Autism Spectrum Disorder (ASD) describes a chronic condition with lasting challenges in social communication, emotional functioning, and adaptive behavior. Applied Behavior Analysis (ABA) has been established as the gold standard intervention for ASD, but the use of Virtual Reality (VR) has proven to be a valuable approach in improving skill acquisition in an immersive and controlled learning environment. But there is limited longitudinal evidence of the effectiveness of VR versions of ABA.

The purpose of this study was to examine the effectiveness of VR+ABA over 12 months for children with ASD in terms of emotional regulation and behavioural outcomes.

The study design was a randomized controlled longitudinal trial of a 12-month treatment period with VR+ABA (n = 30) versus an ABA-only (n = 30) group of children with ASD (6–12 years). The two groups were provided with the same amount of standardized ABA therapy (20 hours per week); an additional 30 minutes per week of VR was administered to the experimental group, with the sessions focused on simulations of social interaction, emotional regulation, and safety skills. The Emotion Regulation Checklist (ERC), Autism Behavior Checklist (ABC), Adaptive Behavior Assessment System-II (ABAS-II), Social Responsiveness Scale-2 (SRS-2), and Behavior Rating Inventory of Executive Function (BRIEF) were used as outcome measures. Three assessments were done at baseline, 6-month, and 12-month timepoints. Repeated-measures ANOVA and mixed-effects models were used to analyse data at the p < 0.05level.

In the VR+ABA group, children showed significantly greater improvements compared to the ABA group on all primary outcomes. Mean ERC scores increased from 32.1 ± 5.2at baseline to 38.7 ± 4.1after 12 months, compared with 31.8 ± 5.5to 33.2 ± 5.0 in the control group (F = 27.84, p < 0.001, η² = 0.324). ABC irritability scores decreased by 51.3%in the VR+ABA group versus 12.4%in controls (p < 0.001). There were also significant improvements in adaptive behaviour (23.1% improvement), emotional recognition (37.8% improvement), executive functioning (18.5% improvement), and social communication (23.8% decrease in SRS-2 scores). The magnitude of the treatment effects was large for all primary outcomes (Cohen's d = 0.95–1.42).

Results show that VR-ABA led to significantly greater gains in emotional regulation, adaptive functioning, executive functioning, and behavioral outcomes than traditional ABA. VR-assisted ABA is a promising, engaging, clinically effective intervention for children with ASD and can be used to complement the long-term effectiveness of behavioural therapy. Further multicentre studies with a larger number of patients and longer follow-up are suggested for confirmation of these results.