Development of Virtual Reality Continuous Performance Test Utilizing Social Cues for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Virtual reality (VR) neuropsychological assessments have the potential for the ecological measurement of attention. We analyzed the newly developed VR continuous performance test (VR-CPT) for Korean children with attention-deficit/hyperactivity disorder (ADHD) and typically developing children (TDC). To identify specific features of a virtual environment that influence the attention performance of children, we investigated whether the presence of a virtual teacher and social cues in the VR environment affects their attention performance. A total of 38 participants (18 TDC and 20 ADHD children and adolescents) were recruited for VR-CPT testing. Bivariate correlational analysis was conducted to examine the associations between the results of the VR-CPT and ADHD questionnaires to determine the capacity of VR-CPT to mirror real-life attention behaviors. Mixed-design analysis of variables was conducted to compare the effects of the social aspects of the VR-CPT on attention performance in groups. There were significant associations between ADHD rating scores and the omission error, commission error, reaction time (RT), reaction time variability (RTV), and total accuracy of the VR-CPT in the ADHD group. In addition, the ADHD group exhibited comparable performance with the TDC group for all measures of the VR-CPT. Also there seemed to be a trend of decreasing RTV when a virtual teacher with social cues was present compared with the equipment control condition in the ADHD group. Performance in the VR-CPT program was associated with behavioral measures of ADHD symptoms. Adding social aspects to a VR environment commonly encountered by children and adolescents has the potential to make a difference in the attention performance of youths with ADHD.