2025, Vol. 5, Issue 2, Part A

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social communication, restricted behaviors, and sensory sensitivities. Traditional therapies, though effective, often face limitations related to accessibility, scalability, and patient engagement. In recent years, Virtual Reality (VR) and gamification have emerged as promising tools that leverage immersive, interactive, and feedback-rich environments to support social, cognitive, and emotional rehabilitation in individuals with ASD.
Objective: This systematic review aimed to critically evaluate the effectiveness of VR and gamification in ASD rehabilitation, focusing on their impact on social communication, emotion recognition, engagement, and adaptive behavior. Additionally, it sought to assess the methodological quality of existing studies and identify challenges and future directions for integrating these tools into evidence-based practice.
Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, PsycINFO, IEEE Xplore, and Google Scholar from January 2010 to July 2025. Studies were eligible if they assessed VR and/or gamification interventions in ASD populations and reported measurable cognitive, emotional, or social outcomes. Twenty-nine studies (18 randomized controlled trials, 7 quasi-experimental designs, and 4 pilot studies) met the inclusion criteria, encompassing a total of 1,432 participants. Data were extracted systematically, and study quality was assessed using the Cochrane RoB 2 and Joanna Briggs Institute appraisal tools. Effect sizes, heterogeneity statistics, and subgroup analyses were employed to synthesize findings.
Results: The pooled analysis revealed moderate-to-large improvements in social communication (Hedges’ g=0.62, p<0.001) and significant gains in emotion recognition (SMD=0.48, p<0.001), particularly in immersive VR interventions. Engagement levels increased by 25-35% compared to controls, and adaptive behavior outcomes showed moderate improvements (SMD=0.39, P=0.002). However, methodological heterogeneity (I²=41.7%), limited long-term follow-ups, and underrepresentation of adult participants were notable limitations.
Conclusion: VR and gamification significantly enhance core rehabilitation outcomes for individuals with ASD, particularly in social and emotional domains. Immersive VR appears more effective than gamified 2D platforms, though the latter offer scalable and cost-efficient alternatives. Practical integration requires clinician training, caregiver involvement, affordable technologies, and rigorous longitudinal research to confirm sustained benefits. These findings highlight VR and gamification as complementary and evidence-informed tools that, if strategically implemented, can broaden the reach and effectiveness of autism rehabilitation programs.