camera allowed us to have an overview of the environment, giving us a broad idea of each child’s behavior. The second camera allowed us to follow and film all of the details of the training, allowing us to follow children’s micro reactions up close. Since the children were using VR glasses, they did not see the camera that was following them closely, and we believe that because of this they did not feel embarrassed or threatened by it. The purpose of the filming was to allow the specialists to observe the children’s behavior several times in the next stage, in order to take notes and make analyses.

Also, during this step, teachers and specialists asked free questions relating to the children’s behavior (e.g. “What do you see? Where are you? Do you like this farm? Do you want to meet a boy”). The goal was not to interview the children (considering the difficulties and limitations of interviewing children with Asperger’s) or to obtain confirmations, but to provide a free conversation according to the children’s behavior, and to obtain new insights into their experience. During the training session, each teacher supervised and supported their mentee.

The videos recorded during the training were manually transcribed by one single researcher. In this study, we avoided using automation tools due to the children using few words, and the possible use of idiomatic expressions which can be better captured by a human. Familiarization was achieved by repeated reading of the text for further coding. Coding is a main analytical procedure used by researchers (Corbin & Strauss, Citation1990). In this study, we employed “Open coding” allowing us to find new insights by interpreting the phenomena depicted in the data, and “Axial coding” which in turn helps to establish a link between categories (Corbin & Strauss, Citation1990). Each participant’s video was initially divided into several parts, and preliminary codes were assigned based on the observed behaviors, interactions, and expressions of the children. The initial codes were then systematically organized and grouped into broader categories, allowing for more in-depth analysis and interpretation. We created a set of codes to identify patterns and meanings throughout the data. The coding process was implemented by one researcher and reviewed by a second researcher. Themes were derived from the data following the principles of grounded theory, where patterns, ideas and recurring motifs were identified in the coded data.

Motivated by different methodological considerations, we adopted Constructivist Grounded Theory (CGT) in this study (Corbin & Strauss, Citation1990; Glaser, Citation2017b). Given the exploratory nature of the research question which seeks to understand the perception of children with Asperger’s syndrome concerning VR learning systems, CGT appears as an appropriate choice. This approach allows for a deeper understanding of the experiences lived by a limited number of participants (Glaser & Strauss, Citation1967), in this case, three children, over three months of interaction with the VR learning system. Recognizing the inherent influence of the researcher in constructing meanings from data and in theoretical formulation, CGT offers a methodological framework that values subjectivity and the social construction of knowledge, incorporating the researcher’s perspective as an integral part of the interpretative process. This proves crucial to enrich the understanding of the complex dynamics involved in the interaction of children with Asperger’s syndrome in VR environments, promoting a reflective and sensitive approach to the specific contexts of the study.

Finally, we used Experimental Analysis of Behavior (Lattal, Citation2022; Skinner, Citation1950; Young, Citation2019) to gain a deeper understanding of student behavior. Once again, our objective was not to seek confirmations or even to use the training methods or behavior changes from the Experimental Analysis of Behavior, but rather to allow the specialists who have been following the children since before the intervention to freely mention where they noticed changes in the children throughout the intervention. At the same time, without the expectation of carrying out confirmatory analyses, we aimed to generate insights based on the previous results of other studies.

The Experimental Analysis of Behavior was conducted with the involvement of a specialist who observed the training. The specialist of the center observed the participants’ behavior, recording important perceptions in a logbook. The expert is a Master of Psychology credentialed psychologist, and a practitioner with more than 10-years of experience in this type of analysis. At the end of the intervention, the specialist discussed the notes saved in the logbook with the researcher responsible for the study (the main author of this article). The data obtained through the Experimental Analysis of Behavior were compared and confirmed through the works of other researchers (see ).

Thus, following the recommendations of CGT and Experimental Analysis of Behavior, our findings are based on interpretations of multiple data sources (i.e. dialogues with children and observation of children’s behaviors), and involve multiple views (teachers, mental health experts, and researchers). In this study, we also collected information about the perception of children’s parents. However, we did not include it in this article, as this information was collected only to help experts interpret the data, and not considered to be a primary source of information for the study itself.

4. Findings

In this section, we present the findings of the study. Our study did not aim to measure interactions or confirm hypotheses, but rather to gain an insight into children’s behavior when using the system. Therefore, based on CGT, our analysis generated the Grounded Theory model (), with insights into children’s behavior using the VR system.

Table 4. Grounded theory model of the children’s communication and social skills in the VR learning system.

4.1. Interest in exploring the system

The concept of “exploring the system” reveals the interest directions of the participants that emerged during the training. The participants showed an interest in pets, vegetation, vehicles, and homes. The participants demonstrated a special interest in the surrounding virtual environment. During the learning process, children explored the virtual space. They expressed interest in the vegetation in the farm and tried to pick and taste fruit and vegetables.

During the use of the system, one of the participants demonstrated an interest in looking at and interacting with the system’s graphical resources, sometimes going further and also declaring their particular interests in some of these elements:

P1 “I love plants”

P1 “You’ve got cosmic tomatoes and pumpkins.”

P1 “My favorite water! Can I have a little bit of water?”

P1 “Can I open the refrigerator? I need food!”

P1 “I like to cluck like a chicken”

P1 “I love tomatoes”

The participants also demonstrated “focus on self-interest.” The children demonstrated attention to their own interests (e.g. space, planets, nature, animals, and plants) during training. In the initial stages of training, instead of interacting with virtual characters, participants expressed desires to fly in space. One participant “kept wanting to fly to the planet Mercury,” and it is also worth noting that he knew the size and mass of all the planets in the Solar system.

P2 “I want to see the planets”

P1 “I see an Earth out there, people living on another planet.”

P1 “Where is the Moon?”

P2 “I don’t want to play with him, I want to watch the planets.”

P2 “I want to fly to the planet Mercury!”

P3 “Now I’m going to get a little closer to the tractor. The tractor should run me over!”

4.2. Social interaction

The concept of “demonstrating social interaction” uncovers the children’s successful and unsuccessful attempts to interact and improve their communication skills with the farmer and the virtual boy. Also, it explores the barriers and difficulties of communication faced during the training process. However, the participants also demonstrated their communication difficulties. At the beginning of the training, the participants refused to answer the greetings and questions of the virtual characters, in some cases simply ignoring them.

P2 “I don’t want to say hello!”

P2 “I don’t want to play with you!”

P2 “Go away boy, I won’t play with you.”

P3 “I don’t want to tell you about myself”

P3 “You’re gonna look at me! I don’t like people looking at me!”

P1 “I don’t like playing with a boy”

The participants were also able to demonstrate their emotional states, revealing emotional states such as fear, sadness, happiness and surprise during the system usage. In the initial stages of the study, participants expressed fear of interactions with the virtual world. In the following sessions, the children expressed happiness when they met the virtual boy, singing along to songs and dancing for joy.

P1 “I got scared”

P1 “The doggy doesn’t bite?”

P3 “The dog is probably biting me.”

Another important point related to the concept of “demonstrating social interaction” was the adaptation problems that show the process of adaptation (i.e. demonstrating their perception regarding obstacles/difficulties) to a new environment and people. Two of the participants were afraid to walk around the virtual farm, expressing a desire to stand in one place or hide away.

P1 “I just want to stand still”

P1 “I don’t want to go in the house”

P1 “Can I just stand here?”

P1 “I might trip and fall”

P2 “I wanna hide”

Finally, the theme of “building communication” uncovers children’s attempts to independently initiate and sustain dialog, and interact with virtual characters. In the final stages of the training, all of the participants became attached to the virtual boy and offered to play a game of “rock-paper-scissors” with him. They also tried to hold the boy’s hand and look at the planets together.

P1 “Hi, where are you, boy?”

P1 “Go ahead and tell me the mission.”

P2 “Let’s watch the planets together!”

P2 “Oh, hey! Where are you?”

P1 “Boy, let’s go to the cosmos! I’m wondering!”

P3 “Maybe I’ll talk to the farmer.”

P3 “I want to walk up to a man.”

P3 “I will play with boy.”

The themes and subthemes are presented in . Next, we analyze the participant’s behavior (considering their behavior before and during the interaction in the system).

Figure 6. Main themes and subthemes.

Figure 6. Main themes and subthemes.

The specialist who has been following the children since before the intervention analyzed the behavior of each child individually. The idea was to outline insights into behaviors considered as key by experts, before and during/after using the VR-based learning system. presents the specialist’s main perceptions about each of the children.

Table 5. Main observed behaviors over the study.

The specialist interpretations demonstrate the changes that have been observed over the course of the study on the formation of social competence in children with Asperger’s syndrome through the system. These changes represent spheres of children’s social interaction. Among the changes, we should especially note the following: reduction of anxiety level, independent initiation of communication, formation of confidence, and a variability of behavior in the process of communication.

The most important achievement of our experiment, however, is the development of a new behavioral strategy, active position, and the positive emotional response of children participating in the study to the process of social interaction, which they later began to show in real life (Frolli et al., Citation2021; Ke & Im, Citation2013; Strickland et al., Citation2007). The findings of this analysis demonstrate the positive result of using IVRS for the formation of communication skills in children with Asperger’s syndrome.

In reflection of these results, our study contributes to promoting the further utilization of VR systems for the educational purposes of children with ASD, by adding different social situations to the scenarios based on the needs of specific autism groups. Furthermore, we believe that our development shows that the combination of a 3D graphics editor, a game engine and a VR headset, can serve as an inspiration for the creation of more advanced immersive systems, focusing on interventions for children with disabilities.

4.3. Discussion

Over the years, researchers have been looking for effective intervention methods for children with ASD. One solution is the use of immersive VR technology, through which children with ASD can practice skills repeatedly, and improve their skills in an ecologically valid and controlled environment. Thus, in this study we analyzed how VR learning systems are perceived by children with Asperger’s syndrome.

For this study, we specifically chose children diagnosed with Asperger’s Syndrome who have good speech ability. This informed decision facilitated a comprehensive evaluation of the VR learning system, as the tasks necessitated proficient speech skills for completion. It’s important to note that many children with more severe manifestations of autism who attend children’s correctional centers, often lack speech abilities. Throughout the training sessions, participants actively engaged by responding to questions, interacting with the virtual environment, and communicating with virtual characters. The results gleaned from our data analysis underscored a notable positive impact of the system on the participants. Furthermore, both the specialists at the correctional center and the parents of the children observed favorable changes in the children’s behavior after the training sessions. This collective feedback supports our assertion regarding the effectiveness of the virtual reality system in enhancing the behavioral and communication skills of children diagnosed with Asperger’s syndrome.

Initially, children paid attention to objects, buildings, transportation, fruit, household appliances, and other things. At the same time, children fixed their attention for a long time and talked a lot about their own interests (space, planets, nature, animals, plants). They either did not engage in social interaction, or did so formally. One of the tested children was afraid and refused to put on the glasses. During the first sessions, none of the participants wanted to communicate with the main character, ignoring his attempts to attract their attention, felt anxious and did not engage in dialog, or refused and took off their glasses. Fear, awkwardness in communication, or a refusal to communicate is more typical for children with Asperger’s syndrome, and all of these behaviors reinforce the central characteristics observed in children with Asperger’s syndrome.

After experiencing some sections, children got used to the glasses and adapted to other conditions. In the main stage of the study, the children presented a formation/development of social and communication skills. Children began to react more calmly to the situation of communication with the characters of the story, began to answer questions, play, perform tasks, and wait for each next session.

The participants specially demonstrated an interest in exploring the VR environment. This observation aligns with existing literature suggesting that individuals with Asperger’s syndrome often find technology-based experiences appealing due to their structured and predictable nature (Grynszpan et al., Citation2014; Zhao et al., Citation2018). The immersive nature of the virtual environment seemingly captivated the participants, offering them a novel and engaging platform for interaction (Parsons & Cobb, Citation2011; Zhao et al., Citation2018). This heightened interest could potentially be harnessed to facilitate and motivate the development of social and communication skills (Ke & Im, Citation2013).

Our study provides support for the findings of previous research (Oono et al., Citation2013; Ke & Im, Citation2013; Didehbani et al., Citation2016; Zhao et al., Citation2018; Rahmadiva et al., Citation2019) that promotes the benefits of using VR to train children with Asperger’s syndrome to practice difficult or individually complex social interactions in a less anxiety-provoking environment. Prior studies by Didehbani et al. (Citation2016) and Ip et al. (Citation2016) have used VR to improve social interactions by providing different social training scenarios such as a VR classroom, library, shop, and school-yard play. In our system, we specifically chose a virtual farm with domestic animals and virtual characters. According to previous studies, children with ASD show improved social functioning with other people in the presence of animals (Nimer & Lundahl, Citation2007). We found support for this suggestion while testing our developed system, as participants paid more attention to pets and felt more comfortable with them during the training session. In the initial stages of the training, participants mainly paid attention to animals on the farm, and only after a couple of sessions did they start to communicate with the virtual characters, answer questions, and perform tasks.

The tendency of participants to focus on their self-interests within the VR environment reflects a characteristic trait commonly associated with Asperger’s syndrome (Hadjipanayi & Michael-Grigoriou, Citation2020; Klin et al., Citation2005). While this finding highlights the importance of individualized approaches, it also underscores the need for tailored interventions that strike a balance between accommodating participants’ preferences, and gradually encouraging a broader range of social interactions. Thus, the VR system’s flexibility may provide an opportunity to design scenarios that cater to individual interests, while gradually expanding their social horizons (Ke & Im, Citation2013).

Our findings also revealed the persistence of communication difficulties among the participants (see and ). This result is consistent with the core challenges faced by individuals with Asperger’s syndrome in real-world social settings (Didehbani et al., Citation2016; Hadjipanayi & Michael-Grigoriou, Citation2020; Klin et al., Citation2005). However, the immersive VR environment allowed for a repeated exposure to communication scenarios, potentially affording participants the opportunity to practice and refine their communication strategies (Lorenzo et al., Citation2013). Moreover, the findings corroborate recent studies (Bellani et al., Citation2011; Didehbani et al., Citation2016) that the controlled and predictable nature of the VR interactions may have reduced anxiety and allowed participants to use different communication approaches in a safe and supportive context.

During our study, the participants initiated communication with the virtual characters (see ). This finding suggests that the immersive VR system facilitated a level of social engagement that may not be readily achievable in traditional therapy settings (Didehbani et al., Citation2016; Kandalaft et al., Citation2012). The ability to initiate interactions is a crucial aspect of social development, and the VR system’s design may have fostered a sense of agency and control, enabling participants to take active steps toward initiating and sustaining communication (Ip et al., Citation2016; Moore et al., Citation2000).

In their study, Zhao et al. (Citation2018) used Skype software for audio and video communication between participants. During the training, users had an opportunity to make a video call to share information and build contact with each other. In our system, compared to the aforementioned studies, users are able to train and improve their communication skills in a virtual environment directly with virtual characters. It is also worth noting that users also have a chance to train their skills repeatedly, i.e. individually to each person, for as long as needed.

While earlier, children demonstrated passive behavior waiting for instructions from specialists, by the end of the study, children began to initiate communication independently, spontaneous speech activity was formed and consolidated, and the repertoire of play actions offered by children expanded (see ). Also, during the study, children began to feel more confident.

The positive changes that have occurred over the period of the study using an immersive VR system to develop social and communication skills in children with Asperger’s syndrome are primarily the qualities of social interaction and communication skills (Ip et al., Citation2016; Lorenzo et al., Citation2013). Children’s fixation on their “favorite” activities (talking about plants, drawing planets, and others) significantly decreased, and they began to adequately include their “favorite activities” in play activities and in the process of communication. The anxiety and fear of communication which were present at the beginning of the experiment decreased significantly, and children began to independently initiate dialog and play interaction, and maintain it for more extended periods (see ), and their perception of the surrounding space expanded. But at the same time, the described changes occurred not only in VR, and children began to better distinguish their emotions and the emotional states of others, as well as to talk about their feelings. However, there are still difficulties in communication, so the skills that have been developed need to be supported and developed further.

4.4. Practical implications

The use of VR for the treatment of autism in children has been discussed in recent years. Although there is no clear understanding of the effects of this technology on children’s behavior, early studies have shown that this technology can be an escape hatch for these children to improve some of their skills related to social behavior. Our study results identified some insights that could be useful for the community.

One of the striking findings from this study is the participants’ inclination to focus on self-interests within the VR environment. Leveraging this propensity, practitioners can devise interventions that align with the child’s individual preferences. By incorporating elements of the child’s interests, VR scenarios can captivate and motivate active engagement (Cai et al., Citation2017; Didehbani et al., Citation2016). This personalized approach enhances the likelihood of sustained participation and skill acquisition, capitalizing on the immersive nature of VR to create a learning environment that is both engaging and personally meaningful (Didehbani et al., Citation2016; Mesa-Gresa et al., Citation2018). Thus, we recommend that future studies and practices implement personalized interventions based on children’s individual interests.

Communication difficulties are a hallmark of Asperger’s syndrome (Hosseini & Molla, Citation2023). The VR system’s ability to simulate diverse social situations can offer a set of opportunities to systematically address these challenges (Ke et al., Citation2020). We recommend that practitioners create tailored scenarios that target specific communication deficits, such as initiating conversations, maintaining eye contact, or interpreting nonverbal cues. Through repeated practice and guidance, children can develop a repertoire of effective communication strategies within a controlled and supportive environment (Mesa-Gresa et al., Citation2018; Ke et al., Citation2020; Almazaydeh et al., Citation2022; Zhao et al., Citation2022).

The controlled and predictable nature of VR interactions provides an advantage in facilitating gradual exposure and skill generalization (Mesa-Gresa et al., Citation2018; Almazaydeh et al., Citation2022). Based on the observed initiation of communication with virtual characters, practitioners can design interventions that scaffold social interactions, starting from relatively simpler exchanges and progressively advancing to more complex communication scenarios (Didehbani et al., Citation2016; Mesa-Gresa et al., Citation2018). This systematic progression aids in reducing anxiety and allows children to acquire and refine their social and communication skills incrementally (Almazaydeh et al., Citation2022; Didehbani et al., Citation2016). Based on this observation, we recommend that future studies gradually present the graphical aspects of the system.

The participants in our study expressed some degree of feelings while using the system. This result shows that as children use the system, they can create a feeling of trust and begin to express their feelings. However, it is necessary for the system to better interpret expressions of feeling and be able to deal with these feelings on an individual basis. Therefore, we recommend that future studies implement resources capable of understanding the feelings expressed by participants and generating personalized feedback according to the feelings expressed.

Towards the end of our study, participants began to interact with the virtual character, starting conversations and maintaining dialogues. This result shows that after some time, children can generate a feeling of companionship with the character and start to interact with them. At this point, it is important that the character is also able to interpret the child’s speech and maintain a dialogue (for a more fluid and dynamic conversation). Therefore, we recommend that future studies can implement characters that have the ability to understand children’s dialogue and maintain an active conversation.

4.5. Limitations and future studies

In this study, we explored the experiences and interactions of children with Asperger’s syndrome while using a VR training system. There are some limitations in the study that should be considered when interpreting the results. Initially, the presence of other people (i.e. teachers and experts) in the environment can limit children’s behavior during the study. Consequently, new studies may consider a setting that allows observation of participants without the presence of other people in the environment.

Only one expert was involved in analyzing the participants’ behavior. Furthermore, another limitation is that not all children may accept VR headsets, especially those who are particularly young or have sensory hypersensitivity (i.e. touch, sound, light, smell). It may also be demonstrated that the technology used may not be suitable for all children or have even negatively influenced their perception throughout the study. The duration of the experience (15–20 min per section) also posed a potential limitation, as this may not be a sufficient time to deeply explore children’s experiences. To mitigate this limitation, experiences were observed over three months.

Another issue that emerged in this study is the gender imbalance among the participants – i.e. only male children participated in this study. This can be mitigated by the much lower prevalence of ASD among females compared to males. Also worth noting is that the same age and diagnosis, as well as the similar demographic or baseline characteristics of the participants may have influenced the results.

For future research, we aim to carry out quantitative studies, analyzing the effects of VR use on children’s emotions (with larger samples). We also aim to implement new features in the system, especially related to the personalization of interactions and user voice recognition for better dialogue throughout interactions. Finally, we aim to investigate how changes in the system and individualized graphic elements for each student are perceived by children while using the system.

5. Final remarks

In this research, we explored an immersive VR training system in the communication skills of children with Asperger’s syndrome by conducting a qualitative study. We identified different concepts which help us to understand children’s perception. While at the beginning there was some difficulty in adapting to the system, in the final rounds of training, the children participated with interest and willingly began to communicate with the virtual character. In future studies, we intend to conduct quantitative studies to evaluate VR-based learning systems on the emotions of children with autism.

Ethical considerations

We followed the ethical standards established by the center. Permission was obtained from the parents to participate in the training of their children and use the collected material for further analysis.

Acknowledgments

The authors would like to thank the staff, parents, participating children, and the director of the Children’s correctional center “Intensive+” for their engagement with this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work has been supported by Suleyman Demirel University Internal Research Funding. This work has been supported by the Academy of Finland Flagship Programme [grant number 337653 – Forest-Human-Machine Interplay (UNITE)].

Notes on contributors

Aiganym Soltiyeva

Aiganym Soltiyeva is a Lecturer at the Department of Information Systems, Faculty of Engineering and Natural Sciences, SDU University, Kazakhstan. Aiganym Soltiyeva is a third-year Ph.D. student in Computer Science at SDU University and also had a scientific internship at Tampere University, Finland. Her research interest is using Virtual Reality technology for the treatment of children with Autism Spectrum Disorder. She holds a Bachelor’s degree in “Computer Science and Software” and a Master’s in “Digital Media Technology” from Kazakh-British Technical University, Kazakhstan. For her undergraduate thesis project, she created with her team a Virtual Reality training simulator for Oil and Gas Field workers. She has more than 10 years of experience working with Computer Graphics and Virtual Reality. Involved in creating graphic materials for the International Exposition “Expo Astana 2017,” and participated in International conferences, in creating animated movies, video clips, and ads for Kazakhstan media. She has published papers and articles in journals in the field of Educational Technologies.

Wilk Oliveira

Wilk Oliveira is a researcher at the Gamification Group, Faculty of Information Technology and Communications, Tampere University, Finland. Dr. Oliveira received his Ph.D. in Computer Science and Computational Mathematics from the University of São Paulo, Brazil (with an internship at Tampere University, Finland), M.Sc. in Computer Science from the Federal University of Alagoas (with an internship at the University of Saskatchewan, Canada) and a B.Sc. in Computing Education from the University of Pernambuco, Brazil. Dr. Oliveira has dedicated most of his academic career to research and has already been a researcher at several other research groups. In his career as a researcher, he has worked on a series of R&D projects, maintained by important international funding agencies, leading the development, application, and evaluation of different educational technologies. His research has already generated a series of products and more than 100 scientific publications in important conferences and journals in the field of Educational Technologies. Such productions generated several awards, including the best paper award in important conferences. Still, in his dedication to research, he has also organized several scientific events in educational technologies. Dr. Oliveira has also stood out as an entrepreneur, co-founding different startups, including the startup Eagle-edu, an evidence-based gamification edutech. In the public sector, Dr. Oliveira collaborated with the Brazilian Ministry of Education, working on projects related to the development, application, and evaluation of educational technologies. Dr. Oliveira also dedicates part of his academic career to teaching, having already worked as a lecturer in post-graduate programs at different universities and maintaining online courses in scientific development. Dr. Oliveira believes in education to improve the world and seeks to improve the quality and access to education. His main areas of activity are Educational Technologies, Gamification, Game-Based Learning, User Experience, and Computing Education.

Madina Alimanova

Madina Alimanova is an Associate Professor and Research Coordinator at the Faculty of Engineering and Natural Sciences, SDU University, Kazakhstan. Dr. Alimanova holds a PhD in Materials Science. She recently returned from a year-long fellowship as a Visiting Fellow in the Leaders in Higher Education (LHE) program in our Department of Computer Science and Electronics at the University of Essex, UK. During her career, Dr. Alimanova headed the Department of Information Systems, opened and headed the 3D laboratory, and was one of the founders of the new bachelor’s degree in Multimedia Sciences. Despite her administrative positions, Dr. Alimanova has been conducting research in the field of computer and multimedia sciences and gamification for the last 9 years, The results of which have been published in more than 30 scientific publications. Dr. Alimanova was also one of the main organizers of the IEEE conference ICECCO’21. For her contribution to the development of science and higher education in general, Dr. Alimanova was repeatedly awarded state certificates. Madina Alimanova always supports young minds, students speak kindly about her teaching methods and consider her not only a good academic supervisor but also a mentor in life.

Juho Hamari

Juho Hamari is a Professor of Gamification at the Faculty of Information Technology and Communications, Tampere University as well as at the Faculty of Humanities at University of Turku. He leads the Gamification Group. Prior to current engagements, Dr. Hamari has been a researcher at Aalto University School of Business, Helsinki Institute for Information Technology HIIT as well as a Visiting Scholar at UC Berkeley School of Information (2015–2016). Dr. Hamari’s and his research group’s (GG) research covers several forms of information technologies such as games, motivational information systems (e.g. gamification, game-based learning, persuasive technologies), new media (social networking services, online video streaming, eSports), peer-to-peer economies (sharing economy, collaborative consumption, crowdsourcing), and virtual economies. Dr. Hamari has authored several seminal empirical, theoretical and meta-analytical scholarly articles on these topics from perspective of consumer behavior, human-computer interaction, game studies and information systems science. His research has been published in a variety of prestigious venues such as Organization Studies, Journal of the Association for Information Science and Technology, User Modeling and User-Adapted Interaction, International Journal of Human-computer Studies, Information & Software Technology, Journal of Documentation, International Journal of Information Management, Computers in Human Behavior, Internet Research, Cyberpsychology, Behavior and Social Networking, Electronic Commerce Research and Applications, Simulation & Gaming as well as in books published by e.g. MIT Press. Dr. Hamari has advised several organizations on varying topics including game design, marketing, behavioral economics and gamification.

Kudaibergenova Gulzhan Kansarovna

Kudaibergenova Gulzhan Kansarovna 2002 graduated from Kazakh National University named after Al-Farabi - specialty “Philosophy.” From 2002 to 2005 she studied in postgraduate studies in the specialty “Ontology and theory of cognition.” In 2009, she received a Master’s degree in Social Sciences, a specialty “Psychology.” 2018–2021 - PhD in Psychology. Kudaibergenova Gulzhan Kansarovna is the founder and general director of the correctional center for children with special educational needs “INTENSIVE PLUS.” Sphere of professional interests: education of children with special educational needs. For the last 10 years, she has been conducting scientific research and practical activities in the socialization and education of autistic children. Throughout her working life, she has been an organizer and curator of various projects aimed at improving the quality of life of children with disabilities, as well as a teacher at higher educational institutions of the Republic of Kazakhstan and the author of special training courses on various problems of special psychology. She has more than 100 articles, methodological recommendations on childhood neuropsychology, sensorimotor development, diagnosis and correction of autism spectrum disorders, and other areas of science.

Shyngys Adilkhan

Shyngys Adilkhan is a lecturer at SDU University in Kazakhstan. He also conducts practice lessons and works as a head of the Multimedia Laboratory in the Information Systems Department of Engineering and Natural Sciences faculty. His research interests lie in 3D technologies, Game Development, Virtual Reality and Gamification. Shyngys Adilkhan received his MSc in Computer Science at Suleyman Demirel University and has publications on Gamification that were indexed in Scopus.

Marat Urmanov

Marat Urmanov is a researcher and senior lecturer at SDU University, Kazakhstan. Mr. Urmanov is a Ph.D. candidate in Computer Science studying at SDU University. He received his M.Sc. in Computer Science and B.Sc. in Computer Science from SDU University. In his career as a researcher, he has worked on various projects related to Game Development and Gamification, leading the application development with different technologies. Mr. Urmanov also stands out as an experienced specialist in the commercial game development industry, working in different startups, including startups related to gamified education. His main scientific interests are Game Development, Gamification, Virtual Reality, AI in Games, and Computer Graphics.

Notes

1 Previous studies of this project can be accessed in Alimanova et al. (Citation2022), Soltiyeva et al. (Citation2023), and Soltiyeva et al. (Citation2024).

References

  • Aane. (2022). Asperger’s Profiles: Prevalence. The Asperger’s / Autism Network (AANE). Retrieved September 15, 2023, from https://www.aane.org/prevalence/
  • Alimanova, M., Soltiyeva, A., Urmanov, M., & Adilkhan, S. (2022). Developing an immersive virtual reality training system to enrich social interaction and communication skills for children with autism spectrum disorder. 2022 international conference on Smart Information Systems and Technologies (SIST). https://doi.org/10.1109/sist54437.2022.9945733
  • Almazaydeh, L., Al-Mohtadi, R., Abuhelaleh, M. A., & Tawil, A. A. (2022). Virtual reality technology to support the independent living of children with autism. International Journal of Electrical and Computer Engineering (IJECE), 12(4), 4111. https://doi.org/10.11591/ijece.v12i4.pp4111-4117
  • Autism Statistics and Facts | Autism Speaks. (2023). Autism Speaks. Retrieved September 15, 2023, from https://www.autismspeaks.org/autism-statistics-asd
  • Bagwell, C. L., Newcomb, A. F., & Bukowski, W. M. (1998). Preadolescent friendship and peer rejection as predictors of adult adjustment. Child Development, 69(1), 140–153. https://doi.org/10.1111/j.1467-8624.1998.tb06139.x
  • Bellani, M., Fornasari, L., Chittaro, L., & Brambilla, P. (2011). Virtual reality in autism: State of the art. Epidemiology and Psychiatric Sciences, 20(3), 235–238. https://doi.org/10.1017/S2045796011000448
  • Berg, L. P., & Vance, J. M. (2017). Industry use of virtual reality in product design and manufacturing: A survey. Virtual Reality, 21(1), 1–17. https://doi.org/10.1007/s10055-016-0293-9
  • Bowman, D. A., & McMahan, R. P. (2007). Virtual reality: How much immersion is enough? Computer, 40(7), 36–43. https://doi.org/10.1109/MC.2007.257
  • Bujić, M., Macey, A., Järvelä, S., & Hamari, J. (2021). Playing with Embodied Social Interaction: A thematic review of experiments on social aspects in gameful virtual reality. Interacting With Computers, 33(6), 583–595. https://doi.org/10.1093/iwc/iwac012
  • Cai, Y., Chiew, R., Nay, Z. T., Indhumathi, C., & Huang, L. (2017). Design and development of VR learning environments for children with ASD. Interactive Learning Environments, 25(8), 1098–1109. https://doi.org/10.1080/10494820.2017.1282877
  • Carreon, A. C., Smith, S. C., Mosher, M. A., Rao, K., & Rowland, A. (2020). A review of virtual reality intervention research for students with disabilities in K–12 settings. Journal of Special Education Technology, 37(1), 82–99. https://doi.org/10.1177/0162643420962011
  • Chasson, G. S., & Jarosiewicz, S. R. (2014). Social competence impairments in Autism Spectrum Disorders. In Springer eBooks (pp. 1099–1118). https://doi.org/10.1007/978-1-4614-4788-7_60
  • Chen, J., Hu, J., Zhang, K., Zeng, X., Ma, Y., Lu, W., Zhang, K., & Wang, Q. (2022). Virtual reality enhances the social skills of children with autism spectrum disorder: A review. Interactive Learning Environments, 1–22. https://doi.org/10.1080/10494820.2022.2146139
  • Chițu, I. B., Tecău, A. S., Constantin, C., Tescașiu, B., Brătucu, T., BrăTucu, G., & Purcaru, I. (2023). Exploring the opportunity to use virtual reality for the education of children with disabilities. Children (Basel), 10(3), 436. https://doi.org/10.3390/children10030436
  • Corbin, J., & Strauss, A. L. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13(1), 3–21. https://doi.org/10.1007/BF00988593
  • Data and Statistics on Autism Spectrum Disorder | CDC. (2023, May 12). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/data.html
  • Dechsling, A., Orm, S., Kalandadze, T., Sütterlin, S., Øien, R. A., Shic, F., & Nordahl-Hansen, A. (2021). Virtual and augmented reality in social skills interventions for individuals with Autism Spectrum Disorder: A scoping review. Journal of Autism and Developmental Disorders, 52(11), 4692–4707. https://doi.org/10.1007/s10803-021-05338-5
  • Delgado, J. M. D., Demian, P., & Beach, T. (2020). A research agenda for augmented and virtual reality in architecture, engineering and construction. Advanced Engineering Informatics, 45, 101122. https://doi.org/10.1016/j.aei.2020.101122
  • Deng, D., Bujić, M., & Hamari, J. (2023). Understanding multi-platform social VR consumer opinions: A case study in VRChat using topics modeling of reviews. In Lecture notes in business information processing (pp. 35–46). https://doi.org/10.1007/978-3-031-32302-7_4
  • Didehbani, N., Allen, T. T., Kandalaft, M. R., Krawczyk, D. C., & Chapman, S. B. (2016). Virtual reality social cognition training for children with high functioning autism. Computers in Human Behavior, 62, 703–711. https://doi.org/10.1016/j.chb.2016.04.033
  • Dincelli, E., & Yayla, A. (2022). Immersive virtual reality in the age of the Metaverse: A hybrid-narrative review based on the technology affordance perspective. The Journal of Strategic Information Systems, 31(2), 101717. https://doi.org/10.1016/j.jsis.2022.101717
  • Elder, L. M., Caterino, L. C., Chao, J., Shaknai, D., & De Simone, G. (2006). The efficacy of social skills treatment for children with Asperger’s syndrome. Education and Treatment of Children, 29(4), 635–663. https://eric.ed.gov/?id=EJ778071
  • F84.0 – Autistic disorder – ICD List 2023. (2023). ICD List. https://icdlist.com/icd-10/F84.0
  • Foster, B., & King, B. H. (2003). Asperger syndrome: To be or not to be? Current Opinion in Pediatrics, 15(5), 491–494. https://doi.org/10.1097/00008480-200310000-00008
  • Freina, L., & Ott, M. (2015). A literature review on immersive virtual reality in education: State of the art and perspectives. In The international scientific conference elearning and software for education (Vol. 1, No. 133, pp. 10–1007).
  • Frolli, A., Bosco, A., Lombardi, A., Di Carmine, F., Marzo, S., Rega, A., & Ricci, M. C. (2021). Asperger’s and virtual reality. Proceedings. http://ceur-ws.org
  • Frolli, A., Savarese, G., Di Carmine, F., Bosco, A., Saviano, E., Rega, A., Carotenuto, M., & Ricci, M. (2022). Children on the autism spectrum and the use of virtual reality for supporting social skills. Children, 9(2), 181. https://doi.org/10.3390/children9020181
  • Gillberg, C. (2015). Lorna Wing OBE, MD, FRCPsych: Formerly psychiatrist and physician, Social Psychiatry Unit, Institute of Psychiatry, King’s College London, co-founder of the UK National Autistic Society. BJPsych Bulletin, 39(1), 52–53. https://doi.org/10.1192/pb.bp.114.048900
  • Glaser, B. G. (2017b). The discovery of grounded theory. In Routledge eBooks. https://doi.org/10.4324/9780203793206
  • Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Aldine.
  • Gopalan, V., Bakar, J. A. A., & Zulkifli, A. N. (2023). Systematic literature review on critical success factors in implementing augmented reality for science learning environment (2006–2021). Education and Information Technologies, 28(9), 11117–11144. https://doi.org/10.1007/s10639-023-11613-y
  • Grynszpan, O., Weiss, P. L., Perez-Diaz, F., & Gal, E. (2014). Innovative technology-based interventions for autism spectrum disorders: A meta-analysis. Autism, 18(4), 346–361. https://doi.org/10.1177/1362361313476767
  • Habri. (2020). The human-animal bond for autism spectrum disorder. HABRI. https://habri.org/blog/the-human-animal-bond-for-autism-spectrum-disorder/
  • Hadjipanayi, C., & Michael-Grigoriou, D. (2020). Conceptual knowledge and sensitization on Asperger’s syndrome based on the constructivist approach through virtual reality. Heliyon, 6(6), e04145. https://doi.org/10.1016/j.heliyon.2020.e04145
  • Hamad, A., & Jia, B. (2022). How virtual reality technology has changed our lives: An overview of the current and potential applications and limitations. International Journal of Environmental Research and Public Health, 19(18), 11278. https://doi.org/10.3390/ijerph191811278
  • Hassan, A., Pinkwart, N., & Shafi, M. (2021). Serious games to improve social and emotional intelligence in children with autism. Entertainment Computing, 38, 100417.
  • Herrero, J. F., & Lledó, G. L. (2019). An immersive virtual reality educational intervention on people with autism spectrum disorders (ASD) for the development of communication skills and problem solving. Education and Information Technologies, 25(3), 1689–1722. https://doi.org/10.1007/s10639-019-10050-0
  • Hidayat, R., & Wardat, Y. (2023). A systematic review of augmented reality in science, technology, engineering and mathematics education. Education and Information Technologies. https://doi.org/10.1007/s10639-023-12157-x
  • Honorato, N., Oliveira, W., Hamari, J., & Delabrida, S. (2023). Gameful approaches for the education of autistic children: A systematic mapping and research agenda. In 2023 IEEE international conference on advanced learning technologies (ICALT) (pp. 116–120). IEEE.
  • Hosseini, S. A., & Molla, M. (2023). Asperger’s syndrome. In Statpearls. StatPearls Publishing.
  • Howard, M. C., & Gutworth, M. B. (2020). A meta-analysis of virtual reality training programs for social skill development. Computers & Education, 144, 103707. https://doi.org/10.1016/j.compedu.2019.103707
  • Huang, H., Xu, H., Liu, Y., Shou, D., Chen, H., Nie, Y., Li, Y., & Zhou, Y. (2022). First application of fecal microbiota transplantation in Adult Asperger syndrome with digestive symptoms—A case report. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.695481
  • Ip, H. H. S., Wong, S. W. L., Chan, D. N., Byrne, J., Li, C., Yuan, V. S. N., Lau, K. S., & Wong, J. (2016). Virtual reality enabled training for social adaptation in inclusive education settings for school-aged children with Autism Spectrum Disorder (ASD). In Lecture notes in computer science (pp. 94–102). Springer Science+Business Media. https://doi.org/10.1007/978-3-319-41165-1_9
  • Ip, H. H. S., Wong, S. W. L., Chan, D., Li, C., Lo Kon, L., Ke, P., Lau, K. S., & Byrne, J. (2022). Enhance affective expression and social reciprocity for children with autism spectrum disorder: Using virtual reality headsets at schools. Interactive Learning Environments, 32, 1012–1035. https://doi.org/10.1080/10494820.2022.2107681
  • Javaheripour, N., Wagner, G., De La Cruz, F., Walter, M., Szycik, G. R., & Tietze, F. (2023). Altered brain network organization in adults with Asperger’s syndrome: Decreased connectome transitivity and assortativity with increased global efficiency. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1223147
  • Jerald, J. (2016). The VR book: Human-centered design for virtual reality. Association for Computing Machinery and Morgan & Claypool.
  • Kandalaft, M. R., Didehbani, N., Krawczyk, D. C., Allen, T. T., & Chapman, S. B. (2012). Virtual reality social cognition training for young adults with high-functioning autism. Journal of Autism and Developmental Disorders, 43(1), 34–44. https://doi.org/10.1007/s10803-012-1544-6
  • Karami, B., Koushki, R., Arabgol, F., Rahmani, M., & Vahabie, A. H. (2021). Effectiveness of virtual/augmented reality–based therapeutic interventions on individuals with autism spectrum disorder: A comprehensive meta-analysis. Frontiers in Psychiatry, 12, 665326. https://doi.org/10.3389/fpsyt.2021.665326
  • Kavanagh, S., Luxton-Reilly, A., Wuensche, B., & Plimmer, B. (2017). A systematic review of virtual reality in education. Themes in Science and Technology Education, 10(2), 85–119.
  • Ke, F., & Im, T. (2013). Virtual-reality-based social interaction training for children with high-functioning autism. The Journal of Educational Research, 106(6), 441–461. https://doi.org/10.1080/00220671.2013.832999
  • Ke, F., Moon, J., & Sokolikj, Z. (2020). Virtual reality–based social skills training for children with autism spectrum disorder. Journal of Special Education Technology, 37(1), 49–62. https://doi.org/10.1177/0162643420945603
  • Klin, A. (2006). Autismo e síndrome de asperger: Uma visão geral. Revista Brasileira De Psiquiatria, 28(suppl 1), s3–s11. https://doi.org/10.1590/S1516-44462006000500002
  • Klin, A., McPartland, J., & Volkmar, F. R. (2005). Asperger’s syndrome. In Handbook of autism and pervasive developmental disorders (Vol. 1, pp. 88–125).
  • Koirala, A., Yu, Z., Schiltz, H., Van Hecke, A. V., Armstrong, B., & Zheng, Z. (2021). A preliminary exploration of virtual reality-based visual and touch sensory processing assessment for adolescents with Autism Spectrum Disorder. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 29, 619–628. https://doi.org/10.1109/TNSRE.2021.3064148
  • Lattal, K. A. (2022). Confluence of science and history in the experimental analysis of behavior course. Perspectives on Behavior Science, 45(4), 743–755. https://doi.org/10.1007/s40614-022-00348-9
  • Lee, H., & Hwang, Y. (2022). Technology-enhanced education through VR-making and metaverse-linking to foster teacher readiness and sustainable learning. Sustainability, 14(8), 4786. https://doi.org/10.3390/su14084786
  • Lorenzo, G., Carreres, A. L., Arráez-Vera, G., & Lorenzo-Lledó, A. (2019). The application of immersive virtual reality for students with ASD: A review between 1990–2017. Education and Information Technologies, 24(1), 127–151. https://doi.org/10.1007/s10639-018-9766-7
  • Lorenzo, G., Pomares, J., & Carreres, A. L. (2013). Inclusion of immersive virtual learning environments and visual control systems to support the learning of students with asperger syndrome. Computers & Education, 62, 88–101. https://doi.org/10.1016/j.compedu.2012.10.028
  • Macey, A. L., Järvelä, S., Fernández Galeote, D., & Hamari, J. (2023). Feeling small or standing tall? Height manipulation affects speech anxiety and arousal in virtual reality. Cyberpsychology, Behavior, and Social Networking, 26(4), 246–254. https://doi.org/10.1089/cyber.2022.0251
  • Mak, G., & Zhao, L. (2023). A systematic review: The application of virtual reality on the skill-specific performance in people with ASD. Interactive Learning Environments, 31(2), 804–817. https://doi.org/10.1080/10494820.2020.1811733
  • Mesa-Gresa, P., Gil-Gómez, H., Lozano-Quilis, J. A., & Gil-Gómez, J. A. (2018). Effectiveness of virtual reality for children and adolescents with autism spectrum disorder: An evidence-based systematic review. Sensors, 18(8), 2486.
  • Mirkovic, B., & Gérardin, P. (2019). Asperger’s syndrome: What to consider? L’Encéphale, 45(2), 169–174. https://doi.org/10.1016/j.encep.2018.11.005
  • Mobach, M. P. (2008). Do virtual worlds create better real worlds? Virtual Reality, 12(3), 163–179. https://doi.org/10.1007/s10055-008-0081-2
  • Moore, D., McGrath, P., & Thorpe, J. J. (2000). Computer-aided learning for people with autism – a framework for research and development. Innovations in Education and Training International, 37(3), 218–228. https://doi.org/10.1080/13558000050138452
  • Motlani, V., Motlani, G., & Thool, A. (2022). Asperger’s Syndrome (AS): A review article. Cureus. https://doi.org/10.7759/cureus.31395
  • Nimer, J., & Lundahl, B. (2007). Animal-assisted therapy: A meta-analysis. Anthrozoös, 20(3), 225–238. https://doi.org/10.2752/089279307X224773
  • Nordahl, R., & Nilsson, N. (2014). The sound of being there: Presence and interactive audio in immersive virtual reality. https://doi.org/10.4018/978-1-5225-3949-0.ch008
  • Oigara, J. (2018). Integrating virtual reality tools into classroom instruction. In Advances in educational technologies and instructional design book series (pp. 147–159). IGI Global. https://doi.org/10.4018/978-1-5225-3949-0.ch008
  • Oono, I. P., Honey, E. J., & Mcconachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Evidence-Based Child Health: A. Cochrane Review Journal, 8(6), 2380–2479.
  • Parsons, S., & Cobb, S. (2011). State-of-the-art of virtual reality technologies for children on the autism spectrum. European Journal of Special Needs Education, 26(3), 355–366. https://doi.org/10.1080/08856257.2011.593831
  • Portman, M. E., Natapov, A., & Fisher-Gewirtzman, D. (2015). To go where no man has gone before: Virtual reality in architecture, landscape architecture and environmental planning. Computers, Environment and Urban Systems, 54, 376–384. https://doi.org/10.1016/j.compenvurbsys.2015.05.001
  • Pyun, K. R., Rogers, J. A., & Ko, S. H. (2022). Materials and devices for immersive virtual reality. Nature Reviews Materials, 7(11), 841–843. https://doi.org/10.1038/s41578-022-00501-5
  • Rahmadiva, M., Arifin, A., Fatoni, M. H., Baki, S. H., & Watanabe, T. (2019). A design of multipurpose virtual reality game for children with Autism Spectrum Disorder. https://doi.org/10.1109/ibitec46597.2019.9091713
  • Ratajczak, H. V. (2011). Theoretical aspects of autism: Causes—A review. Journal of Immunotoxicology, 8(1), 68–79. https://doi.org/10.3109/1547691X.2010.545086
  • Rinehart, N., Bradshaw, J. L., Brereton, A. V., & Tonge, B. J. (2002). A clinical and neurobehavioural review of high-functioning autism and Asperger’s disorder. Australian & New Zealand Journal of Psychiatry, 36(6), 762–770. https://doi.org/10.1046/j.1440-1614.2002.01097.x
  • Sanchez-Vives, M. V., & Slater, M. (2005). From presence to consciousness through virtual reality. Nature Reviews Neuroscience, 6(4), 332–339. https://doi.org/10.1038/nrn1651
  • Sánchez, M. R., Palos-Sanchez, P. R., & Folgado-Fernández, J. A. (2022). Systematic literature review and bibliometric analysis on virtual reality and education. Education and Information Technologies, 28(1), 155–192. https://doi.org/10.1007/s10639-022-11167-5
  • Schnur, J. B. (2005). Asperger syndrome in children. Journal of the American Academy of Nurse Practitioners, 17(8), 302–308. https://doi.org/10.1111/j.1745-7599.2005.0053.x
  • Skinner, B. F. (1950). Are theories of learning necessary? Psychological Review, 57(4), 193–216. https://doi.org/10.1037/h0054367
  • Slater, M. (2003). A note on presence terminology. Presence Connect, 3.
  • Soltiyeva, A., Oliveira, W., Alimanova, M., Adilkhan, S., Urmanov, M., & Hamari, J. (2023). My Lovely Granny’s Farm: An immersive virtual reality training system for children with autism spectrum disorder. Education and Information Technologies, 28(12), 16887–16907. https://doi.org/10.1007/s10639-023-11862-x
  • Soltiyeva, A., Oliveira, W., Hamari, J., & Madina, A. (2024). Parents’ perception of the use of virtual reality-based learning systems for children with Asperger’s syndrome. In 2024 IEEE international conference on advanced learning technologies (ICALT). IEEE.
  • Steuer, J. (1992). Defining virtual reality: Dimensions determining telepresence. Journal of Communication, 42(4), 73–93. https://doi.org/10.1111/j.1460-2466.1992.tb00812.x
  • Strickland, D., McAllister, D. F., Coles, C. D., & Osborne, S. S. (2007). An evolution of virtual reality training designs for children with autism and fetal alcohol spectrum disorders. Topics in Language Disorders, 27(3), 226–241. https://doi.org/10.1097/01.TLD.0000285357.95426.72
  • Tan, Y., Xu, W., Li, S., & Chen, K. (2022). Augmented and virtual reality (AR/VR) for education and training in the AEC industry: A systematic review of research and applications. Buildings, 12(10), 1529. https://doi.org/10.3390/buildings12101529
  • Tremolada, M., Rosa, M., Incardona, R. M., Taverna, L., & Guidi, M. (2023). Impact of the COVID-19 pandemic on psychosocial well-being and adaptation in children and adolescents with Asperger’s syndrome. International Journal of Environmental Research and Public Health, 20(3), 2132. https://doi.org/10.3390/ijerph20032132
  • Usmani, S., Sharath, M., & Mehendale, M. (2022). Future of mental health in the metaverse. General Psychiatry, 35(4), e100825. https://doi.org/10.1136/gpsych-2022-100825
  • Valle, C. L., Chenausky, K., & Tager-Flusberg, H. (2021). How do minimally verbal children and adolescents with autism spectrum disorder use communicative gestures to complement their spoken language abilities? Autism & Developmental Language Impairments, 6, 239694152110350. https://doi.org/10.1177/23969415211035065
  • Wade, J., Bian, D., Zhang, L., Swanson, A., Sarkar, M. S., Warren, Z., & Sarkar, N. (2014). Design of a virtual reality driving environment to assess performance of teenagers with ASD. In Lecture notes in computer science (pp. 466–474). Springer Science+Business Media. https://doi.org/10.1007/978-3-319-07440-5_43
  • Wang, X., Young, G. W., Iqbal, M. Z., & Guckin, C. M. (2023). The potential of extended reality in Rural Education’s future – perspectives from rural educators. Education and Information Technologies, 29(7), 8987–9011. https://doi.org/10.1007/s10639-023-12169-7
  • Werling, D. M., & Geschwind, D. H. (2013). Sex differences in autism spectrum disorders. Current Opinion in Neurology, 26(2), 146–153. https://doi.org/10.1097/WCO.0b013e32835ee548
  • Williams, K. A. (2006). The Son-Rise Program® intervention for autism. Autism, 10(1), 86–102. https://doi.org/10.1177/1362361306062012
  • Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11(1), 115–129. https://doi.org/10.1017/S0033291700053332
  • Wing, L., & Potter, D. (2002). The epidemiology of autistic spectrum disorders: Is the prevalence rising? Mental Retardation and Developmental Disabilities Research Reviews, 8(3), 151–161. https://doi.org/10.1002/mrdd.10029
  • Wohlgenannt, I., Simons, A., & Stieglitz, S. (2020). Virtual reality. Business & Information Systems Engineering, 62(5), 455–461. https://doi.org/10.1007/s12599-020-00658-9
  • Yakubova, G., Kellems, R. O., Chen, B. B., & Cusworth, Z. (2021). Practitioners’ attitudes and perceptions toward the use of augmented and virtual reality technologies in the education of students with disabilities. Journal of Special Education Technology, 37(2), 286–296. https://doi.org/10.1177/01626434211004445
  • Young, M. E. (2019). Modern statistical practices in the experimental analysis of behavior: An introduction to the special issue. Journal of the Experimental Analysis of Behavior.
  • Zhang, M., Ding, H., Naumceska, M., & Zhang, Y. (2022). Virtual reality technology as an educational and intervention tool for children with Autism Spectrum Disorder: Current perspectives and future directions. Behavioral Sciences, 12(5), 138. https://doi.org/10.3390/bs12050138
  • Zhao, H., Swanson, A., Weitlauf, A. S., Warren, Z., & Sarkar, N. (2018). Hand-in-Hand: A communication-enhancement collaborative virtual reality system for promoting social interaction in children with Autism Spectrum Disorders. IEEE Transactions on Human-Machine Systems, 48(2), 136–148. https://doi.org/10.1109/THMS.2018.2791562
  • Zhao, J., Zhang, X., Lu, Y., Wu, X., Fang, Z., Shi-Chang, Y., Wang, L., Wu, X., & Fei, F. (2022). Virtual reality technology enhances the cognitive and social communication of children with autism spectrum disorder. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1029392
  • Zhao, J., Zhang, X., Wang, C., & Yang, J. (2021). Effect of cognitive training based on virtual reality on the children with autism spectrum disorder. Current Research in Behavioral Sciences, 2, 100013. https://doi.org/10.1016/j.crbeha.2020.100013