Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test

ABSTRACT

Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.

KEYWORDS:

• Virtual reality
• ADHD
• Validity
• Neuropsychological assessment
• CPT

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ Virtual-reality-based assessment consists of a certain amount of stimuli delivered to participants in a highly systematic and controlled virtual environment (Bohil et al., 2011) via a human-computer interface facilitated by a computer with an HMD, trackers, headphones and data gloves or joysticks (Gamberini, 2000; Ku et al., 2003; Schultheis, Himelstein, & Rizzo, 2002). These devices generate a 3D environment that resembles the real world using advanced graphics and means of interaction.

² Depending on the cortical mechanisms of sustained attention (Sergeant, Geurts, Huijbregts, Scheres, & Oosterlaan, 2003) two main CPT tasks exist: vigilance tasks (activation mechanism) and arousal tasks (arousal mechanism; M. Servera & Cardo, 2006). In vigilance CPTs (known as X- or AX-types), participants are instructed to respond to target items while ignoring non-target items over longer periods of time (Rosvold et al., 1956) and participants have to respond correctly to target stimuli and inhibit responses to non-target stimuli. In inhibition CPTs described as non-X tasks, participants are asked to respond to non-target items and ignore the target items (Conners et al., 2003; M. Servera & Cardo, 2006).

³ The total number of correct responses reflects the number of cases in which the participant correctly responds to target items. Errors of commission occur when the participant responds to non-target items. Errors of omission occur when the participant does not respond to target items. The mean reaction time reflects the participant’s average hit reaction time, expressed in milliseconds or seconds.

⁴ Diagnostic validity is part of a criterion-related source of validity and is usually established by comparing two contrasted groups on outcomes of interest. In this case, diagnostic validity is established by comparing the performance of children with ADHD with TD children (Wasserman & Bracken, 2003).

Additional information

Funding

This work was supported by the Sectorial Operational Program for Human Resources Development 2007–2013, co-financed by the European Social Fund under the title Young Successful Researchers—Professional Development in an International and Interdisciplinary Environment [grant number POSDRU/159/1.5/S/132400].