1. Introduction

Autism Spectrum Disorders (ASD) are complicated neurodevelopmental illnesses that present lifelong challenges for some people due to atypical brain development [1, 2]. These challenges often manifest themselves as severe difficulties in nonverbal communication, impairing the ability of individuals with autism to understand and express their own and others’ emotions [3]. Such challenges make social interactions particularly challenging and can lead to social isolation.

Traditional interventions, such as behavioral therapy and social skills training, have been widely utilized to support ASD-diagnosed children. However, these methods often do not adequately address the varied needs of ASD-diagnosed children, particularly in recognizing individual differences in the severity and personality of each child’s social challenges. As a result, these conventional approaches may not be as practical as needed.

Recent technological advancements, particularly Virtual Reality (VR), have introduced new possibilities for therapeutic intervention in ASD. VR offers a customizable and adaptable platform that can provide a more tailored and engaging experience for each child. Additionally, VR technology can deliver real-time feedback to the child and the therapist, enabling immediate adjustments and enhancing the learning process. Exploring VR as an intervention tool opens new ways for research and development, potentially leading to further innovations in ASD treatment. Moreover, once developed, VR programs can be more effective than traditional therapist-led interventions, reaching a more significant number of children across different geographical locations. This broader accessibility can potentially democratize access to high-quality interventions, particularly in underserved areas.

2. Methodology

This report initiated a thorough and detailed literature review using Google Scholar to comprehensively cover various interdisciplinary sources related to VR Intervention to Support Social Development in ASD-affected children. The database PsycINFO was utilized as a supplementary tool to refine and focus the search, emphasizing psychological literature and empirical studies. Key search terms such as ‘virtual reality,’ ‘social skills,’ and ‘autism spectrum disorders,’ along with their derivatives including ‘VR,’ ‘ASD,’ ‘autistic children,’ ‘interactive technology,’ and ‘social situation,’ were systematically employed. These terms were critical in pinpointing relevant studies, particularly those delving into technologically mediated therapies for young populations.

The inclusion criteria for studies were defined to ensure relevance and scientific rigor: (i) studies must present empirical data that explore explicitly the application and outcomes of using virtual reality technology to help kids with ASD develop their social abilities, (ii) only research released after 2000 was taken into account to ensure the inclusion of recent technological advancements and contemporary therapeutic methodologies, and (iii) the research must provide clear insights into the effectiveness and applicability of VR as a therapeutic intervention, with a preference for randomized controlled trials, longitudinal studies, and comprehensive meta-analyses. Publications focusing solely on adult populations, other developmental disorders, or non-technological interventions were systematically excluded to maintain the focus on the specified child demographic and the innovative use of VR. This structured approach enabled this report to assemble the most pertinent, recent, and impactful research to inform and guide current therapeutic practices and future studies.

3. Literature Review

3.1. Social Skill Development in Children on the Autism Spectrum

Autistic children usually have difficulties building social skills, which are crucial for successful interactions with others. These challenges include difficulties in nonverbal communication [3]. Accordingly, children with ASD could find it difficult to make and keep friends, which could result in social isolation and a lower standard of living. Recent research by Ahmad Basri et al., underscores the importance of focusing on practical and realistic social skills that align with those used by socially successful peers [4]. The study emphasizes that developing social skills in kids with high-functioning autism should aim to develop these skills and ensure that the training content is culturally sensitive, reflecting diverse reactions and norms across diverse cultural backgrounds [4]. Additionally, improving the realism of virtual environments, especially in replicating nonverbal cues like facial expressions, is crucial for promoting practical social ability development in those children.

3.2. Traditional Intervention for Autistic Children

With the rising number of autistic children, conventional treatments like music therapy, CBT, and social-behavioral therapy are proving to have limitations in addressing the complex needs of every child. Music therapy is a commonly used intervention that has attracted attention for offering a safe, structured musical environment that promotes social engagement and social skills. The American Music Therapy Association (AMTA) defines music therapy as a clinical intervention delivered by professionals who possess a degree from an authorized music therapy program to achieve individualized therapeutic goals through planned musical interactions [5]. However, although studies have shown music therapy to positively impact nonverbal and verbal communication, the reliability of the results is somewhat limited by the small sample sizes of the studies and the short duration of the experiments [6]. Similar studies are only sometimes reliable for validating the efficacy of music therapy. In addition, Accordino, Comer, and Heller’s study also noted that supporting evidence for the effects of music therapy remains limited, further highlighting the limitations of the therapy [7].

Similarly, CBT, although proven to be effective in anxiety, continues to face challenges in its application to autism spectrum children. Although anxiety is not a typical feature of ASD, research has shown that anxiety often co-occurs with ASD [8]. CBT addresses the manifestation of problematic behaviors and tries to understand and mitigate the underlying cognitions that contribute to those behaviors. However, children with ASD, especially high-functioning children, often have difficulty identifying changes in their own social behavior and accurately describing and understanding emotions such as anxiety [9]. This limits the application of CBT to ASD kids. In addition, research suggests that CBT-acquired abilities and behavioral enhancements are not easily transferable to real-world situations [10]. Although appropriately trained while undergoing treatment, parents and educators can facilitate the application of social and adaptive skills in everyday life by implementing behavioral management techniques to address disruptive and repeated behaviors. These approaches remain limited in their effectiveness in reducing anxiety and facilitating the generalization of skills.

Social-behavioral therapies have been widely used in the early development of children with ASD and have demonstrated effectiveness in several cases [11, 12]. ABA promotes behavioral change primarily through positive reinforcement. At the same time, the goal of ESDM is to improve the social and emotional development of children with ASD by fusing the ideas of ABA with relational and developmental techniques. However, these traditional approaches have many limitations. According to Frolli et al., traditional approaches such as social skills groups and educational interventions, while effective, often require a significant investment of time and resources [13]. Additionally, the lack of immersive and interactive elements in these methods leads to their limited effectiveness in real-life applications, making it difficult to stimulate interest and engagement in children with ASD.

Because of the limitations of these traditional treatments, researchers have begun to explore innovative interventions such as VR. The application of VR can not only compensate for the shortcomings of traditional therapies but also provide a personalized and repeatable training environment to create a more realistic social situation for autistic children, thus improving the effectiveness and practicality of social skills training.

3.3. Advantages of VR Intervention

Studies demonstrate that VR creates a highly immersive and safe environment where children can practice social interactions, positively impacting their daily lives [13]. This study involved 60 children (9-10 years old) diagnosed with ASD level 1 [13]. The participants were randomly assigned into two groups [13]. Each group has 30 children with similar socio-economic backgrounds and IQ levels above 97 [13]. One group received a VR intervention focused on emotional literacy, while the other group underwent individual therapy with a therapist using traditional image-based methods [13]. The interventions aimed to improve recognition and understanding of primary and secondary emotions through structured activities [13]. Results showed that both methods were effective [13]. However, the VR intervention demonstrated greater efficacy in improving emotional recognition and situational understanding, indicating its potential as a powerful tool for ASD therapy. Additionally, VR effectively simulates real-life scenarios and other difficult-to-replicate situations, facilitating experiential learning and helping ASD children understand and engage in social interactions. Additionally, customizable and engaging VR environments enhance ASD children’s ability to comprehend and participate in social activities.

Moreover, researchers have found that children can generalize skills acquired in VR settings to real-world situations, making these interventions more practical and adaptable [14]. This is because Ip et al., suggest that although the majority of the instruction takes place virtually, the observations and assessments are done in the regular room environment [14]. The technology also enables children to practice socially awkward or potentially dangerous situations safely and repeatedly, such as crossing the street, without exposing them to real-world risks. Furthermore, VR training significantly improves social reasoning abilities, as children show marked improvements in analogical reasoning and decision-making during social interactions in VR environments [15]. For example, the results of the trial demonstrated that training significantly improved social-cognitive measures of theory of mind and emotion recognition as well as real-life social and vocational functioning [15]. VR interventions also prove effective across different diagnoses. The flexible and semi-structured design of VR social cognition training (VR-SCT) permits kids to have lively and authentic social connections, meeting the needs of more active children and enhancing their overall training experience.

3.4. Limitations of VR in Intervention

The application of VR is still confronted with several notable challenges and limitations. Ahmad Basri et al., highlight the need for VR training programs to prioritize realism and practicality, ensuring that the training content is aligned with the social skills typically developing peers use [4]. Moreover, they emphasize the necessity of cultural adjustments within VR programs to reflect the diverse social norms and responses across diverse cultural backgrounds [4]. Another critical aspect is the enhancement of realism within virtual environments, particularly in accurately simulating facial expressions and non-verbal cues, which are essential for effective social interactions in real-world settings.

Additionally, the widespread adoption of VR technology is hindered by several practical challenges, including excessive costs and accessibility issues related to the necessary hardware, which limit its implementation in broader educational and therapeutic settings. Furthermore, many existing studies need more sample sizes, which restrict the generalizability of the findings and make it challenging to apply these results to broader, real-world contexts [15, 16].

Future research should address these limitations by exploring a range of VR training intensities and durations and, most importantly, by improving the cost-effectiveness of these interventions. This would make VR a more accessible and feasible tool for supporting the social development of autistic children, particularly in broader educational and therapeutic settings [15, 16].

3.5. Potential for the Future Development of VR

The future development of VR as a tool for ASD intervention holds considerable promise. With the further development of VR technology, there is potential for more sophisticated and cost-effective solutions that can be implemented in therapeutic and educational settings. According to Lorenzo, Lledó, Arráez-Vera, and Lorenzo-Lledó, future research should focus on developing structured protocols for VR interventions, emphasizing the need for larger sample sizes to enhance the generalizability of findings [16].

Furthermore, the progress in artificial intelligence (AI) and machine learning could revolutionize VR environments, making them more dynamic and realistic. This development may greatly improve the use of social skills in everyday contexts [15]. The incorporation of features like real-time facial emotion recognition could make VR training more reflective of real-world social interactions, thereby boosting the overall effectiveness of the interventions.

Comparative studies that evaluate VR interventions against traditional methods are also crucial for establishing best practices and refining VR technologies to maximize their benefits for children with ASD. In addition, VR can also be used in conjunction with traditional therapies to provide children with a better therapeutic experience. For example, a study by Maskey, Lowry, Rodgers, McConachie, and Parr combining CBT and VR helped nine boys with autism and no learning disabilities cope with specific fears [17]. Each child received four 20–30-minute treatments [17]. The findings revealed that eight of the children could cope with their fears. In addition, four of the children completely overcame their phobias [17]. By addressing current limitations and exploring new avenues for improvement, VR has the potential to contribute to the social development of ASD patients, offering them a more engaging and effective learning experience.

4. Conclusion

This review underscores the multifaceted challenges faced by individuals with ASD, including difficulties in non-verbal communication and social interactions, causing social isolation. Traditional therapeutic approaches, such as CBT, music therapy, and social-behavioral therapies like ABA and the ESDM, have shown benefits but are limited in effectiveness and generalizability due to their lack of personalization and inability to sustain long-term engagement.

In contrast, VR offers a novel and promising solution by creating immersive, interactive, and customizable training environments. VR enables real-time feedback and realistic social simulations, providing a more effective and accessible alternative to traditional interventions.

However, the consistent limitation across the reviewed studies is the prevalence of small sample sizes, which affects the ability to generalize findings to the broader ASD population. This issue is compounded by difficulties translating the skills acquired in virtual settings to real-world contexts, which underscores the need for training programs to facilitate skill transfer better. Moreover, deploying VR technologies’ excessive costs and logistical complexities limit their accessibility and widespread implementation.

These limitations should be addressed in future studies by incorporating more extensive, diverse samples to enhance the external validity of study results. Additionally, efforts should be made to develop more cost-effective VR solutions that maintain the quality and efficacy of interventions. Integrating naturalistic interaction features, such as real-time facial emotion recognition, could enrich VR training and make it more representative of real-life social interactions. Therefore, comparative studies are also crucial for the next steps in research. These studies should compare VR interventions with traditional methods and other technological approaches. This will help find VR’s unique benefits and limitations in social skills training, providing valuable insights into the most effective practices and helping standardize protocols that leverage VR’s strengths.

In summary, while VR offers a promising tool for enhancing social skills in ASD patients, a strong commitment to rigorous scientific research and ongoing technological innovation is important to unlock its full potential in clinical and educational settings. By addressing current limitations and exploring new paths for improvement, VR can have a meaningful influence on the social development of ASD patients, providing a more immersive and effective learning experience.