{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:25:03Z","timestamp":1787235903403,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2018R1C1B5084570"],"award-info":[{"award-number":["NRF-2018R1C1B5084570"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Aggression is a major challenge for children with autism spectrum disorder (ASD), their family members, friends, and teachers because it can pose a threat or harm not only to the children with ASD but also to others. This study is a case study aimed at verifying the effectiveness of a virtual reality-based aggression control program for children with ASD. Methods: The participants were two children (one was a 10-year-old boy and the other was a 6-year-old girl) who participated in the ACAA (Aggression Replacement Training for Children and Adolescents with ASD) Program for eight sessions over three weeks. Results: The frequency (C1: 48 \u2192 3; C2: 32 \u2192 3) and severity of aggressive behaviors in both participants decreased after the intervention compared to before. Additionally, overall problematic behaviors were also reduced after the intervention (C1: 85 \u2192 70; C2: 87 \u2192 64). Furthermore, both participants demonstrated a slight increase in their levels of adaptation (C1: 17 \u2192 20; C2: 16 \u2192 18). Conclusions: The effectiveness of the ACAA program has been demonstrated in reducing levels of aggression in children with ASD. Therefore, the ACAA program may contribute to helping aggressive children with ASD live in harmony with others in society and promote independence.<\/jats:p>","DOI":"10.3390\/children12020173","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T11:10:39Z","timestamp":1738149039000},"page":"173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of a Virtual Reality-Based Aggression Control Program on Children with Autism Spectrum Disorder: A Case Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7482-8706","authenticated-orcid":false,"given":"Miran","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Nursing, Baekseok University, Cheonan 31065, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-486X","authenticated-orcid":false,"given":"Jaewon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Nursing, Hannam University, Daejeon 34430, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e20193447","DOI":"10.1542\/peds.2019-3447","article-title":"Identification, evaluation, and management of children with autism spectrum disorder","volume":"145","author":"Hyman","year":"2020","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13052-022-01310-w","article-title":"The global prevalence of autism spectrum disorder: A comprehensive systematic review and meta-analysis","volume":"48","author":"Salari","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref_4","unstructured":"(2024, December 01). Data and Statistics on Autism Spectrum Disorder, Available online: https:\/\/www.cdc.gov\/autism\/data-research\/index.html."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1007\/s10803-010-1118-4","article-title":"Aggression in children and adolescents with ASD: Prevalence and risk factors","volume":"41","author":"Kanne","year":"2011","journal-title":"J. Autism Dev. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.2147\/NDT.S84585","article-title":"Aggression in autism spectrum disorder: Presentation and treatment options","volume":"12","author":"Fitzpatrick","year":"2016","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4449","DOI":"10.1007\/s10803-020-04451-1","article-title":"A randomized controlled trial of functional communication training via telehealth for young children with autism spectrum disorder","volume":"50","author":"Lindgren","year":"2020","journal-title":"J. Autism. Dev. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Micai, M., Fatta, L.M., Gila, L., Caruso, A., Salvitti, T., Fulceri, F., Ciaramella, A., D\u2019Amico, R., Giovane, C.D., and Bertelli, M. (2023). Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: A systematic review and meta-analysis. Neurosci. Biobehav. Rev., 155.","DOI":"10.1016\/j.neubiorev.2023.105436"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/S0140-6736(13)61539-1","article-title":"Autism","volume":"383","author":"Lai","year":"2014","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1007\/s10803-022-05876-6","article-title":"Predictors of aggression, disruptive behavior, and anger dysregulation in youths with autism spectrum disorder","volume":"54","author":"Brown","year":"2024","journal-title":"J. Autism. Dev. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.rasd.2012.11.004","article-title":"Physical aggression in children and adolescents with autism spectrum disorders","volume":"7","author":"Mazurek","year":"2013","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.comppsych.2018.10.012","article-title":"An exploration of concomitant psychiatric disorders in children with autism spectrum disorder","volume":"88","author":"Lecavalier","year":"2019","journal-title":"Compr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jung, M., and Lee, E. (2020). Specialised teachers\u2019 perceptions on the management of aggressive behaviours in children and adolescents with autism spectrum disorders. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238775"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/10883576231165265","article-title":"Aggression is associated with social adaptive functioning in children with ASD and anxiety","volume":"38","author":"Kalvin","year":"2023","journal-title":"Focus Autism Other Dev. Disabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.rasd.2012.09.006","article-title":"The relationship between family functioning and behavior problems in children with autism spectrum disorders","volume":"7","author":"Sikora","year":"2013","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1002\/ddrr.118","article-title":"Managing irritability and aggression in autism spectrum disorders in children and adolescents","volume":"16","author":"Robb","year":"2010","journal-title":"Dev. Disabil. Res. Rev."},{"key":"ref_17","unstructured":"Glick, B., and Gibbs, J.C. (2011). Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth, Research Press. [3rd ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.apnu.2016.07.001","article-title":"Effects of aggression replacement training on problem solving, anger and aggressive behaviour among adolescents with criminal attempts in Turkey: A quasi-experimental study","volume":"30","author":"Kaya","year":"2016","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_19","first-page":"488","article-title":"Reducing aggressive behavior of adolescent with using the aggression replacement training","volume":"4","author":"Hardoni","year":"2019","journal-title":"J.Endur. Kaji. Ilm. Probl. Kesehat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1080\/13218719.2011.615807","article-title":"Aggression Replacement Training (ART) in Australia: A longitudinal youth justice evaluation","volume":"19","author":"Currie","year":"2012","journal-title":"Psychiatry Psychol. Law"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.avb.2019.02.006","article-title":"Efficacy of different versions of Aggression Replacement Training (ART): A review","volume":"47","author":"Ensafdaran","year":"2019","journal-title":"Aggress. Violent Behav."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Frolli, A., Savarese, G., Di Carmine, F., Bosco, A., Saviano, E., Rega, A., Carotenuto, M., and Ricci, M.C. (2022). Children on the autism spectrum and the use of virtual reality for supporting social skills. Children, 9.","DOI":"10.3390\/children9020181"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, M., Ding, H., Naumceska, M., and Zhang, Y. (2022). Virtual reality technology as an educational and intervention tool for children with autism spectrum disorder: Current perspectives and future directions. Behav. Sci., 12.","DOI":"10.20944\/preprints202202.0056.v1"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mesa-Gresa, P., Gil-G\u00f3mez, H., Lozano-Quilis, J.A., and Gil-G\u00f3mez, J.A. (2018). Effectiveness of virtual reality for children and adolescents with autism spectrum disorder: An evidence-based systematic review. Sensors, 18.","DOI":"10.3390\/s18082486"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4692","DOI":"10.1007\/s10803-021-05338-5","article-title":"Virtual and augmented reality in social skills interventions for individuals with autism spectrum disorder: A scoping review","volume":"52","author":"Dechsling","year":"2022","journal-title":"J. Autism. Dev. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.compedu.2017.09.010","article-title":"Enhance emotional and social adaptation skills for children with autism spectrum disorder: A virtual reality enabled approach","volume":"117","author":"Ip","year":"2018","journal-title":"Comput. Educ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S2215-0366(18)30053-1","article-title":"Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: A single-blind randomised controlled trial","volume":"5","author":"Geraets","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1177\/13591045211026160","article-title":"Using virtual reality to treat aggressive behavior problems in children: A feasibility study","volume":"26","author":"Alsem","year":"2021","journal-title":"Clin. Child Psychol. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.compedu.2016.03.018","article-title":"Design and application of an immersive virtual reality system to enhance emotional skills for children with autism spectrum disorders","volume":"98","author":"Lorenzo","year":"2016","journal-title":"Comput. Educ."},{"key":"ref_30","unstructured":"The EQUATOR Network (2024, July 20). The CARE Guidelines: Consensus-Based Clinical Case Reporting Guideline Development. Available online: https:\/\/www.equator-network.org\/reporting-guidelines\/care\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/MOP.0b013e32834cf082","article-title":"Behavioral interventions in children and adolescents with autism spectrum disorder: A review of recent findings","volume":"23","author":"Dawson","year":"2011","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1089\/cap.2009.0048","article-title":"Effectiveness of medication combined with intensive behavioral intervention for reducing aggression in youth with autism spectrum disorder","volume":"20","author":"Frazier","year":"2010","journal-title":"J. Child Adolesc. Psychopharmacol."},{"key":"ref_33","first-page":"291","article-title":"The effect of a self-monitored relaxation breathing exercise on male adolescent aggressive behavior","volume":"43","author":"Gaines","year":"2008","journal-title":"Adolescence"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/bin.1663","article-title":"Diaphragmatic breathing as treatment for escape-maintained aggression","volume":"34","author":"Phillips","year":"2019","journal-title":"Behav. Interv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1007\/s41252-018-0073-5","article-title":"Effects of SOBER Breathing Space on aggression in children with autism spectrum disorder and collateral effects on parental use of physical restraints","volume":"2","author":"Singh","year":"2018","journal-title":"Adv. Neurodev. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0272-4944(02)00109-3","article-title":"Tracking restoration in natural and urban field settings","volume":"23","author":"Hartig","year":"2003","journal-title":"J. Environ. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/ab.21690","article-title":"The effects of environmental resource and security on aggressive behavior","volume":"43","author":"Ng","year":"2017","journal-title":"Aggress. Behav."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"125","DOI":"10.12934\/jkpmhn.2022.31.2.125","article-title":"An integrated review of the factors influencing aggression in children and adolescents with autism spectrum disorder","volume":"31","author":"Jung","year":"2022","journal-title":"J. Korean Acad. Psychiatr. Ment. Health Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/109830070100300401","article-title":"A demonstration of the effects of augmentative communication on the extreme aggressive behavior of a child with autism within an integrated preschool setting","volume":"3","author":"Frea","year":"2001","journal-title":"J. Posit. Behav. Interv."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1023\/A:1013299028321","article-title":"The Behavior Problems Inventory: An instrument for the assessment of self-injury, stereotyped behavior, and aggression\/destruction in individuals with developmental disabilities","volume":"31","author":"Rojahn","year":"2001","journal-title":"J. Autism Dev. Disord."},{"key":"ref_41","unstructured":"Achenbach, T.M., and Rescorla, L.A. (2001). Manual for the ASEBA School-Age Forms and Profiles, University of Vermont Research Center for Children, Youth, & Families."},{"key":"ref_42","unstructured":"Oh, K.J., and Kim, Y.A. (2024). Manual for the ASEBA School-Age Forms, Huno. [17th ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"World Medical Association (2005, December 14). WMA Declaration of Helsinki\u2014Ethical Principles for Medical Research Involving Human Participants. Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki\/.","DOI":"10.1515\/9783110208856.233"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/13218710902852859","article-title":"Aggression replacement training in Australia: Youth justice pilot study","volume":"16","author":"Currie","year":"2009","journal-title":"Psychiatry Psychol. Law"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:38:32Z","timestamp":1759919912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["children12020173"],"URL":"https:\/\/doi.org\/10.3390\/children12020173","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}