La réalité virtuelle apparaît comme une technologie prometteuse tant dans ses applications d’évaluation que de prise en charge thérapeutique en psychiatrie. Les outils de réalité virtuelle permettent de combiner divers atouts de par leurs interfaces : un aspect plus ludique de la tâche, un meilleur engagement du sujet, une forme de standardisation par l’immersion du sujet dans un environnement « contrôlé » et une dimension écologique qui mime des « fonctions de la vie quotidienne ». En psychiatrie de l’enfant et de l’adolescent, la réalité virtuelle a été jusqu’alors principalement utilisée dans des troubles anxieux caractéristiques (phobies spécifiques, phobie sociale et scolaire). Dans cette indication, tout comme dans les troubles des conduites alimentaires, des environnements spécifiques de réalité virtuelle sont utilisés comme outil de prise en charge par exposition aux situations anxiogènes. Dans les troubles du spectre de l’autisme, les applications thérapeutiques de la réalité virtuelle ont montré une efficacité dans la reconnaissance des émotions, l’amélioration des habilités cognitives et les compétences sociales. Concernant le trouble déficit de l’attention avec hyperactivité, la réalité virtuelle a été utilisée comme outil d’évaluation en situation scolaire de composantes telles que l’attention, l’hyperactivité et l’impulsivité. Si les premières études sont très encourageantes en termes d’évaluation, d’efficacité dans la prise en charge et d’acceptabilité des outils, de nouvelles études seront nécessaires pour renforcer la standardisation des méthodes et vérifier la généralisation et le transfert des bénéfices acquis aux situations réelles de la vie quotidienne.

Virtual reality is a relatively new technology that enables individuals to immerse themselves in a virtual world. It offers several advantages including a more realistic, lifelike environment that may allow subjects to “forget” they are being assessed, allow a better participation and an increased generalization of learning. Moreover, the virtual reality system can provide multimodal stimuli, such as visual and auditory stimuli, and can also be used to evaluate the patient's multimodal integration and to aid rehabilitation of cognitive abilities. The use of virtual reality to treat various psychiatric disorders in adults (phobic anxiety disorders, post-traumatic stress disorder, eating disorders, addictions…) and its efficacy is supported by numerous studies. Similar research for children and adolescents is lagging behind. This may be particularly beneficial to children who often show great interest and considerable success on computer, console or videogame tasks. This article will expose the main studies that have used virtual reality with children and adolescents suffering from psychiatric disorders. The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by various studies. Most of the studies attest to the significant efficacy of the virtual reality exposure therapy (or in virtuo exposure). In children, studies have covered arachnophobia social anxiety and school refusal phobia. Despite the limited number of studies, results are very encouraging for treatment in anxiety disorders. Several studies have reported the clinical use of virtual reality technology for children and adolescents with autistic spectrum disorders (ASD). Extensive research has proven the efficiency of technologies as support tools for therapy. Researches are found to be focused on communication and on learning and social imitation skills. Virtual reality is also well accepted by subjects with ASD. The virtual environment offers the opportunity to administer controlled tasks such as the typical neuropsychological tools, but in an environment much more like a standard classroom. The virtual reality classroom offers several advantages compared to classical tools such as more realistic and lifelike environment but also records various measures in standardized conditions. Most of the studies using a virtual classroom have found that children with Attention Deficit/Hyperactivity Disorder make significantly fewer correct hits and more commission errors compared with controls. The virtual classroom has proven to be a good clinical tool for evaluation of attention in ADHD. For eating disorders, cognitive behavioural therapy (CBT) program enhanced by a body image specific component using virtual reality techniques was shown to be more efficient than cognitive behavioural therapy alone. The body image-specific component using virtual reality techniques boots efficiency and accelerates the CBT change process for eating disorders. Virtual reality is a relatively new technology and its application in child and adolescent psychiatry is recent. However, this technique is still in its infancy and much work is needed including controlled trials before it can be introduced in routine clinical use. Virtual reality interventions should also investigate how newly acquired skills are transferred to the real world. At present virtual reality can be considered a useful tool in evaluation and treatment for child and adolescent disorders.