The Trail Making Test in Virtual Reality (TMT-VR): Examination of the Ecological Validity, Usability, Acceptability, and User Experience in ADHD

Background: Virtual Reality (VR) is transforming neuropsychological assessment by providing immersive environments that closely replicate real-world conditions. This study presents the Virtual Reality Trail Making Test (TMT-VR), a novel adaptation of the traditional Trail Making Test, aimed at evaluating cognitive functions in individuals with Attention Deficit Hyperactivity Disorder (ADHD). We examined the ecological validity, convergent validity, usability, and user experience of the TMT-VR compared to the traditional version. Methods: Fifty-three participants, including 25 with ADHD and 28 neurotypical controls, completed both the traditional and VR versions of the TMT. Participants also provided feedback on the VR experience via standardized questionnaires. Results: Statistical analyses demonstrated a significant positive correlation between TMT-VR scores and both the traditional TMT and ADHD symptomatology as measured by the Adult Self-Report Scale (ASRS), confirming the TMT-VR’s ecological and convergent validity. High usability and positive user experience ratings indicated strong acceptability of the VR platform. Notably, the ADHD group exhibited greater performance differences in the VR environment, suggesting that VR may more effectively capture real-world cognitive challenges. Conclusions: These findings suggest that TMT-VR is a valid, engaging, and ecologically valid tool for cognitive assessment in ADHD, and other clinical populations, offering enhanced insights over traditional methods.