Neural Correlates of Virtual Reality Intervention in Children With Attention‐Deficit/Hyperactivity Disorder: A Resting‐State fMRI Study Based on Percent Amplitude of Fluctuation

OBJECTIVE: To investigate neural mechanisms associated with improvements in core symptoms of attention-deficit/hyperactivity disorder (ADHD) following a virtual reality (VR) intervention, using resting-state fMRI (rs-fMRI) with the percent amplitude of fluctuation (PerAF) and standardized clinical behavioral assessments. METHODS: Fifteen children with ADHD and fourteen age- and sex-matched typically developing children were enrolled. A pre-post intervention design was applied. Children with ADHD completed the Swanson, Nolan, and Pelham Rating scale-fourth edition (SNAP-IV), the matching familiar figures test (MFFT), and rs-fMRI scans before and after the VR intervention. Healthy controls underwent identical assessments at baseline. Voxel-wise analyses were conducted, and correlation analyses were conducted between changes in PerAF values and behavioral measures. RESULTS: Following the VR intervention, children with ADHD showed significant reductions in SNAP-IV scores for inattention, hyperactivity/impulsivity, and oppositional defiant behaviors, as well as fewer MFFT errors (P < 0.05). Compared with baseline, decreased PerAF values were observed in the right middle frontal gyrus, whereas increased PerAF values were found in the left paracentral lobule (PCL). Relative to healthy controls, the ADHD group exhibited elevated PerAF values in the left inferior temporal gyrus (ITG) after the intervention, which were positively correlated with oppositional defiant symptoms (r = 0.610). CONCLUSION: The VR intervention may ameliorate hyperactivity-impulsivity and behavioral problems in children with ADHD by modulating neural activity in brain regions associated with cognitive control (right MFG) and sensorimotor integration (left PCL). However, its regulatory effects on core attentional deficits and temporo-limbic circuits (left ITG) appear to be relatively limited. These findings provide preliminary neuroimaging evidence supporting the potential of VR as an adjunctive intervention for ADHD.