Cognitive Training in Virtual Reality for Autism

Condition(s) studied

Investigational drug(s) / intervention(s)

Experimental Group: During every single session, each participant will engage in the selected tasks for approximately five minutes per exercise through the use of VRRS, in order to specifically stimulate the different target cognitive functions (visual attention, executive functions, and visuo-spatial memory)

Control Group: During every single session, each participant will engage in the selected tasks with objectives equivalent to those of the experimental group, but without the use of virtual reality, instead employing traditional methods and paper-and-pencil activities.

Study summary

The Virtual Reality Rehabilitation System (VRRS) is an innovative tool for motor and cognitive rehabilitation that has shown promising results in developmental populations, with evidence of feasibility, safety, acceptability, and positive effects on attention, executive functions, and learning-related processes. Its playful and motivating features, together with the possibility of tailoring task difficulty and delivering intensive training in a controlled environment, make VRRS a promising intervention for children with autism spectrum disorder (ASD), who frequently present weaknesses in visual attention, executive functioning, and visuospatial memory.

This randomized controlled trial aims to evaluate the efficacy of a VRRS-based cognitive training program in improving visual attention, executive functions, and visuospatial memory in children with ASD, compared with an active control intervention based on conventional cognitive training. Children aged 4 to 6 years 11 months with ASD, non-verbal IQ \>70, and no severe neurological or sensory comorbidities will be enrolled and randomly assigned to the experimental or control group. The intervention will consist of two 45-minute sessions per week for 12 weeks. VRRS training will include individualized tasks targeting the selected cognitive domains, with adjustable difficulty, execution time, and repetitions. Assessments will be conducted at baseline (T0) and post-intervention (T1). At baseline, non-verbal cognitive functioning will be assessed using Leiter International Performance Scale, Third Edition (LEITER-3), while attention, executive functions, and visuospatial memory will be measured using Preschool Executive Functions Assessment Battery (FE-PS), LEITER-3 attention and memory tasks, Developmental Neuropsychological Assessment - Second Edition (NEPSY-II) (Memory for Designs), and Behavior rating inventory of executive function-preschool version (BRIEF-P). The same battery will be repeated after training to compare pre- and post-intervention scores and estimate the relative efficacy of the two approaches.

It is hypothesized that children receiving VRRS-based training will show greater improvements in the targeted cognitive functions than those receiving conventional training, supporting the clinical utility of virtual reality as an effective and engaging rehabilitation approach for children with ASD.

Eligibility

Primary outcome measure(s)

• Leiter International Performance Scale, Third Edition (LEITER 3) — The evaluation session will be scheduled at the beginning (T0) and at the end (T1) of the intervention. The test needs approximately 20-45 minutes to complete.
  The LEITER-3 is a completely nonverbal test designed to measure IQ and cognitive skills, suitable for children, adolescents and adults aged 3 to 80 years. It includes ten subtests divided into two batteries: the Cognitive Battery and the Attention and Memory Battery. The Cognitive Battery asses intellectual domains, such as reasoning, visualization, and problem-solving, trough following subtests: Form Completion (FC), Classification/Analogies (CA), Sequential Order (SO), and Visual Patterns (VP). The Attention and Memory Battery evaluates attention, memory and other executive functions trough the following tasks: Sustained Attention (SA), Forward Memory (FM), Divided Attention (DA), Reverse Memory (RM), and Nonverbal Stroop (NS). Scores from the Cognitive Battery subtests are combined to provide an overall index of nonverbal intelligence, while the Attention and Memory Battery allows identification of specific cognitive strengths and weaknesses.
• Preschool Executive Functions Assessment Battery (FE-PS 2-6) — The evaluation session will be scheduled at the beginning (T0) and at the end (T1) of the intervention. The test needs approximately 30-45 minutes to complete.
  The FE PS 2-6 is a tool used to assess executive functions in preschool-aged children (2-6 years). It is a battery of 10 subtests, organized into three functional areas: Inhibitory Processes, Delay of Gratification and Complex and Interdependent Abilities such as inhibition, working memory and emerging cognitive flexibility. For each subtest, z-scores and percentiles will be calculated based on the raw score.
• Developmental Neuropsychological Assessment - Second Edition (NEPSY-II) — The evaluation session will be scheduled at the beginning (T0) and at the end (T1) of the intervention. The test needs approximately 5-10 minutes to complete.
  The NEPSY-II is the most internationally known battery for assessing neuropsychological development in developmental age. Only the Designed Memory subtest will be administered. This subtest assesses visuospatial learning ad memory abilities. The child is presented with a grid containing 4 to 10 designees per page, which is subsequently removed from view. The child is then required to select the corresponding designs from a set of cards and place them on the grid in the same spatial locations as previously presented. Memory for visual stimuli and memory for spatial location are scored and analyzed separately.
• Behavior rating inventory of executive function-preschool version (BRIEF-P) — The evaluation sessions will be scheduled pre/post intervention (T0-T1). The test needs approximately 20 minutes to administer.
  The BRIEF-P is a set of questionnaires for parents and teachers designed to evaluate executive function, for preschool children. It consists of 63 items that measure key domains of executive functioning: Inhibit, Shift, Emotional Control, Working Memory, and Plan/Organize. The clinical scales are aggregated into three broader indices (Inhibitory Self-Control, Flexibility, and Emergent Metacognition) and one composite score (Global Executive Composite). Additionally, The BRIEF-P includes two validity scales (Inconsistency and Negativity), to ensure the realiability of the responses.

Trial sites (1)

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