An Open-Label Pilot Study of a Virtual Reality-Based Adaptive Cognitive Training Program for Inattention in Youth with ADHD

Although psychostimulant treatment for attention-deficit/hyperactivity disorder (ADHD) is often effective, the medication does not work for all and some experience adverse side effects. As a result, a desire for effective non-pharmacological options emerges as a top priority for those with lived experience. One such approach is cognitive training focused on the neurocognitive differences associated with ADHD. Its results have been mixed, partly as it is delivered using computers, and sustained engagement with this format is difficult for children with attentional difficulties. To investigate further, we developed a cognitive training tool delivered in a gamified, fully virtual reality (VR) platform (Floreo TM), and here report on an open-label pilot trial of its feasibility, tolerability, and preliminary outcomes. Thirty youth with ADHD (mean age = 12.5 years; 33% female) were enrolled and completed up to 20 VR training sessions over a 4- to 6-week period. The intervention targeted four key cognitive domains implicated in ADHD: impulse control, working memory, temporal processing and processing speed. Clinician-rated inattention symptoms and associated functional impairments, based on interviews with parents, showed significant pre–post improvements (symptoms: t(25.90) = -5.60, p < .001; d = -1.05; impairment: t(25.68) = -3.29, p = .003; d = -0.62). The intervention was well tolerated, with only minor adverse events such as occasional headaches and brief frustration. Usability ratings were high for parents and moderate for youth. Significant near-transfer effects were observed on tasks of impulse control (t (23.49) = -2.86, p = .009; d = -0.56) and processing speed (t(24.06) = 3.40, p = .002; d = 0.66). These findings suggest that VR-based cognitive training is a feasible, acceptable, and potentially effective approach for children with ADHD. Future randomized controlled trials are warranted to confirm efficacy and examine durability of effects.