Exploring the Combination of Serious Games, Social Interactions, and Virtual Reality in Adolescents with ASD: A Scoping Review

Abstract

Autism spectrum disorder (ASD) often presents significant challenges for adolescents in developing social interaction skills. Emerging technologies such as Serious Games (SGs) and Virtual Reality (VR) offer promising solutions by providing immersive, interactive learning environments. This scoping review evaluates the potential of VR-based SGs to enhance social skills in adolescents with ASD by identifying current applications, benefits, limitations, and research gaps. A systematic search of the literature was conducted on Scopus, focusing on empirical studies published between 2013 and 2024. Studies were included based on their relevance to the use of SGs and VR in promoting social interactions in children and adolescents with ASD. The review highlights that VR-based SGs can effectively support the development of social skills, such as communication and collaboration, by providing structured, safe environments for children and adolescents to practice and refine their abilities. However, challenges remain, including the high cost of VR equipment, the need for greater customization, and the limited scope of long-term efficacy studies. While VR-based SGs show considerable promise, further research is needed to explore their long-term impacts and improve accessibility. Addressing these challenges could solidify VR’s role in ASD interventions, enhancing social skill development and improving the quality of life for children and adolescents with ASD.

1. Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental condition that negatively impacts how individuals communicate, interact socially, and behave [1]. For children and adolescents with ASD, these challenges can make participating in everyday social settings—like school or group activities—particularly difficult. This limitation can reduce their opportunities for social interactions during a key period when social skills are typically developing, potentially affecting their confidence and relationships [2].

Recognizing these unique challenges, researchers and clinicians are increasingly exploring tech-driven methods to help children and adolescents with ASD build essential social skills [3]. One promising approach involves using Serious Games (SGs) and Virtual Reality (VR) [4]. SGs are not just for entertainment; they are designed with specific educational or therapeutic goals in mind. When paired with VR, SGs create an engaging, immersive space where children and adolescents with ASD can practice social skills [5].

VR offers realistic simulations of social situations, allowing users to explore and learn without the pressures of real-life interactions. This can be especially beneficial because VR environments are adaptable to each person’s learning pace and style, offering support in ways traditional therapies may not. By combining SGs with VR, children and adolescents with ASD may have new opportunities to develop confidence and practice skills in a safe, flexible environment, tailored to their needs [6].

SGs are more than regular games; they are structured to teach real-world skills, letting players practice scenarios they might encounter in daily life. When SGs are combined with VR, they become an even more powerful tool. VR brings these scenarios to life, creating fully immersive social situations that might otherwise feel intimidating. For children and adolescents with ASD, this pairing offers a judgement-free space to practice interactions. They can try out these exercises at their own speed, receiving personalized support that matches their learning needs. This approach can make social learning both more accessible and effective, building skills and confidence they can bring into the real world [7].

Research on ASD has long indicated that individuals with ASD face challenges in social interaction and communication, which are crucial for daily life and relationship building. Traditional interventions—such as behavioral therapy, social stories, and role-playing exercises—have proven beneficial in supporting social skill development, yet they often lack the immersive, interactive qualities that can boost engagement, especially among children and adolescents [8].

The rationale for focusing on VR-based SGs for social skill training in children and adolescents with ASD lies in their ability to offer highly immersive and customizable environments that mimic real-world interactions, while reducing the anxiety associated with unpredictable social settings. These tools provide safe spaces for children and adolescents to practice essential skills such as empathy, turn-taking, and non-verbal communication, facilitating a gradual and supported learning process. Moreover, VR-based SGs align with the structured and repetitive learning style that benefits many individuals with ASD, making them uniquely suited to address the specific social challenges faced by this population.

This scoping review contributes to scholarly knowledge by addressing a key research gap: although prior reviews have examined the general use of SGs and VR in ASD interventions, few have specifically focused on their role in enhancing social skills for adolescents. This paper seeks to bridge that gap by offering a comprehensive analysis of the applications, benefits, and limitations of these tools in this specific context.

The research questions guiding this study are as follows: (i) How have SGs and VR been used to promote social skills in adolescents with ASD? (ii) What are the main benefits and limitations of these technologies in this area? (iii) What gaps exist in the current literature, and how can future research address them?

SGs and VR have emerged as promising tools to enhance social skills training for children and adolescents with ASD. SGs incorporate repetitive, goal-oriented tasks, which align well with the structured learning style that benefits many individuals with ASD. Studies show that SGs can create safe, controlled environments where users can practice social interactions, offering scenarios that are customizable and adaptable to individual needs. When combined with VR technology, SGs have shown even greater potential by leveraging the immersive, sensory-rich qualities of VR to simulate real-world interactions [9,10]. VR allows children and adolescents with ASD to engage in complex social situations in a low-risk environment, which can reduce social anxiety and facilitate learning through practice. Initial studies reveal that VR-based SGs can foster essential social skills, such as turn-taking, empathy, and non-verbal communication, by providing multisensory cues and realistic feedback that help reinforce learned behaviors.

This paper contributes to the existing literature by conducting a comprehensive review of SGs and VR interventions focused on enhancing social interactions among children and adolescents with ASD. It maps current applications, evaluates their effectiveness, identifies challenges, and highlights research gaps—specifically, the need for more longitudinal studies and the increased accessibility of VR technology [11].

This work provides a foundation for future research and practical recommendations for integrating VR-based SGs into social skills training programs for children and adolescents with ASD. This scoping review explores how combining SGs and VR may support social skill development in children and adolescents with ASD. By systematically analyzing current research, this paper aims to understand how these technologies can enhance communication, social interaction, and collaboration. It also examines both the benefits and limitations of these tools, as well as identifying gaps in the research. Ultimately, this overview aims to show how SGs and VR can be better utilized to support children and adolescents with ASD. With a clearer understanding of what works and what does not, this article hopes to make social skill-building tools more accessible and impactful for young people with ASD. The insights from this review could guide even more effective interventions in the future [12].

2. Background

Over the past decade, research on the use of digital technologies to support interventions for ASD has grown substantially. Traditional interventions, while effective for some, often fail to fully engage individuals with ASD due to their lack of interactivity and adaptability. This has led researchers to explore more innovative approaches, such as SGs and VR, which offer engaging, immersive environments tailored to the unique needs of individuals with ASD.

Prior studies have highlighted the potential of VR and SGs to foster social skill development in individuals with ASD. Bellani et al. (2011) [13] and Parsons and Cobb (2011) [14] provided early overviews of VR technologies, emphasizing their capacity to simulate real-world scenarios in safe, controlled environments. These foundational works underscored the importance of VR for enhancing social interactions and reducing anxiety in social settings.

More recently, Mesa-Gresa et al. (2018) [11] and Zhang et al. (2022) [15] systematically reviewed the effectiveness of VR in improving communication and social skills in children and adolescents with ASD. They concluded that VR’s immersive and customizable features make it a valuable tool for addressing the diverse challenges faced by this population. Similarly, Grossard et al. (2017) [16] demonstrated that SGs could effectively teach emotions and social interactions through repetitive, goal-oriented tasks, aligning with the structured learning preferences of individuals with ASD.

A growing body of literature has also evaluated the broader applications of VR and SGs in ASD interventions. For instance, Bradley and Newbutt (2018) [17] conducted a systematic review of VR head-mounted displays, highlighting their potential to improve attention and reduce sensory overload. Caruso et al. (2023) [18] offered insights into the design of immersive VR serious games tailored for individuals with ASD, emphasizing the need for inclusive and user-centered design practices.

Further, Glaser and Schmidt (2021) [19] identified design patterns in VR interventions for ASD, noting that well-structured VR environments could significantly improve social cognition and adaptive skills. Karami et al. (2021) [20] provided a comprehensive meta-analysis of VR and augmented reality (AR) interventions, demonstrating their efficacy in reducing anxiety and fostering behavioral improvements in individuals with ASD.

Research has also explored specific use cases of SGs and VR. For instance, Lorenzo et al. (2019) [21] reviewed the application of immersive VR for ASD students, identifying its role in enhancing learning and social inclusion. Nordahl-Hansen et al. (2020) [22] analyzed VR interventions targeting both ASD and intellectual disabilities, finding evidence of improved social and emotional outcomes. Dechsling et al. (2021) [23] and Thai and Nathan-Roberts (2018) [24] emphasized the importance of VR-based social skills training, advocating for more tailored and adaptive intervention strategies.

Several studies have specifically addressed the role of SGs in ASD therapy. Azadboni et al. (2024) [25] and Carneiro et al. (2024) [26] conducted systematic reviews on the use of SGs for social skills training, highlighting their ability to provide interactive, engaging, and personalized learning experiences. Hassan et al. (2021) [27] explored how SGs could enhance social and emotional intelligence in children with ASD, offering evidence of their effectiveness in fostering empathy and understanding of social cues.

Finally, Peretti et al. (2024) [28] introduced a pocket guide evaluation framework for assessing immersive VR-based SG interventions, providing practical guidelines for designing and implementing these tools. This framework has the potential to standardize and improve the quality of future studies in this domain.

Despite the growing body of evidence supporting the use of SGs and VR in ASD interventions, there remains a lack of comprehensive studies focusing specifically on the enhancement of social skills in adolescents with ASD. While the existing literature has explored various aspects of SGs and VR, few have systematically analyzed their role in addressing social challenges unique to this developmental stage. This paper addresses this gap by conducting a scoping review that synthesizes the current evidence, identifies key benefits and limitations, and provides actionable recommendations for future research and practice.

By building on the work of Bellani et al. (2011) [13], Grossard et al. (2017) [16], Zhang et al. (2022) [15], and others, this review aims to advance our understanding of how SGs and VR can be effectively integrated into social skills training programs for adolescents with ASD. It contributes to the field by mapping current applications, identifying research gaps, and offering insights that can guide the development of more inclusive and impactful interventions.

3. Autism Spectrum Disorder: Exploring Causes, Prevalence, and Challenges in Diagnosis

The exact origins of ASD remain a complex and evolving field of study, with research indicating that a combination of genetic, neurological, and environmental factors may contribute to the development of the condition. Certain genetic markers and neurological differences have been identified in individuals with ASD, though the precise mechanisms that lead to the behaviors and cognitive patterns typical of ASD are not yet fully understood. Environmental influences, such as prenatal exposure to toxins or complications during birth, are also believed to play a role, although these factors are still being explored. Therefore, understanding ASD necessitates a multidisciplinary approach, incorporating genetics, neuroscience, and environmental science [29]. Diagnosing ASD is particularly challenging due to the absence of standard medical tests, such as blood tests or imaging, to detect the disorder. Instead, the process relies on behavioral assessments and clinical judgment. In most cases, general practitioners (GPs) initially assess a child for signs of ASD, which often include difficulties in communication, social interactions, and behavioral patterns. If ASD is suspected, the child is referred to a specialist, such as a psychologist or psychiatrist, for a more detailed evaluation. Early intervention is crucial, as research shows that the brain’s heightened plasticity in children and adolescents allows for significant developmental progress when identified early [30].

Screenings for ASD can begin as early as 18 months, but a formal diagnosis may take years. This delay is partly due to the need for comprehensive developmental assessments across various domains, including behavior, communication, self-care, and social skills. Diagnostic tools, such as the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADIR), are commonly used to assess children and adolescents’ responses to structured activities and interview questions [31]. However, since the diagnostic process is based on clinical judgment, it can be subjective and may vary depending on the evaluator’s expertise and the child’s ability to engage during the assessment. The importance of early diagnosis cannot be overstated. Research shows that early identification of ASD allows for timely and effective interventions, leveraging the neuroplasticity of children and adolescents’ brains to promote skill acquisition and development. Early intervention programs have been shown to significantly improve outcomes in areas such as communication, social skills, and independent living. This period of heightened brain plasticity presents a critical window for therapeutic interventions to reshape neural pathways and foster positive developmental changes [32].

SGs and VR technologies provide immersive, interactive experiences that can engage children and adolescents in ways that traditional therapeutic methods cannot, making therapy more enjoyable and effective. Through VR, children and adolescents can practice real-life scenarios in a safe, controlled environment, such as navigating social situations or learning essential life skills, like crossing the street. This immersive aspect of VR allows children and adolescents to experience challenges in a manageable way, building their confidence and tolerance [33].

SGs combine entertainment with skill-building exercises, creating an engaging environment where children and adolescents can practice and reinforce skills in a fun and non-intimidating way. SGs can be tailored to address specific developmental needs, whether it is improving cognitive abilities, social skills, or behavioral responses [26]. Moreover, these games can be adapted to individual learning styles, allowing for more personalized therapeutic approaches [16].

Importantly, SGs and VR are not only beneficial for children and adolescents with ASD but also offer significant support for caregivers. The emotional and psychological strain that caregivers experience is often overlooked in discussions of ASD, but it plays a critical role in the overall well-being of families. Parents of children and adolescents with ASD often report higher levels of stress, depression, and lower quality of life. VR and SGs can provide caregivers with valuable tools to manage their own mental health, learn coping strategies, and connect with other families. These technologies can also serve as platforms for caregiver education, providing a supportive space for parents to access resources and share experiences with others in similar situations. This dual-purpose approach—supporting both children, adolescents and caregivers—holds great promise for enhancing family well-being and providing a more holistic solution to managing the challenges of ASD [15].

This paper aims to provide an in-depth review of recent empirical studies that explore the role of SGs and VR in ASD therapy. By evaluating the strengths and weaknesses of these interventions, the paper will assess their potential to improve outcomes for children and adolescents with ASD and their caregivers. Additionally, it will explore the broader implications of using these technologies in therapeutic settings, including their accessibility, scalability, and real-world applicability. While SGs and VR hold great promise, further research is necessary to evaluate their long-term effectiveness, explore their capacity to address a wider range of sensory and behavioral challenges, and ensure their accessibility to families across different socioeconomic backgrounds. As these technologies continue to evolve, they offer exciting prospects for improving the quality of life for individuals with ASD and supporting families who care for them.

4. Method

To analyze the fundamental characteristics of SGs combined with VR programs for the promotion of social skills in children and young adolescents with ASD, a search for empirical studies on the topic was conducted on Scopus. The Scoping Review has been registered on the Open Science Framework (OSF Home) and is available at https://osf.io/eja75/?view_only=352f6f7676a34e61a8e118db1774edde (accessed on 12 December 2024).

The standard guidelines adopted in this review were in line with the PRISMA 2020 flow diagram [34] as also demonstrated in Figure 1. The inclusion criteria were as follows. The following keywords had to be present: “autism spectrum disorders”, “serious games”, “virtual reality”, and “social interactions”. “Social interactions” was chosen to capture studies focusing on a broad range of interpersonal skills, whereas terms like “social skill” or “social cognition” could have excluded relevant works due to narrower definitions. Filters and limits were applied to include only English-language publications from 2013 to 2024. All sources were last searched on 13 January 2025.

Inclusion Criteria:

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Empirical studies published between 2013 and 2024;

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Studies in English;

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Participants aged 5–18 years;

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Focus on SGs and VR for promoting social skills in ASD.

Exclusion Criteria:

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Conference papers, book chapters, and reviews.

Two independent reviewers screened each record for relevance. Discrepancies were resolved through discussion, and an arbitration process was followed for unresolved cases. Automation tools were not used in the screening process.

An initial search was conducted on Scopus, entering the search keywords “autism spectrum disorders”, “serious games”, “virtual reality”, “social interactions”; the search produced twenty results. Including all studies conducted between 2013 and 2024, 8 documents were identified. Of these studies, reviews were excluded which refer to duplicates, non-peer-reviewed sources, and studies unrelated to VR or SGs, and only empirical studies were considered, for a total of seven studies. The inclusion criterion adopted was relevance to the topic of the use of SGs and VR- based programs for the promotion of social skills in children and adolescents with ASD. The research therefore led to seven results.

5. Literature Overview

An overview was conducted to identify existing research on ASD, SGs applications in healthcare, and rehabilitation strategies as also shown in Table 1. Documents published between 2013 and 2024 were considered to ensure the inclusion of the most recent and relevant studies. This section re-organizes the studies to focus on three core aspects: technological design, evaluation methodology, and key outcomes, aligning with the scoping review’s objectives to map the tools’ effectiveness in fostering social interactions and independence.

Ghanouni et al. [35] developed an interactive motion gaming program aimed at enhancing socio-emotional skills, specifically perspective-taking, in children and youth with high-functioning ASD. The study prioritized participatory design, actively incorporating feedback from stakeholders, including children, youth, and their parents, to refine usability and ensure alignment with user needs. This participatory approach is significant as it emphasizes user-centric design, fostering greater adoption and engagement. Findings revealed improvements in program usability and stakeholder satisfaction, underscoring the importance of integrating end-user insights into SG development.

Cadieux et al. [36] explored the potential of Minecraft as a training environment for building social skills in children with ASD. Their project, Social Craft, extended Minecraft’s interactive framework to include structured activities mimicking real-world social scenarios, such as turn-taking and cooperation. By focusing on behavioral principles and tracking the generalization of skills across digital and physical contexts, the study provided evidence for the transferability of skills acquired through gameplay. While Social Craft offers a promising tool for promoting communication, the authors noted that further research is needed to evaluate long-term skill transfer to real-life interactions [37].

Gabrielli et al. [38] introduced Zentastic VR, a multiplayer adventure game designed to enhance social skills in adolescents with ASD. The inclusive design process involved active collaboration with adolescents and therapists, ensuring that the tool was tailored to user needs. Feasibility studies indicated high acceptability among participants, with notable improvements in baseline-to-post-training social skills. This study highlights the potential of co-designed VR interventions in promoting teamwork and collaborative problem-solving while emphasizing the importance of designing tools that accommodate the preferences and challenges of ASD populations.

Simões et al. [39] created a VR-based bus training game aimed at improving adaptive skills and reducing anxiety in individuals with ASD. The game offered an immersive, structured environment for participants to learn public transportation routines, from finding bus stops to selecting routes. Evaluation included electrodermal activity (EDA) measurements to assess anxiety reduction, revealing significant decreases in anxiety and high success rates in task completion (93.8%). Although the primary focus of the study was on procedural and adaptive skills, elements such as ticket validation also involved some degree of social interaction. However, the authors acknowledged that the social element was not a central target of the intervention and suggested future studies could further explore social skills within similar VR environments. Furthermore, the study compared individuals with ASD to neurotypical controls to establish baseline differences in task performance and anxiety levels. While the groups were not matched for neurocognitive profiles, the comparison aimed to highlight specific challenges faced by the ASD group rather than isolate the effects of the intervention from individual differences. Future research could address this limitation by including matched controls or conducting within-group pre- and post-intervention analyses to better assess the intervention’s efficacy. This study demonstrates the utility of VR in equipping individuals with practical, real-world skills through low-risk simulations, paving the way for further development of immersive training tools for ASD populations.

Johnston et al. [40] developed SoundFields, a VR game designed to address auditory hypersensitivity in individuals with ASD. The game integrated exposure therapy techniques within its mechanics, using binaural spatial audio to provide controlled, realistic exposure to triggering sounds. Pilot studies with six participants showed significant reductions in sound-related anxiety and high engagement levels, suggesting that VR-based exposure therapy can be an effective tool for managing sensory sensitivities. This approach highlights VR’s potential for addressing specific sensory challenges common in ASD. Moreover, by exposing participants to sounds commonly encountered in social settings, such as group singing or children shouting, the intervention indirectly targeted social scenarios. By improving tolerance to these sounds, the game aimed to reduce avoidance behaviors, fostering greater participation in social environments.

Johnston et al. [41] further investigated the effects of binaural audio on auditory hypersensitivity, conducting a comparative study between traditional stereo and spatial audio. Participants exposed to spatial audio showed greater reductions in negative reactions to sounds and increased tolerance for auditory stimuli over time. These findings reinforce the role of advanced VR techniques in enhancing sensory processing and emotional regulation for individuals with ASD. Additionally, the VR environments mirrored real-life contexts where social interactions often occur, providing participants with a safe and structured space to practice adapting to socially relevant auditory stimuli. Future studies could explore the direct impact of such interventions on social engagement and communication in noisy environments.

Tan et al. [42] developed a VR-based game to teach children with ASD the critical life skill of road crossing. The game employed various interaction modes, including Kinect sensors, keyboards, and touchscreens, to ensure accessibility. The study’s findings highlighted the game’s effectiveness in improving participants’ knowledge and confidence in road-crossing scenarios, with positive feedback on user experience. In addition to the technical aspects, the social element was integral to this study. The game simulated real-world road-crossing scenarios that inherently involve social interactions, such as responding to traffic signals, observing the behavior of cars and other pedestrians, and timing one’s actions in coordination with these social cues. By engaging with these elements in a controlled VR environment, children with ASD practiced essential social decision-making and situational awareness skills in real-life contexts. These aspects align with the broader goal of enhancing their social adaptability and independence in navigating daily life safely. This intervention demonstrates how VR can address safety and independence in daily life for children with ASD.

The reviewed studies consistently demonstrate the ability of SGs and VR tools to provide structured, adaptive, and engaging environments for skill-building in individuals with ASD. By emphasizing user-centric design and innovative evaluation methods, these tools address both social and sensory challenges, fostering independence and improving quality of life. Future research should focus on longitudinal studies, diverse participant populations, and addressing accessibility barriers to maximize the impact and scalability of these interventions.

Table 1. Synoptic table of the reviewed studies.

Authors	Objectives	Participants	Technology Used	Experimental Design	Evaluation Focus	Parental Involvement	Key Results
Ghanouni et al. [35]	To develop and test an interactive motion gaming program focused on perspective-taking for children and youth with high-functioning ASD.	Twenty participants (children and youth with high-functioning ASD and their parents).	Desktop-based motion gaming program	Usability testing with stakeholders	Usability, acceptability	Parents involved during design and usability testing	The study highlighted significant improvements in usability and alignment with user needs, emphasizing the importance of participatory design for effective tools.
Cadieux et al. [36]	To investigate the potential of Minecraft as a structured framework for social skill training in children with ASD.	Participants unspecified; children with ASD.	Desktop-based video game (Minecraft)	Exploratory evaluation	Generalization of social skills	Not explicitly stated	Social Craft provided evidence for skill generalization across virtual and real-world settings but highlighted the need for long-term studies on skill transfer.
Gabrielli et al. [38]	This study aimed to present the inclusive design process that authors had followed to develop the Zentastic VR adventure game to foster social skills training in adolescents with ASD and to investigate its feasibility as a training environment for adolescents	Thirty-one adolescents (81% male, aged 13–18, level 1 ASD severity, average IQ: 96.6).	Immersive VR (head-mounted display)	Feasibility study (pre-post design)	Acceptability, social skills improvement	Therapists involved as co-designers and facilitators	Strong acceptability among participants, with measurable improvements in social skills from baseline to post-training assessments.
Simões et al. [39]	To design and evaluate a VR-based bus training game to teach public transportation routines to individuals with ASD.	Ten participants with ASD (1–3 sessions) and 10 neurotypical participants (1 session).	Immersive VR (head-mounted display)	Between-group design	Effectiveness, anxiety reduction	Not explicitly stated	Significant anxiety reduction (measured via EDA) and a 93.8% success rate in task completion among participants with ASD.
Johnston et al. [40]	To develop and test SoundFields, a VR game incorporating exposure therapy for auditory hypersensitivity in ASD.	Six participants with ASD (weekly sessions for 4 weeks).	Immersive VR with binaural spatial audio	Pilot study (pre-post design)	Anxiety reduction, engagement	Not explicitly stated	Significant reductions in sound-related anxiety and high levels of engagement reported, highlighting VR’s potential in sensory therapy.
Johnston et al. [41]	To evaluate the impact of binaural spatial audio versus stereo audio in managing auditory hypersensitivity in ASD.	Twenty participants (mean age: 12.23; 18 male, 4 female).	Immersive VR with binaural spatial audio	Within-group design	Sensory processing, emotional response	Not explicitly stated	Strong improvements in tolerance to challenging auditory stimuli, with participants reporting decreased negative reactions over time.
Tan et al. [42]	To design a VR-based serious game to teach road crossing skills to children with ASD.	Five children with ASD (ages 5–12).	VR on multiple platforms (e.g., Kinect, keyboard, touchscreen)	Preliminary experimental evaluation	Learning effectiveness	Not explicitly stated	Participants demonstrated improved road-crossing knowledge and confidence, with positive feedback on usability and learning experience.

Table 1. Synoptic table of the reviewed studies.

Authors	Objectives	Participants	Technology Used	Experimental Design	Evaluation Focus	Parental Involvement	Key Results
Ghanouni et al. [35]	To develop and test an interactive motion gaming program focused on perspective-taking for children and youth with high-functioning ASD.	Twenty participants (children and youth with high-functioning ASD and their parents).	Desktop-based motion gaming program	Usability testing with stakeholders	Usability, acceptability	Parents involved during design and usability testing	The study highlighted significant improvements in usability and alignment with user needs, emphasizing the importance of participatory design for effective tools.
Cadieux et al. [36]	To investigate the potential of Minecraft as a structured framework for social skill training in children with ASD.	Participants unspecified; children with ASD.	Desktop-based video game (Minecraft)	Exploratory evaluation	Generalization of social skills	Not explicitly stated	Social Craft provided evidence for skill generalization across virtual and real-world settings but highlighted the need for long-term studies on skill transfer.
Gabrielli et al. [38]	This study aimed to present the inclusive design process that authors had followed to develop the Zentastic VR adventure game to foster social skills training in adolescents with ASD and to investigate its feasibility as a training environment for adolescents	Thirty-one adolescents (81% male, aged 13–18, level 1 ASD severity, average IQ: 96.6).	Immersive VR (head-mounted display)	Feasibility study (pre-post design)	Acceptability, social skills improvement	Therapists involved as co-designers and facilitators	Strong acceptability among participants, with measurable improvements in social skills from baseline to post-training assessments.
Simões et al. [39]	To design and evaluate a VR-based bus training game to teach public transportation routines to individuals with ASD.	Ten participants with ASD (1–3 sessions) and 10 neurotypical participants (1 session).	Immersive VR (head-mounted display)	Between-group design	Effectiveness, anxiety reduction	Not explicitly stated	Significant anxiety reduction (measured via EDA) and a 93.8% success rate in task completion among participants with ASD.
Johnston et al. [40]	To develop and test SoundFields, a VR game incorporating exposure therapy for auditory hypersensitivity in ASD.	Six participants with ASD (weekly sessions for 4 weeks).	Immersive VR with binaural spatial audio	Pilot study (pre-post design)	Anxiety reduction, engagement	Not explicitly stated	Significant reductions in sound-related anxiety and high levels of engagement reported, highlighting VR’s potential in sensory therapy.
Johnston et al. [41]	To evaluate the impact of binaural spatial audio versus stereo audio in managing auditory hypersensitivity in ASD.	Twenty participants (mean age: 12.23; 18 male, 4 female).	Immersive VR with binaural spatial audio	Within-group design	Sensory processing, emotional response	Not explicitly stated	Strong improvements in tolerance to challenging auditory stimuli, with participants reporting decreased negative reactions over time.
Tan et al. [42]	To design a VR-based serious game to teach road crossing skills to children with ASD.	Five children with ASD (ages 5–12).	VR on multiple platforms (e.g., Kinect, keyboard, touchscreen)	Preliminary experimental evaluation	Learning effectiveness	Not explicitly stated	Participants demonstrated improved road-crossing knowledge and confidence, with positive feedback on usability and learning experience.

6. Discussion

The reviewed studies emphasize the transformative potential of SGs and VR technologies in addressing social interaction challenges faced by individuals with ASD. The existing literature underscores the effectiveness of VR and SGs in simulating real-world scenarios, which allows for the safe, controlled practice of social skills. Foundational studies by Bellani et al. (2011) [13] and Parsons and Cobb (2011) [14] established VR’s capacity to reduce anxiety in social settings and its ability to foster social interactions. This scoping review builds upon the foundational knowledge by confirming the value of these technologies in fostering self-determination, problem-solving, and decision-making among adolescents with ASD. For instance, Ghanouni et al. [35] emphasize how participatory design enhances user engagement by aligning interventions with real-world needs. This approach ensures usability and encourages adoption by creating tools that are both relevant and accessible to users.

Simões et al. [39] provide a concrete example by demonstrating how training individuals to navigate public transportation fosters practical independence. This skill empowers individuals to travel independently, broadening their access to educational and social opportunities. Similarly, Tan [42] highlights how VR-based road safety simulations teach critical decision-making skills. By replicating real-world scenarios, these interventions allow participants to practice and master essential tasks in a safe, controlled environment, enhancing their confidence and ability to act independently in daily life.

Engaging individuals with ASD in the co-design process is crucial for creating interventions that accurately reflect their real-world challenges and preferences. This active involvement not only ensures that the tools are relevant but also fosters a sense of agency and ownership among participants. When individuals see their input valued and incorporated, they are more likely to engage constructively, leading to more meaningful and sustainable outcomes. Co-design also allows developers to address nuanced needs that may be overlooked in traditional top-down approaches, enhancing both usability and effectiveness.

Designing games and virtual experiences that closely mirror real-life situations is essential for facilitating skill transfer. When participants encounter scenarios in the game that resemble those they face in everyday life—such as navigating public transportation or engaging in social interactions—they are better equipped to apply what they’ve learned in practical contexts. This connection between virtual practice and real-world application reinforces independence and confidence, enabling individuals to navigate their environments more effectively.

Prioritizing the development of self-regulation, problem-solving, and decision-making skills is key to promoting long-term autonomy. Rather than focusing solely on behavior compliance, interventions should aim to empower participants to take control of their actions and make informed decisions. By fostering these critical skills, SGs and VR tools encourage individuals to become active agents in their own lives, capable of adapting to new challenges and environments. This empowerment-based approach aligns with neurodiverse principles, emphasizing strength-building and resilience over corrective measures.

Improving communication and social skills is a central objective of many SGs and VR interventions for individuals with ASD. These tools offer structured, immersive environments where users can practice social interactions without the immediate pressures or unpredictability of real-life situations. Cadieux et al. [36] introduce Social Craft, a framework leveraging Minecraft to simulate social scenarios. By creating parallels between in-game and real-world interactions, Social Craft encourages participants to apply learned communication strategies beyond the virtual environment. The framework’s use of natural reinforcement within the game helps to guide and reward positive social behaviors, aligning with behavioral principles [43].

Gabrielli et al. [38] illustrate how VR tasks, such as “Coin Hunt”, foster teamwork and collaboration, emphasizing verbal and non-verbal communication. These activities help participants engage socially, although intrinsic motivation and social comfort were not explicitly measured. Their findings suggest that VR creates structured opportunities for interaction that align with neurodiverse strengths and preferences [44]. Improving communication and social skills is a central objective of many SGs and VR interventions for individuals with ASD. Tools like Social Craft leverage gamification to simulate social scenarios and encourage users to practice communication strategies in a controlled environment. These structured interactions promote skill transfer to real-world settings, reinforcing independence and confidence [45].

Enhancing quality of life through SGs and VR remains an area requiring further study. While the reviewed studies highlight progress in skill acquisition and engagement, claims about reduced caregiver burden, stress levels, and broader family dynamics must be substantiated with longitudinal data and direct measurements.

Ghanouni et al. [35] demonstrate that SGs and VR interventions improve quality of life by fostering social connections, self-determination, and independence. These improvements contribute to reduced stress levels within families, creating a more supportive home environment. Gabrielli et al. [38] highlight the emotional benefits of VR, such as increased engagement and reduced frustration. As participants become more familiar with virtual environments, their comfort and confidence grow, leading to a more positive overall experience.

Johnston et al. [40,41] address the specific issue of auditory hypersensitivity—a common challenge for individuals with ASD. Their research shows that VR-based exposure therapy significantly reduces anxiety related to specific sounds. By managing sensory sensitivities, these interventions contribute to a calmer and more comfortable daily life, enhancing overall well-being.

When evaluating interventions for individuals with ASD, it is crucial to assess their holistic impact, considering not only improvements in targeted skills but also their broader effects on emotional well-being, social integration, and daily functioning. This comprehensive approach ensures that the intervention addresses the full spectrum of an individual’s needs and supports long-term development [46].

Participant-centric design is essential for fostering sustained engagement and achieving meaningful outcomes. By tailoring interventions to align with the preferences, strengths, and specific challenges of individuals with ASD, these tools become more relevant and effective, increasing the likelihood of sustained participation and progress [47].

Longitudinal evaluation plays a vital role in understanding the lasting effects of interventions. Conducting long-term studies allows researchers to assess whether improvements are temporary or contribute to sustained changes in quality of life. By tracking participants over extended periods, the true impact of interventions can be measured, ensuring that positive outcomes are not only immediate but enduring.

SGs and VR interventions also play a critical role in reducing the burden on caregivers and families. By promoting greater independence and social competence in individuals with ASD, these tools help alleviate the stress associated with constant supervision and support [48]. Ghanouni et al. [35] note that improved social and communication skills lead to more harmonious family dynamics, reducing the emotional strain on caregivers. Simões et al. [39] show that practical skill acquisition, such as navigating public transportation, minimizes the need for constant assistance, allowing caregivers more time and flexibility.

Johnston et al. [40,41] emphasize the importance of managing sensory challenges. Reducing auditory hypersensitivity not only benefits individuals with ASD but also lessens the need for intervention during challenging situations, such as public outings. This, in turn, decreases caregiver anxiety and enhances family experiences.Similarly, tools like Social Craft and Zentastic VR demonstrate the potential of these technologies to replicate complex social scenarios, bridging the gap between virtual practice and real-world application. Such advancements offer critical insights into personalizing interventions based on individual profiles, a dimension less explored in earlier studies.

In summary, the integration of new technologies such as SGs and VR may significantly enhance participants’ active role and constructive engagement. Social interactions with peers were additionally fostered. The participants’ quality of life was improved accordingly. Both caregivers’ and families’ burdens were relevantly reduced. Whenever available, external observers endorsed such technology-aided interventions, supporting the clinical validity of the proposed programs. Another significant contribution of this review is the identification of gaps in the literature. While existing research demonstrates the short-term benefits of VR and SG interventions, there is a paucity of longitudinal studies examining their long-term impact and real-world applicability. Additionally, the high costs and limited accessibility of these technologies present significant barriers to widespread adoption, especially in low-resource settings. Addressing these limitations will be crucial for ensuring equitable access and maximizing the potential of these innovative interventions [49,50,51,52,53,54,55].

Thus, the evidence clearly demonstrates that SGs and VR interventions for individuals with ASD offer significant benefits across multiple dimensions. By adopting user-centered, empowerment-focused approaches, and highly customized solutions, these tools create sustainable, meaningful improvements that extend well beyond the virtual environment, positively impacting the daily lives of individuals with ASD and their families [56].

7. Conclusions

The findings of this scoping review emphasize the transformative potential of integrating SGs and VR into therapeutic interventions aimed at enhancing social interactions in children and adolescents with ASD. By simulating real-world scenarios, these technologies offer structured, anxiety-free environments for practicing critical social skills. Recent studies confirm that VR’s immersive qualities and SG’s goal-oriented designs make them uniquely suited to ASD interventions, addressing both traditional therapy’s limitations and the specific needs of neurodiverse individuals [57].

The reviewed studies reveal that VR and SGs offer unparalleled opportunities to simulate real-life social scenarios, allowing children and adolescents to navigate complex interactions without the anxiety often associated with real-world settings. By leveraging VR’s capacity for realistic simulations and SGs’ goal-oriented and interactive designs, these tools foster the development of critical competencies, including turn-taking, empathy, non-verbal communication, and collaborative problem-solving. Such skills, essential for meaningful social engagement, are often difficult to acquire through traditional methods [44].

A key strength of these technologies lies in their adaptability and personalization. VR and SG platforms can be tailored to address the unique needs and learning preferences of each user, ensuring inclusivity across a spectrum of abilities and challenges. This adaptability is particularly valuable in accommodating the diverse manifestations of ASD, allowing interventions to cater to a broad range of individuals. Moreover, the engaging and interactive nature of these tools enhances motivation and encourages sustained participation, factors that are crucial for achieving long-term therapeutic outcomes [58].

Importantly, the structured nature of VR- and SG-based interventions provides an alternative to real-world interactions, which are often unpredictable and anxiety-provoking for individuals with ASD. This controlled environment reduces the risk of negative experiences, creating a supportive space where users can gradually build confidence and mastery over social situations. Despite these advantages, the implementation of VR and SG interventions is not without challenges. High costs associated with VR equipment and software development, coupled with technical and logistical barriers, significantly limit accessibility, particularly in low-resource settings. Furthermore, the current research landscape is characterized by small sample sizes, short study durations, and a lack of diversity in participant populations, which limit the generalizability of findings. The absence of longitudinal studies further leaves unanswered questions about the long-term effectiveness and real-world applicability of the skills learned through these interventions [18].

Nevertheless, the integration of SGs and VR into therapeutic programs represents a promising frontier in ASD intervention. By complementing traditional therapies with innovative, technology-driven solutions, these tools can address existing gaps and meet the growing demand for individualized, effective approaches to social skills training. To fully realize this potential, future efforts must focus on advancing the design of VR and SG platforms, conducting rigorous longitudinal studies, and addressing technological and financial barriers to ensure broad accessibility. These steps are essential for maximizing the impact of these transformative interventions on the lives of children and adolescents with ASD, enabling them to thrive in social and interpersonal domains [59]. Integrating SGs and VR into therapeutic programs represents a promising frontier in ASD intervention. By bridging gaps in existing knowledge and addressing practical implementation challenges, these tools hold the potential to revolutionize how social skills are taught and practiced, ultimately improving the lives of individuals with ASD and their families.

8. Limitations and Future Research Perspectives

Despite the promising outcomes reported in the reviewed studies, several critical limitations must be addressed to unlock the full potential of SGs and VR as therapeutic tools for children and adolescents with ASD. A prominent issue lies in the small sample sizes of many studies, which reduce statistical power and reliability. This makes it difficult to draw generalizable conclusions about the efficacy of these interventions, limiting their applicability across diverse populations. Additionally, the short duration of most studies hinders the assessment of long-term impacts, leaving unanswered questions about the sustainability of the social skills gained and their transferability to real-world interactions. The high costs and technological complexity of VR systems also pose significant barriers to widespread adoption. These challenges are particularly pronounced in resource-constrained settings, where limited funding and infrastructure prevent many families and institutions from accessing these cutting-edge interventions. The inequities in access underscore the importance of addressing scalability and ensuring that these innovations do not exacerbate existing disparities in ASD care [60].

Another key limitation is the narrow focus of many studies, which often target high-functioning individuals within the ASD spectrum. While this subgroup may show more immediate benefits, the exclusion of individuals with more severe or diverse manifestations of ASD limits the inclusivity and relevance of these findings. To maximize the impact of these technologies, future research must account for the wide range of cognitive, sensory, and behavioral profiles seen in the ASD population. To address these gaps, future studies should prioritize longitudinal research designs to evaluate the durability and real-world applicability of skills acquired through SGs and VR. Long-term studies would provide critical insights into whether these interventions foster lasting improvements in social interaction and how they influence quality of life over time. Additionally, research must strive for greater diversity in participant demographics, encompassing individuals across the full spectrum of ASD severity, as well as considering differences in age, gender, cultural backgrounds, and comorbidities [61].

This scoping review has several additional limitations that may have influenced the breadth and comprehensiveness of its findings. First, the search was conducted using only one digital library, Scopus, which may have excluded relevant studies available in other databases, such as PubMed, IEEE Xplore, or PsycINFO. Expanding the search to multiple databases could have provided a more extensive and diverse set of studies. Second, the review was limited to articles published in English, potentially excluding valuable research conducted in other languages. This linguistic restriction may have introduced a bias, especially given the global interest in using serious games and virtual reality for autism spectrum disorder (ASD) interventions. Third, the inclusion criteria restricted the review to studies published after 2013. While this decision was made to focus on recent advancements in serious games and VR technologies, it may have overlooked earlier foundational studies that could have provided additional context or insights into the evolution of these interventions.

Accessibility is another area that requires significant innovation. Developing cost-effective and scalable solutions, such as leveraging mobile or augmented reality technologies, could dramatically expand the reach of these interventions. Partnerships with technology developers, non-profit organizations, and educational institutions may also facilitate the creation of affordable platforms without compromising therapeutic efficacy. Additionally, incorporating flexible and adaptive program designs that address the sensory and cognitive variability within the ASD population will ensure these interventions are not only effective but also inclusive [62]. Future research should focus on longitudinal studies to evaluate the long-term effectiveness and real-world applicability of skills learned through these technologies. Including diverse participants across the ASD spectrum is essential for generalizability, addressing variations in severity, age, and background.

By addressing these limitations, the field can advance toward creating robust, equitable, and adaptable therapeutic tools that significantly enhance support for children and adolescents with ASD. Such advancements have the potential to improve social skills, foster independence, and promote broader societal inclusion, ultimately contributing to a higher quality of life for individuals with ASD and their families.

Finally, such technologies might be further integrated with artificial intelligence-based systems, such as deep learning and reinforcement learning, in a hierarchical-like multistep process in which one can first evaluate the individual to assess whether he/she may be at risk of neurodevelopmental disorders or autism and subsequently design a rigorously tailored intervention built on reinforcement learning principles [63,64,65,66].