Krishnan, Meena M.
Miller, Haylie L.
Bugnariu, Nicoleta L.


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Virtual environments (VEs) are an emerging technology used to assess and treat people with Autism Spectrum Disorders (ASD). VEs can be presented on a traditional computer monitor or in a more immersive setting on a large screen or in a room. This review investigates large screen VEs, which include interactive and non-interactive interfaces. Individuals can engage in varying levels of interaction with the VE by using a computer mouse, using a touch screen monitor, or moving their body in space to control virtual representations of themselves. People with ASD have differing levels of deficits in social skills, movement awareness/coordination, and behavioral regulation. In order to accurately draw conclusions about real-world functioning, researchers must produce naturalistic but repeatable experiences, where key variables can be controlled and systematically manipulated. The use of VEs may enable researchers and clinicians to achieve this balance in the assessment and treatment of ASD. Purpose (a): We aim to provide a comprehensive review of immersive large screen Virtual Environments (VEs), and to determine whether immersive VEs are effective for assessing and treating behavioral, social and motor symptoms of Autism Spectrum Disorder (ASD). Understanding applications of VEs will facilitate better understanding of the benefits of controlling naturalistic experiences balanced with the ability to repeat experiences the same way every time. This will assist researchers and clinicians in their ability to diagnose and treat symptoms of ASD related to social skills, movement awareness/coordination, and behavioral regulation. Methods (b): Six search engines were used: PubMed, Scopus, Ebsco via Medline, CINHAL, PsycINFO, and PsycARTICLES. Search dates were July–October 2013. Keywords used were: Autism, Autism Spectrum Disorder, ASD, Asperger, Pervasive Developmental Disorder, PDD, virtual reality, VR, virtual environment, and augmented reality. 71 articles were found. Articles were sorted according to level of immersion. 7 articles met the final criteria for immersive VEs with large screen presentation. Results (c): The majority of studies involving VEs used a traditional computer monitor display, rather than an immersive setting. Studies using large screen presentation of VEs focused primarily on gross motor movements (Cai et al., 2013; Cook et al., 2013; Cheng et al., 2012; Greffou et al., 2012) or a combination of motor and social skills (Jung et al., 2006). Two studies focused on social skills and engagement with the VE (Mineo et al., 2009; Wallace et al., 2010). In 6 of the 7 studies reviewed, participants with ASD were successfully either treated or assessed using VE technology. However, there is a clear need for more research evaluating cognitive and behavioral abilities in ASD using immersive VEs. Conclusions (d): Immersive VE is a promising tool for use in studies of children and adults with ASD. The use of immersive VEs for assessment/treatment of ASD is still new, and therefore not well-understood. However, several studies have demonstrated that both interactive and non-interactive VEs are an effective and engaging tool for assessing motor and social skills in ASD across a broad age range, and may be effective for delivering interventions. This technology also has potential for use as an assessment tool in non-verbal ASD populations (Cai et al., 2013). This growing body of work highlights the potential utility of VEs for assessment and treatment of ASD.