Attention-Based Applications in Extended Reality to Support Autistic Users: A Systematic Review

With the rising prevalence of autism diagnoses, it is essential for research to understand how to leverage technology to support the diverse nature of autistic traits. While traditional interventions focused on technology for medical cure and rehabilitation, recent research aims to understand how technology can accommodate each unique situation in an efficient and engaging way. Extended reality (XR) technology has been shown to be effective in improving attention in autistic users given that it is more engaging and motivating than other traditional mediums. Here, we conducted a systematic review of 59 research articles that explored the role of attention in XR interventions for autistic users. We systematically analyzed demographics, study design and findings, including autism screening and attention measurement methods. Furthermore, given methodological inconsistencies in the literature, we systematically synthesize methods and protocols including screening tools, physiological and behavioral cues of autism and XR tasks. While there is substantial evidence for the effectiveness of using XR in attention-based interventions for autism to support autistic traits, we have identified three principal research gaps that provide promising research directions to examine how autistic populations interact with XR. First, our findings highlight the disproportionate geographic locations of autism studies and underrepresentation of autistic adults, evidence of gender disparity, and presence of individuals diagnosed with co-occurring conditions across studies. Second, many studies used an assortment of standardized and novel tasks and self-report assessments with limited tested reliability. Lastly, the research lacks evidence of performance maintenance and transferability.Comment: [Accepted version] K. Wang, S. J. Julier and Y. Cho, "Attention-Based Applications in Extended Reality to Support Autistic Users: A Systematic Review," in IEEE Access, vol. 10, pp. 15574-15593, 2022, doi: 10.1109/ACCESS.2022.314772

Cognitive State Measurement from Eye Gaze Analysis in an Intelligent Virtual Reality Driving System for Autism Intervention

Abstract-Autism Spectrum Disorder (ASD) is a group of neurodevelopmental disabilities with a high prevalence rate. While much research has focused on improving social communication deficits in ASD populations, less emphasis has been devoted to improving skills relevant for adult independent living, such as driving. In this paper, a novel virtual reality (VR)-based driving system with different difficulty levels of tasks is presented to train and improve driving skills of teenagers with ASD. The goal of this paper is to measure the cognitive load experienced by an individual with ASD while he is driving in the VR-based driving system. Several eye gaze features are identified that varied with cognitive load in an experiment participated by 12 teenagers with ASD. Several machine learning methods were compared and the ability of these methods to accurately measure cognitive load was validated with respect to the subjective rating of a therapist. Results will be used to build models in an intelligent VR-based driving system that can sense a participant's real-time cognitive load and offer driving tasks at an appropriate difficulty level in order to maximize the participant's long-term performance

Instructional Message Design: Theory, Research, and Practice

Message design is all around us, from the presentations we see in meetings and classes, to the instructions that come with our latest tech gadgets, to multi-million-dollar training simulations. In short, instructional message design is the real-world application of instructional and learning theories to design the tools and technologies used to communicate and effectively convey information. This field of study pulls from many applied sciences including cognitive psychology, industrial design, graphic design, instructional design, and human performance technology to name just a few. In this book we visit several foundational theories that guide our research, look at different real-world applications, and begin to discuss directions for future best practice. For instance, cognitive load and multimedia learning theories provide best practice, PowerPoint and simulations are only a few of the multitude of applications, and special needs learners and designing for cultural inclusiveness are only two of many areas where effective messages design can improve outcomes. Studying effective instructional message design tools and techniques has and will continue to be a critical aspect of the overall instructional design process. Hopefully, this book will serve as an introduction to these topics and inspire your curiosity to explore further

HAZARD PERCEPTION TRAINING FOR ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ON THE INTERACTIVE DRIVING SIMULATOR: USING EYE TRACKING TECHNOLOGY TO DETERMINE EFFECTIVENESS

Rationale: Driving is an important developmental milestone for all adolescents as it increases their independence and ability to participate in vehicle-dependent activities. However, adolescents with high functioning autism spectrum disorder (HFASD) are less likely to obtain licenses and drive independently due to characteristics related to their diagnosis. Although current research exists exploring the efficacy of driving simulator training for adolescent drivers with HFASD and eye tracking, there is a gap in the literature related to training on the simulator and its effects on overall driving performance and hazard perception and response in this population. Purpose: This pilot study utilized a training protocol on the simulator that included hazard perception to determine its effect on overall driving performance. Eye tracking technology was used to determine if there was a change in hazard perception and response to non-social and social hazards after training. Design: This study was a one group, pretest-posttest intervention design. Methods: There were 17 participants between the ages of 15 and 22 with a self-reported diagnosis of ASD and a desire to learn to drive independently. Each participant completed a pre-test and post-test on the driving simulator while wearing eye tracking technology. Each participant completed a protocol of 30 learning modules with scenarios related to driving skills and hazard detection and response in one-to-one training. Analysis: Driving performance was measured by a quantitative score from a standardized observational tool for driving. Eye tracking measures including fixation duration, fixation count, and time to first fixation were analyzed using a Wilcoxon Signed Rank Test. Results: Participants significantly increased their overall driving performance scores pre-test to post-test. Results of hazard perception using eye tracking technology tended towards improvement overall, but specific hazard results were inconsistent and varied for both non-social and social hazards in terms of fixation duration, fixation count, and time to first fixation. Discussion: Findings from this study indicate driving simulator training related to hazard perception was effective in improving overall driving simulator performance in adolescents with HFASD. Additionally, findings indicate hazard perception and response differs for this population after hazard perception training, but specific eye tracking measures may increase or decrease, and results may not be specific to non-social or social hazards

The use of virtual reality and augmented reality in psychosocial rehabilitation for adults with neurodevelopmental disorders: A systematic review

ObjectivesVirtual reality and augmented reality have been used in psychosocial rehabilitation for adults with neurodevelopmental disorders in recent years, to provide functional training in a scaffolded and appealing manner. This systematic review attempted to evaluate (1) how virtual reality or augmented reality technology was deployed, when used as an intervention for adults with neurodevelopmental disorders; and (2) how virtual or augmented reality-assisted psychosocial rehabilitation programs impacted on the functional domains of community living, employment and social participation.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was adopted and a search of publications between June 2012 and June 2022 was carried out. The target groups were adults with schizophrenia/schizoaffective disorders, autism spectrum disorder, intellectual disabilities and attention deficit hyperactivity disorder. Interventions that targeted at least one functional domain were included.ResultsThe database search generated 1,267 records and 38 studies met the inclusion criteria. Three studies utilized augmented reality while the rest utilized virtual reality. The virtual scenarios were displayed in various ways, such as head-mounted displays, computer screens, mobile devices and cave rooms. A few studies also used features such as speech recognition, eye tracking and motion-capture device to provide real-time feedback to participants during rehabilitation. Eleven studies reported interventions that addressed community living, 15 studies addressed vocational skills and nine studies trained participants in social skills or social cognition. Three studies sought to improve quality of life using virtual scenarios to expose participants to various situations. Majority of these studies reported preliminary promising results, with improvement in the functional domains addressed. However, several studies had small sample sizes and many single-arm pretest-posttest studies were assessed to be of serious or critical risk of bias.ConclusionVirtual reality and augmented reality are deployed in various ways to augment psychosocial rehabilitation for adults with neurodevelopmental disorders. Most interventions target skills training or strategy learning in the areas of community living, work and social participation. Preliminary positive findings of their effects on functional performance were reported. Larger and robust studies using ecologically valid outcome measures will be needed to establish their effects on real-world functional outcomes.Systematic review registrationidentifier: CRD42022335443

Coaching Imagery to Athletes with Aphantasia

We administered the Plymouth Sensory Imagery Questionnaire (Psi-Q) which tests multi-sensory imagery, to athletes (n=329) from 9 different sports to locate poor/aphantasic (baseline scores <4.2/10) imagers with the aim to subsequently enhance imagery ability. The low imagery sample (n=27) were randomly split into two groups who received the intervention: Functional Imagery Training (FIT), either immediately, or delayed by one month at which point the delayed group were tested again on the Psi-Q. All participants were tested after FIT delivery and six months post intervention. The delayed group showed no significant change between baseline and the start of FIT delivery but both groups imagery score improved significantly (p=0.001) after the intervention which was maintained six months post intervention. This indicates that imagery can be trained, with those who identify as having aphantasia (although one participant did not improve on visual scores), and improvements maintained in poor imagers. Follow up interviews (n=22) on sporting application revealed that the majority now use imagery daily on process goals. Recommendations are given for ways to assess and train imagery in an applied sport setting

Sensorimotor Differences in Autism Spectrum Disorder: An evaluation of potential mechanisms.

This thesis examined the aetiology of sensorimotor impairments in Autism Spectrum Disorder: a neurodevelopmental condition that affects an individual’s socio-behavioural preferences, personal independence, and quality of life. Issues relating to clumsiness and movement coordination are common features of autism that contribute to wide-ranging daily living difficulties. However, these characteristics are relatively understudied and there is an absence of evidence-based practical interventions. To pave the way for new, scientifically-focused programmes, a series of studies investigated the mechanistic underpinnings of sensorimotor differences in autism. Following a targeted review of previous research, study one explored links between autistic-like traits and numerous conceptually-significant movement control functions. Eye-tracking analyses were integrated with force transducers and motion capture technology to examine how participants interacted with uncertain lifting objects. Upon identifying a link between autistic-like traits and context-sensitive predictive action control, study two replicated these procedures with a sample of clinically-diagnosed participants. Results illustrated that autistic people are able to use predictions to guide object interactions, but that uncertainty-related adjustments in sensorimotor integration are atypical. Such findings were advanced within a novel virtual-reality paradigm in study three, which systematically manipulated environmental uncertainty during naturalistic interception actions. Here, data supported proposals that precision weighting functions are aberrant in autistic people, and suggested that these individuals have difficulties with processing volatile sensory information. These difficulties were not alleviated by the experimental provision of explicit contextual cues in study four. Together, these studies implicate the role of implicit neuromodulatory mechanisms that regulate dynamic sensorimotor behaviours. Results support the development of evidence-based programmes that ‘make the world more predictable’ for autistic people, with various theoretical and practical implications presented. Possible applications of these findings are discussed in relation to recent multi-disciplinary research and conceptual advances in the field, which could help improve daily living skills and functional quality of life.Economic and Social Research Council (ESRC

Assessment of postural, locomotor, and physical fitness status in individuals with intellectual and developmental disabilities

Introduction: Postural control and locomotion deficits can be observed during the early years of childhood development and throughout life. For those with disabilities, these deficits can advance past the development years and into adolescence and adulthood while affecting the quality of life and daily activity. Finding interactive rehabilitative activities to delay or limit these deficits is essential for people with disabilities to improve their quality of life, inclusion, and overall movement. Adapted physical activity/sports like badminton and virtual reality could promote improvements in postural and locomotor status for young adults with intellectual and developmental disabilities like cerebral palsy (CP), intellectual disability (ID), and autism spectrum disorder (ASD). Purpose: These studies aim to assess the postural and locator status of young adults with intellectual and developmental disabilities after participating in a 12-week badminton and intensive virtual reality programs. Methods: Study A will follow a multiple baseline approach to access postural control, locomotion, and areas of physical fitness in young adults with IDD utilizing the immersive virtual reality game Fruit Ninja™ while study B will follow and repeated measures design accessing static postural control for students in a comprehensive transition program for intellectual disabilities at a southeastern university

Simulators, driver education and disadvantaged groups: A scoping review

This paper examines simulators to deliver driver education programs for two very different populations (a) those who have specific impairments or intellectual disabilities and (b) those who may suffer disadvantage associated with their ethnicity. To do this we addressed two research questions (a) What role, if any, can simulation play as an education and/or training intervention for individuals disadvantaged because of individually-orientated concerns such as intellectual impairment or ADHD? (b) What role, if any, can simulation play as an education and/or training intervention for those who are disadvantaged because of their indigenous ethnicity? Technological developments have enabled the incorporation of driving simulators into driver education programs. A review of major databases using keywords identified 2,420 records. After duplicates were removed and screening occurred, thirteen studies were included in the review. The disadvantaged populations for the driver education initiatives that incorporated a simulator were very specific (e.g. intellectual disabilities) with no interventions for those disadvantaged because of ethnicity. A second search identified six papers that discussed interventions for indigenous populations. None of these interventions had a simulator component. The review highlights the need for high quality empirical research in the area of simulators, driver education and disadvantaged groups in order to inform policy development within this area. While there are some preliminary results indicating potential benefits, there is limited research evidence for an initiative of this type making it difficult to develop evidence based policy and practice. Therefore, when these types of initiatives are introduced, they need to be evaluated</p