Study: Virtual Reality Improves Cognitive Functioning in Children with ADHD
Improvement in cognitive performance without side effects makes immersive virtual reality-based interventions an effective treatment option for children with ADHD, according to this 2023 study.
March 11, 2024
Immersive virtual reality-based interventions (VR) can improve cognitive deficits associated with ADHD in children, according to a study published in 2023 in the journal Virtual Reality. Compared to active and passive control groups, children with ADHD experienced positive outcomes with large effect sizes global cognitive functioning, attention, and memory when using immersive VR therapies.1
In a meta-analysis of seven randomized controlled trials (RCTs), 149 participants were assigned to the immersive VR group and 172 participants to the control group. The study found a significant difference in performance outcomes for attention (g = 0.94) and global cognition (g = 1.06) in favor of the immersive VR group. Only one RCT assessed for memory outcomes, but as with attention and global cognition, the VR group showed a significant advantage (g = 1.81). Improvements were greater for children who were not otherwise treated for ADHD.
Efficacy of Immersive VR
Virtual reality is increasingly used in healthcare, and evaluations by clinicians have been positive. 2, 3 Patients say that brain training — an umbrella term used to describe cognitive tools like VR — is effective at improving ADHD symptoms. In a 2024 treatment survey conducted by ADDitude, brain training ranked in the top three most effective ADHD treatment options according to caregivers and adults with ADHD.
XRHealth is the maker of one commercially available VR therapy for ADHD. “Applications for kids with ADHD include a boxing-like game in which players choose which stimuli to punch, which to avoid, and what distractions to ignore,” said Randy Kulman, Ph.D., in “A User’s Guide to Digital Therapeutics for ADHD.”
VR-based interventions may also be useful in the classroom, according to the researchers. “Given the positive association between global cognitive functioning and academic performance, and social functioning, VR-based interventions may benefit the daily life of children with ADHD in terms of school performance and peer relations.”
Yet, brain training was also one of the least utilized treatment options used by ADDitude survey respondents. Out of more than 12,000 respondents, only 6% of caregivers and adults reported having used it to treat ADHD for their child or personally. Lack of personalization to patient needs, treatment goals, and knowledge on the added value of VR have been cited as barriers to implementation.3Access to providers who have experience treating ADHD was the biggest overall barrier to care, according to survey respondents.
Potential Moderators
Researchers performed a second meta-analysis to identify potential moderators of the effect size of global cognitive functioning, for which there was significant substantial heterogeneity (I2 = 71.23%). Improvements in global cognition were observed across all participant ages and intervention durations, regardless of diagnostic status (formal vs. informal), novelty of headsets (new vs. old), or control group intervention (passive vs. active). The study did not assess for moderators of attention alone, for which heterogeneity was also significant (I2 = 68.26%).
The significance of moderators on immersive VR-based outcomes are mixed. Research has shown that longer interventions, younger participants, and passive control groups may lead to different outcomes, the researchers noted. Follow-up measurements could help “assess the long-term effects of VR interventions and whether improvements made on cognitive functioning outcomes from baseline to post-intervention are maintained after the intervention has ceased.”
Limitations and Future Research
The systematic review and meta-analysis was the first to address treatment adherence and safety of immersive VR in improving cognitive deficits in children with ADHD. Compared to control groups, drop-out rates were similar across groups, and there were no adverse effects. Researchers concluded that immersive VR “is feasible in terms of treatment adherence and a safe cognitive rehabilitation tool.”
A rigorous literature search was conducted for the current study according to PRISMA guidelines and the Cochrane Handbook, and improvements were observed even after correcting for publication bias. However, of the limited studies that were included, all were judged to have an unclear risk of bias based on randomization and selective reporting. Results should be interpreted cautiously.
Control group interventions included non-immersive VR, medication, psychotherapy, cognitive training, neurofeedback, hemoencephalographic biofeedback, being placed on a waiting list, or no treatment. Head-mounted displays were required to be considered an immersive VR-based intervention.
Learn about the current state of affairs in implementing VR technology in healthcare here.
View Article Sources
1Corrigan, N., Păsărelu, C.R., & Voinescu, A. (2023). Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis. Virtual Reality, 1-20. doi:10.1007/s10055-023-00768-1.
2Zangiacomi, A., Flori, V., Greci, L., Scaglione, A., Arlati, S., & Bernardelli, G. (2022). an immersive virtual reality-based application for treating ADHD: A remote evaluation of acceptance and usability. Digital Health, 8. doi:10.1177/20552076221143242
3Kouijzer, M., Kip, H., Bouman, Y., Kelders, S. (2023). Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings. Implement Sci Commun, 4(1):67. doi: 10.1186/s43058-023-00442-2.
