Research Recap with Skye: Virtual Reality and ADHD
Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our research recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try to find any practical takeaways.
In this episode, we're going to be discussing a paper called Virtual Reality Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review. This paper is actually a review that provides a comprehensive look at how virtual reality is transitioning from a high-tech novelty to perhaps more of a legitimate clinical tool for managing ADHD. Also, as a note, this was a listener-submitted paper and definitely something I would have never thought to look into on my own, so I was really excited to get this submission because I had no idea that this was something people were doing.
If you'd life to follow along on the show notes page you can find that at https://HackingYourADHD.com/301
https://tinyurl.com/56rvt9fr - Unconventional Organisation Affiliate link
https://tinyurl.com/y835cnrk - YouTube
https://www.patreon.com/HackingYourADHD - Patreon
William Curb: Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. Today, I'm joined by Skye Waterson for our research recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try to find any practical takeaways.
In this episode, we're going to be discussing a paper called Virtual Reality Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review. This paper is actually a review that provides a comprehensive look at how virtual reality is transitioning from a high-tech novelty to perhaps more of a legitimate clinical tool for managing ADHD. Also, as a note, this was a listener-submitted paper and definitely something I would have never thought to look into on my own, so I was really excited to get this submission because I had no idea that this was something people were doing.
Skye Waterson: Yeah. Very, very cool.
William Curb: Let's get into it.
Skye Waterson: Awesome. So this paper is a systematic review. It's called Virtual Reality Interventions for Attention Deficit Hyperactivity Disorder. And yeah, it was based in China, which was very interesting. Was it a pre-press or in press at the time? I think the copy we got...
William Curb: It's not connected to a particular journal that I can see. Yeah, I think it was pre-press, but they did do a lot of the things you'd expect, like a PRISMA review, and they connected to all the major databases and stuff. So I don't know if it was connected to anything yet. So yeah, probably pre-press.
Skye Waterson: But it is a very interesting idea because I did not realize that there were papers discussing this already, as it is not particularly an avenue I thought was a good use for ADHD interventions.
Yeah, it's an interesting one. I mean, in some ways it makes sense. ADHD is about attention. Being in a 360-degree environment is pretty attention-grabbing. It's hard to lose attention at that point, so it makes sense. But it is interesting because I don't know if virtual reality is really something that is widely used on a daily basis by lots of people yet.
William Curb: No, and this comes right as Meta has just announced that they're downgrading all of their virtual reality stuff, so we'll see how this ends up going because they were the biggest investor in it recently. But yeah, I was really interested in looking at what you actually would do in a VR environment to work on this.
I was like, okay, so you get things like going into this 3D environment and then having these tracking targets and stuff to help with response inhibition, and doing memory-based matching types of things. I still don't have a great picture of it, though. I probably need to find a video of this to actually get a sense of it.
Skye Waterson: Yeah. Well, they had three categories which they were kind of looking at. First, they had VR interactive game training, which involved cognitive tasks to enhance attention, executive function, and problem-solving with reward mechanisms. So you can imagine it’s kind of like a game in that way where you get a reward.
Then they had VR exergaming body motion training. That was combining physical movement and cognitive training. It was designed to target specifically motor-cognitive integration, inhibitory control, and coordination. So it's kind of a new, fun way to do the stop-go tasks that people are always doing.
And then they had the VR virtual scenario training, which I thought was particularly interesting and maybe particularly relevant for this, which was simulating real-life scenarios to improve emotional regulation and social functioning. Quite frankly, I could have used something like that as a child, because I did not know what was going on.
William Curb: Yeah. And they were also very much looking at near transfer versus far transfer of skills. A lot of times we want to see whether an intervention is just going to improve performance in the lab, or if it is going to improve things when we're out of the lab. I will say they did find great improvement in the lab, but they have not had as much good data about that far transfer yet.
Skye Waterson: Yeah. Doing a longitudinal study—a really long longitudinal study—is hard to do. So they went through the different papers. I don't remember how many papers they had in total, but they had a whole bunch of different kinds. They had 11 randomized controlled trial papers.
William Curb: My notes say they had 22 studies total.
Skye Waterson: Yes! Yes, sorry, you're right. 22 studies total, and 11 randomized controlled trial studies within that.
William Curb: Yeah, and then eight quasi-experimental and three that were more open-label kind of things.
Skye Waterson: And the studies were actually conducted across various places including South Korea, Italy, Germany, Switzerland, China, Portugal, Spain, Iran, Israel, and France. So it was quite well-distributed across cultures in terms of where these studies were coming from.
William Curb: Yeah. And two of the things I appreciate about this are that they were talking about it more in a multimodal sense, where we're not using this to replace any particular treatment. It's more like, "You're going to do this alongside medication or with some other therapy." Because while this has promising results—I shouldn't say it definitively works, I don't want to overstate it, but it has promising results—they noted that you often get better results when you combine more than one therapy.
Skye Waterson: 100%. And it's interesting, it felt like whoever wrote this paper was particularly interested in figuring out how to get it to help people with ADHD, which is not always the case. Some papers are just more observational; they're just trying to get the information. This paper was very much about using all the tools in the toolbox. Why wouldn't we? It was very refreshing.
William Curb: Yeah. And VR does have the advantage of being very novel. Especially for kids who might not want to do traditional therapies, this could be a very good intervention because it's an "Oh, I want to go and do this" activity, not an "I have to go do this" chore.
Skye Waterson: Yeah, and you could see that in the drop-off rates. The drop-off rates were pretty low, which was very helpful. One of the biggest problems we have is that the only people who benefit from interventions are the people who stay in the interventions. Often you'll see in other papers, they'll be like, "And then the ADHD group all dropped out."
William Curb: Yeah, the adherence rates were often 85% or higher, which is just unheard of for most studies.
Skye Waterson: Yeah. Sometimes, especially if it's a longer study, the adherence rate can be around 50%. Then you're sort of left wondering: did the people who stayed just have an unusual ability to manage things? Because we're looking at perseverance and the ability to focus, you're almost losing the data from the exact people who drop out to even do this particular study.
William Curb: Yeah. So having this as one part of a multimodal treatment—if that's what keeps you involved in doing your treatment in general, that's a huge boon.
Skye Waterson: Exactly, yeah. So overall, the findings were really, really positive.
William Curb: Yeah, which again was a very pleasant surprise because this was a listener-submitted study. I had not heard anything about VR in this field before, so I was really interested to see that this is happening and it's just not being talked about loudly.
Skye Waterson: They found that it was really helpful with attention and working memory. They found it was good when it was added to other treatments as well. Pretty much everything that could be positive was positive in terms of the results. There was one study—and this is just one study, so I'm not going to say this definitively proves anything—but it actually reported superior memory improvement compared to the pharmacological treatment group. Imagine if we combined both situations!
William Curb: Yeah. I do want to include some of the caveats that we should consider. Like we talked a little bit about the near and far transfer rates, we don't have any data that says this is great in the classroom versus just in the clinic. Also, a lot of the papers didn't include comorbidities. While it is nice to have a very strict "ADHD only" group for research, we all know that ADHD comes with friends, and it can be hard to apply if you don't have that full picture.
Skye Waterson: Yeah. And to our point around attrition rates, they also found that participants in the VR groups generally reported higher satisfaction. I think that's worth mentioning because adherence, compliance, and the ability to continue doing things are so important. We have a life and we want to live it, and we want it to be good. Managing your ADHD can often feel difficult, complicated, and sometimes impossible. So it was nice to hear that people enjoyed this and they enjoyed the VR.
William Curb: Yeah. Just a slightly off-topic question here: have you ever done any VR stuff yourself?
Skye Waterson: Yes! When VR first came out, we went to those VR gaming spaces and did it. Then we bought a VR headset and used it right up until our kids became toddlers. It's not the best when you've got kids running around under your feet.
William Curb: Yeah, you really lose track of your surroundings very quickly.
Skye Waterson: Yeah, nothing knocks you out of your immersion like realizing a toddler just ran past you.
William Curb: Yeah, I was going to say, I have some experience, but with anything where I moved virtually, I immediately got incredibly motion sick.
Skye Waterson: Oh no, really?
William Curb: Yeah. So I could do something like Beat Saber where I'm standing still and doing stuff; that works great. But then a game will just move you forward a little bit, and I'm like, "Oh, no."
Skye Waterson: Yeah, I mostly did the standing-still stuff. Beat Saber was my favorite as well. I know some people who watched videos of people living in VR. I do feel like—and this is a bit off-topic—at the time, it was such a big thing and everyone was talking about it. Now, AR (augmented reality) or a combination of real and virtual reality is probably going to be the next move.
That might be less helpful for ADHD, though, because it's less focused. There was something almost mindful about being completely inside VR where I couldn't see my phone.
William Curb: Yeah, well, I could see AR having potential if you have an augmented reality layer that gently prompts you when your eyes are no longer where you wanted them to be, giving a correction in the right direction. Just little things; I wouldn't want it to be a lot, but maybe a little vibration when I look away.
Skye Waterson: But not a lot. We don't want to start aggressively monitoring people or anything like that.
William Curb: Yeah, I don't need a shock bracelet going off like, "You need to pay attention."
Skye Waterson: Yeah, especially because brain breaks are important! But it was interesting. They did mention some of the side effects that you experienced. The paper framed it like, "But it's no big deal," and I was like, "Well, it is to the people who actually had it." They reported heaviness in the head because of the head-mounted device, mild dizziness, and simulator sickness. They also noted more dream activity, which is wild that they even wanted to track that.
William Curb: Well, I just want to mention one more time that this was a listener-submitted paper. If you have a paper that you think we should talk about, please send it in. We would love to do more of these.