Speaking AnxietySocial Communication

Feasibility and acceptability study of virtual environments for treating childhood social anxiety disorder - foundational early-childhood VRET evidence cited as anchor by Delangle 2026 and Moïse-Richard 2021

Wong Sarver N et al. · 2014 · Journal of Clinical Child and Adolescent Psychology · Case Study 0 · Children with social anxiety disorder · DOI
Evidence certainty: Low certainty
How this was rated

Early feasibility and acceptability design rather than randomized controlled trial. Peer-reviewed in Journal of Clinical Child and Adolescent Psychology (Taylor & Francis, established peer-reviewed clinical child psychology venue) - special section on Technology and Children's Mental Health, edited by Deborah J. Jones. Modest sample (specific n not fully extracted in available abstract excerpt). Hardware era-appropriate for 2013-2014 (early-modern HMDs, before consumer Quest era). Sample composed of children with SAD - precise age range and diagnostic criteria reported in the published article. As foundational evidence the contribution is acceptability + presence + clinician + parent + child reports of feasibility - the prerequisites for downstream efficacy testing.

Ratings use a simplified four-tier scheme (High, Moderate, Low, Very Low) informed by the GRADE working group. Learn more about how studies are rated.

A feasibility and acceptability study of virtual environments for treating childhood social anxiety disorder, published in the Journal of Clinical Child and Adolescent Psychology special section on Technology and Children's Mental Health. The work examines whether VR exposure environments are tolerable, acceptable, and clinically usable with children with SAD - the developmental phase before the adolescent population studied by Parrish 2016 and before the adult VRET literature anchored by Anderson, Bouchard, and Wallach. Foundational evidence frequently cited as the pediatric-VRET anchor in subsequent stuttering+VR work (Delangle 2026, Moïse-Richard 2021).

Clinical bottom line

An early pediatric VR exposure feasibility study establishing that virtual environments are acceptable and clinically usable with children who have social anxiety disorder. Predates the Parrish 2016 adolescent-population work; together the two studies cover the developmental range from childhood through adolescence. Frequently cited as the pediatric VR-exposure anchor in subsequent stuttering+VR research (Delangle 2026, Moïse-Richard 2021). For clinicians working with children who have SAD (including PWS children with social-anxiety comorbidity), this is foundational evidence that VR can be used with this developmental age group. Does NOT establish treatment efficacy - feasibility and acceptability are the contribution.

Key findings

  • First major peer-reviewed feasibility and acceptability study of VR environments specifically for CHILDHOOD social anxiety disorder - filling a developmental gap below the adult-focused VRET literature
  • Published in the Journal of Clinical Child and Adolescent Psychology special section on Technology and Children's Mental Health (Guest Editor: Deborah J. Jones)
  • Frequently cited as the pediatric VR-exposure anchor in subsequent stuttering+VR research - both Delangle 2026 (Journal of Fluency Disorders) and Moïse-Richard 2021 (Journal of Fluency Disorders) reference this study to justify their pediatric VR exposure designs in PWS children and adolescents
  • Establishes that the prerequisite acceptability and feasibility conditions hold for VR exposure work with children - precursor to treatment-outcome research in pediatric SAD
  • Author affiliations: Wong Sarver and Beidel at University of Central Florida (US); Spitalnick affiliated with Virtually Better Inc (commercial VR therapy company) - a meaningful industry affiliation that readers should be aware of when evaluating the paper

Background

The VRET literature at the time of this study (2013-2014) was overwhelmingly adult-focused. Social anxiety disorder, however, typically onsets in late childhood to mid-adolescence. Whether VR exposure environments are feasible and acceptable for children - the developmental phase BEFORE the adolescent population - had not been established. This left a developmental gap below the adolescent-focused work that would later be done by Parrish et al. 2016.

What the researchers did

The authors conducted a feasibility and acceptability study of virtual environments specifically for treating childhood social anxiety disorder. Published as part of a special section in Journal of Clinical Child and Adolescent Psychology on Technology and Children’s Mental Health (Guest Editor Deborah J. Jones), the study evaluated whether children with SAD could tolerate, engage with, and meaningfully respond to VR exposure environments designed for their developmental level.

The study was clinician-supervised, used era-appropriate VR hardware, and included structured assessments of presence, immersion, acceptability, and tolerability.

Why this matters

Feasibility and acceptability work precedes efficacy research in any new clinical modality. Before randomized controlled trials of VRET in pediatric SAD can be ethically and practically conducted, the prerequisite developmental questions must be answered: can children focus on the VR environment, do they report the expected pattern of anxiety in socially reactive scenarios, and is the experience acceptable to children, parents, and clinicians? This study addressed those questions affirmatively.

The clinical importance is reflected in the citation pattern: both Delangle et al. 2026 (pilot RCT in youth who stutter) and Moïse-Richard et al. 2021 (virtual classrooms in school-age children who stutter) cite this paper as the pediatric VR-exposure anchor to justify their own designs. For SLPs working with pediatric PWS who have social-anxiety comorbidity, this study underpins the rationale for considering VR exposure in this population.

Limitations

Implications for practice

For clinicians considering VR exposure with children who have SAD - including SLPs working with pediatric PWS who present with social-anxiety comorbidity - this study provides the foundational acceptability evidence at the youngest end of the developmental range covered by the VRET literature. Together with Parrish 2016 (adolescent SAD feasibility), it establishes that VR exposure is workable from late childhood through adolescence. Clinical use should focus on socially anxious children where VR offers a controlled, replicable exposure modality unavailable through in-vivo or imaginal exposure alone. Note the Spitalnick / Virtually Better commercial affiliation - the study's findings reflect a Virtually Better-era system, not contemporary consumer HMDs. Treatment efficacy not established here - this is feasibility evidence.

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Cite this study

If you reference this study in your work, the canonical citation formats are:

APA 7th
Wong Sarver, N., Beidel, D. C., & Spitalnick, J. S. (2014). The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder. Journal of Clinical Child and Adolescent Psychology. https://doi.org/10.1080/15374416.2013.843461.
AMA 11th
Wong Sarver N, Beidel DC, Spitalnick JS. The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder. Journal of Clinical Child and Adolescent Psychology. 2014. doi:10.1080/15374416.2013.843461.
BibTeX
@article{wongsarver2014,
  author = {Wong Sarver, N. and Beidel, D. C. and Spitalnick, J. S.},
  title = {The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder},
  journal = {Journal of Clinical Child and Adolescent Psychology},
  year = {2014},
  doi = {10.1080/15374416.2013.843461},
  url = {https://withvr.app/evidence/studies/wong-sarver-2014}
}
RIS
TY  - JOUR
AU  - Wong Sarver, N.
AU  - Beidel, D. C.
AU  - Spitalnick, J. S.
TI  - The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder
JO  - Journal of Clinical Child and Adolescent Psychology
PY  - 2014
DO  - 10.1080/15374416.2013.843461
UR  - https://withvr.app/evidence/studies/wong-sarver-2014
ER  -

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Funding & independence

Affiliations: Wong Sarver, Beidel - University of Central Florida; Spitalnick - Virtually Better, Inc. (commercial VR therapy company; meaningful industry affiliation). Funding sources not extracted in detail. Peer-reviewed in Journal of Clinical Child and Adolescent Psychology (Taylor & Francis). No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published peer-reviewed paper. The VR system used was a Virtually Better-era configuration, NOT Therapy withVR or Research withVR.

Last reviewed: 2026-05-17 Next review due: 2027-05-17 Reviewed by: Gareth Walkom