Evaluation of a virtual reality-based office room for a multimodal assessment of adult ADHD

Abstract Introduction Traditional neuropsychological tests still have limited diagnostic value for assessing adult attention-deficit hyperactivity disorder (ADHD), as they often fail to fully capture ADHD symptoms in everyday life. Recent studies suggest that virtual reality (VR) has the potential to alleviate this problem by enabling the creation of more naturalistic and symptom-relevant test environments. Following prior research investigating VR as an assessment method for ADHD, the present study reports on a VR scenario that does not only entail a realistic environment but also a more naturalistic task design. Specifically, participants are immersed in a newly developed virtual office, where they conduct a virtual email sorting task (VEST), while simultaneously being exposed to distracting events. Methods Twenty-one individuals with ADHD and 21 healthy controls (HC) underwent our new VR paradigm while we simultaneously recorded their VEST performance, task-related subjective symptom ratings, head actigraphy, gaze behavior, and brain activity, assessed via functional near-infrared spectroscopy (fNIRS) during distraction and non-distraction phases. Data were analyzed in a mixed ANOVA design. Results Individuals with ADHD showed greater processing time variability compared to HC in the VEST. No group differences were found in mean processing time and error rates. In head position, a significant interaction effect of Phase and Group was found, with the ADHD group showing a significant increase in movement during distraction phases compared to non-distraction phases. Additionally, with respect to gaze behavior, a trend effect of Group indicated higher perceptual off-task gaze in ADHD compared to HC. Individuals with ADHD also reported higher hyperactivity and inattention during task performance than HC. No group differences in fNIRS activity in dorsolateral prefrontal cortex were found. Discussion Our study provides a further step towards the application of more realistic task designs compared to classic continuous performance tasks and underlines the utility of actigraphy, eye tracking, and distractors in ADHD assessment. However, further studies are necessary to improve the VEST task design and discriminatory ability.