Virtual Reality-Assisted Applied Behavior Analysis in Autism Spectrum Disorder: Opportunities, Challenges, and Future Directions for Emotion Regulation and Caregiver Training

Autism Spectrum Disorder (ASD) is a prevalent neurodevelopmental condition characterized by challenges in social communication and restrictive behaviors. Among its core difficulties, emotion regulation (ER) remains a critical but under-addressed domain, closely linked to behavioral dysregulation, social withdrawal, and reduced adaptive functioning. Applied Behavior Analysis (ABA) is widely recognized as an evidence-based intervention for ASD and has shown utility in targeting ER through reinforcement-based learning. However, ABA’s implementation is often limited by high cost, caregiver fidelity issues, and limited contextual generalization—particularly in low- and middle-income countries (LMICs). Virtual Reality (VR) technologies offer immersive, interactive, and controlled environments that can complement ABA strategies, particularly for ER training. Emerging studies suggest VR may enhance engagement, enable safe emotional rehearsal, and support skill generalization in children with ASD. Additionally, caregiver-mediated VR models hold promise in increasing training scalability and contextual relevance. Yet, most existing evidence comes from pilot studies conducted in high-income countries, with limited exploration of caregiver roles, cultural adaptability, or long-term sustainability. This narrative review critically synthesizes literature on VR-assisted ABA interventions for ER in children with ASD, with a special focus on caregiver-mediated models and LMIC applicability. It outlines key trends, highlights feasibility findings, and identifies major research gaps—particularly the need for culturally tailored, longitudinal, and caregiver-integrated approaches. The review argues that while VR can bridge existing gaps in ASD behavioral care, its widespread adoption requires rigorous validation, ethical safeguards, and contextual sensitivity.