Using virtual reality and psychophysics to test embodied cognitive flexibility in children with ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is often studied using seated, computer-based tasks that overlook the embodied aspects of cognition. To address this gap, we introduce a novel approach that harnesses virtual reality (VR) to systematically test cognitive flexibility measures during whole-body action. In our study, nineteen children (7- to 11-year-olds) diagnosed with ADHD played in a large VR room and intercepted virtual objects that fell from above onto the floor. On “Switch” trials, the task goal changed from one trial to the next (e.g., from focusing on an object’s shape to focusing on its color), while on “Non-Switch” trials, the same goal was maintained. We systematically varied the descent duration of the virtual objects, enabling us to fit psychometric curves that reveal the threshold at which children reliably succeeded in catching the objects. Findings showed that children performed worse (lower success thresholds) on Switch trials, indicating cognitive costs in rapidly shifting attention between different target dimensions. Moreover, the magnitude of these performance decrements correlated with parent-reported measures of impulsivity and inattention, suggesting that these VR assessments capture individual differences in ADHD. Our findings highlight the potential of embodied VR paradigms in providing a more ecologically valid view of cognitive flexibility. By requiring children to physically move and dynamically adapt to changing task demands, our approach offers an embodied insight into the interplay of perception, action, and cognition, expanding the methodological toolkit available for developmental research on ADHD.