During the primary search, to elaborate on this review, we had the initial impression, that VR has been extensively applied and tried in skill development in various disorders; abstracts and conclusions of most of the explored studies tend to showcase the positive effect of this new technology, without acknowledging the fact that of the studies are small-scaled, single-armed, without any control arm. Nevertheless, most of the mentioned reports in systematic reviews do not mention monitoring complications of this technology, as if it comes with pure benefit [6, 7, 12, 13].

In this study, we identified a total of 4 controlled trials on skill development in autism, ADHD, and dyslexia; comprising a total of 208 patients, a sample size that does not match a very large population of interest [8,9,10,11].

Moreover, the age range in the four studies is from 6 to 16 years, which means that VR technology is still not extensively available for early training of patients with learning difficulties. This makes the use of VR unfavorable as it is increasingly recognized that early identification and early childhood intervention can improve cognitive skills and lead to better integration in society and mainstream education [14].

A study that was mainly sight-opening is the controlled trial conducted by Ip and colleagues which did not overlook one of the major setbacks of VR technology. Ip et al. demonstrated, that VR was able to improve emotional recognition in patients with autism, however, it was less efficient than conventional training in developing social and adaptive skills [8].

The use of virtual reality (VR) in educational and therapeutic settings for children with disabilities presents several challenges and potential disadvantages. One disadvantage is its ability to isolate children from other kids and their surroundings. Especially with children with disabilities who might prefer spending time in a closed environment; VR emphasizes that and decreases the opportunities for natural interactions. Hence why it is crucial to find a balance and integrate VR as a supplementary tool rather than a sole means of intervention [15].

We also realize that the controlled studies did not mention thoroughly other drawbacks of VR-prolonged use, such as sensory overstimulation, and myopia in HMD especially if employed in early years of life.

The risk of sensory overstimulation, especially for individuals with auditory processing disorders (APD), due to their intense sensitivity to auditory stimuli, should not be overlooked. Careful consideration and customization of VR experiences are essential to prevent overwhelming sensory input, ensuring a positive and effective learning environment for individuals with APD. Moreover,

A specific drawback that was highlighted in studies was the potential of VR to cause discomfort, anxiety, and fatigue with its prolonged use. Some children expressed unease with VR headsets, and there were fluctuations in pulse rates, suggesting increased anxiety during VR sessions. Additionally, factors such as VR difficulty, potential biases in technologies, and limitations of VR eyewear should be carefully considered. Despite the potential benefits of VR, it may not be suitable for all cases, particularly for children with certain medical conditions. Balancing the integration of VR with real-world experiences and ensuring gradual exposure and supervision are crucial for effective and safe implementation in educational settings [16].

Ocular effects of VR remain unleashed, a study by Turnbull et al. showed that VR use on a short-term basis was not associated with an increased risk of myopia, however, a significant choroidal thickening was noted [17, 18].

High costs can also be a burden, since the expenses associated with VR technology, including both hardware and software, pose a barrier to its widespread adoption and accessibility. Therefore, addressing the cost factor is critical to making VR interventions more accessible [19].