Comparative Study on the Effectiveness of Joint Attention Interventions: Virtual Reality Tasks versus Conventional Treatments in Enhancing Social-Communication Skills of School-Aged Children with Autism - A Study Protocol for a Randomized Controlled Trial (Preprint)

Abstract

Introduction: Joint attention (JA) deficits are often among the initial indicators of Autism Spectrum Disorder (ASD), making them a key focus of early intervention programs. Recently, the advent of Virtual Reality (VR) technology has piqued the interest of researchers in the ASD field. A VR-based intervention, designed to provide JA skills training for school-aged children with autism, has been developed. The primary objective of the study outlined in this protocol is to assess the effectiveness of this VR-based intervention in enhancing JA skills. Additionally, the study aims to evaluate the influence of JA skills training on the social-communication behaviors of these children. Methods and analysis: Students aged between 7 years 0 months to 10 years 11 months, diagnosed with ASD, will be recruited for this double-blind, randomized controlled trial through convenience sampling. Eligible participants will be stratified into verbal and nonverbal groups and then randomly assigned to either the treatment group or the control group. The VR-based treatment will be delivered through a headset using specially developed VR scenarios. The primary outcome (JA skills) will be evaluated using the Childhood Joint Attention Rating Scale (C-JARS) and a behavior sample of participants. Additionally, a cross-validation tool named Joint Attention Assessment Tasks (JAST) has been designed and implemented within the virtual environment to measure the JA skills targeted in the intervention. The secondary outcome is social-communication skills and will be evaluated using the Gilliam Autism Rating Scale, Third Edition (GARS-3). Furthermore, it will be classified using the Autism Classification System of Functioning: Social Communication, in each study phase. Assessments will be performed at baseline, post-training, and follow-up. Ethics and dissemination: This study has been approved by the Ethics Commission of the University of Social Welfare and Rehabilitation Sciences, Iran. Study data will be submitted for publication irrespective of results. Trial registration: IRCT20221224056907N1