Exploring Adaptive Virtual Reality Systems Used in Interventions for Children With Autism Spectrum Disorder: Systematic Review

Abstract

[EN] Background: Adaptive systems serve to personalize interventions or training based on the user's needs and performance. Theadaptation techniques rely on an underlying engine responsible for processing incoming data and generating tailored responses.Adaptive virtual reality (VR) systems have proven to be efficient in data monitoring and manipulation, as well as in their abilityto transfer learning outcomes to the real world. In recent years, there has been significant interest in applying these systems toimprove deficits associated with autism spectrum disorder (ASD). This is driven by the heterogeneity of symptoms among thepopulation affected, highlighting the need for early customized interventions that target each individual's specific symptomconfiguration. Objective: Recognizing these technology-driven therapeutic tools as efficient solutions, this systematic review aims to explorethe application of adaptive VR systems in interventions for young individuals with ASD.Methods: An extensive search was conducted across 3 different databases-PubMed Central, Scopus, and Web of Science-toidentify relevant studies from approximately the past decade. Each author independently screened the included studies to assessthe risk of bias. Studies satisfying the following inclusion criteria were selected: (1) the experimental tasks were delivered via aVR system, (2) system adaptation was automated, (3) the VR system was designed for intervention or training of ASD symptoms,(4) participants'ages ranged from 6 to 19 years, (5) the sample included at least 1 group with ASD, and (6) the adaptation strategywas thoroughly explained. Relevant information extracted from the studies included the sample size and mean age, the study'sobjectives, the skill trained, the implemented device, the adaptive strategy used, the engine techniques, and the signal used toadapt the systems. Results: Overall, a total of 10 articles were included, involving 129 participants, 76% of whom had ASD. The studies includedlevel switching (7/10, 70%), adaptive feedback strategies (9/10, 90%), and weighing the choice between a machine learning (ML)adaptive engine (3/10, 30%) and a non-ML adaptive engine (8/10, 80%). Adaptation signals ranged from explicit behavioralindicators (6/10, 60%), such as task performance, to implicit biosignals, such as motor movements, eye gaze, speech, and peripheralphysiological responses (7/10, 70%). Conclusions: The findings reveal promising trends in the field, suggesting that automated VR systems leveraging real-timeprogression level switching and verbal feedback driven by non-ML techniques using explicit or, better yet, implicit signal processing have the potential to enhance interventions for young individuals with ASD. The limitations discussed mainly stemfrom the fact that no technological or automated tools were used to handle data, potentially introducing bias due to human error.