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Wang P, Zhang X, Ai X, Wang S. Modulation of EEG Signals by Visual and Auditory Distractors in Virtual Reality-Based Continuous Performance Tests. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2049-2059. [PMID: 38801679 DOI: 10.1109/tnsre.2024.3405549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Compared to traditional continuous performance tasks, virtual reality-based continuous performance tests (VR-CPT) offer higher ecological validity. While previous studies have primarily focused on behavioral outcomes in VR-CPT and incorporated various distractors to enhance ecological realism, little attention has been paid to the effects of distractors on EEG. Therefore, our study aimed to investigate the influence of distractors on EEG during VR-CPT. We studied visual distractors and auditory distractors separately, recruiting 68 subjects (M =20.82, SD =1.72) and asking each to complete four tasks. These tasks were categorized into four groups according to the presence or absence of visual and auditory distractors. We conducted paired t-tests on the mean relative power of the five electrodes in the ROI region across different frequency bands. Significant differences were found in theta waves between Group 3 (M =2.49, SD =2.02) and Group 4 (M =2.68, SD =2.39) (p < 0.05); in alpha waves between Group 3 (M =2.08, SD =3.73) and Group 4 (M =3.03, SD =4.60) (p < 0.001); and in beta waves between Group 1 (M = -4.44 , SD =2.29) and Group 2 (M = -5.03 , SD =2.48) (p < 0.001), as well as between Group 3 (M = -4.48 , SD =2.03) and Group 4 (M = -4.67 , SD =2.23) (p < 0.05). The incorporation of distractors in VR-CPT modulates EEG signals across different frequency bands, with visual distractors attenuating theta band activity, auditory distractors enhancing alpha band activity, and both types of distractors reducing beta oscillations following target stimuli. This insight holds significant promise for the rehabilitation of children and adolescents with attention deficits.
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Fernández-Martín P, Rodríguez-Herrera R, Cánovas R, Díaz-Orueta U, Martínez de Salazar A, Flores P. Data-driven profiles of attention-deficit/hyperactivity disorder using objective and ecological measures of attention, distractibility, and hyperactivity. Eur Child Adolesc Psychiatry 2024; 33:1451-1463. [PMID: 37386204 PMCID: PMC11098896 DOI: 10.1007/s00787-023-02250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
In the past two decades, the traditional nosology of attention-deficit/hyperactivity disorder (ADHD) has been criticized for having insufficient discriminant validity. In line with current trends, in the present study, we combined a data-driven approach with the advantages of virtual reality aiming to identify novel behavioral profiles of ADHD based on ecological and performance-based measures of inattention, impulsivity, and hyperactivity. One hundred and ten Spanish-speaking participants (6-16 years) with ADHD (medication-naïve, n = 57) and typically developing participants (n = 53) completed AULA, a continuous performance test embedded in virtual reality. We performed hybrid hierarchical k-means clustering methods over the whole sample on the normalized t-scores of AULA main indices. A five-cluster structure was the most optimal solution. We did not replicate ADHD subtypes. Instead, we identified two clusters sharing clinical scores on attention indices, susceptibility to distraction, and head motor activity, but with opposing scores on mean reaction time and commission errors; two clusters with good performance; and one cluster with average scores but increased response variability and slow RT. DSM-5 subtypes cut across cluster profiles. Our results suggest that latency of response and response inhibition could serve to distinguish among ADHD subpopulations and guide neuropsychological interventions. Motor activity, in contrast, seems to be a common feature among ADHD subgroups. This study highlights the poor feasibility of categorical systems to parse ADHD heterogeneity and the added value of data-driven approaches and VR-based assessments to obtain an accurate characterization of cognitive functioning in individuals with and without ADHD.
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Affiliation(s)
- Pilar Fernández-Martín
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain
- Health Research Center (CEINSA), University of Almeria, Almería, Spain
| | - Rocío Rodríguez-Herrera
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain
- Health Research Center (CEINSA), University of Almeria, Almería, Spain
| | - Rosa Cánovas
- Neurorehabilitation and Autonomy Center Imparables, Almería, Spain
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
- International University of La Rioja (UNIR), Logroño, Spain
| | | | - Pilar Flores
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain.
- Health Research Center (CEINSA), University of Almeria, Almería, Spain.
- Neurorehabilitation and Autonomy Center Imparables, Almería, Spain.
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Levy O, Hackmon SL, Zvilichovsky Y, Korisky A, Bidet-Caulet A, Schweitzer JB, Golumbic EZ. Neurophysiological Patterns of Attention and Distraction during Realistic Virtual-Reality Classroom Learning in Adults with and without ADHD. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.17.590012. [PMID: 38659916 PMCID: PMC11042341 DOI: 10.1101/2024.04.17.590012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Many people, and particularly those diagnosed with ADHD, report difficulties maintaining attention and proneness to distraction during classroom learning. However, the behavioral, neural and physiological basis of attention in realistic learning contexts is not well understood, since current clinical and scientific tools used for evaluating and quantifying the constructs of "distractibility" and "inattention", are removed from the real-life experience in organic classrooms. Here we introduce a novel Virtual Reality (VR) platform for studying students' brain activity and physiological responses as they immerse in realistic frontal classroom learning. Using this approach, we studied whether adults with and without ADHD (N=49) exhibit differences in neurophysiological metrics associated with sustained attention, such as speech-tracking of the teacher's voice, power of alpha-oscillations and levels of arousal, as well as responses to potential disturbances by background sound-events in the classroom. Under these ecological conditions, we find that adults with ADHD exhibit higher auditory neural response to background sounds relative to their control-peers, which also contributed to explaining variance in the severity of ADHD symptoms, together with higher power of alpha-oscillations and more frequent gaze-shifts around the classroom. These results are in-line with higher sensitivity to irrelevant stimuli in the environment and increased mind-wandering/boredom. At the same time, both groups exhibited similar learning outcomes and showed similar neural tracking of the teacher's speech. This suggests that in this context, attention may not operate as a zero-sum game and that allocating some resources to irrelevant stimuli does not always detract from performing the task at hand. Given the dire need for more objective, dimensional and ecologically-valid measures of attention and its real-life deficits, this work provides new insights into the neurophysiological manifestations of attention and distraction experienced in real-life contexts, while challenging some prevalent notions regarding the nature of attentional challenges experienced by those with ADHD.
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Affiliation(s)
- Orel Levy
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Yair Zvilichovsky
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Adi Korisky
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Julie B. Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA U.S.A
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Rivella C, Bazzurro A, Olla V, Potente C, Vio C, Viterbori P, Usai MC. Impact of Distractors on Sustained Attention and Inhibition in Children With ADHD. J Atten Disord 2024; 28:970-981. [PMID: 38178562 DOI: 10.1177/10870547231218932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVE This study examines the impact of visual and auditory distractors on attention and inhibition in children with and without ADHD. METHOD The study used the MOXO d-CPT child version. The sample consisted of 208 children aged 8 to 12 years, including 64 with ADHD and 144 controls. RESULTS Children with ADHD and controls differed in their reaction to distracting stimuli; visual distractors cause a higher decrease in sustained attention and inhibitory control in the ADHD group. Moreover, auditory distractors generate improved performance in the control group but not in the ADHD group. In addition, age-related effects were found in both sustained attention and inhibitory control in all children, regardless of whether the ADHD condition was present. CONCLUSIONS The findings indicate that children with ADHD performed poorer compared to controls, and that distractors differently affected the performance of the two groups.
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Teruel MA, Sanchis J, Ruiz-Robledillo N, Albaladejo-Blázquez N, Ferrer-Cascales R, Trujillo J. Measuring attention of ADHD patients by means of a computer game featuring biometrical data gathering. Heliyon 2024; 10:e26555. [PMID: 38434359 PMCID: PMC10907648 DOI: 10.1016/j.heliyon.2024.e26555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
ADHD is a neurodevelopmental disorder diagnosed mainly in children, marked by inattention and hyperactivity-impulsivity. The symptoms are highly variable, such as different ages of onset and potential comorbidities, contributing to frequent misdiagnoses. Professionals note a gap in modern diagnostic tools, making accurate identification challenging. To address this, recent studies recommend gamification for better ADHD diagnosis and treatment, though further research is essential to confirm its efficacy. This work aims to create a serious game, namely "Attention Slackline", to assess attention levels. The game, designed with expert input, requires players to concentrate on a specific point to recognize specific patterns while managing distractions. A controlled experiment tested its precision, and results were compared with established attention tests by a correlation analysis. Statistical analysis confirmed the game's validity, especially in tracking attention through correct responses and errors. Preliminary evidence suggests that "Attention Slackline" may serve as a credible instrument for the assessment of attentional capacities in individuals with ADHD, given that its outcomes have been empirically shown to correlate with those derived from a well-established attention assessment methodology.
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Affiliation(s)
- Miguel A. Teruel
- Lucentia Research Group, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
| | - Javier Sanchis
- Lucentia Research Group, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
- XSB Disseny I Multimedia, S.L., Carrer Del Mercat, 21, 03430, Onil, Alicante, Spain
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
| | - Natalia Albaladejo-Blázquez
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
| | - Juan Trujillo
- Lucentia Research Group, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Carretera San Vicente Del Raspeig S/n, 03690, San Vicente Del Raspeig, Alicante, Spain
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Oh HK, Cho YJ, Kim JJ, Shin B, Kim SJ, Park S, Seok JH, Kim S, Kim E. Advancing ecological validity and clinical utility in virtual reality-based continuous performance test: exploring the effects of task difficulty and environmental distractors. Front Psychiatry 2024; 14:1329221. [PMID: 38304403 PMCID: PMC10832060 DOI: 10.3389/fpsyt.2023.1329221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction Researchers have highlighted concerns regarding the limited diagnostic utility and ecological validity of the Continuous Performance Test (CPT). Recent advancements in VR-based CPTs have attempted to address these concerns by simulating real-life scenarios and enhancing attention deficit hyperactivity disorder (ADHD) diagnosis; however, certain areas require improvement for obtaining reliable data from both healthy individuals and those with ADHD. To tackle these issues, we developed an enhanced VR-based CPT program featuring four distinct difficulty levels, advancing toward home-based assessment. Method Our feasibility study involved subjects without ADHD to establish a normative profile for VR-based CPT before extending it to ADHD assessment. Our sample included 20 Korean adults. They received a VR device with the VR-based CPT program installed and were asked to perform 1-2 blocks per day at home. Participants were instructed to complete 12 blocks over the subsequent 2 weeks. Psychological assessments and electroencephalograms (EEGs) were administered before and after the program. Post-study usability measures were also collected. Result Higher commission errors were notably evident in the "very high" difficulty level which featured complex stimuli and increased distraction. A notable correlation emerged between the overall distraction level and CPT accuracy, along with a significant link between intensity scores and commission errors. No significant differences were found in psychological assessment and there were no significant changes in the Theta-Beta Ratio (TBR) index before and after the program. The usability of our program was fair. Discussion The study reveals that the newly designed VR-CPT program, simulating diverse real-life environments and offering varying task difficulty levels, proved acceptable and feasible. The key point of our study was that the adjustment and segmentation of difficulty levels in the VR-based CPT were achieved, and that this effort was validated by examining the impact of different levels of difficulty on CPT measures. Implementing this experimental setup in a home-based environment increased ecological validity, as well as clinical utility. Limitations and suggested directions for further investigation are described in detail.
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Affiliation(s)
- Hyang-Kyeong Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jae Cho
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bokyoung Shin
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Jeong Kim
- Department of Psychiatry, Bundang Jesaeng General Hospital, Seoul, Republic of Korea
| | - Soobin Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kannen K, Rasbach J, Fantazi A, Wiebe A, Selaskowski B, Asché L, Aslan B, Lux S, Herrmann CS, Philipsen A, Braun N. Alpha modulation via transcranial alternating current stimulation in adults with attention-deficit hyperactivity disorder. Front Psychol 2024; 14:1280397. [PMID: 38282845 PMCID: PMC10812111 DOI: 10.3389/fpsyg.2023.1280397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/23/2023] [Indexed: 01/30/2024] Open
Abstract
Background One potential therapy treating attention-deficit/hyperactivity disorder (ADHD) is to modulate dysfunctional brain activations using brain stimulation techniques. While the number of studies investigating the effect of transcranial direct current stimulation on ADHD symptoms continues to increase, transcranial alternating current stimulation (tACS) is poorly examined. Previous studies reported impaired alpha brain oscillation (8-12 Hz) that may be associated with increased attention deficits in ADHD. Our aim was to enhance alpha power in adult ADHD patients via tACS, using different methods to explore potential therapeutic effects. Methods Undergoing a crossover design, adults with ADHD received active and sham stimulation on distinct days. Before and after each intervention, mean alpha power, attention performance, subjective symptom ratings, as well as head and gaze movement were examined. Results Frequency analyses revealed a significant power increase in the alpha band after both interventions. Despite a trend toward an interaction effect, this alpha power increase was, however, not significantly higher after active stimulation compared to sham stimulation. For the other measures, some additional pre-post effects were found, which were not intervention-related. Conclusion Our study cannot provide clear evidence for a tACS-induced increase in alpha power in adult ADHD patients, and thus no stimulation related improvement of attention parameters. We provide further recommendations for the future investigation of tACS as a potential ADHD treatment.
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Affiliation(s)
- Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Johanna Rasbach
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Amin Fantazi
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Christoph S. Herrmann
- Experimental Psychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Wiebe A, Aslan B, Brockmann C, Lepartz A, Dudek D, Kannen K, Selaskowski B, Lux S, Ettinger U, Philipsen A, Braun N. Multimodal assessment of adult attention-deficit hyperactivity disorder: A controlled virtual seminar room study. Clin Psychol Psychother 2023; 30:1111-1129. [PMID: 37209018 DOI: 10.1002/cpp.2863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/29/2023] [Indexed: 05/21/2023]
Abstract
In the assessment of adult attention-deficit hyperactivity disorder (ADHD) symptoms, the diagnostic value of neuropsychological testing is limited. Partly, this is due to the rather low ecological validity of traditional neuropsychological tests, which usually present abstract stimuli on a computer screen. A potential remedy for this shortcoming might be the use of virtual reality (VR), which enables a more realistic and complex, yet still standardized test environment. The present study investigates a new VR-based multimodal assessment tool for adult ADHD, the virtual seminar room (VSR). Twenty-five unmedicated ADHD patients, 25 medicated ADHD patients, and 25 healthy controls underwent a virtual continuous performance task (CPT) in the VSR with concurrent visual, auditive, and audiovisual distractions. Simultaneously, head movements (actigraphy), gaze behaviour (eye tracking), subjective experience, electroencephalography (EEG), and functional near-infrared spectroscopy (fNIRS) were recorded. Significant differences between unmedicated patients with ADHD and healthy controls were found in CPT performance, head actigraphy, distractor gaze behaviour, and subjective experience. Moreover, CPT performance parameters demonstrated potential utility for assessing medication effects within the ADHD population. No group differences were found in the Theta-Beta-Ratio (EEG) or dorsolateral-prefrontal oxy-haemoglobin (fNIRS). Overall, the results are very promising regarding the potential of the VSR as an assessment tool for adult ADHD. In particular, the combined assessment of CPT, actigraphy, and eye tracking parameters appears to be a valid approach to more accurately capture the heterogeneous symptom presentation of the disorder.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Charlotte Brockmann
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Lepartz
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Dominika Dudek
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Voinescu A, Petrini K, Stanton Fraser D. Presence and simulator sickness predict the usability of a virtual reality attention task. VIRTUAL REALITY 2023; 27:1-17. [PMID: 37360806 PMCID: PMC10038382 DOI: 10.1007/s10055-023-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 02/26/2023] [Indexed: 06/28/2023]
Abstract
Attention is the ability to actively process specific information within one's environment over longer periods of time while disregarding other details. Attention is an important process that contributes to overall cognitive performance from performing every day basic tasks to complex work activities. The use of virtual reality (VR) allows study of the attention processes in realistic environments using ecological tasks. To date, research has focused on the efficacy of VR attention tasks in detecting attention impairment, while the impact of the combination of variables such as mental workload, presence and simulator sickness on both self-reported usability and objective attention task performance in immersive VR has not been examined. The current study tested 87 participants on an attention task in a virtual aquarium using a cross-sectional design. The VR task followed the continuous performance test paradigm where participants had to respond to correct targets and ignore non-targets over 18 min. Performance was measured using three outcomes: omission (failing to respond to correct targets), commission errors (incorrect responses to targets) and reaction time to correct targets. Measures of self-reported usability, mental workload, presence and simulator sickness were collected. The results showed that only presence and simulator sickness had a significant impact on usability. For performance outcomes, simulator sickness was significantly and weakly associated with omission errors, but not with reaction time and commission errors. Mental workload and presence did not significantly predict performance. Our results suggest that usability is more likely to be negatively impacted by simulator sickness and lack of presence than performance and that usability and attention performance are linked. They highlight the importance of considering factors such as presence and simulator sickness in attention tasks as these variables can impact usability. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-023-00782-3.
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Affiliation(s)
- Alexandra Voinescu
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY UK
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Karin Petrini
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY UK
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, UK
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Sokołowska B. Impact of Virtual Reality Cognitive and Motor Exercises on Brain Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4150. [PMID: 36901160 PMCID: PMC10002333 DOI: 10.3390/ijerph20054150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Innovative technologies of the 21st century have an extremely significant impact on all activities of modern humans. Among them, virtual reality (VR) offers great opportunities for scientific research and public health. The results of research to date both demonstrate the beneficial effects of using virtual worlds, and indicate undesirable effects on bodily functions. This review presents interesting recent findings related to training/exercise in virtual environments and its impact on cognitive and motor functions. It also highlights the importance of VR as an effective tool for assessing and diagnosing these functions both in research and modern medical practice. The findings point to the enormous future potential of these rapidly developing innovative technologies. Of particular importance are applications of virtual reality in basic and clinical neuroscience.
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Affiliation(s)
- Beata Sokołowska
- Bioinformatics Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
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Corrigan N, Păsărelu CR, Voinescu A. Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis. VIRTUAL REALITY 2023; 27:1-20. [PMID: 36845650 PMCID: PMC9938513 DOI: 10.1007/s10055-023-00768-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/05/2023] [Indexed: 06/17/2023]
Abstract
Virtual reality (VR) shows great potential in treating and managing various mental health conditions. This includes using VR for training or rehabilitation purposes. For example, VR is being used to improve cognitive functioning (e.g. attention) among children with attention/deficit-hyperactivity disorder (ADHD). The aim of the current review and meta-analysis is to evaluate the effectiveness of immersive VR-based interventions for improving cognitive deficits in children with ADHD, to investigate potential moderators of the effect size and assess treatment adherence and safety. The meta-analysis included seven randomised controlled trials (RCTs) of children with ADHD comparing immersive VR-based interventions with controls (e.g. waiting list, medication, psychotherapy, cognitive training, neurofeedback and hemoencephalographic biofeedback) on measures of cognition. Results indicated large effect sizes in favour of VR-based interventions on outcomes of global cognitive functioning, attention, and memory. Neither intervention length nor participant age moderated the effect size of global cognitive functioning. Control group type (active vs passive control group), ADHD diagnostic status (formal vs. informal) and novelty of VR technology were not significant moderators of the effect size of global cognitive functioning. Treatment adherence was similar across groups and there were no adverse effects. Results should be cautiously interpreted given the poor quality of included studies and small sample.
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Affiliation(s)
- Niamh Corrigan
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Costina-Ruxandra Păsărelu
- Department of Clinical Psychology and Psychotherapy, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babe-Bolyai University, No.37, Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alexandra Voinescu
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY UK
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Pagán AF, Huizar YP, Schmidt AT. Conner's Continuous Performance Test and Adult ADHD: A Systematic Literature Review. J Atten Disord 2023; 27:231-249. [PMID: 36495125 DOI: 10.1177/10870547221142455] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE ADHD is a neurodevelopmental disorder affecting millions of adults worldwide. Continuous performance tests (CPTs) are widely used as assessment and diagnostic tools; however, their use in diagnosing undiagnosed ADHD in adults has been questioned due to their lack of specificity and sensitivity. This review sought to outline relevant findings concerning the diagnostic utility of the Conner's Continuous Performance Test (CCPT) in adults. METHOD This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PsycArticles, Cochrane, Scopus, Google Scholar, and PubMed. RESULTS Thirty-five articles were reviewed and analyzed. Most articles reviewed used outpatient and university populations. Moderate reliability, subpar discriminant and ecological validity, and mixed sensitivity and specificity were noted. CONCLUSION The results of this review lend support to previous critiques of the CCPT's diagnostic and utility as a treatment measure.
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13
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The eSports Medicine: Pre-Participation Screening and Injuries Management-An Update. Sports (Basel) 2023; 11:sports11020034. [PMID: 36828319 PMCID: PMC9966106 DOI: 10.3390/sports11020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Recently, electronic sports (eSports) became one of the growing forms of new media due to the wide diffusion of games and online technologies. Even if there is still a debate about the definition and characterization of eSports, eAthletes train heavily, compete in tournaments, must abide by competition, association, and governing body rules, just like all other athletes. Furthermore, as in any other competitive discipline, there can be injuries. Aberrant sitting posture, repetitive movements, screen vision, prolonged playing hours, and a sedentary lifestyle can lead to several medical hazards in musculoskeletal, ophthalmology, neurological, and metabolic systems. Moreover, several cardiovascular changes occur in eAthletes. This paper aims to explore the different injuries that can occur in a professional eAthlete, suggesting how every high-level gamer could benefit from a pre-participation evaluation and a correct injury prevention strategy.
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14
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Selaskowski B, Asché LM, Wiebe A, Kannen K, Aslan B, Gerding TM, Sanchez D, Ettinger U, Kölle M, Lux S, Philipsen A, Braun N. Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder. BMC Psychiatry 2023; 23:74. [PMID: 36703134 PMCID: PMC9879564 DOI: 10.1186/s12888-023-04551-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial interindividual heterogeneity that challenges the systematic assessment and treatment. Considering mixed evidence from previous neurofeedback research, we present a novel feedback system that relies on gaze behavior to detect signs of inattention while performing a neuropsychological attention task in a virtual seminar room. More specifically, an audiovisual feedback was given whenever participants averted their gaze from the given task. METHODS Eighteen adults with ADHD and 18 healthy controls performed a continuous performance task (CPT) in virtual reality under three counterbalanced conditions in which either gaze-based feedback, sham feedback, or no feedback was provided. In all conditions, phases of high and low virtual distraction alternated. CPT errors and reaction times, proportions of gaze dwell times (e.g., task focus or distraction focus), saccade characteristics, EEG theta/beta ratios, head movements, and an experience sampling of ADHD symptoms were analyzed. RESULTS While patients can be discriminated well from healthy controls in that they showed more omission errors, higher reaction times, higher distraction-related dwell times, and more head movements, the feedback did not immediately improve task performance. It was also indicated that sham feedback was rather associated with an aggravation of symptoms in patients. CONCLUSIONS Our findings demonstrate sufficient suitability and specificity for this holistic ADHD symptom assessment. Regarding the feedback, a single-session training was insufficient to achieve learning effects based on the proposed metacognitive strategies. Future longitudinal, multi-session trials should conclusively examine the therapeutic efficacy of gaze-based virtual reality attention training in ADHD. TRIAL REGISTRATION drks.de (identifier: DRKS00022370).
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Affiliation(s)
- Benjamin Selaskowski
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Marie Asché
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Wiebe
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Thiago Morano Gerding
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Dario Sanchez
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ulrich Ettinger
- grid.10388.320000 0001 2240 3300Department of Psychology, University of Bonn, Bonn, Germany
| | - Markus Kölle
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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15
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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16
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Yıldırım Demirdöğen E, Esin İS, Turan B, Dursun OB. Assessing sustained attention of children with ADHD in a class flow video task. Nord J Psychiatry 2022; 76:497-506. [PMID: 35521909 DOI: 10.1080/08039488.2022.2064545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate sustained attention performance of children with ADHD and effect of distractors on sustained attention through an eye-tracking during a class-flow video task. METHOD Data were collected using an eye-tracking during a class-flow task conducted with 60 children (ADHD and control groups). Two areas of interest were determined in the task, these are relevant (teacher and whiteboard) and irrelevant (any regions outside the relevant area) areas. The task also included distractors in relevant and irrelevant areas, comprising a brief conversation and dropping of a pencil, respectively. Proportion of total fixation duration on areas of interest (PFDAOI) was used to assess sustained attention. RESULTS Children with ADHD had lower PFDAOI in the relevant area during the whole class than children in the control group. After the relevant area distractor, PFDAOI increased in relevant area in ADHD group, indicating these children may have better attention after the distractor. However, children with ADHD also showed increased PFDAOI in the irrelevant area following the irrelevant area distractor, indicating that it negatively affected them. There was no significant change in the control group following the distractors. CONCLUSION These findings indicate that children with ADHD have poor sustained attention performance during the whole class. Moreover, distractors in distinct areas could affect children with ADHD differently. Thus, students with ADHD could benefit from increased stimuli in the relevant area and this can be a guide for classroom arrangements to improve the academic functionality of these children.
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Affiliation(s)
- Esen Yıldırım Demirdöğen
- Atatürk University Medicine Faculty, Department of Child and Adolescent Psychiatry, Erzurum, Turkey
| | - İbrahim Selçuk Esin
- Health Science University, Department of Child and Adolescent Psychiatry, Trabzon, Turkey
| | - Bahadır Turan
- Karadeniz Technical University, Department of Child and Adolescent Psychiatry, Trabzon
| | - Onur Burak Dursun
- Health Science University, Department of Child and Adolescent Psychiatry, Trabzon, Turkey
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17
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McKay E, Kirk H, Coxon J, Courtney D, Bellgrove M, Arnatkeviciute A, Cornish K. Training inhibitory control in adolescents with elevated attention deficit hyperactivity disorder traits: a randomised controlled trial of the Alfi Virtual Reality programme. BMJ Open 2022; 12:e061626. [PMID: 36127121 PMCID: PMC9490587 DOI: 10.1136/bmjopen-2022-061626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is characterised by significant deficits in attention and inhibition. These deficits are associated with negative sequelae that emerge in childhood and often continue throughout adolescence. Despite these difficulties adolescents with ADHD often demonstrate poor treatment compliance with traditional interventions (eg, psychostimulant medication). Virtual reality (VR) presents an innovative means of delivering engaging cognitive interventions for adolescents with ADHD and offers the potential to improve compliance with such interventions. The current parallel, randomised controlled trial aims to evaluate the effects of a VR intervention (Alfi) designed to improve inhibition in adolescents with ADHD. METHODS AND ANALYSIS A sample of 100 adolescents (aged 13-17) with elevated ADHD symptoms will be recruited from secondary schools and ADHD organisations located in the state of Victoria, Australia. Participants will be randomly assigned to either an 8-week VR intervention or a usual care control. The VR intervention involves the completion of 14 sessions, each 20 min in duration. Participants will complete computerised assessments of inhibition and risk-taking preintervention and immediately postintervention. Parents/guardians will complete online questionnaires about their child's ADHD symptoms and social functioning at each of these timepoints. The primary outcome is change in inhibition performance in adolescents who received the intervention from preintervention to postintervention compared with adolescents in the control condition. Secondary outcomes include change in risk-taking, ADHD symptoms and social functioning in adolescents who received the intervention from preintervention to postintervention compared with adolescents in the control condition. If the intervention is shown to be effective, it may offer a supplementary approach to traditional interventions for adolescents with ADHD experiencing inhibitory control difficulties. ETHICS AND DISSEMINATION This trial has ethics approval from the Monash University Human Research Ethics Committee (HREC) (21530) and the Victorian Department of Education and Training HREC (2020_004271). Results will be disseminated through peer-reviewed journals, conference proceedings and community activities. Individual summaries of the results will be provided to participants on request. TRIAL REGISTRATION NUMBER ACTRN12620000647932.
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Affiliation(s)
- Erin McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Hannah Kirk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - James Coxon
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Danielle Courtney
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Mark Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Aurina Arnatkeviciute
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Kim Cornish
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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18
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Seesjärvi E, Puhakka J, Aronen ET, Lipsanen J, Mannerkoski M, Hering A, Zuber S, Kliegel M, Laine M, Salmi J. Quantifying ADHD Symptoms in Open-Ended Everyday Life Contexts With a New Virtual Reality Task. J Atten Disord 2022; 26:1394-1411. [PMID: 34865551 PMCID: PMC9304743 DOI: 10.1177/10870547211044214] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To quantify goal-directed behavior and ADHD symptoms in naturalistic conditions, we developed a virtual reality task, EPELI (Executive Performance in Everyday LIving), and tested its predictive, discriminant and concurrent validity. METHOD We collected EPELI data, conventional neuropsychological task data, and parent-ratings of executive problems and symptoms in 38 ADHD children and 38 typically developing controls. RESULTS EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity. Further, the five combined EPELI measures showed excellent discriminant validity (area under curve 88 %), while the correlations of the EPELI efficacy measure with parent-rated executive problems (r = .57) and ADHD symptoms (r = .55) pointed to its concurrent validity. CONCLUSION We provide a proof-of-concept validation for a new virtual reality tool for ecologically valid assessment of ADHD symptoms.
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Affiliation(s)
- Erik Seesjärvi
- University of Helsinki, Helsinki,
Finland,Child Neurology, University of Helsinki
and Helsinki University Hospital, Finland
| | | | - Eeva T. Aronen
- Child Psychiatry, University of
Helsinki and Helsinki University Hospital, Finland
| | | | - Minna Mannerkoski
- Child Psychiatry, University of
Helsinki and Helsinki University Hospital, Finland
| | | | - Sascha Zuber
- University of Geneva, Switzerland,Swiss National Centre of Competence in
Research LIVES, Switzerland
| | - Matthias Kliegel
- University of Geneva, Switzerland,Swiss National Centre of Competence in
Research LIVES, Switzerland
| | - Matti Laine
- Åbo Akademi University, Turku,
Finland,University of Turku, Turku,
Finland
| | - Juha Salmi
- University of Helsinki, Helsinki,
Finland,University of Turku, Turku,
Finland,Department of Neuroscience and
Biomedical Engineering, Aalto University, Espoo, Finland,Juha Salmi, Department of Neuroscience and
Biomedical Engineering, Aalto University, P.O. Box 00076 (Rakentajanaukio 2,
Espoo), Finland.
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19
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Wiebe A, Kannen K, Li M, Aslan B, Anders D, Selaskowski B, Ettinger U, Lux S, Philipsen A, Braun N. Multimodal Virtual Reality-Based Assessment of Adult ADHD: A Feasibility Study in Healthy Subjects. Assessment 2022:10731911221089193. [PMID: 35435010 DOI: 10.1177/10731911221089193] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuropsychological assessments are often surprisingly inaccurate in mapping clinically-reported attention-deficit hyperactivity disorder (ADHD) symptoms, presumably due to their low ecological validity. Virtual reality (VR) might offer a potential solution for this problem, given its capability to generate standardized and yet highly realistic virtual environments. As the first adaptation of existing virtual classroom scenarios to an adult population, we developed a Virtual Seminar Room (VSR) for multimodal characterization of ADHD symptoms. To test its feasibility, N = 35 healthy participants were immersed into the VSR via a head-mounted display and carried out a VR-embedded continuous performance task (CPT) under varying levels of distractions in two experimental blocks (24 min each). CPT performance, electroencephalography (EEG) measures, and head movements (actigraphy) were simultaneously recorded and analyzed offline. Although CPT performance remained constant throughout the task, head movements increased significantly from Block 1 to Block 2. In addition, EEG theta (4-7 Hz) and beta (13-30 Hz) power was higher during Block 1 than Block 2, and during distractor-present than distractor-absent phases. Moreover, P300 amplitudes were higher during Block 1 than Block 2, and P300 latencies were prolonged in distractor-absent compared with distractor-present phases. Although the paradigm awaits further improvements, this study confirms the general feasibility of the VSR and provides a first step toward a multimodal, ecologically valid, and reliable VR-based adult ADHD assessment.
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Affiliation(s)
- Annika Wiebe
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - David Anders
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Silke Lux
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department for Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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20
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Goharinejad S, Goharinejad S, Hajesmaeel-Gohari S, Bahaadinbeigy K. The usefulness of virtual, augmented, and mixed reality technologies in the diagnosis and treatment of attention deficit hyperactivity disorder in children: an overview of relevant studies. BMC Psychiatry 2022; 22:4. [PMID: 34983446 PMCID: PMC8728980 DOI: 10.1186/s12888-021-03632-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by attention problems, excessive physical activity, and impulsivity. ADHD affects not only the patients but also their families. The development and use of technologies such as virtual reality (VR), augmented reality (AR), and mixed reality (MR) for ADHD has increased over recent years. However, little is known about their potential usefulness. This overview aimed to clarify the current knowledge about the use of these three innovative technologies for the diagnosis and treatment of children with ADHD. METHODS This overview was conducted using the PubMed, Web of Science, and Scopus databases until January 24th, 2021. The following descriptive information was compiled from the identified studies: country, year of publication, sample size, study design, ADHD diagnosis methods, applied technology, hardware equipment, clinical target, and main findings. RESULTS The initial database searches yielded 409 articles, but 103 were removed as duplicates. Eventually, 30 eligible studies remained for analysis, the majority of which were case-control (n = 22, 73%). Regarding the applied technology/hardware equipment, VR (n = 27; 90%), head-mounted displays (n = 19, 63%), VR-based continuous performance tests (VR-CPT) (n = 21, 70%) were most frequently used. Most studies (n = 21, 70%) used the DSM criteria for the diagnosis of childhood ADHD. They primarily evaluated the utility of these technologies in assessing ADHD symptoms (n = 10, 33%) and improving the ADHD diagnostic process (n = 7, 23%). CONCLUSION This comprehensive overview evaluated the studies on the use of VR, AR, and MR technologies for children with ADHD. These technologies seem to be promising tools for improving the diagnosis and management of ADHD in this population.
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Affiliation(s)
- Saeideh Goharinejad
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Goharinejad
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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21
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Kim E, Han J, Choi H, Prié Y, Vigier T, Bulteau S, Kwon GH. Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review. JMIR Serious Games 2021; 9:e30249. [PMID: 34822341 PMCID: PMC8663439 DOI: 10.2196/30249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/31/2021] [Accepted: 09/19/2021] [Indexed: 01/19/2023] Open
Abstract
Background In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR. Objective The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles. Methods This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review. Results In keyword analysis, the number of articles focused on dementia including the keywords “MCI,” “SCD,” and “dementia” were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified. Conclusions There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area.
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Affiliation(s)
- Euisung Kim
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, Republic of Korea
| | - Jieun Han
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, Republic of Korea
| | - Hojin Choi
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yannick Prié
- Laboratory of Digital Science of Nantes (LS2N), CNRS UMR6004, Nantes Université, Nantes, France
| | - Toinon Vigier
- Laboratory of Digital Science of Nantes (LS2N), CNRS UMR6004, Nantes Université, Nantes, France
| | - Samuel Bulteau
- CHU Nantes, Psychiatry Department, Nantes, France.,INSERM U1246, SPHERE, University of Nantes, University of Tours, Nantes, France
| | - Gyu Hyun Kwon
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, Republic of Korea
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22
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Bell IH, Nicholas J, Alvarez-Jimenez M, Thompson A, Valmaggia L. Virtual reality as a clinical tool in mental health research and practice
. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 22:169-177. [PMID: 32699517 PMCID: PMC7366939 DOI: 10.31887/dcns.2020.22.2/lvalmaggia] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Virtual reality (VR) is a potentially powerful technology for enhancing assessment
in mental health. At any time or place, individuals can be transported into immersive
and interactive virtual worlds that are fully controlled by the researcher or clinician.
This capability is central to recent interest in how VR might be harnessed in both
treatment and assessment of mental health conditions. The current review provides a
summary of the advantages of using VR for assessment in mental health, focusing on
increasing ecological validity of highly controlled environments, enhancing
personalization and engagement, and capturing real-time, automated data in real-world
contexts. Considerations for the implementation of VR in research and clinical settings
are discussed, including current issues with cost and access, developing evidence base,
technical challenges, and ethical implications. The opportunities and challenges of VR
are important to understand as researchers and clinicians look to harness this
technology to improve mental health outcomes.
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Affiliation(s)
- Imogen H Bell
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; University of Warwick - Division of Mental Health and Wellbeing, University of Warwick, UK
| | - Lucia Valmaggia
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
Initially designed for the treatment of phobias, the use of virtual reality in phobic disorders has expanded to other mental health disorders such as posttraumatic stress disorder, substance-related disorders, eating disorders, psychosis, and autism spectrum disorder. The goal of this review is to provide an accessible understanding of why this approach is important for future practice, given its potential to provide clinically relevant information associated with the assessment and treatment of people suffering from mental illness. Most of the evidence is available for the use of virtual reality exposure therapy in anxiety disorders and posttraumatic stress disorder. There is hardly any evidence that virtual reality therapy is effective in generalized anxiety disorder and obsessive-compulsive disorder. There is increasing evidence that cue exposure therapy is effective in addiction and eating disorders. Studies into the use of virtual reality therapy in psychosis, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) are promising.
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Affiliation(s)
- Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, 1001 NK Amsterdam, The Netherlands;
| | - Katharina Meyerbröker
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands.,Altrecht Academic Anxiety Center, 3524 SH Utrecht, The Netherlands
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Gilboa Y, Fogel-Grinvald H, Chevignard M. Virtual Classroom Assessment for Children and Adolescents With Attention Deficits: A Systematic Review and Meta-Analysis of Measurement Properties. J Atten Disord 2021; 25:300-311. [PMID: 30371134 DOI: 10.1177/1087054718808590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: The virtual classroom (VC) is a head-mounted display immersive system for the assessment of attention. A meta-analysis was performed to examine the use of the VC to assess attention in children and adolescents. Method: We conducted a systematic literature search to select articles up to December 2017. Results: Thirteen studies using the VC to assess attention were included. Studies reporting comparisons between patients with various clinical conditions and healthy controls were included in the meta-analysis. The meta-analysis results revealed significant differences between groups for the percentage of identified targets (nine studies; total combined N = 431), for commission errors, and reaction time (eight studies; total combined N = 399) in favor of the nonclinical group. Conclusion: Preliminary evidence establishes the validity of the VC and suggests that this task has the potential to serve as a useful and enjoyable ecological assessment tool for the diagnosis of attention deficits in children and adolescents. (J. of Att. Dis. XXXX; XX(X) XX-XX).
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Affiliation(s)
- Yafit Gilboa
- School of Occupational Therapy, The Hebrew University of Jerusalem, Israel
| | | | - Mathilde Chevignard
- Rehabilitation Department for Children and Adolescents with Acquired Neurological Injury, and Outreach Team for children and adolescents with acquired brain injury, Saint-Maurice Hospitals, France.,Laboratoire d'Imagerie Biomédicale, LIB, 75006 Sorbonne Université, Paris, France.,GRC n°18, Handicap Cognitif et Réadaptation (HanCRe), Sorbonne Université, Paris, France
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25
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Lee H, Jung J, Lee HK, Yang HS. Discipline vs guidance: comparison of visual engagement approaches in immersive virtual environments. MULTIMEDIA TOOLS AND APPLICATIONS 2021; 80:31239-31261. [PMID: 33456314 PMCID: PMC7796854 DOI: 10.1007/s11042-020-10267-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/30/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Immersive virtual environments (IVEs) have been extensively investigated for applications in education and man-power training because of the benefits of immersion-driven experiences as immersion becomes a factor that can both accelerate and hamper learning depending on the user's area of focus, which supports the importance of engagement. In this paper, two fundamental approaches to visual engagement in IVE are compared: discipline and guidance. The approaches aim to foster the learner's engagement to predefined area to be focused by either subtracting visual stimuli (discipline) or appending visual indicators pointing to the area (guidance). The experimental results showed no significant improvement in memory recall accuracy and time. However, the guidance group showed superior performances in usability metrics. Interestingly, a significant difference was found in the objective measure of the participants' gaze pattern revealing that the discipline makes the user's gaze consistent and stable.
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Affiliation(s)
- Hyeopwoo Lee
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jinki Jung
- Digital Maritime Consultancy Aps, H.C. Ørstedsvej 13, 1 tv 1879 Frederiksberg, Denmark
| | - Heung-Kyu Lee
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hyun Seung Yang
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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Abstract
AbstractVirtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world.
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27
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Yeh SC, Lin SY, Wu EHK, Zhang KF, Xiu X, Rizzo A, Chung CR. A Virtual-Reality System Integrated With Neuro-Behavior Sensing for Attention-Deficit/Hyperactivity Disorder Intelligent Assessment. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1899-1907. [PMID: 32746303 DOI: 10.1109/tnsre.2020.3004545] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Attention-deficit/Hyperactivity disorder(ADHD) is a common neurodevelopmental disorder among children. Traditional assessment methods generally rely on behavioral rating scales (BRS) performed by clinicians, and sometimes parents or teachers. However, BRS assessment is time consuming, and the subjective ratings may lead to bias for the evaluation. Therefore, the major purpose of this study was to develop a Virtual Reality (VR) classroom associated with an intelligent assessment model to assist clinicians for the diagnosis of ADHD. In this study, an immersive VR classroom embedded with sustained and selective attention tasks was developed in which visual, audio, and visual-audio hybrid distractions, were triggered while attention tasks were conducted. A clinical experiment with 37 ADHD and 31 healthy subjects was performed. Data from BRS was compared with VR task performance and analyzed by rank-sum tests and Pearson Correlation. Results showed that 23 features out of total 28 were related to distinguish the ADHD and non-ADHD children. Several features of task performance and neuro-behavioral measurements were also correlated with features of the BRSs. Additionally, the machine learning models incorporating task performance and neuro-behavior were used to classify ADHD and non-ADHD children. The mean accuracy for the repeated cross-validation reached to 83.2%, which demonstrated a great potential for our system to provide more help for clinicians on assessment of ADHD.
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28
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Self-Regulation in Children with Neurodevelopmental Disorders "SR-MRehab: Un Colegio Emocionante": A Protocol Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124198. [PMID: 32545534 PMCID: PMC7345694 DOI: 10.3390/ijerph17124198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
Self-regulation refers to the ability to control and modulate behavior, and it can include both emotional and cognitive modulation. Children with neurodevelopmental disorders may show difficulties in self-regulation. The main objective of this study is to improve self-regulation skills in children between 6 and 11 years of age with neurodevelopmental disorders. Methodology: A randomized controlled trial will be conducted with the use of “SR-MRehab: Un colegio emocionante”, based on a non-immersive virtual reality system where virtual objects can be managed by children in a natural way using their hands. Children will be recruited from several schools of Granada (Spain) and they will be randomly allocated to two groups. An assessment will be conducted before and after the intervention and 24 weeks after the end of the intervention process. The experimental group will receive the intervention using virtual reality. The control group will receive a standard self-regulation program. Both interventions will be performed once a week for a total of 10 sessions. Changes in self-regulation, as well as the acceptability of technology with the use of SR-MRehab, will be evaluated. The results will be published and will provide evidence regarding the use of this type of intervention in children with neurodevelopmental disorders. Trial registration: Registered with code NCT04418921.
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Mangalmurti A, Kistler WD, Quarrie B, Sharp W, Persky S, Shaw P. Using virtual reality to define the mechanisms linking symptoms with cognitive deficits in attention deficit hyperactivity disorder. Sci Rep 2020; 10:529. [PMID: 31953449 PMCID: PMC6969149 DOI: 10.1038/s41598-019-56936-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/09/2019] [Indexed: 11/09/2022] Open
Abstract
The mechanisms underpinning attentional deficits are only partially understood. Here we ask if shifts in a child's field of view (FOV) act as a mediator between symptoms of attention deficit hyperactivity disorder (ADHD) and associated cognitive anomalies, particularly in attentional processes. Real time measurement of shifts in FOV were obtained on 85 children (mean age 9.4 (SD 1.9) years; 45 with DSM 5-defined ADHD) as they completed the continuous performance task in a "virtual classroom". We extracted measures reflecting focused and selective attention across the task, along with diffusion modelling of latent cognitive processes of information uptake, response conservativeness and non-decision time. Mediation analyses showed that shifts in FOV partially mediated the relationship between hyperactive impulsive symptoms and both poor focused attention and information uptake. Performance accuracy decreased and shifts in FOV increased during the task, but these changes over time did not differ by symptom severity. Employing virtual reality and mediation analysis, we implicate shifts in FOV as a mechanism linking symptoms of ADHD and deficits in focused attention and in the gathering of information to make decisions. The identification of mediating mechanisms might provide new targets for intervention.
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Affiliation(s)
- Aman Mangalmurti
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States
| | - William D Kistler
- Immersive Virtual Environment Testing Unit, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States
| | - Barrington Quarrie
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States
| | - Wendy Sharp
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States
| | - Susan Persky
- Immersive Virtual Environment Testing Unit, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States
| | - Philip Shaw
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, NHGRI/NIH, Bethesda, United States.
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30
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Wiguna T, Wigantara NA, Ismail RI, Kaligis F, Minayati K, Bahana R, Dirgantoro B. A Four-Step Method for the Development of an ADHD-VR Digital Game Diagnostic Tool Prototype for Children Using a DL Model. Front Psychiatry 2020; 11:829. [PMID: 32973578 PMCID: PMC7461963 DOI: 10.3389/fpsyt.2020.00829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children resulting in disturbances in their daily functioning. Virtual reality (VR) and machine learning technologies, such as deep learning (DL) application, are promising diagnostic tools for ADHD in the near future because VR provides stimuli to replace real stimuli and recreate experiences with high realism. It also creates a playful virtual environment and reduces stress in children. The DL model is a subset of machine learning that can transform input and output data into diagnostic values using convolutional neural network systems. By using a sensitive and specific ADHD-VR diagnostic tool prototype for children with DL model, ADHD can be diagnosed more easily and accurately, especially in places with few mental health resources or where tele-consultation is possible. To date, several virtual reality-continuous performance test (VR-CPT) diagnostic tools have been developed for ADHD; however, they do not include a machine learning or deep learning application. A diagnostic tool development study needs a trustworthy and applicable study design and conduct to ensure the completeness and transparency of the report of the accuracy of the diagnostic tool. The proposed four-step method is a mixed-method research design that combines qualitative and quantitative approaches to reduce bias and collect essential information to ensure the trustworthiness and relevance of the study findings. Therefore, this study aimed to present a brief review of a ADHD-VR digital game diagnostic tool prototype with a DL model for children and the proposed four-step method for its development.
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Affiliation(s)
- Tjhin Wiguna
- Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ngurah Agung Wigantara
- Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Raden Irawati Ismail
- Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fransiska Kaligis
- Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kusuma Minayati
- Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Raymond Bahana
- Faculty of Computer Science, Bina Nusantara University, Jakarta, Indonesia
| | - Bayu Dirgantoro
- Faculty of Computer Science, Bina Nusantara University, Jakarta, Indonesia
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31
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Bioulac S, Micoulaud-Franchi JA, Maire J, Bouvard MP, Rizzo AA, Sagaspe P, Philip P. Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study. J Atten Disord 2020; 24:326-335. [PMID: 29562853 DOI: 10.1177/1087054718759751] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.
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Affiliation(s)
- Stéphanie Bioulac
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Jenna Maire
- University of Bordeaux, INSERM U1219, Bordeaux, France
| | - Manuel P Bouvard
- Pôle Universitaire Psychiatrie Enfants et Adolescents, Bordeaux, France
| | | | - Patricia Sagaspe
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Pierre Philip
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
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Alqithami S, Alzahrani M, Alzahrani A, Mustafa A. AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with ADHD. Healthcare (Basel) 2019; 7:E146. [PMID: 31731576 PMCID: PMC6955707 DOI: 10.3390/healthcare7040146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think and behave. This type of therapy is mostly common in treating patients with anxiety and depression but also is useful in treating autism, obsessive compulsive disorder and post-traumatic stress disorder. A major limitation of traditional CBT is that therapists may face difficulty in optimizing patients' neuropsychological stimulus following a specified treatment plan. Other limitations include availability, accessibility and level-of-experience of the therapists. Hence, this paper aims to design and simulate a generic cognitive model that can be used as an appropriate alternative treatment to traditional CBT, we term as "AR-Therapist." This model takes advantage of the current developments of augmented reality to engage patients in both real and virtual game-based environments.
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Affiliation(s)
- Saad Alqithami
- Department of Computer Science, Albaha University; Albaha 65799, Saudi Arabia; (M.A.); (A.A.); (A.M.)
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Friso-van den Bos I, van de Weijer-Bergsma E. Classroom versus individual working memory assessment: predicting academic achievement and the role of attention and response inhibition. Memory 2019; 28:70-82. [PMID: 31645187 DOI: 10.1080/09658211.2019.1682170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Working memory (WM) is an important predictor for academic learning and achievement. Typically, children's WM is assessed in controlled testing situations, which might not reflect functioning in typical classroom learning situations with natural distractions. In this study, we compared WM performance in controlled and classroom situations and their predictive value for academic achievement. Also, we examined whether performance differences between situations were moderated by attention or response inhibition. In a within-subjects design, primary school children completed visuospatial and verbal WM tasks in two settings (classroom versus controlled individual setting). First, WM functioning was lower in the classroom setting. Second, attention moderated individual differences in this discrepancy between settings, but response inhibition did not. Third, classroom obtained verbal WM scores were the strongest predictors of academic achievement. Our results indicate that classroom assessment of verbal WM provides a more ecologically valid measurement of WM abilities in a real-life learning situation.
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Affiliation(s)
- Ilona Friso-van den Bos
- Department of Pedagogical and Educational Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands.,Department of Educational Sciences, Faculty of Behavioural and Management Sciences, University of Twente
| | - Eva van de Weijer-Bergsma
- Department of Pedagogical and Educational Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
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Ferreira-Brito F, Fialho M, Virgolino A, Neves I, Miranda AC, Sousa-Santos N, Caneiras C, Carriço L, Verdelho A, Santos O. Game-based interventions for neuropsychological assessment, training and rehabilitation: Which game-elements to use? A systematic review. J Biomed Inform 2019; 98:103287. [PMID: 31518700 DOI: 10.1016/j.jbi.2019.103287] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/19/2019] [Accepted: 09/07/2019] [Indexed: 01/16/2023]
Abstract
Game-based interventions (GBI) have been used to promote health-related outcomes, including cognitive functions. Criteria for game-elements (GE) selection are insufficiently characterized in terms of their adequacy to patients' clinical conditions or targeted cognitive outcomes. This study aimed to identify GE applied in GBI for cognitive assessment, training or rehabilitation. A systematic review of literature was conducted. Papers involving video games were included if: (1) presenting empirical and original data; (2) using video games for cognitive intervention; and (3) considering attention, working memory or inhibitory control as outcomes of interest. Ninety-one papers were included. A significant difference between the number of GE reported in the assessed papers and those composing video games was found (p < .001). The two most frequently used GE were: score system (79.2% of the interventions using video games; for assessment, 43.8%; for training, 93.5%; and for rehabilitation, 83.3%) and narrative context (79.2% of interventions; for assessment, 93.8%; for training, 73.9% and for rehabilitation, 66.7%). Usability assessment was significantly associated with six of the seven GE analyzed (p-values between p ≤ 0.001 and p. = 027). The use of GE that act as extrinsic motivation promotors (e.g., numeric feedback system) may jeopardize patients' long-term adherence to interventions, mainly if associated with progressive difficulty-increase of gaming experience. Lack of precise description of GE and absence of a theoretical framework supporting GE selection are important limitations of the available clinical literature.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal.
| | - Mónica Fialho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal.
| | - Ana Virgolino
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal.
| | - Inês Neves
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal.
| | - Ana Cristina Miranda
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal; USF AlbaSaude, ACeS de Sintra, Administração Regional de Saúde de Lisboa e Vale do Tejo, Bairro da Tabaqueira 30, 2635-101 Rio de Mouro, Portugal.
| | - Nuno Sousa-Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal; Escola Superior de Saúde de Leiria, Instituto Politécnico de Leiria, Campus 2 - Morro do Lena, Alto do Vieiro - Apartado 4137, 2411-901 Leiria, Portugal.
| | - Cátia Caneiras
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal; Healthcare Department, Nippon Gases Portugal, Rua Real Fábrica de Atanados, n°. 1, 2600-242 Vila Franca de Xira, Portugal.
| | - Luís Carriço
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Portugal; Departamento de Informática, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal.
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal; Instituto de Medicina Molecular (iMM), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, 1649-028 Lisboa, Portugal; Departamento de Neurociências, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Osvaldo Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisboa, Portugal.
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35
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Eom H, Kim KK, Lee S, Hong YJ, Heo J, Kim JJ, Kim E. Development of Virtual Reality Continuous Performance Test Utilizing Social Cues for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:198-204. [PMID: 30672714 DOI: 10.1089/cyber.2018.0377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Hyojung Eom
- 1 Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea.,2 Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwanguk Kenny Kim
- 3 Department of Computer Science, Hanyang University, Seoul, South Korea
| | - Sungmi Lee
- 2 Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Ju Hong
- 2 Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiwoong Heo
- 3 Department of Computer Science, Hanyang University, Seoul, South Korea
| | - Jae-Jin Kim
- 1 Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea.,2 Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,4 Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- 2 Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,4 Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
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Fang Y, Han D, Luo H. A virtual reality application for assessment for attention deficit hyperactivity disorder in school-aged children. Neuropsychiatr Dis Treat 2019; 15:1517-1523. [PMID: 31239686 PMCID: PMC6559774 DOI: 10.2147/ndt.s206742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background and objective: The development of objective assessment tools for attention deficit hyperactivity disorder (ADHD) has become a hot research topic in recent years. This study was conducted to explore the feasibility and availability of virtual reality (VR) for evaluating symptoms of ADHD. Methods: School-aged children were recruited. The children with ADHD or without ADHD were assigned into the ADHD group or Control group, respectively. They were all evaluated using the Conners' Parent Rating Scale (CPRS), Child Behavior Checklist (CBCL), Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), and a VR test. Results: The correct items, incorrect items, and the accuracy rate of the VR test of the children with ADHD were significantly different with those of the children in the Control group. The correct items, incorrect items, total time, and accuracy of the VR test were significantly correlated with the scores of IVA-CPT (auditory attention and visual attention), CPRS (impulsion/hyperactivity and ADHD index), and CBCL (attention problems and social problems), respectively. Discussion: The results supported the discriminant validity of the VR test for evaluating ADHD in school-age children suffering from learning problems. The VR test results are associated with the commonly used clinical measurements results. A VR test is interesting for children and therefore it attracts them to complete the test; whilst at the same time, it can also effectively evaluate ADHD symptoms.
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Affiliation(s)
- Yantong Fang
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Dai Han
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China.,Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, People's Republic of China
| | - Hong Luo
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
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Effect of Acute Static Stretching on Lower Limb Movement Performance Using STABL Virtual Reality System. J Sport Rehabil 2018; 27:520-525. [PMID: 28714771 DOI: 10.1123/jsr.2017-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT The effect of acute static stretching (ASS) on the lower limb reaction time (RT) has been recently questioned to decrease the risk of falling and injuries in situations requiring a rapid reaction, as in the cases of balance disturbance. OBJECTIVE The main purpose of this study was to detect the effect of ASS on the lower limb RT using a virtual reality device. DESIGN Two-group control group design. SETTING Research laboratory. PARTICIPANTS The control and experimental groups were formed randomly from 60 female university students. INTERVENTION Each participant in the experimental group was tested before and after ASS for the quadriceps, hamstrings, and planter flexor muscles, and compared with the control group with warming-up exercise alone. The stretching program involved warming up in the form of circular running inside the lab for 5 minutes followed by stretching of each muscle group three times, to the limit of discomfort of 45 seconds, with resting period of 15 seconds between stretches. MAIN OUTCOME MEASURES The measurements included the RT of the dominant lower-extremity using the dynamic stability program STABL Virtual Reality System (model no. DIZ 2709; Motekforce Link). RESULTS There was a statistically significant reduction (F = 162, P < .05) in posttest RT between the 2 groups and significant decrease in RT after stretching in the experimental group (7.5%; P < .05). CONCLUSION ASS of the lower limb muscles tends to decrease the lower limb RT and improve movement performance.
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Riva G, Wiederhold BK, Mantovani F. Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:82-96. [PMID: 30183347 PMCID: PMC6354552 DOI: 10.1089/cyber.2017.29099.gri] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Is virtual reality (VR) already a reality in behavioral health? To answer this question, a meta-review was conducted to assess the meta-analyses and systematic and narrative reviews published in this field in the last twenty-two months. Twenty-five different articles demonstrated the clinical potential of this technology in both the diagnosis and the treatment of mental health disorders: VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management, with long-term effects that generalize to the real world. But why is VR so effective? Here, the following answer is suggested: VR shares with the brain the same basic mechanism: embodied simulations. According to neuroscience, to regulate and control the body in the world effectively, the brain creates an embodied simulation of the body in the world used to represent and predict actions, concepts, and emotions. VR works in a similar way: the VR experience tries to predict the sensory consequences of an individual's movements, providing to him/her the same scene he/she will see in the real world. To achieve this, the VR system, like the brain, maintains a model (simulation) of the body and the space around it. If the presence in the body is the outcome of different embodied simulations, concepts are embodied simulations, and VR is an embodied technology, this suggests a new clinical approach discussed in this article: the possibility of altering the experience of the body and facilitating cognitive modeling/change by designing targeted virtual environments able to simulate both the external and the internal world/body.
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Affiliation(s)
- Giuseppe Riva
- 1 Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.,2 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Brenda K Wiederhold
- 3 Virtual Reality Medical Center, La Jolla, California.,4 Virtual Reality Medical Institute, Brussels, Belgium
| | - Fabrizia Mantovani
- 5 Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
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Rodríguez C, Areces D, García T, Cueli M, González-Castro P. Comparison between two continuous performance tests for identifying ADHD: Traditional vs. virtual reality. Int J Clin Health Psychol 2018; 18:254-263. [PMID: 30487931 PMCID: PMC6225036 DOI: 10.1016/j.ijchp.2018.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
Background/Objective: Continuous Performance Tests (CPTs) have demonstrated validity when differentiating children with ADHD from healthy controls. However, these CPTs have limitations such as low ecological validity. New CPTs based on the use of Virtual Reality (VR) have appeared as supposedly improved methods for assessing ADHD. This study aims to compare the discriminant value of attentional variables produced by a VR CPT (Aula Nesplora) with that of variables from a traditional CPT (Test of Variables of Attention; TOVA) for identifying ADHD. Method: A total of 338 children aged between 6 and 16 years old (M = 10.84, SD = 3.01) participated in the study: 31.95% correspond to the inattentive presentation, 15.38% to the impulsive-hyperactive presentation, 22.78% to the combined presentation, and the remaining 29.88% correspond to children without ADHD. Results: Results indicated that Aula Nesplora predicts ADHD presentations better than TOVA. It also differentiates better between ADHD and non-ADHD students. Conclusions: These findings show the potential advantages of using virtual reality in ADHD assessment, as it facilitates the diagnosis of ADHD and the differentiation of its presentations in a realistic environment.
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Areces D, Dockrell J, García T, González-Castro P, Rodríguez C. Analysis of cognitive and attentional profiles in children with and without ADHD using an innovative virtual reality tool. PLoS One 2018; 13:e0201039. [PMID: 30110334 PMCID: PMC6093610 DOI: 10.1371/journal.pone.0201039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
In previous studies, children with Attention-Deficit Hyperactivity Disorder (ADHD) have been found to have more difficulties with processing speed, working memory, and attentional tasks. The present study aimed to compare the cognitive variables (working memory and processing speed) and the attentional profiles of a sample of students with and without ADHD, using scales from the WISC-IV, and the virtual reality-based attentional test known as 'Aula Nesplora'; and determine the extent to which the aforementioned variables may predict student group membership. A total of 88 students took part in this study (66 males and 22 females), aged from 6 to 16 years (M = 10.20; SD = 2.79). The sample was divided into two groups: an ADHD group (n = 50) and a Control group (n = 38). Students in the ADHD group obtained lower scores in working memory and in processing speed, as well as demonstrating poorer performance in Aula Nesplora than did their peers. Working memory, and the number of omissions, were both shown to be reliable predictors of group membership. This study revealed the importance of obtaining data from attentional variables differentiated by modality when considering cognitive variables, in order to better characterize the difficulties experienced by individuals diagnosed with ADHD.
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Affiliation(s)
- Débora Areces
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Julie Dockrell
- Department of Psychology, University College London, London, United Kingdom
| | - Trinidad García
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Davidson F, Rusak B, Chambers C, Corkum P. The Impact of Sleep Restriction on Daytime Functioning in School-Age Children With and Without ADHD: A Narrative Review of the Literature. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2018. [DOI: 10.1177/0829573518770593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this narrative review was to synthesize the existing literature on the impact of sleep on daytime functioning in both typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). Correlational studies in children suggest that insufficient sleep and impaired daytime functioning are significantly associated; however, this does not address the causal relationships between sleep and daytime functioning. The review results indicated that there is limited experimental sleep manipulation research in children. In the eight studies that employed experimental methods to examine sleep restriction, the consequences of insufficient sleep were greatest for attention and inconsistent for other domains, such as cognition and emotion regulation. Despite the significant co-occurrence of ADHD and sleep problems, the experimental sleep research focused on the daytime impact of shorter sleep in children with ADHD is extremely limited and as such more research is needed.
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Affiliation(s)
| | | | | | - Penny Corkum
- Dalhousie University, Halifax, Nova Scotia, Canada
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Fuermaier ABM, Fricke JA, de Vries SM, Tucha L, Tucha O. Neuropsychological assessment of adults with ADHD: A Delphi consensus study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:340-354. [DOI: 10.1080/23279095.2018.1429441] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jan A. Fricke
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Stefanie M. de Vries
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
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Bashiri A, Ghazisaeedi M, Shahmoradi L. The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: a literature review. KOREAN JOURNAL OF PEDIATRICS 2017; 60:337-343. [PMID: 29234356 PMCID: PMC5725338 DOI: 10.3345/kjp.2017.60.11.337] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/22/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in childhood. This disorder, in addition to its main symptoms, creates significant difficulties in education, social performance, and personal relationships. Given the importance of rehabilitation for these patients to combat the above issues, the use of virtual reality (VR) technology is helpful. The aim of this study was to highlight the opportunities for VR in the rehabilitation of children with ADHD. This narrative review was conducted by searching for articles in scientific databases and e-Journals, using keywords including VR, children, and ADHD. Various studies have shown that VR capabilities in the rehabilitation of children with ADHD include providing flexibility in accordance with the patients' requirements; removing distractions and creating an effective and safe environment away from real-life dangers; saving time and money; increasing patients' incentives based on their interests; providing suitable tools to perform different behavioral tests and increase ecological validity; facilitating better understanding of individuals' cognitive deficits and improving them; helping therapists with accurate diagnosis, assessment, and rehabilitation; and improving working memory, executive function, and cognitive processes such as attention in these children. Rehabilitation of children with ADHD is based on behavior and physical patterns and is thus suitable for VR interventions. This technology, by simulating and providing a virtual environment for diagnosis, training, monitoring, assessment and treatment, is effective in providing optimal rehabilitation of children with ADHD.
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Affiliation(s)
- Azadeh Bashiri
- Health Information Management Department, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Health Information Management Department, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Health Information Management Department, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most well-established and at the same time controversial disorders to the extreme of being placed in doubt. In the first of two parts, the established position is critically reviewed, beginning with showing fallacious reasoning on which the diagnosis is based, lacking clinical proof. Similarly, a certain rhetoric and metaphysics in genetic and neurobiological research is highlighted, where, for example, a meager accumulation of data is offered as robust conclusions, and correlates and correlations as causes and bases. However, that may be, the controversy is silenced in a dialog of the deaf between “defenders” and “critics.” with no way out in sight in empirical and scientific terms. A new meta-scientific position is necessary to analyze the science of ADHD itself and its social uses. In this respect, the second part introduces Aristotle’s four causes, material, formal, efficient, final, as an instrument of enquiry. According to this analysis, ADHD is not the pretended clinical entity as presented, but a practical entity providing a variety of functions. The implications would be rather different from the usual.
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