**1.1 Congenital social communication obstacles in children with autism**

The common obstacles for the social skills of children with autism include the following [1]: they have difficulty in their social reciprocity with others, they have difficulty in maintaining mutual social relations, they are unable to share their feelings with others, they are unable to think like, and understand the emotions, of others, from their perspective [2, 3], and they have a lack of empathy [4, 5]. Children with autism find it difficult to establish effective social relations due to their social skill barriers [6–9], which lead to them to feel uneasy and to retreat when interacting with a crowd [7], and indirectly lead to social isolation [5]. A person's social skills refers to his/her ability to successfully and independently participate in social interaction, to establish and maintain social relations with others [10, 11], and to meet the social reciprocity conditions and communication skills required in different situations [12]. Having social skills is one of the important abilities that people need, in order to get along with others in society. It includes the ability to observe and listen to others, to make basic eye contact with people [13], to give social body feedback [14], to have complex social interactions and to manage their emotions [15]. Social skills are often constructed on the basis of some non-verbal social communication behaviors [16], such as facial expressions, head or hand movements [2], posture and eye expressions, etc. However, children with autism generally lack these important social communication skills [17, 18].

reciprocity for ordinary people to interact with others, to share their feelings, to think and understand their behavior, from their perspective, as well as their intentions, emotional feelings and empathy [3]. Moreover, this ability requires consider-

*How to Use the Advantages of AR and VR Technique to Integrate Special Visual Training…*

**1.4 Social training methods and teaching strategies are widely used in autism**

There are many social training methods [31] and teaching strategies to help autistic children learn to judge more "social situations", to understand different "non-verbal social cues", and to make an appropriate social reciprocal performance; these include behavioral interventions [32], pivotal response training (PRT) [33],

Among them, the most common training strategy is the use of Social Stories™ [36], or the social intervention training method, based on situational stories [35]. The Social Stories™ method can help children with autism to better understand and follow social rules and routines. In addition, it can promote a better self-awareness, help them to gain insight into the perspectives of others, and to understand how their behavior impacts others. This model appropriates social interaction by describing a situation by using the relevant social cues, it gives the perspectives of others, and it suggests an appropriate response. Generally-speaking, social stories or scripts are created to test for autism and they are used to assess the effects of multiple-baseline designs, across the different participants of Social Stories™, for intervention or training [36]. By using the social story method, combined with role play, autistic children can be guided to handle a situation and understand the relationship between social objects and other social communication states [37]. This includes how to respond with appropriate social reciprocal behavior, according to different social objects, and to grasp social skills [38]. For example, according to other people's non-verbal social cues (such as their posture and eye expressions, facial expressions, or all kinds of social body movements), they will try to figure out the social intentions of the other person, or to carry out a role exchange and a role disguise game [39], which is the same as a psychological intervention training strategy [21]. This kind of teaching method can help autistic children to master the situation, as well as the interpersonal interactions in social stories, and it guides them to observe, and familiarize themselves with, the social behavior and skills that an adult society should have [36]. Through targeted social behavior intervention training [32], the social reciprocity and judgment of autistic children in a social situation can be gradually improved, and their ability to communicate socially with

able visual information for grasping and making social judgments [17, 18]. However, this ability is very difficult for autistic children, as they often have difficulty in handling non-verbal social communication proficiently, and they cannot carry out effective social interaction and communication with others. Similarly, it is a challenge for them to actively make eye contact with others and to make appropriate social responses [29]. Such symptoms will cause autism patients to become estranged from people and will make it difficult for them to effectively

integrate into society [30].

*DOI: http://dx.doi.org/10.5772/intechopen.94587*

others can be enhanced [17, 40].

**33**

**1.5 Current limitations of social training for autism**

The existing social intervention training, such as role-playing, using the social story method, or interpersonal skills on empathy, requires considerable imagination

scripting [34], story-based interventions, etc. [35].

**nowadays**

#### **1.2 Social communication skills for children with autism**

The social communication skills that autistic children need to master are mainly divided into various levels: (1) social initiation, (2) social reciprocity, and (3) non-verbal social communication [19, 20]. Social initiation refers to the ability to actively interact with others and to initiate social content. Social reciprocity refers to the ability to have good social communication and interaction with others, to be able to have appropriate behavioral responses, and to engage in a dialog. A person's non-verbal social communication ability refers to his/her ability to understand the deeper meaning, or symbolic metaphors, of other people's body language and expressions in non-verbal communication [21]. Among them, the ability to reciprocate socially summarizes most of a person's comprehensive ability and behavior performance in social skills, and it is also considered as the most important comprehensive ability in social contact [22, 23]. For example, people can judge the environmental background and social situation of the other party, while understanding the other party's emotion and discourse and making an appropriate social response [24]; it includes the ability to understand other people's emotions [25], their deep feelings, and their implications [26]. Therefore, social reciprocity is often regarded as the focus of learning social skills for autistic children.

#### **1.3 Non-verbal social orientation covered by social reciprocity ability**

The DSM-V [27] of the fifth edition of the diagnostic manual of the American Psychiatric Association (APA) points out that one of the most important symptoms of autistic patients is the behavioral disorder of social reciprocity. The key to this behavior is whether they can master some more subtle non-verbal social communication clues, including facial expressions, eye contact, social body movements, social ceremony actions, or emotional gestures and eye expressions [17, 28]. These social features cover a large number of slight visual characterizations and non-verbal communication cues, which provide the basic elements of strong social

*How to Use the Advantages of AR and VR Technique to Integrate Special Visual Training… DOI: http://dx.doi.org/10.5772/intechopen.94587*

reciprocity for ordinary people to interact with others, to share their feelings, to think and understand their behavior, from their perspective, as well as their intentions, emotional feelings and empathy [3]. Moreover, this ability requires considerable visual information for grasping and making social judgments [17, 18]. However, this ability is very difficult for autistic children, as they often have difficulty in handling non-verbal social communication proficiently, and they cannot carry out effective social interaction and communication with others. Similarly, it is a challenge for them to actively make eye contact with others and to make appropriate social responses [29]. Such symptoms will cause autism patients to become estranged from people and will make it difficult for them to effectively integrate into society [30].

#### **1.4 Social training methods and teaching strategies are widely used in autism nowadays**

There are many social training methods [31] and teaching strategies to help autistic children learn to judge more "social situations", to understand different "non-verbal social cues", and to make an appropriate social reciprocal performance; these include behavioral interventions [32], pivotal response training (PRT) [33], scripting [34], story-based interventions, etc. [35].

Among them, the most common training strategy is the use of Social Stories™ [36], or the social intervention training method, based on situational stories [35]. The Social Stories™ method can help children with autism to better understand and follow social rules and routines. In addition, it can promote a better self-awareness, help them to gain insight into the perspectives of others, and to understand how their behavior impacts others. This model appropriates social interaction by describing a situation by using the relevant social cues, it gives the perspectives of others, and it suggests an appropriate response. Generally-speaking, social stories or scripts are created to test for autism and they are used to assess the effects of multiple-baseline designs, across the different participants of Social Stories™, for intervention or training [36]. By using the social story method, combined with role play, autistic children can be guided to handle a situation and understand the relationship between social objects and other social communication states [37]. This includes how to respond with appropriate social reciprocal behavior, according to different social objects, and to grasp social skills [38]. For example, according to other people's non-verbal social cues (such as their posture and eye expressions, facial expressions, or all kinds of social body movements), they will try to figure out the social intentions of the other person, or to carry out a role exchange and a role disguise game [39], which is the same as a psychological intervention training strategy [21]. This kind of teaching method can help autistic children to master the situation, as well as the interpersonal interactions in social stories, and it guides them to observe, and familiarize themselves with, the social behavior and skills that an adult society should have [36]. Through targeted social behavior intervention training [32], the social reciprocity and judgment of autistic children in a social situation can be gradually improved, and their ability to communicate socially with others can be enhanced [17, 40].

#### **1.5 Current limitations of social training for autism**

The existing social intervention training, such as role-playing, using the social story method, or interpersonal skills on empathy, requires considerable imagination

difficulty in maintaining mutual social relations, they are unable to share their feelings with others, they are unable to think like, and understand the emotions, of others, from their perspective [2, 3], and they have a lack of empathy [4, 5]. Children with autism find it difficult to establish effective social relations due to their social skill barriers [6–9], which lead to them to feel uneasy and to retreat when interacting with a crowd [7], and indirectly lead to social isolation [5]. A person's social skills refers to his/her ability to successfully and independently participate in social interaction, to establish and maintain social relations with others [10, 11], and to meet the social reciprocity conditions and communication skills required in different situations [12]. Having social skills is one of the important abilities that people need, in order to get along with others in society. It includes the ability to observe and listen to others, to make basic eye contact with people [13], to give social body feedback [14], to have complex social interactions and to manage their emotions [15]. Social skills are often constructed on the basis of some non-verbal social communication behaviors [16], such as facial expressions, head or hand movements [2], posture and eye expressions, etc.

However, children with autism generally lack these important social

The social communication skills that autistic children need to master are mainly divided into various levels: (1) social initiation, (2) social reciprocity, and (3) non-verbal social communication [19, 20]. Social initiation refers to the ability to actively interact with others and to initiate social content. Social reciprocity refers to the ability to have good social communication and interaction with others, to be able to have appropriate behavioral responses, and to engage in a dialog. A person's non-verbal social communication ability refers to his/her ability to understand the deeper meaning, or symbolic metaphors, of other people's body language and expressions in non-verbal communication [21]. Among them, the ability to reciprocate socially summarizes most of a person's comprehensive ability and behavior performance in social skills, and it is also considered as the most important comprehensive ability in social contact [22, 23]. For example, people can judge the environmental background and social situation of the other party, while understanding the other party's emotion and discourse and making an appropriate social response [24]; it includes the ability to understand other people's emotions [25], their deep feelings, and their implications [26]. Therefore, social reciprocity is often regarded as the focus of learning social skills for autistic

**1.3 Non-verbal social orientation covered by social reciprocity ability**

The DSM-V [27] of the fifth edition of the diagnostic manual of the American Psychiatric Association (APA) points out that one of the most important symptoms of autistic patients is the behavioral disorder of social reciprocity. The key to this behavior is whether they can master some more subtle non-verbal social communication clues, including facial expressions, eye contact, social body movements, social ceremony actions, or emotional gestures and eye expressions [17, 28]. These social features cover a large number of slight visual characterizations and non-verbal communication cues, which provide the basic elements of strong social

**1.2 Social communication skills for children with autism**

communication skills [17, 18].

*Types of Nonverbal Communication*

children.

**32**

and pretend-game skills [41] to guide autistic children to figure out and understand "social relations" and "social behavior cognition". Among them, empathy is the ability to understand and comprehend the emotions and behavior of another person. This skill, which can be trained, facilitates interpersonal relationships.

provides users with a great breakthrough by providing a visual sensory experience [45]. This includes the most basic interactive game operation for complex multiperson perspective exchanges, self-reference imitations, and a variety of situation

*How to Use the Advantages of AR and VR Technique to Integrate Special Visual Training…*

**2.1 Overview of AR and VR technology and their benefits and differences**

AR technology is an interactive display platform that superimposes virtual objects in a real environment. Using the computer, it generates 3D image display, sound, text and animation effects to enhance the user's visual sensory experience. Therefore, it is good for pretend-play and symbolic play games to use AR technology, because they can augment the virtual 3D materials by overlaying them on the real objects to make it look like another thing. For example, by using AR technology, we can add the 3D model or animation overlay to real matchboxes to symbolize cars (**Figure 1**). By using the AR app, the matchboxes will look like the shape of a car on the screen, which can help autistic children to pretend and imagine that the matchboxes are cars. This concept can be easily understood from Bai's (2014)

Another VR technology provides a more immersive and realistic environment in which people can experience the environment. VR provides visual images on the media to help children with autism to have an in-depth experience, to master their imagination, and to experience visual sensory stimulation. Thus, VR technology has another benefit in that it lets the children with autism become immersed in another world and to empathize with another person's perspectives, feelings and thoughts. Therefore, the goals of AR and VR technology can be very different in the way that it presents the virtual environment, by either enhancing or changing the perceptual

The biggest difference between AR and VR is that AR integrates with real objects (**Table 1**), while VR is completely immersed in a virtual environment. AR presents an interaction with the objects in the actual field, such as the social skills training

*AR technology is used to help children with autism to elicit pretend-play and imagination skills, such as imagining a square matchbox as a car. The original picture was produced and re-drawn from Bai [47].*

simulations [42, 43, 46].

*DOI: http://dx.doi.org/10.5772/intechopen.94587*

research article [47].

world.

**Figure 1.**

**35**

However, children with autism are reluctant to participate in the situation guidance of intervention training, when they cannot see the scene, or anything to help them understand the situation or game [42]. For example, starting from general social training, game intervention activities, such as role-playing or perspectivetaking, are training methods that are used for autistic children to perceive the feelings of other people and to generate empathy. However, due to their inherent social defects and weak imagination, they cannot be effectively implemented, which leads to the exclusion of autistic children from teaching and training, making it even more difficult to attain effective training results [43].

In addition, the ability of role play or transposing their thinking is a very difficult skill for autistic children, and they cannot understand their social relationship with others, from the perspective of the others, by using empathy or their imagination [43]. Moreover, they are often unable to identify the non-verbal social cues in different complex social situations. It is difficult to effectively teach autistic children to understand special and complex social situations, or to develop further empathy. It is a complicated and abstract social structure for them, which makes it challenging for them to acquire such concepts and social skills [17, 18].

#### **1.6 Key factors of good social intervention training strategy**

For children with autism, the key point of a good social intervention strategy is to provide powerful visual media in this training game, to attract their attention and maintain their interest [17]. Compared with oral expression, or the written communication performance, image information is one of the best ways of learning. Temple Grandin, who is one of the most well-known and accomplished adults with autism [44], once described in his work that all the words and dialogs presented before the eyes of autistic patients are like pictures, which represents the unique visual learning approach and learning ability of autistic patients.

However, past research has pointed out that the traditional way of matching a picture with a text is not attractive to autistic children, and the effect is not significant [21]. The reason for this phenomenon is that traditional teaching strategies lack interaction and a clear teaching framework, and it is difficult for them to present or demonstrate an appropriate interactive situation. For example, traditional storybook combines social storytelling methods for teaching; however, storybooks can only provide fragments of situational pictures. (Situational pictures, like the normal photographic capture of a real scene, which we call a "montage" or a "stop motion video", include some people's interactions and social reciprocity behavior in a specific place. This material is used to help the therapist to teach the children and to indicate their roles and their interaction with it). However, it is difficult to show continuous details from situational pictures, and traditional storybooks lack an interactive mechanism, and many details can only be imagined, which causes autistic children to get bored or to lose interest.
