Virtual reality and autism: Process preparations enabling future research and intervention practices

Background: The overall aim of this study is to examine key parts that need to be considered when planning and conducting research using virtual reality (VR) for autistic individuals. VR is a technology that simulates realistic environments and experiences that also can be tailored to meet specific needs. VR has the possibility to mimic real-life situations integrated in a controlled, predictable, safe, and supportive space. Moreover, VR can enhance engagement and motivation for autistic individuals, and offers customizable opportunities to develop and practice essential skills. The integration of virtual reality (VR) represents an exciting frontier in autism research and intervention practices. However, the complexity represented by such research and that the evidence of the effectiveness of VR-interventions is still scarce. It is therefore a need to carefully examine auxiliary assumptions that can affect the outcomes. In this thesis, I present four studies aimed at enabling researchers and conducting process preparations for future scientific endeavors. Objectives: The objective of this thesis is to investigate elements that are important to enable future research on autism and VR. This objective will be reached by (1) providing knowledge about the overall acceptability towards VR by autistic individuals, (2) addressing research gaps on autism, VR, and social skills, (3) evaluate whether available software create valid emotion expressions in avatars, and (4) investigating factors important for implementation of VR in schools. Methods: The four papers presented in this doctoral thesis utilized different methods. The first study is a review of the available peer-reviewed literature on autism and VR. We qualitatively analyzed the reporting of acceptability from autistic participants. We categorized the findings as positive, negative, or inconclusive. Inconclusive meaning variations within the sample in a study. The second study is a systematic scoping review providing an extensive overview of the literature reporting on social skills interventions, involving autistic participants, in VR. We analyzed the studies and identified several research gaps. The third study is a web-based pilot-survey where we quantitatively evaluate emotions expressed by avatars. We created avatars from real person photos using an available software which automatically expressed various basic and complex emotions. Using structural equation modelling and Bayesian confirmatory factor