JMIR Publications

ABSTRACT

Background:

Autism spectrum disorder (ASD) is characterized by core impairments in social interaction and communication, with limited effective interventions to address these challenges. Traditional therapies such as behavioral training and pharmacotherapy often face limitations in ecological validity and side-effect profiles. Virtual reality (VR) technology has emerged as a promising alternative, leveraging immersive and interactive environments to simulate real-world social scenarios. However, the comparative effectiveness of different VR modalities remains unclear. This knowledge gap hinders clinical decision-making and the adoption of VR technologies in ASD intervention, highlighting the need for systematic evaluation to clarify the efficacy of various VR approaches.

Objective:

This study aimed to evaluate the effectiveness of different virtual reality (VR) technologies in improving social and communication skills in children with Autism Spectrum Disorder (ASD) and to determine the optimal intervention program through a network meta-analysis (NMA).

Methods:

A systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, EBSCOhost, CNKI, VIP, Wanfang databases for randomized controlled trials (RCTs) from January 1990 to 26 February, 2025. The overall risk of bias of the included literature was summarized using the revised Cochrane risk of bias tool for randomized trials (RoB-2). Based on the frequency theory framework, statistical analysis was conducted using STATA 18.0. The quality of evidence was evaluated using the confidence in the network meta-analysis (CINeMA) framework.

Results:

A total of 11 RCTs (n = 718) were included. The network evidence diagram showed that eight techniques constitute the main comparison nodes. Compared with conventional care, HMD significantly improved social communication deficits (SMD = 8.17, 95% CI: 2.60, 13.74), with the highest SUCRA value (82.6%), making it the optimal intervention. The risk of bias in the included literature is relatively low, and the overall quality of evidence is moderate.

Conclusions:

As an immersive VR technology, HMD can effectively improve the social ability of children with ASD and is recommended as a first-line supplementary intervention. Further studies are needed to expand the sample size. Clinical Trial: This study is registered in PROSPERO international system evaluation platform registered (CRD420250654696).