Enhancing Ecological Validity: Virtual Reality Assessment of Executive Functioning in Children and Adolescents with ADHD

• Published in: Children (Basel) 2024-08, Vol.11 (8), p.986
• Main Authors: Romero-Ayuso, Dulce, Del Pino-González, Antonio, Torres-Jiménez, Antonio, Juan-González, Jorge, Celdrán, Francisco Javier, Franchella, María Constanza, Ortega-López, Nuria, Triviño-Juárez, José Matías, Garach-Gómez, Ana, Arrabal-Fernández, Luisa, Medina-Martínez, Inmaculada, González, Pascual
• Format: Article
• Language: English
• Subjects: Activities of daily living; ADHD; Analysis; assessment; Attention deficit hyperactivity disorder; Behavior; Executive function; executive functions; Flexibility; Neuropsychology; Pediatrics; Problem solving; Professionals; Questionnaires; Sensory perception; Teenagers; Validity; Virtual reality
• ISSN: 2227-9067; 2227-9067
• DOI: 10.3390/children11080986

SmartAction-VR uses virtual reality to simulate daily life tasks and assess cognitive performance based on the multi-errand paradigm. This study explored whether this new task could provide insights into the executive functioning of children and adolescents with ADHD in their everyday activities. A cross-sectional study was conducted between November 2021 and December 2022. It consisted of one session and was divided into two parts (cognitive tests; and SmartAction-VR). The sample comprised 76 children and adolescents with a median age (IQR) of 13 (11-14) years and an age range of 9-17 years. Of these participants, 60.50% ( = 46) were males. Out of this sample, 40 participants were in the ADHD group and 36 were in the neurotypical group. The following instruments were used: Waisman Activities of Daily Living Scale, Assessment of Sensory Processing and Executive Functioning, Pediatric Simulator Disease Questionnaire, Digit span subtest, Stroop test, NEPSY-II Subtest of Auditory Attention and Cognitive Flexibility, Trail Making Test, Zoo Map Test, and SmartAction-VR. The ADHD group demonstrated lower accuracy (U = 406, = 0.010), higher values for total errors (U = 292, = 0.001), more commissions (U = 417, = 0.003), new actions (U = 470, = 0.014), and forgetting actions (U = 406, = 0.010), as well as fewer perseverations compared to the neurotypical group (U = 540.5, = 0.029). Additionally, participants who forgot more actions were found to have lower independence in daily life (r = -0.281, = 0.024). The correlations between the results of SmartAction-VR and activities of daily living, as well as cognitive tests, suggest that this new task could be useful for evaluating executive functioning in daily life.