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 learning.

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.

Previous Applications
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, 1994).

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 treatment situations.

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 as

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.


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.

Project Team
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.

VR 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.


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 often.

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 to it.
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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