Virtual reality assessment of cognitive performance in adults with ADHD and problematic internet use: a pilot study

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is associated with variability in attentional and executive functioning, and individuals with ADHD frequently present problematic patterns of internet use. Virtual-reality (VR)–based assessments have been proposed to improve ecological evaluation of cognitive performance. This pilot study explored cognitive performance variations in adults with ADHD, examining associations with problematic internet-use during routine clinical treatment.Methods: A pilot study was conducted in 17 adults with ADHD and clinically relevant problematic internet use. Participants were evaluated at baseline (T0) and after 4 weeks (T1) using the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Internet Addiction Test (IAT), and an immersive VR continuous performance test (Nesplora Aquarium) assessing attentional and executive-function indices.Results: Comparison between T0 and T1 revealed a significant improvement in working memory (Z = −2.638, p = 0.008) and a reduction in IAT scores (Z = −2.392, p = 0.017). Conversely, attention scores showed a decline (Z = −2.899, p = 0.004). At baseline, a positive correlation was found between IAT scores and working memory, which disappeared after treatment.Discussion: These results provide preliminary evidence supporting the feasibility of VR-based cognitive monitoring in adults with ADHD and require confirmation in larger controlled studies.