January 21, 2024
Virtual reality consists of computer-generated simulated environments. These can be on a flat screen as on a computer or tablet, in which the viewer’s peripheral vision is unimpaired. These types of virtual reality are non-immersive. Where vision of the outward actual environment is blocked, as by goggles, virtual reality becomes immersive.
A Romanian and British trio of researchers embarked on a systematic review and meta-analysis of randomized controlled trials (RCTs) to explore whether immersive virtual reality interventions are effective at improving cognitive deficits in children and adolescents with ADHD, what factors influence effect sizes, and whether such interventions are safe and likely to be adhered to by patients.
They distinguished between RCTs with passive control groups using either no treatment or waiting list, and RCTs using an active comparator group, where participants received an intervention with similar levels of contact with research personnel and a similar number of sessions as the intervention group (e.g., psychotherapy or non-immersive VR). Medication was also classified as an active comparator group.
A meta-analysis of seven RCTs with a combined 321 participants found that across all outcome measures, immersive virtual reality interventions were associated with large effect size improvements in cognitive functioning. Correcting for publication bias maintained the finding of large effect size improvements. Variation (heterogeneity) between studies was moderately high, but the mean outcome in every RCT was likewise positive though not always statistically significant.
A second meta-analysis of six RCTs totaling 273 persons likewise found large effect size improvements on attention measures. Again, heterogeneity was moderately high, but the mean outcome in every RCT was likewise positive though not always statistically significant.
There was no significant difference in outcomes between RCTs with active controls and those with passive controls. Nor did newer vs. older VR technology make any difference. Likewise, formal ADHD diagnosis vs. participants with ADHD-like symptoms but no formal diagnosis had no significant effect on outcomes.
The authors concluded, “immersive VR-based interventions are effective at improving global cognitive functioning, attention, and memory in children with ADHD compared with controls. Moreover, immersive VR is feasible in terms of treatment adherence and a safe cognitive rehabilitation tool.”
But they noted, “Results should be cautiously interpreted given the poor quality of included studies and small sample.”
Niamh Corrigan, Costina‐Ruxandra Păsărelu, and Alexandra Voinescu, “Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta‐analysis,” Virtual Reality (2023), https://doi.org/10.1007/s10055-023-00768-1.