Any crippling or disabling of body parts (like the antennae to frenzy the ants) can be done in real-time as well as V.A.T.S. So if a guy’s charging me in real time and I shoot at his leg, I could cripple him to slow him down. I could shoot an ant’s antennae to frenzy him, shoot a Super Mutant’s arm in the hope that he drops his weapon, etc.
I’ve found V.A.T.S. to be better for this stuff simply because the paused screen makes things much less hectic. But you can absolutely do it in real-time as well.[...]
I’ve got to admit, I find it pretty funny when people hear some stuff and freak out, assuming we’ve someone injected Oblivion-esque magic into Fallout 3. We do some interesting things with technology, sure — Rock-It Launcher, Mesmetron (whatever that may be…), Shiskebab — but it’s all pretty well grounded in science/science fiction and, more importantly, the Fallout universe.
So, V.A.T.S. is, in fact, *not* a substitute or nod to targeted or turn-based combat. It is just a way for the slower twitch gamers to keep up with the 15 year old Mountain Dew Game Fuel (OMFG Halo 3 rawks!) crowd.