Virtual Reality and Autism Spectrum Disorder: Emergence of

Sensory-Motor and Olfactory Potentialities in an Anthropocentric

Epistemological Approach

Cécile Lacôte-Coquereau

, Paul Richard

, Emmanuelle Richard

and Patrice Bourdon

Centre de Recherche en Education de Nantes, Nantes University, Chemin de la Censive du Tertre, Nantes, France

LARIS – SFR MATHSTIC, University of Angers, 62 Av. Notre Dame du Lac, Angers, France

Keywords: Virtual Reality, Virtual Environment, 3D Interaction, User-Centred Design, Autism Spectrum Disorder.

Abstract: The work presented in this paper is part of an innovative program including researchers from computer science,

psychology, and education science. The aim is to propose immersive virtual environments to develop

autonomy skills of young adults with autism having specific visual, psycho-sensorial, and cognitive

capabilities. Several skills towards a progressive autonomy are thus targeted: interactions and social skills,

verbal or alternative communication, perception-action coupling, and joint attention. In this context, a virtual

supermarket has been developed, allowing participants to be confronted with shopping activity.

1 INTRODUCTION

Since the dawn of the 21

century, in the hope of

alleviating cognitive dysfunction, researchers, and

therapists have been seizing the potential offered by

virtual reality (VR) (Fallet et al., 2022). Despite the

abundance of literature cross-referencing autism

spectrum disorder (ASD) and VR, there is a dearth of

work addressing this atypical triple comorbidity

profile. This raises the question of the potential

applications of VR in this ethical context: to what

extent this technology may reduce the attentional and

sensorimotor disorders of an autistic public with

specific psycho-sensory percepts (Bogdashina, 2020;

Mottron et al., 2006)? Our pioneering participatory

research aims to support socio-educational strategies

for a particularly vulnerable autistic population with

intellectual development disorders (IDD), language

development disorders (LDD) and sensory-motor

disorders (WHO, 2022).

In the next section, we provide a brief overview of

the use of VR techniques and recommendations for

non-verbal or dyscommunicative autistic individuals.

In Section 3, we describe our unique approach to the

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design of effective virtual environments (VEs) aimed

at developing autonomy skills in young adults with

autism who possess specific visual, psycho-sensorial,

and cognitive capabilities. Section 4 presents and

discuss some preliminary results. The paper

concludes with a summary and introduces some

future work.

2 PROPOSED APPROACH

2.1 User-Centred Design Methodology

VR technologies and 3D multimodal interaction

techniques have been studied and used in the field of

medicine and education for almost three decades

(Burdea & Coiffet, 1994; Burdea et al., 1996;

Popescu et al., 2002; Jankowski et al., 2013). In this

context, olfactory feedback was used to increase the

sense of presence in VEs and the memorization of

information (Richard et al., 2006; Tijou 2007;

Andonova et al., 2023; Cowan et al., 2023).

In the field of autism, recommendations support

the importance of learning devices that are

484

Lacôte-Coquereau, C., Richard, P., Richard, E. and Bourdon, P.

Virtual Reality and Autism Spectrum Disorder: Emergence of Sensory-Motor and Olfactory Potentialities in an Anthropocentric Epistemological Approach.

DOI: 10.5220/0012409600003660

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 19th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2024) - Volume 1: GRAPP, HUCAPP

and IVAPP, pages 484-491

ISBN: 978-989-758-679-8; ISSN: 2184-4321

intrinsically centred on users, to enter affordance

(Gibson, 1977) with their cognitive percepts. In this

context, we propose an epistemological,

anthropocentric approach (Fuchs, 2016) that is part of

innovative participatory research in which the

psycho-sensory specificities of users are integrated

into the process of designing VEs (Lacôte-

Coquereau, 2023).

Appropriate to autism, the User-Centred Design

methodological approach (Guffroy et al., 2017) is part

of the subject-participant concept (Bourdon, 2021).

The participation of users, who become co-creators

during the innovation design and implementation

processes, is a key point of the proposed

methodology. We can then, via this systemic

approach, design, prototype, test and improve the VE

(Renaud & Cherruault-Anouge, 2018).

The design process took place directly in the

living environment (specialised medico-educational

home) and with the autistic people concerned (Figure

1). The process started in June 2021 with the

introduction of immersive VR to the participants,

researchers, and the socio-educational team members

engaged in the project. The initiation involved the

exploration of the Antarctic National Geographic VR

application. Throughout this initial phase, spanning

several months, we were able to discern the interests

of autistic users in VR, recognize their sensitivities,

assess their motor and cognitive limitations, and

gauge their potential. This evaluation was grounded

in the diagnostic assessments specifically designed

for autism spectrum disorder (ASD).

Following the initial phase of immersion and

acclimatization, the experiment commenced with

young adults diagnosed with autism spectrum

disorder (ASD). Adjustments and enhancements to

the virtual environment (VE) were carried out based

on feedback from participants, considering the

responses and reactions of both the autistic

individuals involved and the medical team that

supports them daily. The VE was also refined and

adapted according to the specific psycho-sensory

specificities of the participants, enriched by

brainstorming and design thinking sessions and

design thinking sessions with the entire socio-

educational team and the researchers (Renaud &

Cherruault-Anouge, 2018).

During the design process, the VE was adjusted

after each trial according to the difficulties observed

by the medical-educational team or the observations

of the participants. These modifications included a

reduction in light intensity (visual hypersensitivity),

an increase in olfactory stimuli, and the addition of

certain pictograms to make it easier to understand the

interaction possibilities. The equipment was also

modified to facilitate observation of the VE, for

example by replacing a fixed chair with a swivel

chair.

(a) (b) (c) (d)

Figure 1: Illustration of the User-Centred Design process:

young adults with ASD, researchers, and socio-educational

team first immersion in the Antarctic application (a, b, c),

and experiment with the young adults with ASD (d).

2.2 Participants

The study involves a vulnerable population,

benefiting from a legal protection measures, due to

impaired cognitive, relational, or physical faculties.

The cohort is made up of 8 young adults with autism

spectrum disorder (ASD), language impairment and

Intellectual Development Disorder / IDD (WHO,

2022):

- 4 men - 4 women

- Average age: 23

- 6 out of 8 subjects have no access to writing or

reading

- 8 out of 8 have impaired oral language skills

Clinical assessments were based on the international

diagnostic scale AMSE - Autism Mental Status Exam

(Grodberg et al., 2014). Seven significant ASD items

are rated from 0 to 2, depending on the severity of the

impairments: eye contact, interest in others, pointing

ability, language, language pragmatics, stereotypies,

intrusive preoccupations. The average score for the

group (1.6/2) indicates moderate to severe language

impairment. On the other hand, the evaluations show

a relatively preserved pointing ability (group average:

0.3/2). In this sense, the ray-casting metaphor, which

can support alternative communication, seems to us

to be a major support provided by the VE.

2.3 Task Description

A meta Quest 2 headset was used to immerse the

participants in the virtual supermarket. The task asked

of the participants was as follows. They had to collect

different products from the shelves in a basket,

according to their wishes, in order to enable self-

determination. Given their sensory-motor difficulties,

Virtual Reality and Autism Spectrum Disorder: Emergence of Sensory-Motor and Olfactory Potentialities in an Anthropocentric

Epistemological Approach

485

the proposed navigation technique was teleportation.

A guide-experimenter pressed a key on the keyboard

to teleport the participants from point to point in the

shop: bakery, fishmonger, fruit, flowers, bookshop.

The participants had to point with their hands at the

objects to be collected. A ray (ray-casting), which did

not require verbalisation, was

then used to select the

objects to be collected. The item was directly placed

into the basket, until the checkout.

A garden, designed as a sensory resting place was

proposed to give each user a cognitive break. An

avatar, designed to resemble the physiognomy of the

educational team co-ordinator, was also implemented

to enable users to ask for help, also using the hand-

free ray casting technique, if they felt the need during

the task. The participant's ability to social interaction

and self-determination of the subject-participant were

thus and enhanced.

3 VIRTUAL ENVIRONMENT

3.1 Visual/ Acoustic Affordance Design

Autism Spectrum Disorders (ASD) are characterized

by impaired communication and social interaction,

sensory atypia, stereotyped behaviours, and restricted

interests, sometimes making engagement in cognitive

activities complex (WHO, 2022). Thus, for people

with autism, digital tools can arouse a particular

interest, conducive to learning (Mercier et al., 2022).

In this context, VR seems very appropriate as it is part

of an environment designed in affordance, in line with

users' emerging abilities (Gibson, 1977). Affordance

is that space-time of possibilities, the result of a

relationship between two entities. In VR, this induces

the anthropocentric conception of a secure, iterative,

and gradual space, qualitatively and quantitatively

controlling the information delivered by the system

(Klinger, 2014). In this sense, VR facilitates

individualized consideration of the autistic person's

specific sensory perceptions, prevailing over

exogenous stimuli (Zhao et al., 2022).

In our everyday world, the perceptual-motor and

perceptual-cognitive systems of people with ASD are

overwhelmed by a noisy, overly rapid flow of

information (Chokron et al., 2020; Swart, 2006). In

contrast, VR can offer a stable, reproducible learning

context, free from exogenous distractors (noise,

comings and goings, unexpected intrusions, etc.), all

of which are deleterious to concentration and

attention. By minimizing the intensity of acoustic and

visual flows (Mottron et al., 2007), slowing down

images and speech flow, immersive technologies

promote a reduction in behavioral disorders,

subjective well-being (Lacôte-Coquereau, Vigier, et

al., 2023) and, subsequently, an availability

conducive to learning (Tardif et al., 2017).

3.2 Ray-Casting: Supporting Executive

and Language Functions

Cognitively, ASD impacts executive functions:

planning, memorization, inhibition, attention

(Klinger, 2014). Often targeted in the field of autism,

joint attention deficit profoundly affects social

cognition (Baron-Cohen et al., 1997). In VR, this

essential skill can receive special support. In

dyscommunicative subjects, the design of interaction

metaphors based on the pointing gesture, such as ray-

casting (Baloup et al., 2019), appears to be able to

support attentional skills (Jordan, 2004).

Figure 2: Evolution of the success rate of pointing gestures

over the first 13 months.

A precursor to pointing and intentionality, joint

attention can be defined as preverbal communication

(Aubineau et al., 2015). It is the key interaction for

social development (Mundy & Newell, 2007). Its

mastery is therefore essential to the psycho-cognitive

development of dyscommunicative subjects. The

implementation of this pointing (ray-casting)

technique proved to be relevant in three ways:

reinforcing intersubjective attention, substituting for

absent or defective verbalization, and supporting

impaired motor functions (Figure 2).

3.3 Hands-Free Ray-Casting

Motor stereotypies are frequent hyperkinetic

disorders (Goldman et al., 2009), whose main

characteristics are that they are involuntary,

predictable, rhythmic, and repetitive. In the case of

motor stereotypies typical of ASD (flapping or

elevated hand tremors), it is now possible to filter data

from localization sensors to stabilize these actions by

motor-behavioral software aids (Fuchs, 2016) and

improve interaction (Sakkalis et al., 2022). Immersive

HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications

486

ray-casting techniques can also be used with the

hand-tracking approach. In this way, the technique

efficiently replaces the use of 3D controllers,

joysticks or buttons that are too complex for people

with intellectual development and motor coordination

difficulties.

(a)

(b)

Figure 3: Self-determined avatars in the virtual shop: virtual

educator (a), and the cashier (b).

3.4 Social Presence

On a societal scale, social interactions "enable us to

construct representations that are indispensable to our

understanding of others and the world" (Aubineau et

al., 2015). However, these fundamental skills in

society give rise to real difficulties for subjects with

autism. Yet "the experience of self can be enhanced if

other beings exist in the virtual world" (Biocca et al.,

2003). Showing "appearances of human faces or

forms plays an essential role in the symbolism of a

representative scene" (Willumeit et al., 2022). Thus,

envisaged as scaffolding for social interactions

hampered by ASD, "avatars and virtual elements

contribute to training in the recognition of facial

expressions and bodily gestures" (Mesa-Gresa et al.,

2018). Several avatars, chosen by the autistic users

themselves in self-determination, were thus added to

the VE. The aim here is to reinforce the feeling of

"social presence" (Biocca et al., 2003), in a reassuring

context conducive to learning (Figures 3a and 3b).

4 RESULTS AND DISCUSSION

The results of the study confirm that VR techniques

with an anthropocentric focus can promote activity

engagement and learning in dyscommunicative

autistic people (Lacôte-Coquereau et al., 2023). The

results also underline the importance of a VE

designed in affordance with the psycho-sensory needs

of learners to increase their cognitive availability and,

subsequently, their learning. A major question

remains, however, as to the generalizability of this

immersive protocol: how can we involve autistic

users who have little or no willingness to experiment

with the VR headset? Faced with this motivational

fragility, we felt it was essential to heuristically

investigate the restricted interests and particular

sensorialities of each subject, in an ethic respectful of

human diversity.

4.1 Sensory Feedback: A Memetic and

Cognitive Vector?

Among the sensory modalities offered by VR, one of

the avenues currently under study applies to the

olfactory domain, a sensory-cognitive channel now

integrated into the headset during immersive trials.

Retro-olfaction, evident from the moment a child is

born (Candau, 2000), is a physiological mechanism

that enables the olfactory system to perceive aromatic

characteristics. Research into the neurophysiology of

olfaction suggests that depriving ourselves of the

powerful emotional tone of odors would mean

"cutting ourselves off from an essential link with the

world" (Holley, 1999).

At the memetic and cognitive levels, olfactory

impressions, "individual symbols par excellence",

convey "the capacity to evoke memories and feelings

removed from social communication" (Sperber,

1974, p. 130). According to the work of André

Holley, the olfactory channel may have two

dimensions: a "cognitive dimension" driven by

olfactory signals, and a "motivational dimension of

sensory stimuli" (Holley, 1999; Washburn, et al.,

2003; Richard et al. 2006; Tijou, 2007).

4.2 Sensory Feedback: A Personalized

Motivational Vector?

During the VR trials, the orthonasal route was

implemented, inspiring the scent directly from

cartridges integrated into the VR headset. Following

the anthropocentric participatory approach, several

cartridges were selected in accordance with users'

wishes. As users stroll through the virtual

Virtual Reality and Autism Spectrum Disorder: Emergence of Sensory-Motor and Olfactory Potentialities in an Anthropocentric

Epistemological Approach

487

supermarket, they synchronously diffuse a fragrance

corresponding to the food on the shelves, encouraging

visual identification and olfactory stimulation: coffee,

chocolate, apple, orange.

Diagnostic assessments carried out beforehand

with autistic people highlight an olfactory hypo-

hyper-sensitivity (Bogdashina, 2020; Degenne-

Richard, 2014): "R 7 agrees to smell the scented cups.

Her inspiration is deep and fresh. On two occasions

she was able to differentiate between sweet and salty

smells. ... was able to say that she doesn't like the

smell of fire" "R4 looks for strong smells". In keeping

with these sensory specificities, the choice of scents

was closely linked to the interests and tastes of the

autistic people: a major appetite for apples for one,

chocolate for another. On the other hand, an olfactory

surplus could prove repellent to a subject with

olfactory hypersensitivity or who rejects one of the

scents inhaled. A detailed knowledge of the user's

sensory specificities is therefore essential in this field

of experimentation.

Professionals and scientists attest that, in the field

of autism, "personalization according to centers of

interest is a prerequisite for arousing interest" and

enhancing an often-random engagement in learning

activities (Renaud & Cherruault-Anouge, 2018, p.

140). Thus, it seems relevant to us to mobilize

"different sensory modalities" (Vandromme, 2018, p.

18) to elicit greater immersive interaction.

Philosophers and anthropologists have stressed the

importance for perceptual awareness of combining

signals transmitted by different sensory pathways

(Cassirer, 1972; Lévi-Strauss, 1964). At the end of

the first experiments, users' verbatims, facial

expressions and gestures revealed sensations of

pleasure when scent was diffused (Figure 4).

4.2.1 Olfactory Test R1

R1 - "I smelled...it smells like coffee, it's nice...it

makes me want to... Apple, yeah, it's good" (smile and

thumbs up).. " Orange, it smells good... it's good, it

makes me want to go shopping.

GP - Do you remember the smells of the helmet?

R1 - Yes, chocolate and coffee

GP - And the fruit?

R1 - Apple, orange

Olfactory feedback supports the correlation towards

the subject's ability to memorize, evoking pleasure,

and thus developing motives for activity (Leontiev,

1975).

Figure 4: User's deictic gesture of assent to olfactory

diffusion during a trial.

4.2.2 Scent Test R2 (Non-Verbal)

During another trial in the virtual supermarket, the

professional guide offers R2 (non-verbalizing

subject) an olfactory diffusion of chocolate (a scent

that R2 particularly likes):

GP - "Would you like some chocolate now?

R2 - Mmm (nodding, agreeing)

GP - It's going to smell like chocolate now.

(new diffusion of chocolate scent)

R2 - (pause for scent diffusion) R2 concentrated.

No rictus, no postural retreat during retro-

olfaction). With a pointing gesture via ray-casting, R2

selects the chocolate box of her choice from the shelf.

She laughs and applauds loudly" (Figure. 5). For

participant R2, a non-verbalizer, olfactory diffusion

induced increased thinking time, concentration, and

visual attention, culminating in an autonomous choice

of the chosen food product (chocolate), by ray-

casting. "All sensory stimuli are tangled and

interchangeable dialects of the universal language of

perception" (Steiner, 1967). Ultimately, while the

current results are promising and encouraging, it will

now be a matter of replicating and refining the

innovative immersive approach using olfactory

modality, with a broader corpus. The anthropological

evidence (Passeron & Revel, 2005) from this

participatory research is based on a quantitatively

small cohort (8 adults with ASD), which does not

allow for convincing generalization. However, for

Passeron and Revel (2005), "even in a single

individual, we can solidify hypotheses on the basis of

recurring clues". Although this case is singular, it

reveals a new reflexive space. As such, it is highly

HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications

488

relevant, and can be tested in other scientific,

therapeutic, or educational contexts.

Figure 5: Ray-casting of chocolate by R2 after retro-

olfaction.

5 CONCLUSION AND FUTURE

WORK

The work presented in this paper aims to design

immersive VEs to develop autonomy skills of young

adults with autism having specific visual, psycho-

sensorial, and cognitive capabilities. Several skills

towards a progressive autonomy are targeted:

interactions and social skills, verbal or alternative

communication, perception-action coupling, and joint

attention. In this context, a specific user-cent red

design methodology is proposed. A virtual

supermarket, with the integration of olfactory

feedback, has been developed allowing participants to

be confronted with shopping activity and the

development of this skill. Results showed that VR

with an anthropocentric focus can promote activity

engagement and learning in dyscommunicative

autistic people. The results also highlight the need to

design and offer immersive environments specifically

tailored to the psycho-sensory needs of the end users,

in this case young adults with autism. To extend and

validate our approach, we plan to design other virtual

environments such as a city and a flat. We will also

be proposing and comparing other navigation

techniques, such as free teleportation and step-in-

place, to favor users’ autonomy.

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