Effect of Distractors on Sustained Attention and Hyperactivity in Youth With Attention Deficit Hyperactivity Disorder Using a Mobile Virtual Reality School Program.

OBJECTIVE: This study examined whether distractors in virtual reality (VR) environment affected the attention and hyperactivity in children and adolescents with ADHD. METHOD: A total of 40 students (21 ADHD, 19 controls) aged between 9 and 17 years participated in this study. A rapid visual information processing task utilizing VR (VR-RVP) was performed under two conditions (no-distractor and distractor condition). Task performance and head movement during each condition were compared, and additional analyses were conducted after grouping participants into two developmental stages. RESULTS: Children with ADHD performed comparably to the controls under the distractor condition, but had poorer performance under the no-distractor condition. They displayed more head movement under the distractor condition than in the no-distractor condition. CONCLUSION: VR is possibly a useful tool for investigating the effect of distractors on individuals with ADHD, and children with ADHD are more vulnerable to a low-level stimulation situation than normal children in VR.

Feasibility of a Virtual Reality Program in Managing Test Anxiety: A Pilot Study.

Test anxiety has been a growing problem in school-aged children, especially for students in East-Asian countries where the pressure for academic achievement is high. These students are more vulnerable to academic stress, which could further lead to anxiety disorders. For this reason, this study examined the feasibility of virtual reality (VR) test anxiety program in managing anxiety in students. A total of 22 typically developing children with varying levels of test anxiety and no history of psychiatric illnesses participated in the study (mean age = 11.6 and standard deviation [SD] = 1.84). A self-reported questionnaire measuring test anxiety, state-trait anxiety, and depression was administered. Heart rate (HR) variability and subjective anxiety were also measured to examine the changes during each of the anxiety-inducing (Exam 1 and Exam 2) and meditation (Med 1 and Med 2) sessions in the program. There was a significant difference in self-perceived anxiety during the program (p < 0.001), as well as a significant main effect of time on the standard deviation of R-R interval (p = 0.002). In addition, a significant relationship between changes in HR and perceived anxiety during Exam 1 (p = 0.003), Med 1 (p < 0.001), and Med 2 (p = 0.011) was found. In conclusion, this work demonstrates the feasibility of the virtual environment to induce different levels of anxiety and explores the potential use of VR program as a viable method to manage the negative emotion in students. This work shows the potential of technology-enhanced tools in addressing psychological problems in school-aged children. Further study is needed to validate the use of the program in clinical practice.

Use of Virtual Reality Working Memory Task and Functional Near-Infrared Spectroscopy to Assess Brain Hemodynamic Responses to Methylphenidate in ADHD Children.

Virtual reality (VR) neuropsychological tests have emerged as a method to explore drug effects in real-life contexts in attention deficit hyperactivity disorder (ADHD) children. Functional near-infrared spectroscopy (fNIRS) is a useful tool to measure brain activity during VR tasks in ADHD children with motor restlessness. The present study aimed to explore the acute effects of methylphenidate (MPH) on behavioral performance and brain activity during a VR-based working memory task simulating real-life classroom settings in ADHD children. In total, 23 children with ADHD performed a VR n-back task before and 2 h after MPH administration concurrent with measurements of oxygenated hemoglobin signal changes with fNIRS. Altogether, 12 healthy control (HC) subjects participated in the same task but did not receive MPH treatment. Reaction time (RT) was shortened after MPH treatment in the 1-back condition, but changes in brain activation were not observed. In the 2-back condition, activation of the left dorsolateral prefrontal cortex (DLPFC) and bilateral medial prefrontal cortex (mPFC) was decreased alongside behavioral changes such as shorter RT, lower RT variability, and higher accuracy after MPH administration. Bilateral mPFC activation in the 2-back condition inversely correlated with task accuracy in the pre-MPH condition; this inverse correlation was not observed after MPH administration. In ADHD children, deactivation of the default mode network mediated by mPFC reduced during high working memory load, which was restored through MPH treatment. Our results suggest that the combination of VR classroom tasks and fNIRS examination makes it easy to assess drug effects on brain activity in ADHD children in settings simulating real-life.