University of New Orleans ScholarWorks@UNO University of New Orleans Theses and Dissertations and Theses Dissertations Spring 5-18-2018 Mental Health Practitioners Perceptions’ of Presence in a Virtual Reality Therapy Environment for Use for Children Diagnosed with Autism Spectrum Disorder Panagiotis Markopoulos University of New Orleans, pmarkopo@uno.edu Follow this and additional works at: https://scholarworks.edu/td Part of the Education Commons, Medicine and Health Sciences Commons, and the Social and Behavioral Sciences Commons Recommended Citation Markopoulos, Panagiotis, "Mental Health Practitioners Perceptions’ of Presence in a Virtual Reality Therapy Environment for Use for Children Diagnosed with Autism Spectrum Disorder" (2018). University of New Orleans Theses and Dissertations.edu/td/2472 This Dissertation is protected by copyright and/or related rights. It has been brought to you by ScholarWorks@UNO with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use.
For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in University of New Orleans Theses and Dissertations by an authorized administrator of ScholarWorks@UNO. For more information, please contact scholarworks@uno. Mental Health Practitioners Perceptions’ of Presence in a Virtual Reality Therapy Environment for Use for Children Diagnosed with Autism Spectrum Disorder A Dissertation Submitted to the Graduate Faculty of the University of New Orleans in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Counselor Education by Panagiotis Markopoulos B.
National and Capodistrian University, Athens/Greece, 2007 B. Western Kentucky University, United States, 2008 M. Eastern Kentucky University, United States, 2012 May 2018 © 2018, Panagiotis Markopoulos ii Dedication I dedicate my dissertation research work to my parents, as well as to the autism research. Special feelings of gratitude to my beloved parents Aggelo and Eleftheria Markopoulou for their unconditional love and support.
Without your love and ongoing courage, I would not have been able to make it so far. You both taught me how to be a humble person, kind to others, never give up in life, and always be optimistic. I love you, mom and dad. I also dedicate this dissertation work to Dr.
Dufrene for chairing my research study. Thank you for your ongoing hard work, mentorship love, believing in me and my research, as well as for taking the time to teach me how to become a researcher. I will always be grateful to you. Lastly, I dedicate this work to Dr.
Puglia for her non-stop mentorship, love, wisdom, and for helping me to become the good clinician I am today. I will always be grateful to you. iii Acknowledgments Thank you to all my friends for your love, support and encouragement. I will be forever grateful.
Thank you to my faculty committee members Drs. O’Hanlon and Zarus E. Watson for your time, feedback and ongoing guidance. iv Table of Contents List of Tables.
ix List of Figures. xii Chapter I: Introduction .1 Purpose of Study .3 Significance of the Study .4 Cognitive Development Theory .6 Counseling application of CDT .9 Overview Methods and Research Questions .11 Limitations and Delimitations.12 Assumptions of the Study .13 Definition of Terms.13 Chapter II: Literature Review .19 The Birth of Autism: Then and Now .19 DSM History of Autism .22 Societal Perceptions of ASD .24 Characteristics of ASD .26 Age, Gender and Ethnicity Characteristics .26 Medical and Clinical Characteristics .27 Cognitive Development Theory as a Framework for ASD .30 CDT and ASD .35 Therapeutic Interventions Used with ASD .37 Cognitive Behavioral Therapy .37 Applied Behavioral Analysis .39 Program for Education and Enrichment of Relationship Skills Program .40 Early Start Denver Model .41 Sensory Integration Therapy .41 Picture Exchange Communication System .42 Auditory Integration Therapy .42 Speech-Language Therapy .43 Verbal Behavior Therapy .44 Developmental Individual-Differences Relationship-Based Model .44 Relationship Development Intervention Program .45 Social Communication/Emotional Regulation/Transactional Support Model .46 A New Treatment Era in Mental Health: Technology .47 Professional Ethics When Using Technology .48 Mental Health Practitioners Use of Technology .51 Types of Therapy Provided Using Technology .58 Research using VREs .59 v Head-mounted displays .61 Virtual Reality and ASD .63 Research using VREs with ASD .69 Chapter III: Research Design .70 Pilot Study: First Part .70 Equipment and Technology .77 Pilot Study: Second Part .86 Equipment and Technology .91 Summary of Pilot Study .97 Main Study: Research Questions and Hypotheses.101 Data Collection Methods .101 Temple Presence Inventory .102 Temple Presence Inventory scoring .116 vi Research Question 4 .116 Chapter IV: Main Study Results .117 Demographic Questionnaire Descriptives and Frequencies .117 Temple Presence Inventory Descriptives and Frequencies .120 Condition A: Exposure Laptop first, then Oculus Rift HMD .120 Condition A: Exposure to Laptop first – spatial presence .121 Condition A: Exposure to HMD second – spatial presence .121 Condition A: Exposure to Laptop first – social presence-actor within medium (parasocial interaction).121 Condition A: Exposure to HMD second – social presence-actor within medium (parasocial interaction) .122 Condition A: Exposure to Laptop first– engagement (mental immersion) .122 Condition A: Exposure to HMD second – engagement (mental immersion) .122 Condition A: Exposure to Laptop first – social realism.122 Condition A: Exposure to HMD second – social realism .123 Condition A: Exposure to Laptop first– TPI evaluation of equipment experience.123 Condition A: Exposure to HMD second – TPI evaluation of equipment experience.123 Condition A: Qualitative responses .126 Condition B: Exposure Oculus Rift HMD first, then Laptop .127 Condition B: Exposure to HMD first – spatial presence .127 Condition B: Exposure to Laptop second – spatial presence .127 Condition B: Exposure to HMD first – social presence-actor within medium (parasocial interaction).127 Condition B: Exposure to Laptop second – social presence-actor within medium (parasocial interaction) .128 Condition B: Exposure to HMD first – engagement (mental immersion).128 Condition B: Exposure to Laptop second– engagement (mental immersion) .128 Condition B: Exposure to HMD first – social realism .128 Condition B: Exposure to Laptop second – social realism .129 Condition B: Exposure to HMD first – TPI evaluation of equipment experience.129 Condition B: Exposure to Laptop second – TPI evaluation of equipment experience.130 Condition B: Qualitative responses .132 Summary table of descriptives for conditions a and b .133 Results of Research Questions .134 Preliminary data analysis .134 Testing for normality .134 Differences in the Laptop and HMD and order of conditions for TPI total scores .137 vii Differences in the Laptop and HMD and order of conditions for TPI subscale scores .138 Data analysis for research question 1 .150 Discussion of Research Findings .150 Physical Conditions Experienced .150 Experience with ASD and Technology.151 Experience with ASD .151 Experience with technology .152 Assessment of Presence in the VRTE .159 Implications for Mental Health Practitioners .159 Implications for Technology in Mental Health Practice .166 Appendix A: Pilot Study: Faculty Demographic Questionnaire.192 Appendix B: Pilot Study: Student Demographic Questionnaire.195 Appendix C: Pilot Study: Virtual Reality Therapy Environment Questionnaire (VRTEQ).198 Appendix D: Pilot Study: IRB Approval Letter .202 Appendix E: Pilot Study: Faculty Informed Consent .204 Appendix F: Pilot Study: E-mail to Faculty and Student Informed Consent .206 Appendix G: Pilot Study: Student Demographic Questionnaire-Revised .208 Appendix H: Pilot Study: Virtual Reality Environment Questionnaire-Revised (VREQ-R) .211 Appendix I: Pilot Study: Student Verbal Informed Consent-Revised .215 Appendix J: Demographic Questionnaire .217 Appendix K: Temple Presence Inventory (TPI) .220 Appendix L: Author’s Permission to Use the Temple Presence Inventory (TPI) .227 Appendix M: IRB Approval Letter .229 Appendix N: Invitation to Practitioners .231 Appendix O: Informed Consent .236 viii List of Tables Table 1 Descriptives for Gender, Age, and Ethnicity of Faculty and Graduate Students .78 Table 2 Frequencies of Ethnicity for Faculty and Graduate Students .78 Table 3 Frequencies of Degree for Faculty.79 Table 4 Frequencies of Degree and Discipline for Graduate Students .79 Table 5 Descriptives for Years of Autism Experience of Faculty and Graduate Students .80 Table 6 Frequencies of Technology and Software Used by Faculty and Graduate Students .81 Table 7 Descriptives of Amount of Time Technology Used by Faculty and Graduate Students .82 Table 8 Descriptives of the VRTE Resemblance to the Film by Faculty and Grduate Students .83 Table 9 Correlations for Technology Use to Overall Resemblance and Nine Checkpoints in VRTEQ .85 Table 10 Descriptives for Gender, Age and Ethnicity of Undergraduate Students .91 Table 11 Frequencies of Technology and Software Used by Undergraduate Students .92 Table 12 Descriptives of Amount of Time Technology Used by Undergraduate Students .93 Table 13 Descriptives of VRE Similarity to the Film by Undergraduate Students .94 Table 14 Correlations for Technology Use to Overall Similarity and Nine Checkpoints in VREQ-R.96 Table 15 VRTEQ and VREQ-R Mean Comparison Table .98 Table 16 Frequencies, Means and Standard Deviations for Gender, Age, and Ethnicity .118 Table 17 Frequencies for Degree, Professional Licensure, Work Setting, and Credentials .118 Table 18 Descriptives of Mental Health Practitioners’ Experience with Children with Autism and Technology .120 Table 19 Cronbach’s Alphas for TPI Subscales .120 Table 20 Descriptives and Frequencies for TPI Scores: Condition A .124 Table 21 Descriptives and Frequencies for TPI Scores: Condition B .130 Table 22 Summary of Means and Standard Deviations for TPI Total and Subscale Scores for Condition A and B .133 Table 23 Repeated-Measures MANOVA for Differences and Order for Laptop and HMD: TPI Total Scores .138 Table 24 Repeated-Measures MANOVA of Differences and Order for Laptop and HMD: TPI Subscale Scores .140 Table 25 Repeated-Measures MANOVA of Differences in Laptop and HMD: TPI Subscales Scores .140 Table 26 Repeated-Measures MANOVA of Differences and Order of Laptop and HMD of Mental Health Practitioners’ Ratings of the Likelihood of Using VRTE with Children Diagnosed with ASD .143 ix Table 27 Descriptives for Mental Health Practitioners Likelihood of Using Techology with Children Diagnosed with with ASD for Conditions A and B .143 Table 28 Correlations of Mental Health Practitioners’ Age and Years of ASD Experience to TPI Scores for Conditions A and B .145 Table 29 Correlations of Mental Health Practitioners’ Number of Years and Hours Using Technology, and Years of Experience Playing Online Games to TPI Scores for Conditions A and B .147 Table 30 Correlations of Mental Health Practitioners’ Years of Experience Using Technology with Children with ASD and Times Used Interactive Virtual Technology to TPI Scores for Conditions A and B .148 x List of Figures Figure 1 Piaget’s Cognitive Development Theory .31 Figure 2 VRTE and VRE Computer Equipment .88 Figure 19 VRTE Computer Equipment .111 Figure 20 VRTE HMD Equipment .114 Figure 25 Normal Q-Q Plot – Condition A .135 Figure 26 Histogram – Condition A .135 Figure 27 Normal Q-Q – Condition B .136 Figure 28 Histogram – Condition B.137 Figure 29 Estimated Marginal Means for TPI total scores .138 Figure 30 Estimated Marginal Means for Subscale I – Spatial Presence .140 Figure 31 Estimated Marginal Means for Subscale II – Social Presence .141 Figure 32 Estimated Marginal Means for Subscale III – Engagement .141 Figure 33 Estimated Marginal Means for Subscale IV – Social Realism.142 Figure 34 Estimated Marginal Means for Likelihood of Use of Technology with Children with ASD .143 xi Abstract Children with autism spectrum disorder (ASD) think and understand social contexts primarily from a visual stand point. Feelings of being present in their social environment are a key component to their development (Strickland, Marcus, Mesibov, & Hogan, 1996). A virtual reality environment (VRE) can provide a therapeutic setting for children with ASD to learn social skills (Ehrlich & Munger, 2012).
In the present research, a pilot study was used to assess the validity of a Second Life VRE developed by the researcher (Markopoulos, 2016b) by comparing the VRE to a real life film by The National Autistic Society (2016) in the United Kingdom. Feedback from the pilot study was used to make revisions to the VRE. The validated virtual reality therapy environment (VRTE) was used in the main research study.