Heart Rate Variability in Adolescents with Autistic Spectrum Disorder Practicing a Virtual Reality Using Two Different Interaction Devices (Concrete and Abstract): A Prospective Randomized Crossover Controlled Trial

Abstract

Individuals with autism spectrum disorder (ASD) often experience dysregulation of the autonomic nervous system, as evidenced by alterations in heart rate variability (HRV). It can be influenced by virtual reality (VR), which affects physiological responses due to its sensitivity to environmental and emotional stimuli. Objectives: This study aimed to assess HRV in individuals with ASD before, during, and after VR-based tasks over a 10-day period, specifically examining how HRV fluctuated in response to concrete (touchscreen) and abstract (webcam) interactions. Methods: Twenty-two male participants were randomly assigned to two sequences based on the order of tasks performed (starting with either the concrete or abstract task). Results: The findings revealed significant changes in HRV indices (RMSSD, SD1, SDNN, and SD2) between the two task types. Conclusions: The participants engaged in abstract tasks demonstrated higher motor demands, which were indicated by decreased parasympathetic activity and an increased LF/HF ratio, suggesting greater activation of the sympathetic nervous system.

Keywords: autism spectrum disorder; autonomic nervous system; heart rate; virtual reality.

Figure 1

Representative design of a participant engaging with the MoveHero software task (Research Group and Technological Application in Rehabilitation—PATER Group, São Paulo, Brazil). (A) Illustration showing a successful hit by the participant, with the targeted sphere highlighted. (B) Illustration depicting a miss by the participant, indicated by a red X on the sphere. (C) Illustration of the task being performed using the touchscreen. The spheres are ordered from left to right in the following colors: blue, green, red, and purple.

Figure 2

Study design.

Figure 3

Representation of the mean and standard error of HRV indices (Time domain: Mean HR, Mean RR, SDNN, RMSSD, and PNN50) across sequences (A: abstract-concrete and B: concrete-abstract) and assessments (Rest–pre and post, Activity—D1 to D10).

Figure 4

Representation of the mean and standard error of HRV indices (Frequency domain: LF n.u., HF n.u. and LF/HF; and Poincaré plot analysis: SD1 and SD2) across sequences (A: abstract-concrete and B: concrete-abstract) and assessments (Rest–pre and post, Activity—D1 to D10). In the LF/HF graph, the dotted line indicates the ideal reference value of 1 for this measure.