New Symptom Test for Children

January 19, 2023

Virtual reality (VR) games may be used to accurately and objectively diagnose ADHD symptoms in children, according to a team of Finland-based researchers. Their newly developed VR game, Executive Performance in Everyday Living (EPELI), performed better than standard behavioral tests in distinguishing children with ADHD from those without ADHD in a small study of 76 subjects. According to the study, “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.”1

Unlike the questionnaires, interviews, and clinical observations commonly used to assess ADHD, EPELI simulates tasks that occur in everyday life. Players are asked to remember to engage in simple tasks like brushing their teeth or eating a banana despite distractions in the environment.

“The game measures everything: how much the child clicks on the controls and how efficiently they perform the tasks,” says Topi Siro, the developer of EPELI. “Efficiency correlates with everyday functioning, where children with ADHD often have challenges.2

How EPELI Gauges ADHD

EPELI presents 13 task scenarios to players over 25 to 35 minutes. Each scenario includes one general topic (eg morning routines) and 4 to 6 subtasks (eg wash hands). Participants engage in an instruction phase and execution phase for each scenario. The execution phase must be completed within 90 seconds.

A previous study of EPELI successfully distinguished children with ADHD from a neurotypical control group.1 That research was recently replicated in a study published by Naturebut with an added behavioral marker: visual attention.3 Children played EPELI followed by a second VR game called Shoot the Target. The latter tracked eye movement by asking participants to “shoot” virtual objects with their gaze.

Liya Merzon, a doctoral researcher at Aalto University, said this proved to be “an effective way of detecting ADHD symptoms.”

“The ADHD children’s gaze paused longer on different objects in the environment, and their gaze jumped faster and more often from one spot to another. This might indicate a delay in visual system development and poorer information processing than other children.”2

Practical Applications of VR for ADHD

In a recent ADHD Experts webinar on this topic, Randy Kulman, founder of LearningWorks for Kids, explained why VR games may offer a more comprehensive and useful way to measure ADHD behaviors.

“As somebody who does assessments on a regular basis, I know that the tools I use — like the Continuous Performance Test, tests from the NEPSY, the Auditory Attention and Response Subtest — are only capturing certain kinds of things from the kids. And some of it involves observation and hand-scoring,” Kulman said. “Whereas when you are using VR to assess kids with ADHD, you’re picking up on everything. You’re picking up on their eye movement. You’re seeing how quickly they actually respond. You’re seeing what they do when there are transitions. You’re seeing how much they’re actually looking or paying attention to distractors.”

Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at Helsinki University Hospital, said EPELI is available for professionals to use in their clinical work and that “the experience has been very positive.”

“All of the neuropsychologists who answered a feedback survey after the first pilot said they had benefited from using virtual reality methods as a complementary tool in their work.”2

Its creators say EPELI could be used to understand and assess other conditions including age-related diseases, autism, language problems, brain trauma, adult ADHD, and cerebral palsy.

VR is being used more commonly today in ADHD treatment. Companies like XRHealth and Amelia Virtual Care are using VR in their mental health treatment practices, and several research centers are now investigating the efficacy of VR treatments in improving ADHD symptoms such as working memory, executive function, and cognitive processes. Although further research is needed, initial analyzes conclude that “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.”4

Virtual Reality Games for ADHD: Next Steps

View Article Sources

1Seesjärvi, E. et al. (2021). Quantifying ADHD symptoms in open-ended everyday life contexts with a new virtual reality task. J. Atten. Disord. https://doi.org/10.1177/10870547211044214

2Salmitaival, JPS, Merzon, L., & Seesjärvi, E. (2022, December 20). Virtual reality game to objectively detect ADHD. Aalto University. https://www.aalto.fi/en/news/virtual-reality-game-to-objectively-detect-adhd

3Merzon, L., Pettersson, K., Aronen, ET et al. (2022). Eye movement behavior in a real-world virtual reality task reveals ADHD in children. Sci Rep 1220308. https://doi.org/10.1038/s41598-022-24552-4

4Bashiri, A., Ghazisaeedi, M., & Shahmoradi, L. (2017). The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: a literature review. Korean journal of pediatrics, 60(11), 337–343. https://doi.org/10.3345/kjp.2017.60.11.337

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