Development of a Novel Virtual Reality Treatment for Emerging Adults with ADHD

Project Summary/Abstract Attention deficit hyperactivity disorder (ADHD) is a highly prevalent and impairing disorder. Behavioral treatments that structure the environment and provide frequent and consistent monitoring are efficacious but resource and time intensive, leading to problems with access and adherence. This study will utilize a virtual reality platform to minimize distractions and provide the structure and monitoring necessary for individuals with ADHD to maintain focus while completing homework and studying. The virtual reality (VR) headset will place students in a distraction free environment that automates the frequent and consistent point-of-performance feedback and reinforcement that serves as the core mechanisms of behavioral treatment. The VR technology will allow for direct comparison between two novel intervention approaches and a VR passthrough to laptop control. Survey and objective data (keyboard and mouse click data) will be collected to directly evaluate the impact of VR on core targets of action, including concentration, motivation, and homework effort. This novel alternative to medication and behavior therapy offers a completely new tool for supporting individuals with ADHD. This study includes four separate projects, three in the R61 phase and a large randomized trial in the R33 phase. Project 1 (N = 30 college students with ADHD) focuses on optimizing and refining objective data capture algorithms to quantify on-task behavior and work productivity while completing a variety of different types of academic tasks. Project 2 (N = 30 college students with ADHD) focuses on developing and refining on-task monitoring and performance feedback algorithms within VR, including a green, yellow, and red-light display that allows individuals with ADHD to receive consistent and frequent feedback and work towards specific short-terms goals and rewards. Focus groups will also be completed to improve VR feasibility and usability. Project 3 involves a small randomized controlled trial to ensure that the key targets of action are engaged. Project 3 will assess the feasibility/usability and preliminary effects of the VR environment alone (n=15) as compared to VR environment + contingency management (n=15) and a passthrough control wearing of the VR headset (n=15). Time on-task, homework motivation, and homework effort are the proposed mechanisms of action. If the Go/No-Go criteria are met in Project 3, the protocol moves to Project 4, which involves a randomized trial of the VR intervention. 252 college students with ADHD will be randomized to receive either: (1) VR environment alone, (2) VR environment + contingency management, or (3) pass-through VR headset control for 8 weeks. Measures of mental health and academic functioning will be collected at baseline, 4 weeks, 8 weeks, and at a 3-month follow-up.