Effectiveness of Different Virtual Reality Technologies for Social and Communication Skills in Children With Autism Spectrum Disorder: Systematic Review and Network Meta-Analysis of Current Evidence and Future Directions

Background: Virtual reality (VR) technology offers a new approach for the intervention of social communication skills in children with autism spectrum disorder (ASD), but the comparative effects of different forms of VR technology remain unclear. Objective: This study aims to conduct a systematic review and network meta-analysis (NMA) based on existing randomized controlled trials (RCTs) to initially explore and compare the effects of different VR technologies on improving the social and communication skills of children with ASD. Methods: We systematically searched relevant RCTs in both Chinese and English databases from January 1990 to February 2025. The quality of the literature was evaluated using the revised Cochrane risk of bias assessment tool (RoB-2), and an NMA was conducted under the frequentist framework using STATA 18.0 software. The quality of evidence was assessed using the Confidence in Network Meta-Analysis framework. Unlabelled: A total of 11 RCTs (718 children) were included, evaluating 8 VR technologies. The evidence network was extremely sparse, with most interventions connected by single studies. Pairwise meta-analysis revealed overwhelming heterogeneity (I²=91.9%, P<.001), indicating profound clinical and methodological diversity. Due to this heterogeneity and the sparse network, the NMA model failed to produce stable or clinically interpretable effect estimates. Formal assessment using the Confidence in Network Meta-Analysis framework rated the confidence in all comparisons as very low. Conclusions: The existing evidence is insufficient to support any comparative efficacy conclusions or rankings among VR technologies for ASD social skills. The key finding is the demonstration that current evidence is too heterogeneous and immature for valid quantitative synthesis. Future research must prioritize methodological standardization before head-to-head trials can be meaningfully conducted.