Brief Report: Two Case Studies Using Virtual Reality as a Learning Tool for Autistic Children
Reprinted with permission from the Journal of Autism and Developmental Disorders, Vol. 26, No. 6, 1996.
Dorothy Strickland , North Carolina State University
Lee Marcus, Gary B. Mesibov, and Kerry Hogan , University of North Carolina at Chapel Hill School of Medicine
In 1895 the Lumieres' documentary Train Entering
Station reputedly made audiences flee or duck for cover, fearful for their lives
(Pirie, 1981). Film is now widely recognized as a technology capable of making
the human body respond emotionally, as when adrenaline increases at a horror
movie. Virtual reality carries the fantasy a step further, immersing the user
in an illusion which responds as the real world does. The human interaction
with the imaginary world is not conducted through watching other peoples' motions
but by controlling the new reality through one's own actions. For this reason
virtual reality (VR) allows individuals to explore new ways of responding and
Definition of Virtual Reality
The key difference between VR and typical
computer programs is the level of interaction with the computer-generated
images. In conventional systems, predetermined pictures and choices are
presented to the user. With VR, the computer generates a three-dimensional
world, places the user within it, and allows independently determined
motion by the user with appropriate environmental responses (Gregory,
1991). In its finest form, VR produces computer-generated real life experiences.
There are several levels of VR, the most
sophisticated of which is called immersion. In this version the user wears
a headset containing two small video screens, one suspended in front of
each eye. As the person moves, the movement is tracked and used to reposition
the user's location in the scene.
Just how convincing are these computer-generated
realities? Research is just beginning, but early studies indicate that
the senses are susceptible to this illusion. The sense of realism was
convincing enough in an immersion system to treat acrophobia with visually
limited worlds (Rothbaum et. al., 1995). In claustrophobia studies, participants
responded to an immersive shrinking virtual room with claustrophobic symptoms
when the room reached a minimum size (Pyne, 1994). Flat-screen virtual
displays were used to transfer spatial information on building interiors
to children with poor mobility (Wilson, 1993) and teach shopping and monetary
skills in a virtual supermarket (Brown, Cobb & Eastgate, 1993). Physically
handicapped individuals are using flat-screened virtual settings to learn
to navigate with wheelchairs (Kuhn, 1994; Powell & McJunkin, 1994;
Swain & Stredney, 1994). Prototype immersion VR buses are being developed
to train adolescents with mental retardation to ride school buses (Mowafay,
Why Consider VR for Autism?
Several aspects of autism suggest that virtual
reality might be helpful with this population:
Sensory Problems. Many children with autism
have difficulty with multiple sources of sensory input (Grandin &
Acariano, 1996). Stimulation in certain settings can be overpowering,
causing difficulties and behavior deterioration. VR isolates specific
stimuli from the environment and allows subjects to control how much they
will experience. Complex stimulus arrays can be simplified.
Lack of Generalization. Difficulty generalizing
behaviors learned in a single setting to similar appropriate situations
has frustrated treatment efforts in autism. What is taught in one situation
does not necessarily occur naturally in related appropriate situations.
VR makes generalization easier because of the realism that it brings to
Visual Thought Patterns . Many have observed
that thinking in people with autism is primarily visual (Grandin, 1992;
Schopler, 1987). Intervention techniques have been successful when they
capitalize on these visual strengths (Mesibov, Schopler, & Hearsey,
1994). VR, emphasizing visual skills, seems to be an appropriate modality
for people with autism and should give them an excellent opportunity for
learning new concepts and behaviors.
Individualized Treatment. Although there
are general characteristics that all people with autism share, effective
approaches must individualize their techniques to meet the needs of individual
clients (Schopler, Mesibov, & Hearsey, 1995). Computerized instruction
using VR allows for constant readjustments, based on the needs and skills
of individual clients. Learning imagery can be readjusted to compensate
for individual styles and changing patterns.
Responsiveness with Computer Technology.
Although computers have not been adapted by special education programs
quickly as some would like, there is increasing evidence that they represent
an effective new approach to education and learning for children with
developmental disabilities (Howard, Buch, Watson, & Shade, 1991).
Given the characteristics of autism and the encouraging preliminary data,
it appears reasonable to expand the use of computerized instruction for
individuals with autism and VR is a promising avenue for this extension.
DESIGN OF STUDY
This study was designed to determine if
children with autism would tolerate VR equipment and respond to the computer-generated
world in a meaningful way.
The project was a collaborative effort between
the North Carolina State University Computer Science and Computer Engineering
Departments plus the staff and two families from the Division for the
Treatment and Education of Autistic and other Communication Handicapped
Children (TEACCH) at the University of North Carolina at Chapel Hill.
The parents of the children acted as collaborators and co-therapists in
the treatment, an idea central to the TEACCH approach (Schopler, 1987).
Teaching the children how to cross the street was selected as the target
VR scenario. The design of the tests took place over approximately a 6-month
period with the actual tests conducted in 5 weeks.
The children were selected as subjects based
of the following criteria: (a) unequivocal diagnosis of autism, based
on early history and behavioral observations, Childhood Autism Rating
Scale (CARS) ratings (Schopler, Reichler, & Renner, 1988), test results,
and parent reports; (b) moderate level of skills and abilities that would
make participation and interest in the technology possible, but a challenge;
(c) strong interest in learning, but resistance to change and new situations;
(d) prior experience with computers; (e) parents and older siblings who
had the time and interest to work closely with the research staff.
S. is a 71/2 year-old girl with very strong
visual spatial skills, limited verbal and language based abstract reasoning
skills. Recent cognitive testing resulted in an IQ of 91 on the Leiter
International Performance Scale. She was able to do one subtest of the
WPPSI-R with good success (Object Assembly), but was unable to complete
other performance tests. On the CARS (Schopler et. Al., 1988), she was
classified as Mild to Moderately Autistic with a score of 36.5.
R. is a 9-year-old boy with somewhat better
language skills, but also considered a visual learner. Cognitive testing
resulted in an IQ of 62 on the Merril Palmer Scale of Mental Tests. He
was able to do relatively well of the Object Assembly test of the WPSSI-R,
but unable to complete other tests on this scale. On the CARS, he was
classified as Mild to Moderate Autistic with a score of 34.0.
Equipment and World
The computer we used was a ProVision 100
fully integrated VR system, provided by Division Inc. of Chapel Hill,
NC. Hard to render objects such as people were avoided in favor of simplified,
unfamiliar street settings with different colored moving cars. For our
tests, the children were asked to watch a car moving at a moderate pace
or follow images created by a hand-controlled five-button 3D mouse (Figures
1 & 2). Since 20 minutes is the point at which discomfort often appeared
in previous tests with normal adults, we limited our immersion to 5 minutes
at one time.
The interactive controls standard with
most VR were difficult for the children to use. Pointing also would not
work because the computer cannot track the hand motion unless it has a
tracking device affixed, and it is disconcerting to point at something
in front of your face and not see your arm and hand. Because both children
had some language skills, we primarily used simple verbal responses such
as "car," "red," "blue," and walking motion
to indicate response to the world.
Design of Sessions
The willingness of the children to wear
a heavy, awkward helmet was the initial major concern. To provide the
greatest possibility of acceptance, we followed the TEACCH concept of
structured teaching, which the children use in their classrooms at school.
In this technique, physical organization, schedules, individual work systems,
and routines help to make situations more understandable to the children,
thereby making them more comfortable (Mesibov et al., 1994).
Physical Layout and Schedule
The physical layout involved consistent,
visually clear areas and boundaries for specific activities. Although
the studies were done in the offices of Division Inc. in Chapel Hill,
we removed unnecessary items where possible, closed connecting doors,
and defined separate activity areas.
Schedules were used to explain which activities
would occur and in what sequence they would occur to help the children
anticipate and predict events. Each child had a basic routine of work
first and then play with the VR test between. In later tests the play
period was dropped.
Preliminary Helmet Acceptance Efforts
The week before the tests began, R's mother
had R. try several different helmets for familiarization. S. wears a helmet
for horseback riding although she does not like it. Before attempting
to place the helmet on a child during the actual test, the older brother
or sister of the child assisted us by wearing the helmet and responding
correctly to the VR scene. It was hoped that seeing the sibling respond
enthusiastically to the helmet would make it more acceptable.
RESULTS AND DISCUSSION
S. and R. came in separately for approximately
30-minute to 1-hour sessions. During that time both children repeated
the work, helmet, play cycle multiple times. S. had twenty-one 3- to 5-minute
sessions over a 7-day period, and R. had sessions of shorter duration
over a 4-day period. The goal was to teach the children to accept the
helmet and pay attention to the images. We initially asked each child
to identify cars when they appeared and say the car color if possible.
On the first attempt, both children accepted
the helmet and immersed themselves in the scenes. We started the children
sitting in a swivel chair. S. immediately followed the cars visually and
identified the colors correctly. At one point she said "ca"
when a car turned a corner. In the first session S. stayed the full 5-minute
maximum before the helmet was removed. R. would not wear the helmet as
long initially. He appeared more concerned with understanding where the
images were coming from. R. would look at the in the helmet and then lift
it up and look at the same scene of the flat screen. Several times he
tried to look in the front of the helmet from the outside as if trying
to find the images. We finally removed the flat screen from his range
of vision and R. immersed himself in the helmet for longer periods. R.
then followed the cars with his eyes for short times and correctly identified
the cars and their colors when asked.
The number, color and speed of the cars
were modified repeatedly and the children were placed in three different
street scenes. Once it became obvious they needed a more difficult task
in the virtual world, we tried a variety if experiments to measure the
children's reaction to changes in the VR task. We asked both children
to walk in the virtual world. We also asked each child to locate a movable
stop sign in the scene and walk toward it.
The results of these trials indicated:
1. These two autistic children accepted the virtual helmet.
2. The children repeatedly immersed themselves in the virtual scenes to
a degree that they verbally labeled objects and colors of objects.
3. Both children wore the helmet while standing and moved their bodies
while in the virtual scenes.
4. The children responded similarly to three different street scenes,
but more study needs to be done to determine if they were generalizing
across different surroundings.
5. Both children voluntarily took the hand controls at least once and
attempted to use them. R. is more computer literate and did this more
Additional individual results were as follows:
1. Both children consistently tracked moving objects in a scene, with
both eyes, head, and body turning.
2. S. repeatedly turned and located a stop sign in a scene and walked
3. R. identified the stop sign, but would not consistently walk to it.
The difference between these two children's
ability to walk toward the sign appeared to be related to their understanding
of the VR image as an interactive three-dimensional world. Although S.
freely walked to the sign to receive a reward, R., when told to "go
to sign," would point to the sign inside the helmet. R. appeared
to respond to the image as though it were on a typical flat computer screen
. S. appeared to understand that her motions were translated into motions
in the virtual world.
The children complied with most requests.
Some of our teaching goals were limited by technology or space, while
others were limited by the difficulty of presenting a task to the children
in a way that was understandable within their environment. However, the
opportunity to introduce this technology to children was an important
first step in exploring the potential VR offers to understanding the perceptual
processes involved in autism.
Our results indicate that the children
will accept a VR helmet and wear it, identify familiar objects in their
environment while using the helmet, and locate and move toward objects
in their environment while wearing the helmet.
More research is necessary to verify the
potential in this area, especially to discover if learning experiences
through VR generalize to other environments, but it appears virtual reality
may provide a useful tool for furthering our understanding of autism and
guiding efforts at treatment and intervention.
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