An AI-Assisted Virtual Reality Game to Improve Spontaneous Verbal Requesting in Children with Moderate-to-Severe Autism: A Feasibility Study (Preprint)

BACKGROUND Autism Spectrum Disorder (ASD) is characterized by persistent difficulties in social communication, restricted interests, and sensory challenges. Although Applied Behavior Analysis (ABA) is widely used, traditional interventions often face challenges, such as high costs, limited access to qualified therapists, and balancing structured therapy with individual needs. Recent advances in consumer-grade virtual reality (VR) and artificial intelligence (AI) offer opportunities to design personalized, immersive interventions aligned with naturalistic developmental behavioral intervention (NDBI) principles. OBJECTIVE This study aimed to design, develop, and evaluate an immersive VR game, the “Elevator Game” for verbal requesting and social initiation, to determine its feasibility, acceptability, and preliminary behavioral impact on children with ASD. METHODS Three children with autism and limited verbal skills participated in home-based VR sessions consisting of 10-15 minutes of gameplay followed by breaks. RESULTS Results suggest the intervention is feasible, well tolerated, and associated with increased spontaneous verbal requesting. CONCLUSIONS AI-assisted VR interventions integrating ABA and NDBI principles are feasible, engaging, and potentially effective for children with ASD, including those with limited progress in traditional therapy. Personalized reinforcers, immersive engagement, and sensory-adaptive environments appear critical for success. Findings support further development and evaluation in larger trials.