When technology adds up: virtual reality to support children and adolescents with autism

In a consultation room at the Child and Adolescent Mental Health Centre (CSMIJ) Badalona 1, a child wearing virtual reality goggles waves their hands and stretches their arms. There is nothing in front of them, but inside the immersive environment generated by the headset, a virtual kitchen unfolds. The child enjoys sorting fruits, vegetables and other foods, choosing options and interacting with different elements. They try, make mistakes and try again. Beside them, their parents and Anna Vallmitjana, a mental health nurse specialist at the centre, closely follow what is happening on the screen and observe how the child responds to the challenges posed by the game.

The initiative is part of ‘NutriVRTEA’, one of the strands of the AUTIS+ programme led by Badalona Serveis Assistencials (BSA), an organisation that has been working with virtual reality in healthcare for years. The project aims to improve therapeutic support for children and adolescents with Autism Spectrum Disorder (ASD) through immersive tools co-created with families and clinical professionals. The programme also includes a second strand, ‘TransiTEA 360’, currently under development, which seeks to create immersive experiences with adolescents with ASD to support school and life transitions using 360° videos recorded in real-life settings.

BSA’s experience with virtual reality began in 2017, applying this resource to the treatment of phobias and addictions. Since then, the organisation has incorporated immersive technology into various initiatives and structured them into different lines — clinical, educational, wellbeing and community. The aim is to develop useful, safe tools adapted to real needs, often co-created with professionals and users.

A virtual kitchen to learn healthy habits

One of the AUTIS+ projects is ‘NutriVRTEA’, which emerged from a specific difficulty identified by professionals in clinical practice. “Some children with ASD have issues related to nutrition; they are often very rigid and find it hard to make changes in this area,” Anna Vallmitjana explains. She notes that this is not a universal reality, but it does affect a portion of children with autism. “Many already have a baseline sensitivity and rigidity that extends to food; some children cannot tolerate certain textures, like purées, or completely reject fruit,” she adds.

The nurse traces the origin of the project to the need to respond to these challenges. “We thought that if we explained to these children why healthy eating matters in a different way, they might understand it better,” she says.

‘NutriVRTEA’ is structured around four mini-games within a virtual kitchen environment. The child must sort foods, distinguish between healthy and unhealthy options or feed a virtual character that reacts according to their decisions. Everything is designed so that the experience is brief and guided. Vallmitjana stresses the importance of control and supervision. “It’s not about giving the child the headset and letting them play however they want; there is always guidance and support,” she explains.

This support also involves families, who can follow everything happening via a tablet and are part of the process. “Families come into the consultation room and can see on a tablet how the child is playing. The idea is for them to take part and learn as well. Afterwards, we work with them on how much to insist or be more flexible to help ease this rigidity,” Vallmitjana highlights.

In this initial pilot phase, involving around twenty children, the team has mainly observed changes in children’s predisposition towards food. “It’s not a complete transformation, but there is an improvement in motivation and also in parents’ attitudes,” the nurse summarises. Virtual reality does not replace standard clinical intervention, but it provides a safe space to begin loosening rigid behaviours.

Training for change through 360° videos

Difficulties associated with ASD are not limited to eating. As children grow, new challenges appear related to life transitions and the need to gain autonomy. “These are natural transitions in the process of becoming independent, but adolescents with ASD may face greater difficulties adapting due to changes in routines or more uncertain contexts,” explains Irene Álvarez, clinical psychologist and researcher at BSA. The transition from primary to secondary school, changes in spaces or less structured moments — such as time between classes — can generate anticipatory anxiety.

This is where the second strand of AUTIS+, ‘TransiTEA 360’, comes in. It aims to train these situations before they occur through virtual reality. Using 360° videos recorded in real environments, adolescents can explore a school, a corridor or a playground and make decisions within an interactive story. “It’s a training and familiarisation tool. What we aim to do is reduce anticipatory anxiety,” Álvarez explains.

A key element of the project is that it has been designed through a co-creation process involving young people, families and health and education professionals, using surveys and focus groups to prioritise which transitions to address. The goal is to recreate everyday reality as closely as possible so that the virtual training makes sense when the change happens outside the screen, in real life.

The association ViuTEA has also played an essential role as part of the project’s core group, participating in decisions and validating the development. “We have worked with ViuTEA from the beginning because the aim is to develop a tool together with the people who will use it,” Álvarez explains.

The project began with a survey sent to 350 adolescents attended by CSMIJ services, gathering nearly 200 responses to identify which transitions caused the most distress. Based on this feedback and several focus groups, the team prioritised two specific situations: the transition from primary to secondary school — “starting secondary education is a very anxiety-provoking moment for many people,” Álvarez notes — and time between classes, described as “moments with unstructured interactions, a lot of noise and uncontrolled stimuli that generate anxiety.”

From there, the ‘TransiTEA 360’ team has begun building scenarios using 360° videos recorded in real settings, such as a secondary school in Badalona, to reproduce these contexts as faithfully as possible. The proposal also includes decision-making elements: “It’s like ‘choose your own adventure’ stories — the video pauses and poses a question, and depending on the answer, the situation evolves differently,” the psychologist explains.

The project is currently in a development and testing phase. Evaluation will not only measure whether the experience is useful or reduces perceived anxiety, but also whether it leads to changes in adolescents’ real participation in school or community settings. The underlying question is whether this virtual training has effects beyond the consultation room.

From virtual to real life

Both Vallmitjana and Álvarez emphasise that virtual reality is not a solution in itself, and its value depends on how it is integrated into clinical follow-up. In the case of ‘NutriVRTEA’, Vallmitjana highlights the importance of timing and context of use. “The game lasts five minutes. The times we’ve extended it because they were enjoying it, they become very overstimulated,” she explains. She adds: “Virtual reality, like screens in general, works very well if used properly. If it’s overused or not used appropriately, it becomes difficult.”

Álvarez adds a broader critical perspective on the use of these tools with adolescents. “I take a fairly critical stance on the widespread, unreflective use of technology,” she says. For her, the risk is that the experience remains confined to the screen. “There’s a danger of overusing the virtual tool without it translating into improved social integration or practical application,” she warns.

Even so, AUTIS+ illustrates a way of incorporating virtual reality into therapeutic support by starting from concrete needs, designing tools with the people who will use them and focusing on everyday situations. With a clear guiding idea: technology should add, not replace. Perhaps the most relevant aspect of AUTIS+ is not the technology itself, but how it has been conceived — through a shared process involving users, families, professionals and organisations.