A Physiologically-Mediated Virtual Reality Experience for Children with Autism Spectrum Disorder

Background: Many children with autism spectrum disorder (ASD) have difficulty with transitions to new situations and settings, and this can lead to increased anxiety and missed opportunities for education and meaningful participation. Virtual Reality (VR) systems have highly desirable features to help children cope with such transitions. In particular, they can offer high levels of authenticity and realism, allowing children to explore new and anxiety-provoking settings in safe, controlled, and personalized settings prior to the actual experience. Although many VR systems are commercially available, very little is known about the safety and usability of these systems for children with ASD.

Objectives: The objective of this study was to evaluate the safety and usability of an immersive head mounted display (HMD) VR system for children with ASD.

Methods: Thirty-five children with a diagnosis of ASD participated in the study (age=13.0±2.6 years; 10 females; IQ>=70). During a two-hour session, participants watched two 5-minute, 360^o video of a school bus, presented in two ways: a video on a computer monitor (video) and an immersive VR experience on an HMD (VR; Oculus Rift). Each task was separated by a baseline video clip from the Blue Planet series. The order of presentation (video/VR) was randomized. After each task, the participants completed questionnaires probing self-reports of anxiety (State-Trait Anxiety Inventory), sense of presence (ITC-SOPI), and usability (custom questionnaire).

Results: Of the 35 participants, 33 completed the study. The reasons for early drop-out were previous negative experiences on the school bus, sensitivity to the video content (whistling), and difficulty with heart monitoring electrodes. There was no significant difference in self-report of anxiety level pre/post the video and VR conditions. None of the participants reported side effects (e.g., cybersickness, nausea) on the ITC-SOPI for either condition. No significant differences were found between video and VR conditions on the ITC scales of spatial presence, engagement, ecological validity, or negative effects. Based on responses to the usability questionnaire, there were no significant differences between the VR and video condition in self-reports of levels of fatigue, enjoyment, task understanding, ease of navigation, and helpfulness in future school bus experiences. However, 29 of 33 participants indicated that they preferred VR to video. On a follow-up call a month after the study, no side effects were reported. Three of the 35 participants indicated that the study had helped them with school bus anxiety in real life.

Conclusions: The results of this study provide preliminary evidence to support safety and usability of virtual reality for children with ASD.