Redefining autism in adulthood interventions in and through social virtual environments: an exploratory cross-cultural study

Abstract

Background Autism intervention research has largely prioritized children and adolescents, with limited guidance for adults. Social virtual environments (SVEs; e.g., VRChat) are widely used by autistic adults for connection, yet their role as intervention settings remains under-examined. This study explores clinicians’ perspectives on feasibility, risks, and essential design requirements for clinician-informed SVE-based socio-relational interventions for autistic young adults with low support needs. Methods We conducted nine semi-structured focus groups with Italian clinicians (N = 26) across three regions (Veneto, Trentino, Lazio) and five semi-structured international interviews (U.S. n = 4; Australia n = 1). Transcripts were analyzed via inductive, codebook-informed thematic analysis grounded in reflexive qualitative principles. Because the study involved four coders working across two linguistically distinct datasets, a shared coding framework was used as a pragmatic coordination tool to support transparency, interpretive consistency, and auditability across the research team (the intent was not to establish positivist inter-rater reliability or eliminate researcher subjectivity). Datasets were first coded separately and then integrated through matrix-based synthesis to identify contextually situated points of convergence and divergence. Results Italian clinicians emphasized neurodiversity-affirming aims, context-dependent social difficulty (including anxiety/overwhelm), structured scaffolding and mediation, ecological generalization, and SVEs as conditional tools requiring boundaries. International clinicians foregrounded autonomy and choice, emotional safety in relation to masking, neurotype composition as an ingredient for belonging, identity-affirming collaboration, and regulation/repair practices. Across datasets, clinicians emphasized safety-contingent participation, non-negotiable personalization/controllability of demands (i.e., sensory, social), and the protective value of supported pauses and exits. Contextual differences centered on the dominant logic of support (competence-building scaffolding vs. liberation/identity integration), mediator-led structure vs. neurotype-aligned spaces, intersectionality as primary vs. contextual framing, and distinct risk emphases (avoidance/overuse vs. relational ambiguity and rejection). Conclusion Clinicians conceptualize SVEs not as inherently therapeutic technologies but as conditional social infrastructures whose potential value depends on how safety, autonomy, and identity are supported. Clinician-informed SVE-based interventions for autistic adults may therefore require integrating structured mediation with explicit autonomy- and identity-affirming safeguards, offering a pathway beyond the traditional’ skills vs. acceptance’ divide in autism intervention research.