# Relationships Between Parent Ratings of Attention-Deficit/Hyperactivity Disorder Behaviors and the Virtual Reality Attention Tracker in School-Aged Children: Cross-Sectional Study

## TL;DR

This study explores how a virtual reality attention test relates to parent-reported ADHD symptoms in children, suggesting VR could offer a more objective way to assess ADHD.

## Contribution

The study introduces a virtual reality attention task as a novel, ecologically valid tool for assessing ADHD symptoms in children.

## Key findings

- VRAT performance correlated with parent-reported inattention and hyperactivity symptoms (P<.001).
- VRAT showed moderate discriminatory power for ADHD symptoms (AUC 0.56–0.74).
- Gender differences were observed in both parent ratings and VRAT performance.

## Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with symptoms of inattention, hyperactivity, and impulsivity, which can significantly impact social functioning. Traditional ADHD diagnostic methods rely on subjective behavioral ratings and neuropsychological tests, but these tools may have limitations, including biases and restricted ecological validity.

This study aimed to explore the relationship between parental ratings of ADHD symptoms and performance on a Virtual Reality Attention Task (VRAT) in school-aged children. The objective was to examine whether the VRAT could provide an objective, ecologically valid measure of ADHD symptoms, and how it correlates with established ADHD rating scales, namely the Swanson Nolan and Pelham, Version IV Scale-Parent Scales (SNAP-IV) and the Chinese version of the Conners’ Parent Rating Scale–Revised (CPRS-48).

A total of 425 school-aged children (6 to 8 years old) participated in this cross-sectional study. They completed the VRAT, a continuous performance test embedded within an immersive virtual classroom, while their parents completed the SNAP-IV and CPRS-48 rating scales. Bivariate correlational analysis and receiver operating characteristic curve analysis were used to examine the relationships between the VRAT and rating scales, as well as the discriminatory capacity of the VRAT.

VRAT shows several correlations with the SNAP-IV subscales and the CPRS-48 subscales. Participants with higher SNAP-IV inattention and hyperactivity scores exhibited lower VRAT attention and motion performance index scores (all P<.001). For the CPRS-48, significant correlations were noted with conduct problems, learning problems, psychosomatic problems, impulsivity-hyperactivity, and attention index, particularly with the attention performance and motion performance indexes (all P<.05). Gender differences were significant in attention and hyperactivity measures of the SNAP-IV and CPRS-48, while only latency showed gender differences in the VRAT. In addition, the receiver operating characteristic analysis indicated that the key performance metrics of VRAT showed moderate discriminatory power, with area under the curve values varying from 0.56 to 0.74.

This study highlights the potential of virtual reality–based assessments such as the VRAT in ADHD diagnostics, providing an innovative approach to evaluating attention in a more immersive and ecologically valid setting. However, given the modest correlation with parent rating scales, it suggests that a combination of objective and subjective assessment tools would provide the most accurate and comprehensive ADHD diagnosis.