The review, led by Xiaowen Liu and Haoli Zhao of Xi’an University of Technology together with colleagues, analyzed 72 peer-reviewed empirical publications from 2019 to 2025. Following the established JBI and PRISMA-ScR methodological guidance, the team searched four major databases—Web of Science, Scopus, PubMed and IEEE Xplore—and supplemented the results with backward and forward citation searches. Rather than sorting the studies by the specific gadget involved, the authors took a more conceptually ambitious approach: they classified every study into one of four mutually exclusive pathways defined by the dominant interaction mechanism, a framework they argue moves beyond device-based categories to focus on what actually organizes the intervention.

The four pathways are extended reality, or XR, which encompasses virtual and augmented reality systems; socially assistive robotics, or SAR, in which physical robots mediate therapeutic interaction; exergames and embodied-interaction systems, or EXG, which engage the body through movement-based play; and hybrid or adaptive systems, or HYB, which combine multiple modalities or adjust their behavior dynamically. The distribution across these categories is telling. XR dominated the landscape with 25 publications, or 34.7 percent of the total, followed closely by socially assistive robotics with 23 publications, or 31.9 percent. Exergames accounted for 13 publications, or 18.1 percent, while hybrid and adaptive systems made up the remaining 11 publications, or 15.3 percent. The near-parity between XR and SAR suggests that the two most visible faces of assistive technology in autism research—digital worlds on one hand, embodied machines on the other—are developing in parallel rather than one displacing the other.

Just as striking is what these technologies are being asked to do. Social communication appeared as a target outcome in 49 of the 72 publications, a commanding 68.1 percent, and cognition or executive function featured in 32 publications, or 44.4 percent. At the other end of the spectrum, daily-living and safety-related skills appeared in only 5 publications, a mere 6.9 percent, and sensory processing in just 3, or 4.2 percent. The imbalance is significant because sensory processing differences and adaptive daily-living skills are core features of the autism profile with profound real-world consequences. The review’s authors point to this as a clear signal that the technology pipeline, whatever its strengths, is concentrating its firepower on a narrow band of outcomes while leaving other critical domains underexplored.

The technical sophistication on display across the included studies is considerable. In the XR pathway, systems range from fully immersive head-mounted displays used in randomized trials of psychological and behavioral intervention to augmented reality coloring books designed to teach children to focus on specific nonverbal social cues. Some platforms integrate multi-modal sensing to assess children while they train, fusing what the system presents with what it measures. Others embed cognitive behavioral therapy within immersive environments, as in a randomized feasibility trial that paired virtual reality with CBT to treat specific phobias in young people on the spectrum. The underlying logic is consistent: virtual environments allow clinicians to control, repeat and gradually scale social scenarios that would be unpredictable or overwhelming in the real world, providing a rehearsal space where difficulty can be tuned to the individual child.

The socially assistive robotics pathway tells a complementary story. Humanoid platforms such as the NAO robot have been deployed to train imitation skills using human action recognition, to support joint attention in comparative studies against typically developing peers, and even to assist minimally verbal children in communication-focused therapy. Researchers have built long-term personalization into in-home robots, tracked gaze behavior across months of in-home deployment, and run randomized controlled trials comparing robot-assisted pivotal response treatment against the same therapy delivered without robotic support. One recurring theme in this literature is predictability: robots can be engineered to behave with a consistency and simplicity that human interaction partners cannot always maintain, which may lower the social demands placed on autistic children and create a bridge toward human-human interaction. Yet studies have also documented how visual and hearing sensitivities affect robot-based training, a reminder that the sensory profile of each child constrains what any single technology can deliver.

The exergame and embodied-interaction pathway brings the body into the loop. Motion-tracking games and somatosensory systems have been used to train motor skills, executive function and postural balance, with randomized and crossover trials examining effects on inhibitory control and restricted and repetitive behaviors. This pathway reflects a growing recognition that motor, cognitive and socio-cognitive mechanisms are intertwined in autism, and that physical activity delivered through engaging game formats can target several of them simultaneously. Augmented reality game-based cognitive-motor training and virtual reality rehabilitation studies sit at the intersection of this pathway and the XR category, illustrating why the authors chose to classify studies by interaction mechanism rather than by surface technology: the same headset can serve fundamentally different intervention logics depending on how the interaction is structured.

Perhaps the most forward-looking findings concern the hybrid and adaptive systems pathway, and here the numbers reveal how early the field still is. Only 11 publications fell into this category, and just 5 studies—6.9 percent of the total—used physiologically or neurally driven closed-loop adaptation, meaning systems that read signals such as brain activity or heart rate variability and adjust their behavior in real time. These include brain-computer interface video games using neurofeedback to train attention, wearable EEG neurofeedback systems built on machine learning algorithms, and mobile augmented reality neurofeedback training games. Closed-loop adaptation represents the logical endpoint of personalized intervention: a system that senses when a child is dysregulated or disengaged and responds automatically. But at fewer than one in ten studies, it remains a frontier rather than a foundation, and the review’s authors explicitly call for greater transparency about how these adaptive mechanisms work, since an opaque algorithm that changes therapy on the fly is difficult to evaluate, replicate or trust.

The methodological picture that emerges from the review is one of a field in transition. Only 18 of the 72 publications, or 25 percent, used randomized designs, meaning the majority of the evidence base rests on weaker study architectures that are more vulnerable to bias and less able to establish causal effects. The authors also highlight the lack of longitudinal evaluation in real-world settings: many systems are validated in short laboratory sessions with researchers present, leaving open the question of whether gains persist and generalize to homes, classrooms and communities. Their recommendations are correspondingly concrete—strengthen pathway-specific reporting so that studies within each interaction mechanism can be compared, extend evaluation over longer time horizons in authentic environments, and open up the black box of adaptive systems.

What makes this review more than a bookkeeping exercise is the framework itself. By organizing the literature around interaction mechanisms rather than devices, the authors have created a shared vocabulary that connects system design to intervention goals and participant needs. A clinician choosing between a robot partner and a virtual scenario is not merely choosing hardware; they are choosing between fundamentally different interaction logics with different demands on the child. Mapping those logics makes it possible, for the first time, to see where the evidence is dense, where it is thin, and where the next generation of studies should aim. As multimodal technologies continue to migrate from research labs into clinics and homes, that kind of structural clarity may prove to be the field’s most valuable intervention yet.

Subject of Research: Multimodal human–computer interaction interventions for children and adolescents with autism spectrum disorder

Article Title: Multimodal Human–Computer Interaction Interventions for Children and Adolescents With Autism Spectrum Disorder: A Scoping Review

Article References: Liu, X., Zhao, H., Zhang, W., Zhang, C., & Liu, X. (2026). Multimodal Human–Computer Interaction Interventions for Children and Adolescents With Autism Spectrum Disorder: A Scoping Review. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07555-2

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07555-2

Keywords: autism spectrum disorder, multimodal human-computer interaction, extended reality, socially assistive robotics, exergames, virtual reality, augmented reality, neurofeedback, social communication, scoping review, assistive technology, closed-loop adaptation