computers

Systematic Review
Application of Augmented Reality Interventions for Children
with Autism Spectrum Disorder (ASD): A Systematic Review
A. B. M. S. U. Doulah 1, * , Mirza Rasheduzzaman 1 , Faed Ahmed Arnob 2 , Farhana Sarker 3 , Nipa Roy 4 ,
Md. Anwar Ullah 5 and Khondaker A. Mamun 2,6, *

1 Department of Electrical and Electronic Engineering, University of Liberal Arts Bangladesh (ULAB),
Dhaka 1209, Bangladesh; [email protected]
2 Advanced Intelligent Multidisciplinary Systems Lab (AIMS Lab), Institute of Research Innovation,
Incubation and Commercialisation (IRIIC), United International University, Dhaka 1212, Bangladesh;
[email protected]
3 CMED Health, Dhaka 1206, Bangladesh; [email protected]
4 Institute of Natural Sciences, United International University, Dhaka 1212, Bangladesh; [email protected]
5 Statistics and Informatics Division, Dhaka 1207, Bangladesh; [email protected]
6 Department of Computer Science and Engineering, United International University, Dhaka 1212, Bangladesh
* Correspondence: [email protected] (A.B.M.S.U.D.); [email protected] (K.A.M.)

Abstract: Over the past 10 years, the use of augmented reality (AR) applications to assist individuals
with special needs such as intellectual disabilities, autism spectrum disorder (ASD), and physical
disabilities has become more widespread. The beneficial features of AR for individuals with autism
have driven a large amount of research into using this technology in assisting against autism-
related impairments. This study aims to evaluate the effectiveness of AR in rehabilitating and
training individuals with ASD through a systematic review using the PRISMA methodology. A
comprehensive search of relevant databases was conducted, and 25 articles were selected for further
investigation after being filtered based on inclusion criteria. The studies focused on areas such
as social interaction, emotion recognition, cooperation, learning, cognitive skills, and living skills.
Citation: Doulah, A.B.M.S.U.; The results showed that AR intervention was most effective in improving individuals’ social skills,
Rasheduzzaman, M.; Arnob, F.A.; followed by learning, behavioral, and living skills. This systematic review provides guidance for
Sarker, F.; Roy, N.; Ullah, M.A.;
future research by highlighting the limitations in current research designs, control groups, sample
Mamun, K.A. Application of
sizes, and assessment and feedback methods. The findings indicate that augmented reality could be a
Augmented Reality Interventions for
useful and practical tool for supporting individuals with ASD in daily life activities and promoting
Children with Autism Spectrum
Disorder (ASD): A Systematic
their social interactions.
Review. Computers 2023, 12, 215.
https://doi.org/10.3390/ Keywords: autism spectrum disorder; augmented reality; systematic review
computers12100215

Academic Editor: Miguel

Correia Melo
1. Introduction
Received: 9 August 2023 Autism spectrum disorder (ASD) is a neuro-developmental disorder determined by
Revised: 25 September 2023 difficulties with social communication, restricted interests, and compulsive behavior [1].
Accepted: 1 October 2023 Early detection of ASD is possible between the ages of 18 and 24 months; at this time,
Published: 23 October 2023
the diagnostic symptoms can be distinguished from regular developmental delays as well
as other developmental disorders [2]. Globally, it is estimated that one in 100 children
suffers from ASD. Significant advancements in international policy have significantly
Copyright: © 2023 by the authors.
complemented the developments in autism research. Along with the policy changes
Licensee MDPI, Basel, Switzerland. brought about by the significant rise in global consciousness and campaigns, autism has
This article is an open access article been impacted by advancements in related fields including human rights, maternal and
distributed under the terms and child health, and mental well-being [3–6]. The foundation and impetus for this development
conditions of the Creative Commons came from the United Nations Convention on the Rights of Persons with Disabilities
Attribution (CC BY) license (https:// (UNCRPD), which outlines key principles such as respect for dignity, freedom of choice,
creativecommons.org/licenses/by/ non-discrimination, full participation and inclusion in society, and accepting people with
4.0/). disabilities as a part of human diversity.

Computers 2023, 12, 215. https://doi.org/10.3390/computers12100215 https://www.mdpi.com/journal/computers

Computers 2023, 12, 215 2 of 23

Each child with ASD is unique; it is possible that a technological solution that is
beneficial for one child may not be effective for another. Therefore, researchers have begun
to integrate a variety of technology for the betterment of children with autism with an
aim of determining the best suited technologies for each individual. Technologies such as
computer-based tools, virtual/augmented reality, mobile- and tablet-based applications,
and robotics are currently viewed as propitious approaches for designing interventions for
ASD, addressing a variety of goals including social and learning skills, on-task behavior,
and challenging behaviors [7–19].
Early intensive behavioral intervention can ameliorate some of the symptoms of
autism [7]. Nevertheless, the tools of certain classic media intervention approaches, such as
video modeling (VM), are typically overly lengthy and lack an interactive mechanism [8–10].
It is difficult for ASD children to dynamically alter their cognitive focus and position.
In recent years, information and communication technologies (ICTs) have been deployed
extensively in the healthcare industry [11]. In the field of autism rehabilitation, technology-
based interventions (TBI) include social robots [12], computer-based interventions [13,14],
VR [15,16], tablet computers [17], and serious games [18,19].
As a new form of human–computer interaction (HCI) technology, AR has advanced
significantly throughout the last few years to offer rich visual information and diverse in-
teractive experiences by combining real scene information and virtual information [20–22].
AR presents fresh ideas for enhancing the learning experience [23]. There is evidence that
autistic individuals are eager to analyze visual information and use electronic gadgets [24].
In addition, according to their parents, technology, such as tablets and smartphones, are
significantly beneficial in treating these behavior issues [24,25]. Applications of mobile
augmented reality (MAR) make the treatment more engaging [26,27] and improve the
academic progress of children with autism [28].
In recent years, there has been a great deal of interest in examining the efficacy of
technology-based strategies in training and teaching different skills, such as communication
and social skills, academic skills, and information processing, to increase independence in
children and adolescents with ASD. Marto et al. conducted a systematic literature review
(SLR) of 16 primary papers on the use of augmented reality (AR) for the rehabilitation of
people with ASD [29]. Only eight studies on MAR were considered. However, the authors
of [30] examined ten preliminary studies published between 2012 and 2016 and made
recommendations for future research and evaluation. Similarly, the collection contains only
six studies on MAR. Adnan et al. [31] articulated AR’s development and research prospects
in the treatment of autism; however, the literature study was inadequate. Khowaja et al. [32]
presented a systematic literature review of major works published in 2005–2018 on AR
intervention in improving a variety of skills in children and adolescents with ASD and
presented the research classification of ASD. However, the article did not include MAR
and the research timeline must be revised. Berenguer et al. [33] assessed the efficacy of AR
technology on ASD.

1.1. Research Question and Objects

Through a systematic review, this study examines how AR methods are used with
children who have ASD. This study seeks to answer the following question by conducting
a systematic review using the PRISMA methodology:
How effective are augmented reality interventions for the training and rehabilitation
of individuals with autism spectrum disorder (ASD) in terms of social interaction, emotion
recognition, cooperation, learning, cognitive skills, and living skills?
Additionally, by systematically evaluating the existing literature, this study seeks to
address the following research objectives:
• Systematically review the existing literature on augmented reality interventions for
children with autism spectrum disorder (ASD);
Computers 2023, 12, 215 3 of 23

• Evaluate the effectiveness of augmented reality interventions in rehabilitating and

training individuals with ASD across various domains, including social interaction,
emotion recognition, cooperation, learning, cognitive skills, and living skills;
• Identify the strengths and limitations of the current research designs, control groups,
sample sizes, and assessment and feedback methods used in the reviewed studies.

1.2. Contributions and Organization

This article presents a systematic literature review on the application of AR interven-
tions for children with autism spectrum disorder (ASD) with an aim to investigate the
recent trends, potential, and future research in AR technologies for the purpose of autism
spectrum disorder intervention. This SLR includes works in the time span from 2010 to
2022. A summary of this work’s essential contributions are the following:
• We conducted a systematic search for studies evaluating the types of intervention
on the ASD population and analyze the efficacy of AR intervention on a variety of
functions, such as social and communication, emotion management, daily living,
and cognitive skills;
• We discussed the limitations and future works of the existing research.
The remaining sections of the paper are structured as follows. Section 2 discusses the
linked concepts first. Then, we present the methodology in Section 3 before delving into
the detailed results in Section 4. In Section 5, the discussion and limitations are presented.
In Section 6, we conclude the paper with suggestions for future research.

2. A Brief Overview of The Related Concepts

2.1. Autism Spectrum Disorder
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
defines autism spectrum disorder (ASD) as a condition characterized by deficits in two
core domains: (1) social communication and social interaction and (2) restricted repetitive
patterns of behavior, interests, and activities. Since 2013, the DSM-5 has included Asperger’s
disorder, childhood disintegrative disorder, Rett’s disorder, and a number of other related
diseases such as ASD. Despite this, many researchers continue to interchange Asperger’s
syndrome with ASD. According to a study conducted by the National Institute of Health
(NIH) of the United States published in June 2018, 2.41 percent of American kids are
diagnosed with an autism spectrum disorder. This represents a 0.94 percent increase from
2010. In Bangladesh, two community studies [34,35] conducted in 2005 and 2009 revealed
that the statistics of children with autism were 0.2 and 0.84/1000 children, respectively.

2.2. Augmented Reality

Given the current technical advancements, AR technology is increasingly expanding
into a range of fields, including gaming, travel, leisure, business, medicine, and education.
Aggarwal and Singhal [36] define AR as the superimposition or augmentation of digital
images onto real-world objects using a variety of AR technologies. The authors identified
four distinct types of augmented reality: marker based, marker-less, projection based,
and superimposition based. Marker-based augmented reality, also referred as image
recognition, creates the output using a camera and a visual marker. Markers may consist
of a quick response (QR) code, a two-dimensional (2D) code, a paper-based trigger image,
or a physical object, provided that the camera can detect it. Marker-less augmented reality,
also termed location-based augmented reality, utilizes a global positioning system (GPS) to
provide location-based data. AR that relies on projection casts artificial light onto real-world
objects. It is employed to project a three-dimensional (3D) interactive hologram. Another
form is superimposition-based augmented reality, which replaces the original perspective
of an object with an enhanced one, either partially or entirely. AR is contrasted with virtual
reality (VR), another prominent immersion-based technology, in that digital information
is augmented in the real world. In contrast, VR immerses the individual in an entirely
virtual world.
Computers 2023, 12, 215 4 of 23

Due to the proliferation of user-friendly and cost-effective mobile applications, aug-

mented reality is also becoming more prevalent in education [37]. AR technology may be
utilized to create interactive learning environments for children with ASD and intellectual
development disability (IDD), allowing them to visualize complex topics and master a
range of complicated activities in a visual environment [33,38]. The camera of a mobile
device can be used to explore AR platforms while using AR. One can scan an image or
marker, for instance, to display and manipulate digital information in a three-dimensional
(3D) mode (e.g., a 3D visual of a cell will appear, which the user can touch or turn) or to
display detailed information on an object (e.g., additional reading, video, or audio compo-
nents will appear) [39]. AR technology has been determined to be an excellent instructional
technology platform for assisting children with a wide range of impairments to acquire a
variety of skills [40].

3. Methodology
3.1. Search Strategy and Data Sources
To perform this literature review, we sifted through seven scientific article databases:
IEEE Xplore Digital Library, ACM Digital Library, Science Direct, Scopus, PubMed, Sage,
and Web of Science. While analyzing these resources, we only considered documents
relevant to computer-related categories, such as technology, engineering, and computer
science, disallowing medical and chemical disciplines. In addition, we chose articles that
were published between January 2010 and November 2022, spanning thirteen years.

3.2. Search Strings

We devised the search strings based on the topics pertinent to our systematic literature
review. We selected a list of specific keywords, including “Autism Spectrum Disorder”,
“Augmented Reality”, “Inclusive Digital Technologies”, and “Smartphone” that would be
relevant in answering our study questions. These strings focused on finding studies that
studied or experimented with AR with ASD patients, taking into account user experience,
accessibility, and region of experimentation. In Table 1, we list the search strings employed
by the selected databases.

Table 1. Keywords.

Category 1 Category 2 Category 3

Autism Augmented Reality Mobile
Autism Spectrum Disorder AR Tablet
ASD Mobile Augmented Reality Smartphone
Autistic Augmented Toolkit
Autistic Children Inclusive Digital Technologies Smartglass

The search was conducted in order to match the following logical expression: Ti-
tle/Keywords/Abstract contains (“Autism” OR “Autism Spectrum Disorder” OR “ASD”
OR “Autistic” OR “Autistic Children”) AND (“Augmented Reality” OR “AR” OR “Mo-
bile Augmented Reality” OR “Augmented” OR “Inclusive Digital Technologies”) AND
(“Mobile” OR “Tablet” OR “Smartphone” OR “Toolkit” OR “Smartglass”).

3.3. Inclusion and Exclusion Criteria

We incorporated the requirements illustrated in Table 2 in order to address the research
queries based on the selected publications and gain a comprehensive understanding of the
designs we are dealing with.
Computers 2023, 12, 215 5 of 23

Table 2. Inclusion and Exclusion Criteria.

Inclusion Criteria Exclusion Criteria

Ex1: Studies with an exclusively medical focus
In1: Studies published between January 2010
or a focus on the diagnosis of autism
and November 2022, spanning the last ten years
spectrum disorder
Ex2: Not peer-reviewed (i.e., commentaries,
In2: Journal articles
letters to the editor, opinion articles, lectures)
In3: Studies with a focus on AR technology for Ex3: Studies that involve AR but do not
ASD patients include ASD exclusively
Ex4: Studies that take into account usability
In4: Studies related to the usage of technology and accessibility in contexts where technology
is not involved
In5: Authors reported intervention impact, Ex5: Descriptive case studies with no reported
generalization, or maintenance research design or participant outcome.
In6: Empirically based studies employing Ex6: Studies that do not directly attempt to aid
single-subject, qualitative, quantitative, individuals with autism spectrum disorder,
or mixed methodologies but rather their caregivers

3.4. Data Extraction

Using a systematic approach for data extraction, the whole text of each selected
article was thoroughly evaluated in order to extract key information. The data extraction
included the following domains: study design, study characteristics, method/algorithm
employed, significant findings, region of experimentation, and assessment methodology.
Table 3 illustrates the domains of each paper.

Table 3. Characteristics of Included Studies.

Functional No. of Partici- Groups Geographic Duration

No. Study Study Design Study Purpose Skills/Observed pants/Consent Location/
(Sex/Age) of AR
Improvements Taken Ethnicity
Assist children
with mild autism Learning/significant Mildly ASD
Design and in acquiring Total: 6 (M:5, 15–20 h
01. Hashim (2022) [41] improvements in children; age: Malaysia/Malaysian
development F:1)/yes in total
English learning 5–12 years
vocabulary
Evaluate
multiplayer
games with
dual-task
exercise
employing AR Social
Single skills/promising Total: 14
02. Nekar (2022) [42] group;pre- and a personal (M:11, ASD children; South 3 h in total
health record improvement in age: 6–16 Korea/Korean
test–post-test F:3)/yes
(PHR) system for social skills
autistic
children’s social
skills and
cognitive
function
Improve
Multiple
responding to
baseline joint attention Joint atten- Total: 6 (M:5, ASD children;
single-subject age: 3–8 years 30 min per
03. Perez (2022) [43] tion/moderate F:1)/did not Spain/Spanish
(RJA) skills such session
experimental engagement mention old
as gaze tracking
design and pointing
Analyze the
effectiveness of a
multi-component
intervention Living
Program Total: 4/did Did
04. Root (2022) [44] using AR and skills/moderate Age: 21 USA
evaluation not mention not mention
modified improvements
schema-based
instruction
(MSBI)
Computers 2023, 12, 215 6 of 23

Table 3. Cont.

Functional No. of Partici- Groups Geographic Duration

No. Study Study Design Study Purpose Skills/Observed pants/Consent Location/
(Sex/Age) of AR
Improvements Taken Ethnicity
Using support
modules,
dynamic video, Social interaction,
AR and AR in (key verbal/non-verbal 2 TD male 3
05. intervention communication, Total: 5 (M:4, ASD (2 male Did
Wang (2022) [45] partial video) China/Taiwanese
study facial emotion F:1)/yes and 1 female); not mention
KPV, enhance the recognition, mean age: 7
communication attention
of youngsters
with ASD.
Help children
with autism
Multiple recognize social ASD children;
Social reciprocal
baseline across Total: 3 (M:2, age: 7–9 years Did
06. Lee (2021) [28] greetings and skills/improvement Taiwan/Taiwanese
single-subjects F:1)/yes old (mean age not mention
body gestures so observed
design = 8.1 years)
they can respond
appropriately
Determine the
feasibility and
effectiveness of
VR gadget in Cognitive and Total: 1
Single-subject 40 min per
07. Luca (2021) [46] improving behavioral (M:1)/did not Male; age: 16 Italy/Italian
design session
cognitive and skills/indeterminate mention
behavioral skills
of an ASD-
affected boy
Interactive AR
coaching system,
CheerBrush, Living
Feasibility to improve the Total: 12/did (6 with ASD, 6 Did
08. Zheng (2021) [47] skills/improved USA/American
study not mention TD); 3–6 years not mention
tooth-brushing living skills
skills of children
with ASD
Employment of
alphabet letters
Pre-test–post- (48 with ASD,
09. and numbers in Learning/significant Did
Anto (2020) [48] test Total: 96/yes 48 TD); mean Brazil/Brazilian
AR environment improvement not mention
age
and its influence
on reaction time
Design a system
for ASD
rehabilitation Untrained
Arpaia (2020) combining AR Social interac- ASD/ADHD
10. Total: 3/Did Did
Case study smart glasses tion/significant children; Age: Italy/Italian
[49] not mention not mention
improvement
and SSVEP 8–10 years old
brain–computer
interface
To improve
interaction,
communication,
and emotional
intelligence in Social, emotional, Age: 9–11 years
Program elementary social interac- Did
11. Lopez (2020) [50] tion/satisfactory Total: 38/yes (mean = 10.42, Spain/Spanish
evaluation school students, not mention
SD = 0.59)
build a results
multiplayer
game using
marker-less
MAR.
A pre–post
experimental
Prototype,
pre–post research design
quasi- named BLS Education/significant Total: 4/did Not Did not
12. Kung (2019) [51] Malaysia/Malaysian
(Basic Living improvements not mention mentioned mention
experimental
design Skills)
E-courseware to
help in teaching
Feasibility study
of Empowered
Single-case Brain Face2Face
Social Fully-verbal
experimen- module, a social Total: 1 20 min daily
13. Sahin (2018) [52] skills/moderate ASD boy; age: USA/American
tal design communication (M:1)/Yes for 3 weeks
improvements 13 years
intervention
using smart
glasses
Computers 2023, 12, 215 7 of 23

Table 3. Cont.

Functional No. of Partici- Groups Geographic Duration

No. Study Study Design Study Purpose Skills/Observed pants/Consent Location/
(Sex/Age) of AR
Improvements Taken Ethnicity
Create
interactive
games that are
adjusted for a
child’s sensory
preferences and
level of challenge. Subjects with
Magrini (2019) Feasibility Children’s gross Social interaction, 45 min per
14. emotional intelli- Total: 10/yes ASD and Italy/Italian
[53] study and fine motor dyspraxia; age: session
gence/improved
capabilities, 6–10 years
imitation skills,
social interaction,
and personal
autonomy will
all be improved
by the prototype.
Using AR
applications to
enhance learning Acquisition of Total: 12 (M:6, (6 boys,
Within-subject Did
15. Singh (2019) [54] certain F:6)/Did not 6 girls); age: India/Indian
user study experiences for not mention
skills/indeterminate mention 9–12 years
less privileged
autistic children.
Design a
lightweight
AR-based mobile Study one: did Age: one
vocabulary study not mention;
16. Education/significant study two: under 5; Did
Tang (2019) [55] Pilot study application for China/Chinese
improvements another not mention
autistic children, five/did not 6–8 years
particularly for mention
outdoor and
home use
Empowered
Brain, an AR
smart glasses
tool for
behavioral and ASD
social individuals
Short-term, communication, Social (male to
17. Vahabzadeh Total: 8 (M:7, Did
uncontrolled was used to skills/significant female ratio of USA/American
(2018) [56] F:1)/yes not mention
pilot study assess improvements 7:1); mean age:
ADHD-related 15 years
symptom
changes in ASD
children and
adolescents.
Examine the use
of multimedia
PECS (Picture
Exchange
Communication
Kurniawan Program System)-based Social interac- Autistic
18. Total: 12/did Did
(2018) [57] AR as an tion/significant children Indonesia/Indonesian
evaluation not mention not mention
alternative improvements
learning tool for
autism children’s
communication
training
Design an AR
system using
leap motion
Syahputra (2018) Emotional intelli- N/A/did not
19. Pilot study controller to help N/A Indonesia/Indonesian N/A
[58] gence/indeterminate mention
train the focus of
autistic
individuals

Single-subject Improve ASD 5 boys and 1

children’ Social-emotional girl and Age:
20. with multiple reciprocity/ Total: 6 (M:5, Did
Chen (2016) [59] attention to 11–13 years; Taiwan/Taiwanese
baseline F:1)/yes not mention
nonverbal improved mean:
design social cues 11.53 years
Evaluate AR
Group- intervention in
teaching a chain Living Total: 3 Male with Did
21. Cihak (2016) [60] experimental USA/American
task to elementary skills/indeterminate (M:3)/Yes ASD not mention
design
students
with ASD
Computers 2023, 12, 215 8 of 23

Table 3. Cont.

Functional No. of Partici- Groups Geographic

No. Duration of
Study Study Design Study Purpose Skills/Observed pants/Consent (Sex/Age) Location/
AR
Improvements Taken Ethnicity
PECS method
implemented,
Quasi- and program
Hosseini (2016) experimental Communication Did not Did
22. was for training 6–11 years Iran/Iranian
[61] skills/indeterminate mention/N/A not mention
study and orientation
of objects of the
real world
Assess AR
intervention for
Multiple teaching science Three students
vocabulary to with ID
23. McMahon (2016) probes across Education/improved Total: 4 (M:1, Did
[62] navigation F:3)/yes and one with USA/American
behaviors college students ASD; age: not mention
design with intellectual 19–25 years
disabilities and
ASD.
Design an
interactive
method to Emotional
visualize intelligence using Total: 12 ASC; 10 male
24. Within-subject Did
Bai (2014) [22] pretense in an (M:10, and 2 female; UK/British
experiment games/significant not mention
F:2)/N/A 4–7
open-ended play improvement
environment
using AR
Help teachers
lessen the
burden and (7 teachers,
workload of 14 students);
Education/enables
Escobedo (2014) Deployment administering Total: 21/did age of Did
25. multitasking Mexico/Mexican
[63] study not mention students (3–7, not mention
therapies by abilities
m = 5.08,
allowing sd = 0.90)
children to use
tangible objects

4. Results
4.1. Data Selection
A summary of the selected articles is presented in Figure 1. It illustrates a PRISMA
diagram and eventually selected articles for the review after the primary selection. We
identified 4591 articles, out of which 501 were from IEEE Xplore, 1101 were from PubMed,
1120 were from Science Direct, 401 were from Web Science, 205 were from Scopus, 256 were
from ACM library, 152 were from SpringerLink, 348 were from Sage, and 507 were from
Google Scholar.
A total of 1084 duplicate papers were eliminated from the searches. The identified
articles underwent a manual screening process based on their title and abstract. Sub-
sequently, the articles were further screened based on their relevance in addressing the
research questions. Following this rigorous screening process, out of the initial 3507 articles,
only 25 articles met the inclusion criteria and were deemed suitable for further analysis in
this systematic review. The study examined and collated the essential data from eligible
studies, including the identity of the lead author, year of publication, characteristics of the
participants, study design, and region of the experiment.

4.2. Descriptive Characteristics of The Selected Studies

4.2.1. System Protocol Design
From the 25 studies reviewed, two studies [52,56] implemented empowered brain
integration Google Glass and Face2Face module and four studies [41,54,57,63] developed
their own android applications. The study [44] used a calculator app, HP Reveal, and AR
markers using HP reveal. A recent study [51] implemented augmented reality animation,
and some other studies [42,44,45,53,60] used different AR development applications such
as HP Reveal, Unity Vuforia, Kinect, AR Kit, MAKAR, and Aurasma. In [48], the authors
introduced a computer game named “MoviLetrando”. The authors in [55] proposed and
implemented deep learning models and simple, lightweight applications. Most of the
studies reviewed [44,51,57,60,64] used the camera of tablets and smartphones. Two of
the reviewed studies [52,56] used Google Glasses, whereas two other studies [45,54] used
Computers 2023, 12, 215 9 of 23

a computer monitor as the AR setup. Some other studies [41,44,45,54] used flashcards,
worksheets, picture cards, and Tangram puzzles in the learning process.

Figure 1. Flow chart of the study selection procedure.

4.2.2. Target Skills

A plurality of the studies (8 out of the 25) focused on improving social skills, particularly
social interaction and reciprocity. Meanwhile, three studies aimed to enhance daily living
skills such as teeth brushing, and two others centered on improving focus and attention;
illustrated in Figure 2. Three additional studies specifically addressed behavior modification.
Finally, a total of seven studies aimed to improve literacy and language skills, specifically by
increasing vocabulary.

Figure 2. Characterization of studies by target skills.

Computers 2023, 12, 215 10 of 23

4.2.3. Participant Characteristics

From the observation of Figure 3, Most of the studies included in this analysis involved
participants whose ages ranged from 6 to 20 years old. Among all studies, 10 studies had
a mean age between 6 and 9 years, and seven studies had a mean age between 10 and
20 years. Only three studies had a mean age below 5 years, and two studies had a mean
age above 20 years old. Geographical location of the studies were also taken in account to
illustrate the regions where the studies took place, it can been in Figure 4. Table 4 represents
the assessment in which the characteristics of the studies were performed. This focuses on
the inclusion criteria and the possible covariates of the selected studies.

Figure 3. Participants Characteristics.

4.2.4. Region of Experimentation

A plurality of the studies included were performed in the United States (n = 6). Other
studies were conducted in the UK, Iran, Malaysia, Indonesia, Mexico, and India.

Figure 4. Region of Experimentation.

Computers 2023, 12, 215 11 of 23

Table 4. Assessment Characteristics of Included Studies.

No. Study Assessment of Inclusion Criteria Possible Covariates

01. Hashim (2022) [41] N/A N/A
(1) Having been diagnosed with autism, (2) the
ability to see, hear, and understand basic
02. Nekar (2022) [42] instructions, (3) the ability to read and N/A
understand Korean (the main language used in
the game contents)
03. Perez (2022) [43] N/A N/A
(1) Educational or medical classification of ASD,
(2) enrolled in a public school transition program,
04. Root (2022) [44] N/A
(3) researcher observation of prerequisite skills
via screening tool.
05. Wang (2022) [45] N/A N/A
(1) A clinical diagnosis of ASD based on
DSM-IV-TR criteria, (2) no other specific
disabilities, (3) not taking medications for
06. Lee (2021) [28] physician or self-diagnosed illnesses, (4) no N/A
physician-diagnosed comorbidities, (5) not
undergoing any other therapies at the time of the
testing, (6) an FIQ > 90.
07. Luca (2021) [46] N/A N/A
(1) Height of at least 3 feet for successful Kinect
recognition; (2) age 3–6 years; and, for children
08. Zheng (2021) [47] N/A
with ASD, (3) a documented diagnosis of ASD by
a licensed clinical provider
09. Anto (2020) [48] N/A N/A
10. Arpaia (2020) [49] N/A N/A
H0h-P2Obs1-Sustaining mutual understanding,
H0i-P2Obs2-Dialogue management,
H0j-P2Obs3-Information pooling,
11. H0k-P2Obs4-Reaching consensus,
Lopez (2020) [50] N/A
H0l-P2Obs5-Task division, H0m-P2Obs6-Time
management, H0n-P2Obs7-Technical
coordination, H0o-P2Obs8-Reciprocal interaction,
H0p-P2Obs9-Individual task orientation.
Basic Living Skills (BLS) e-courseware prototypes
12. Kung (2019) [51] N/A (Augmented Reality Animation) and Basic Living
Skills (Static graphic)
13. Sahin (2018) [52] N/A N/A
14. Magrini (2019) [53] N/A N/A
Training Time, solve time, correct placements,
15. Singh (2019) [54] N/A
subjective questionnaire.
16. Tang (2019) [55] N/A N/A
17. Vahabzadeh (2018) [56] N/A N/A
18. Kurniawan (2018) [57] N/A N/A
19. Syahputra (2018) [58] N/A N/A
(1) A clinical diagnosis of ASD based on
DSM-IV-TR criteria, (2) not undergoing any other
20. Chen (2016) [59] N/A
therapies/medication at the time of the testing,
(3) no other disabilities, (4) an FIQ > 90.
21. Cihak (2016) [60] N/A N/A
22. Hosseini (2016) [61] N/A N/A
23. McMahon (2016) [62] N/A N/A
24. Bai (2014) [22] N/A N/A
25. Escobedo (2014) [63] N/A N/A
Computers 2023, 12, 215 12 of 23

4.2.5. Quality Assessment of the Articles

The quality assessment of the included 25 papers was performed using Critical Assess-
ment of Structure Prediction (CASP) [65]. The CASP checklist has 10 questions divided in
three sections: Section A, B, and C. Tables 5 and 6 illustrates the CASP. Furthermore, Table 7
cumulatively illustrates the key features of the included studies. It shows the software and
hardware that are used also the assessment method followed by the authors. The following
questions of the sections have assisted in assessing the quality of the papers

Table 5. Quality Assessment Using CASP-Section A.

Do You Think All the Did the Paper’s If the Results of the
Did the Paper Did the Authors Look
Important, Relevant Authors Do Enough Paper Have Been
No. Study Address a Clearly for the Right Type
Studies Were to Assess Quality of Combined, Was It
Focused Question? of Papers?
Included? the Included Studies? Reasonable to Do So?
01. Hashim (2022) [41] Yes Yes Yes Yes Yes
02. Nekar (2022) [42] Yes Yes No Indeterminate Yes
03. Perez (2022) [43] Yes Yes Yes Yes Yes
04. Root (2022) [44] Yes Yes Yes Yes Yes
05. Wang (2022) [45] Yes Yes Yes Yes Yes
06. Lee (2021) [28] Yes Yes Yes Yes Yes
07. Luca (2021) [46] Yes Yes No Yes Yes
08. Zheng (2021) [47] Yes Yes Yes Yes Yes
09. Anto (2020) [48] Yes Yes Yes Yes Yes
10. Arpaia(2020) [49] Yes Yes Yes Yes Yes
11. Lopez (2020) [50] Yes Yes Yes Yes Yes
12. Kung (2019) [51] Yes Yes Yes Yes Yes
13. Sahin (2018) [52] Yes Yes Yes Yes Yes
14. Magrini (2019) [53] Yes Yes Yes Yes Yes
15. Singh (2019) [54] Yes Yes Yes Yes Yes
16. Tang(2019) [55] Yes Yes No Indeterminate Indeterminate
17. Vahabzadeh (2018) [56] Yes Yes Yes Yes Yes
18. Kurniawan (2018) [57] Yes No No Yes Indeterminate
19. Syahputra (2018) [58] No No No Indeterminate Indeterminate
20. Chen (2016) [59] No Yes Yes Yes Yes
21. Cihak (2016) [60] Yes Yes Yes Yes Yes
22. Hosseini (2016) [61] Yes Yes Yes Yes Yes
23. McMahon (2016) [62] Yes Yes Yes Yes Yes
24. Bai (2014) [22] Yes Yes Yes Yes Yes
25. Escobedo (2014) [63] Yes Yes No No No

Table 6. Quality Assessment Using CASP-Section A and B.

Can the Results Be Were All Important Are the Benefits

What Are the Overall How Precise Are the
No. Study Applied to the Local Outcomes Worth the Harms and
Results of the Paper? Results?
Population? Considered? Costs?
Did not mention
01. Hashim (2022) [41] Did not mention Indeterminate Indeterminate Indeterminate
clearly
Despite no statistically
significant result in
social communication
and restricted
interests and
02. Nekar (2022) [42] p < 0.05 Yes Yes Yes
repetitive behavior,
a decrease in the mean
was observed when
compared to the
baseline data.
Computers 2023, 12, 215 13 of 23

Table 6. Cont.

Were All
What Are the Can the Results Be Are the Benefits
How Precise Are Important
No. Study Overall Results of Applied to the Worth the Harms
the Results? Outcomes
the Paper? Local Population? and Costs?
Considered?
An overall PAND of
98% was obtained
for v2 and an
overall PAND of
96% was measured
for v3. This shows
that the
intervention was
03. Perez (2022) [43] p < 0.01 Indeterminate Yes Yes
highly effective
(PAND > 90%) for
enhancing the
abilities of gaze
following and
pointing to the
target object in six
autistic children.
The combination of
MSBI and
video-based
instruction
delivered via AR
helped four adult
04. Root (2022) [44] Did Not Mention Yes Yes Yes
students with ASD
improve in their
ability to solve
percentage of
change problems
(i.e., tip)
ASD improved
from baseline 1 at
83% when using the
05. Wang (2022) [45] p < 0.05 Indeterminate Yes Indeterminate
AOM to 98% at
intervention 2 when
using KPV with AR
Baseline mean:
06. Lee (2021) [28] p < 0.05 Yes Yes Yes
19.16%
Significant increase
07. Luca (2021) [46] in attention Did not mention Indeterminate Indeterminate Yes
processes
The HR and SCL
differences of ASD
group reached and
08. Zheng (2021) [47] ASD Baseline: 98.89 was near Indeterminate Yes Yes
statistically
significant,
respectively
ASD Total Points:
09. Anto (2020) [48] p < 0.05 Indeterminate Yes Yes
54.5
Positive feedback
on the device
acceptance and
attentional
performance were
10. Arpaia (2020) [49] offered after tests Did not mention Yes Yes Yes
on three ASD
patients (with three
different CGI
scores) between 8
and 10 years
Computers 2023, 12, 215 14 of 23

Table 6. Cont.

Were All
What Are the Can the Results Be Are the Benefits
How Precise Are Important
No. Study Overall Results of Applied to the Worth the Harms
the Results? Outcomes
the Paper? Local Population? and Costs?
Considered?
A total of 95% of the
children participated
11. Lopez (2020) [50] actively in the search p < 0.05 Yes Yes Yes
for the solution to
end the game
Improvement in
12. Kung (2019) [51] academic Did not mention Yes Indeterminate Yes
performance
SRS measure
13. Sahin (2018) [52] baseline raw Did not mention Yes Yes Yes
score: 92
Children embraced
experiments,
14. Magrini (2019) [53] showing improved Did not mention Yes Indeterminate Yes
attention, and
response times
More training time
compared to
15. Singh (2019) [54] Did not mention Yes Indeterminate Yes
desktop and
in-person
Did not mention
16. Tang (2019) [55] N/A Indeterminate Indeterminate Indeterminate
clearly
Vahabzadeh (2018)
17. Baseline mean: 5.5 Did not mention Yes Yes Yes
[56]
The increase
achieved an
Kurniawan (2018) average of 76% in
18. Did not mention Yes Yes Yes
[57] the communication
skills of children
before treatment.
With an average
percentage of 83%
on a Likert scale,
Syahputra (2018)
19. respondents Did not mention Indeterminate Indeterminate Indeterminate
[58]
strongly agree that
the app can train
the child’s focus.
baseline range:
20. Chen (2016) [59] Yes No Yes Yes
86.66–94.28%
Students’
independent
performance
immediate
21. Cihak (2016) [60] increased when Did not mention Indeterminate Indeterminate Yes
augmented reality
was introduced
with 98% non-
overlapping data.
Data obtained
results using
22. Hosseini (2016) [61] p < 0.05 Yes Yes Yes
Wilcoxon test
of 0.007
Computers 2023, 12, 215 15 of 23

Table 6. Cont.

Were All
What Are the Can the Results Be Are the Benefits
How Precise Are Important
No. Study Overall Results of Applied to the Worth the Harms
the Results? Outcomes
the Paper? Local Population? and Costs?
Considered?
Baseline scores on
the vocabulary
assessments for the
students indicated
McMahon (2016) that the students
23. Did not mention Yes No Yes
[62] had very low initial
knowledge of the
science vocabulary
words across the
three-word lists
Did not mention
24. Bai (2014) [22] Did not mention Indeterminate Indeterminate Indeterminate
clearly
Mobile Object
Identification
System helped
Escobedo (2014)
25. teachers to attend to Did not mention Yes No Yes
[63]
multiple students
(n > 1) during the
therapy

Table 7. System Protocol Design.

Method Fol- Survey

No. Study Software Hardware Setting Phase Duration lowed/Feedback Questions
Method Availability
Smartphone Kohan Cappa
Flashcards Five 30 to
01. Hashim (2022) application, containing Home and 40 min 5 weeks Analysis/ Yes
[41] called Classroom sessions interviews and
words
‘AReal-Vocab’ field notes
3 Wilcoxon
Baseline, signed-rank
intervention, test/System
02. Nekar (2022) Kinect Tablet Local social post- Three weeks Yes
[42] welfare center intervention Usability Scale
Survey (SUS)-based
survey
Social Com-
munication
Questionnaire,
Pre-baseline Leiter
LCD Projector, phase, pre- International
Interactive assessments, Performance
Digital baseline phase, Scale, Autism
Whiteboard, learning phase, Diagnostic
03. Perez (2022) Pictogram School intervention Yes
Room Computer, 12 Weeks Observation
[43] classroom phase, post-
Kinect, Schedule
and Samsung intervention Second
SCC-301P phase, post- Edition
Video camera assessments, (ADOS-2),
follow-up Early Social
assessments Communica-
tion Scales
(ESCS)/N/A
Calculator
application, Classroom, Baseline,
Campus coffee intervention,
04. Root (2022) HP Reveal, Worksheet generalization, N/A N/A No
[44] and First-Then and iPod and snack
Visual shop and
Schedule HD maintenance
Computers 2023, 12, 215 16 of 23

Table 7. Cont.

Method Fol- Survey

No. Study Software Hardware Setting Phase Duration lowed/Feedback Questions
Method Availability
Two phases:
the first phase
comprises the
Teacher- A1 baseline
Paper-based and B1
HP Reveal, selected
Wang (2022) picture cards, computer treatment
05. Unity Vuforia, 4 Months t-test/N/A No
[45] AR Kit, vocabulary classrooms in periods,
MAKAR, KPV textbooks, elementary and the second
tablet schools phase includes
the C1 reversal
and B2
treatment
periods

Baseline, Kolmogorov–
06. Lee (2021) [28] KST System Computer Classroom Intervention, 6 weeks Smirnov test, No
Maintenance Likert
scale/Verbal
Raven’s
Matrices test,
Two different Modified
trainings: CBT Little Bell Test,
according to developmental
Luca (2021) Medical standardized test of
07. N/A Device named Clinic approach, CBT One month visual–motor No
[46] BTS-N in a VR integration,
environment Gilliam
(Total 48 Autism Rating
sessions)
Scale/
Questionnaire
Mechatronic
toothbrush Baseline,
Zheng (2021) pre-test, p-values/
08. and Microsoft Yes
Virtual Avatar Kinect V2
N/A N/A Questionnaire,
[47] coaching, Likert Scale
Camera and post-test
Sensor, E4
Mann–Whitney
Computer U test,
Anto (2020) game Laptop Pre-test, Wilcoxon
09. computer Classroom post-test N/A No
[48] signed-rank
MoviLetrando
test/N/A
A SSVEP-
Arpaia (2020) based single- Social
10. Smart glasses N/A N/A N/A No
[49] interaction
channel BCI
Lopez (2020) EmoFindAR Gender: did Questionnaire/
11. Smartphone Classroom N/A Yes
[50] application not mention N/A
Kung (2019) Smartphone Smartphone Pre-test and N/A/
12. Classroom N/A No
[51] application and flashcards post-test Questionnaire
N/A/Social
Empowered Responsive-
Shanin (2018) Brain N/A Baseline ness Scale2
13. N/A Classroom and 2 weeks No
[52] Face2Face intervention (SRS-2)
module school-age
form
Four phases:
repeat the
movements,
Magrini (2019) Computer, guess the Time and score
14. Kinect SDK Sensor N/A 6 weeks for each No
[53] movements,
connect the exercise/verbal
dots and guess
the card
Tangram Time required
Puzzle and to solve a
Singh (2019) Desktop-based Desktop Training and
15. Classroom N/A Tangram Yes
[54] Application Testing
Computer and puzzle/
Webcam Questionnaire
Deep learning
platform, Special
Tang (2019) TensorFlow education
16. and simple N/A school and N/A N/A No/verbal No
[55] university
lightweight
mobile campus
application
Computers 2023, 12, 215 17 of 23

Table 7. Cont.

Method Fol- Survey

No. Study Software Hardware Setting Phase Duration lowed/Feedback Questions
Method Availability
Baseline, Qualitative,
17. Kurniawan Mobile Intervention visual analy- No
(2018) [57] application Smartphone Classroom after 24 and N/A
48 h sis/interview

Baseline, Social Com-

Vahabzadeh Empowered Intervention munication
18. Google Glass N/A 48 h Questionnaire No
(2018) [56] Brain System after 24 and (SCQ),
48 h ABC-H/N/A

Syahputra Leap Motion Camera, 3D

19. object marker, N/A N/A N/A Detection/ No
(2018) [58] Controller Computer Questionnaire

Tablet and No/

AR-based Baseline, questionnaires
20. Chen (2016) Application video School intervention, 4 weeks No
[59] and interviews
modeling maintenance after each
storybook phase

Hosseini Mobile Wilcoxon test

21. (2016) [61] Smartphone School N/A N/A for data collec- No
application tion/N/A
Webcam,
Bluetooth
keyboard,
and play
materials
consisting of
AR items
(three foam
blocks and a
box with CARS2,
connected BPVS3, play
22. Bai (2014) [22] Goblin XNA markers) and Home N/A N/A frequency, No
non-AR play time/
physical props questionnaire
(three cotton
balls, two
paper tubes,
three popsicle
sticks, three
pen tops, three
strings and a
piece of cloth)
Baseline,
iPod, pretraining, Likert scale,
Cihak (2016) AR percentage of
23. application toothbrush, Classroom AR 9 weeks No
[60] paper cup intervention, steps/no
maintenance
Number of
vocabulary
McMahon Mobile app Computer lab Baseline, items defined
24. Book in a university training, N/A and labeled Yes
(2016) [62] Aurasma
campus intervention correctly/
Likert-type
survey
Pre-
deployment Weekly
(2 weeks), interview; LSA
Escobedo MOBIS, an AR Specialized deployment and
25. application Smartphone (5 weeks), 8 weeks No
(2014) [63] clinic ANOVA/group
and post- interview,
deployment survey
(1 week)

5. Discussion
This systematic literature review explores the potential of establishing a standard
protocol in the field of technology to benefit children with autism spectrum disorder
(ASD). The review analyzed twenty-five articles, published between 2010 and 2022, re-
trieved from various reputable databases. Participants’ ages ranged from 6 to 20 years old.
However, three studies [51,57,58] did not mention the age of the participants. The find-
ings emphasized the importance of having a standard protocol for data collection and
Computers 2023, 12, 215 18 of 23

the development of augmented reality (AR) technology tailored for children with ASD.
Currently, AR researchers are creating impressive prototypes [18,21,28,48,51], but their im-
plementation is hindered by a lack of communication between caregivers and developers.
A crucial step towards progress involves fostering effective two-way communication be-
tween the researchers and the caregivers. Furthermore, government policy makers should
actively engage in this field to support and empower children with ASD and their parents.
The widespread adoption of this technology will heavily rely on the intervention and support
of the government. Another objective of this review was to evaluate and summarize research
that dealt with the efficacy of using AR programs in treating children and adolescents with
ASD. Social skills, emotion recognition, daily living skills (brushing, finance, etc.), verbal and
non-verbal communication, and learning can be distinguished as distinct areas of intervention
when considering the capabilities of augmented reality technologies.
Social skills, the most obvious deficiency in children with ASD, were given the most
attention in the examined AR study. Using a blend of real-world and virtual elements to
replicate social environments allows for the training to occur in a safe, regulated, and cus-
tomizable environment. For ASD treatment, the characteristics of this kind of intervention
are particularly intriguing. In these articles, improvements in social–emotional reciprocity
and emotional intelligence [28,47,50,53,59] were significantly observed. It is important to
highlight that among the 25 selected papers, 18 of them documented notable enhancements
in social-emotional reciprocity and emotional intelligence. In Table 3, we have illustrated
the study purpose of each study and its outcome. Additionally, these approaches assist
in the development of important social abilities such as initiation of play, social response,
and facial expression perception. The studies [26,28] found that AR systems can positively
improve understanding of social greeting behavior and learning appropriate responses to
greetings. A few other studies [22,42] evaluated the feasibility of game content to assist
autistic children with their social and emotional development. Other studies have been
based on areas related to training in activities of daily living skills, teaching language,
education and improving attention to individuals with ASD. Studies [41,48,51,55,62,63],
demonstrate that using augmented reality can offer adjustable learning environments
including videos, 3D images, and animation where people with special needs can engage in
more fulfilling interaction activities. Children and adolescents with ASD could learn basic
human skills such as tooth brushing and financial skills through AR intervention [44,47].
The majority of the included research suggests that children with ASD benefit from
exposure to AR-based interventions. However, the majority of research utilized small
sample sizes. Two studies [46,52] only comprised a single subject. Fourteen of the twenty-
five studies had individuals under the age of ten. One study cited as [58] missed the
number of participants. There was rarely any kind of comparison to either a group of
healthy volunteers or patients who were receiving conventional therapies. If the control
group does not exhibit the similar features or the same questionnaires are provided at
distinct points in the intervention procedure, comparing the changes produced by an AR
intervention could be challenging. Considering this, some of the findings from the research
included in this study might be regarded as preliminary and having limited practical utility.
Due to the limited sample size and lack of a control group, extending the results to the
entire population impacted by this disorder is challenging. Another factor that makes it
difficult to generalize the results is the sample’s gender ratio. It is established that ASD
affects boys more frequently than girls (the most recent research indicates a 4:1 ratio [2]);
however, certain studies [46,52,60] are conducted exclusively with affected boys, which
may limit the validity of the conclusions. Lastly, it should be mentioned that some research
was conducted on children labeled with high-functioning autism or Asperger syndrome.
Consequently, only results from this sub-sample should be evaluated, as they cannot be
generalized to the remaining children with ASD.
One of the primary benefits of augmented reality is that it enables the simulation of
real-world circumstances so that training may be undertaken in a safe, therapist-controlled
environment. This issue is particularly intriguing when treatment should concentrate on
Computers 2023, 12, 215 19 of 23

the training and enhancement of social skills, social interaction, communication, emotional
reaction, and executive functions. In addition, this intervention style can be further ex-
tended to acquire various subject performance measures. This enables therapists to monitor
and analyze the patient’s progress and to apply feedback or possible task repetitions. Con-
sequently, an intervention based on technology may incorporate multi-user apps in playful
environments or everyday scenarios, which could be regulated and customized based on
the intervention’s goals. Despite the numerous potential benefits of augmented reality, it is
recommended that practitioners do cost–benefit analyses to see whether there is a benefit to
facilitating the specific interventions or intervention components under consideration with
augmented reality. Notably, the majority of the research included in this evaluation still
relied on the therapist to prompt or correct errors. This prompts the question of whether
the integration of AR would lead to more effective and efficient therapies. It is also likely
that there exist low-tech alternatives that achieve the same effects as augmented reality.
Therefore, it would be useful to identify the qualities of the individuals for which AR
technologies are most beneficial (e.g., cognitive ability, physical ability, etc.).
In accordance with the WHO Ethics Review Committee (ERC), when proposing
research with human participants, an Informed Consent Form (ICF) must be included
with each proposal to establish that the study participant has chosen to participate in the
research voluntarily. If the research involves more than one group of participants, such as
healthcare users and healthcare professionals, a separate, individualized informed consent
form must be supplied for each group. This guarantees that each participant group receives
the necessary information to make an informed decision. Each new intervention requires a
different informed consent form for the same reason. Twelve of the research explicitly state
that written agreement was obtained from the participants. However, in the other thirteen
investigations, there was no statement of a signed consent form. In research initiatives,
evaluation methods are also a major concern. Both survey research and qualitative research
rely on human participation and require well-trained observers to ensure accurate and
reliable results. Without proper training, the error rate can increase, and the usefulness and
reliability of the measurement can decrease. To avoid the introduction of human errors,
researchers should implement a comprehensive training program for observers prior to the
intervention. This training should cover all aspects of the research process, including data
collection and analysis, to ensure that observers are equipped with the necessary knowledge
and skills to carry out their tasks accurately. Additionally, researchers can minimize the risk
of human errors by conducting numerous calculations of the data or by using computer-
assisted data gathering techniques. These methods can help to streamline the data collection
process and reduce the potential for human error. In addition, the majority of research did
not employ a particular method for evaluating the efficacy of AR interventions. Several
studies [22,26,28,41–43,45,48,56,61,64] used a variety of established methods, including the
Mann–Whitney U Test, Wilcoxon signed-rank Test, Social Communication Questionnaire
(SCQ), ABC-H, CARS2, BPVS3, LSA, and ANOVA. Some research gathered input from
participants, parents, or teachers through survey questionnaires, whereas others employed
verbal feedback. A few other studies did not mention any such feedback method. Only
four studies disclosed their questionnaire form in the papers.
Based on the reviews of selected articles, it is evident that future research in the field
of AR for individuals with ASD should pay closer attention to comparing the various AR
technologies employed because AR encompasses a wide range of technologies, some of
which may potentially have compatibility issues, particularly concerning user immersion.
Therefore, it is advisable that the researchers should shed light on AR technologies on their
relative effectiveness, usability, and potential limitations.
Most of the studies included in this review were conducted in developed countries
(United Nations Development Programme). Out of 25 studies, a total of 15 studies were
conducted in the developed countries. Augmented reality (AR) technology has the potential
to bring many benefits to both developed and developing countries; however, there are
some limitations to consider [66]. In many developing countries, access to technology,
Computers 2023, 12, 215 20 of 23

including smartphones and tablets, is limited. This can make it difficult for people to access
and use AR applications. Internet connectivity in many developing countries is also limited,
which can make it difficult for people to access and use AR applications that require a
stable internet connection. Apart from that, in some areas, electricity is not available or
is not reliable, which can make it difficult to use devices that require electricity, such as
smartphones and tablets. Another limitation is that many AR applications are developed
primarily in English, which can make them difficult to use for people in developing
countries who speak other languages. Additionally, developing countries often have
limited financial resources, which can make it difficult for people to afford to purchase
technology such as smartphones and tablets, or to pay for internet connectivity. Finally,
many developing countries may not have the necessary infrastructure or regulations to
ensure the privacy and security of data collected or stored by AR applications. It is
important to note that although there are limitations, researchers and practitioners are
working to overcome these challenges and make AR technology more accessible and
effective in developing countries.
Although this review has summarized and evaluated various studies, it is crucial to
acknowledge that the effectiveness of interventions can vary widely from person to person.
This individual variation presents a significant challenge when attempting to extrapolate
data from individual studies to the entire ASD population. Therefore, it is important to
provide emphasize the need for personalized, client-centered approaches in the treatment
and support of individuals with ASD. This approach may lead to a better understanding
of ASD as a spectrum and promote interventions aimed at enhancing the well-being and
development of individuals with ASD.

6. Conclusions and Future Work

ASD, from its identification to its treatment, is a complicated condition; it does not
appear in the same way in all children; its severity can be low, moderate, or severe;
and according to many authors, it is a disorder with no cure and a lifetime duration.
Because ASD manifests itself in children in a variety of ways and degrees, making them
receptive to various stimuli, it seeks alternatives to the same behavior or reaction to the
same stimulus. As a result, other particular areas must be targeted to strengthen their
relationship with their environment. This study shows how effective AR intervention is at
minimizing ASD-related deficiencies. The substantial effectiveness observed for activities
of daily living could justify the use of AR therapies in clinical practice. For future research,
the selection of participants, the type and duration of the intervention, and the choice of
a measurement tool should incorporate more controlled features, and more effort should
be devoted to follow-up assessments conducted weeks or months after the termination
of the intervention to ensure that the effects of training are maintained. In our search,
only peer-reviewed articles were included to eliminate a number of possibly relevant gray
literature articles and conference papers. However, as our goal is to provide researchers
and practitioners with constructive advice, it is essential to examine the quality of the
studies. Future studies should aim to use the relevant study designs and procedures to
close the gaps in the quality criteria. Heterogeneity of symptoms, individualized demands,
and contextual circumstances are some critical features that are likely to be defined in
future studies on autism. Furthermore, discussed as crucial AR features are multi-sensory
integration, customization and flexibility, social interaction facilitation, generalization and
transferability, and immersive and interactive experiences.

Author Contributions: Conceptualization, A.B.M.S.U.D. and M.R.; methodology, A.B.M.S.U.D.;

software, F.A.A.; validation, F.S., N.R., M.A.U. and K.A.M.; formal analysis, A.B.M.S.U.D. and
F.A.A.; investigation, A.B.M.S.U.D. and M.R.; resources, A.B.M.S.U.D.; data curation, A.B.M.S.U.D.
and F.A.A.; writing—original draft preparation, A.B.M.S.U.D.; writing—review and editing, F.A.A.;
visualization, F.A.A.; supervision, A.B.M.S.U.D. and M.R.; project administration, N.R., M.A.U. and
K.A.M.; funding acquisition, F.S., N.R., M.A.U. and K.A.M. All authors have read and agreed to the
published version of the manuscript.
Computers 2023, 12, 215 21 of 23

Funding: This work was supported by Institute for Advanced Research (IAR) of United Interna-
tional University (UIU) in collaboration with Office of Faculty Research, University of Liberal Arts
Bangladesh (ULAB) under Grant UIU-IAR-01-2022-SE-34.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

Abbreviations
The following abbreviations are used in this manuscript:

AR Augmented Reality
ASD Autism Spectrum Disorder
GPS Global Positioning System
HCI Human-Computer Interaction
ICTs Information and Communication Technologies
IoT Internet of Things
MAR Mobile Augmented Reality
SLR Systematic Literature Review
SUS System Usability Scale
PHR Personal Health Record
TBI Technology-based Intervention
VM Video Modeling
VR Virtual Reality

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