A future-oriented executive control design framework for immersive virtual reality interventions: development and randomized controlled evaluation

Background Immersive virtual reality (VR) has increasingly been applied in cognitive training and behavioral interventions; however, many existing VR‐based interventions primarily emphasize technological features or intervention outcomes while providing limited explanation of how cognitive theory guides interaction design. A mechanism‐based framework linking cognitive theory, cognitive mechanisms, immersive interaction principles, and behavioral outcomes is needed to support the systematic development of VR interventions. Methods The present study proposed the Future‐Oriented Executive Control (FOEC) Framework, a theory‐driven design framework for developing immersive VR interventions targeting future‐oriented executive control. The framework translates cognitive mechanisms into immersive behavioral experiences through structured interaction design principles. The FOEC Framework was implemented and evaluated through a randomized controlled trial involving 80 children with attention‐deficit/hyperactivity disorder (ADHD). Participants were randomly assigned to either conventional executive‐function (EF) training alone or EF training supplemented with the FOEC‐based immersive VR intervention. Executive‐control outcomes were assessed using the Executive Function Assessment Scale (EFAS), the Behavior Rating Inventory of Executive Function (BRIEF), and the Childhood Executive Functioning Inventory (CHEXI). Results Compared with conventional EF training alone, the FOEC‐based intervention demonstrated additional improvements in several executive‐control domains, particularly inhibitory control, behavioral regulation, task initiation, and planning‐related processes. However, improvements were not uniformly observed across all executive‐function measures, suggesting differential responsiveness across assessment domains. Conclusion These findings provide preliminary empirical support for the FOEC Framework as a mechanism‐based approach for designing immersive VR cognitive interventions. By establishing a structured connection among cognitive theory, cognitive mechanisms, interaction design principles, and behavioral experiences, the framework offers a structured methodology for developing future VR interventions targeting cognitive and behavioral outcomes. Clinical Trial Registration ClinicalTrials.gov , Identifier: NCT07591896.