# High-Functioning Autism and Virtual Reality Applications: A Scoping Review
## 4 Discussion
The papers included in this review targeted both social interaction and/or adaptation. This demonstrates that addressing social functioning as a core fragility to be supported in a person's lifespan remains the most discussed topic. Recent evidence confirms the link between eye gaze cueing and joint attention [71], which refers to the use of the perceived gaze direction to automatically shift visual attention and orient it to the same object/individual that other people are looking at. Among the available technologies, HMDs have the potential to study eye gaze behavior in VR environments. Three studies included in this review assessed the eye gaze behavior and joint attention of HF ASD adults by using HMDs to gain a better understanding of these attention mechanisms. All the included studies were aimed at adolescents and adults and did not propose a specific intervention. Further research is needed since joint attention deficits are an early-developing social communication skill [72], and early intervention through VR could be beneficial. These results taken together might be supportive evidence of the early difficulties of ASD individuals and their subsequent need for support, including the ones characterized by the high-functioning phenotype. Even at an early age, autistic children manifest a tendency to favor non-social stimuli [33]; when encountering society, ASD individuals might suffer from isolation and low-quality peer interactions, with escalating negative effects also registered in the linguistic domain [73]. Alongside socio-communicative manifestations, motor difficulties have been reported even in early descriptions of the ASD disorder [74]. Atypical movements and deficits in locomotor abilities are common across the spectrum, with consequences such as limited exploration of surrounding spaces, limited interaction with the environment, and an overall impact on quality of life [75]. The papers included in this review assessed postural balance [49], gait pattern [54], and upper limb movements [61] using motion-tracking systems to assess motor performance quantitatively. These papers only reported the use of CAVE and semi-immersive systems, while HMDs were not used. This could be due to the fact that wearing a headset might lead to a higher risk of falls, hindering the vestibular and visual system [76] and causing cybersickness due to visual-vestibular conflicts [77]. Two papers on motor skills included in the current review refer to a group of participants below 18 years of age, potentially due to the fact that early assessments and interventions are recommended. Only the contribution of [PERSON] and colleagues [49]included both children and adults in order to investigate if postural behavior might differ as a function of development: the results confirmed the contingency of age and motor behavior. Chronological age has been described as a possible determinant of postural hypo-reactivity, but more investigation is needed to combine immersive VR applications and different age groups across different motor domains. Another domain that emerged from the papers included in this scoping review is represented by job training. The need for VR to promote independence and autonomy is well documented, thus enabling the exercise of adaptive and functional behaviors in a controlled and safe environment [78] and enabling effective skill interventions that might be implemented by occupational therapists in their practices [79]. Two papers included in this review were dedicated to job training for HF ASD participants older than 18 years, with a specific focus on immersive VR for vocational skills. The exclusive use of HMDs in these papers might be supported by the fact that interventions on job skills might benefit from the portability of VR applications in future applications (e.g., in corporate contexts). Regarding age range, ASD is indeed classified as a neurodevelopmental-idental disorder, with consequences that endure through adulthood.