Autism therapists and researchers started to use VR in the mid-1990s, not long after headsets became widely available to consumers and other forms of immersion, such as first-person shooter games, became popular. Researchers often deployed the technology to create virtual environments to help autistic people rehearse stressful encounters. For instance, Rizzo’s team built a virtual job-interview training program. In a study published last year, they recruited adults with autism or other conditions for a training regimen involving interviewers who ranged from gentle to aggressive. Rizzo says the participants with autism significantly improved in their interviewing skills, as rated by job counselors.
A similar application lets autistic children practice public speaking in a virtual classroom with an audience of eight avatars. To encourage them to look around the room rather than stare straight ahead, the avatars start to fade away if the speaker fails to make eye contact with them. “So it became a game of keeping the avatars on the screen by shifting attention,” says Peter Mundy, a psychologist at the University of California, Davis, who developed the program. “We found that the kids with autism really responded to that.”
VR can also make autistic children more comfortable in strange environments. In an unpublished July 2018 case study, a team led by Nigel Newbutt at the University of the West of England in Bristol gave 11 autistic children, aged 10 to 14 years, a VR tour of a local science museum a few days before their actual visit. “Students reported feeling less anxious, less stressed, more prepared for that space,” he says. “In fact, the teachers also found that when the pupils got there, they knew where they wanted to go; they had a greater sense of purpose and direction.”
Back in the lab, virtual environments have also offered researchers a welcome new experimental technique. Nathan Caruana, a cognitive neuroscientist who uses VR to study social cognition in autism, prefers it to standard screen-based scenarios. “All of those paradigms have largely relied on non-interactive tasks, where people are responding to a face with averted gaze on a screen,” says Caruana, associate investigator at Macquarie University in Sydney, Australia. “But it doesn’t really reflect the dynamics and complexity of a social interaction.”
VR also facilitates imaging experiments that would otherwise be impossible — such as enabling someone lying in a scanner to banter with virtual humans. “In order to measure this in an imaging platform, you basically have to use virtual reality,” Mundy says.
For all its apparent advantages, however, VR has yet to be rigorously tested as a therapeutic or research tool for autism. Several meta-analyses this year turned up comparatively few studies, and most had only a handful of participants and no control group. Newbutt and a colleague, for instance, found a total of six studies since 1990 that have tested head-mounted VR displays in students with autism. “There isn’t that much evidence to support the use of this yet,” Newbutt says.
One reason is cost, not just of the equipment but of the programmers and animators needed to create the content. Mundy laments that he hasn’t been able to implement some of his ideas for lack of people with the relevant expertise. “One of the reasons I couldn’t go further with it was that I couldn’t pay the coder as much as a high-tech company [could],” he says. Consequently, VR scenarios remain highly simplified, and the technology’s much-touted advantage — realism — remains out of reach.
Newbutt also says that researchers have seldom asked autistic people what they want from the technology. “There’s still a bit of a tendency to research about autism and autistic groups as opposed to research with them,” he says. This is precisely what the new first-person experiences seek to rectify.