Research Recap with Skye: Virtual Reality and ADHD

0:04Welcome 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 Sky 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 and 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.

0:34And this paper is actually a, it's 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 'cause I had no idea that this was something people were doing. Yeah.

0:58Very, very cool. let's get into it 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've gotten It's not connected to a particular journal that I can see Yeah, I think it was pre, but it's, was, they did do a lot of the things they did, like a Prisma, and Yeah yeah, and they connected to all, like, the major databases and stuff.

1:35So I don't know if it was connected to anything. So yeah, probably prepress But it is a very interesting idea because I did not realize that there were papers discussing this already because 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, to lose attention at that point.

2:07so it makes sense, but it is interesting because I don't know if virtual reality is really, I guess, something that is widely used on a daily basis by lots of people yet No. and, this does come, we… Meta has just, like, announced that they're, like, downgrading all of their virtual reality stuff, so we'll see how this ends up going 'cause they were, the biggest investor in it recently. But yeah, I was really interested too also looking at, like, what you actually would do in a VR thing to work on this.

2:41And so I was like, okay, so you get things like, going into this 3D environment and then having these, like, tracking targets and, stuff to, like, help with response inhibition and doing, like, memory-based matching type of things. And it's like, I mean, I still don't have a good… I mean, I probably need to find, like, a video of this to, like, actually get a sense of it Yeah. Well, they had three, three categories which they were kind of looking at.

3:05So they had VR interactive game training, so that was the cognitive task to enhance attention, executive function, and problem-solving with reward mechanisms. So you can imagine, you know, you get a reward. It's like, kind of like a game in that way. then they had the EverGaming, or sorry, VR exergaming body motion training. So that was combining physical movement and cognitive training. It was to target specifically motor cognitive integra- integration, inhibitory control, and coordination.

3:37So it's kind of a, 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. And quite frankly, I could have used something like that as a child, 'cause I did not know. Did not know what was going on Yeah.

4:05And it was, they were also, like, very much looking at this, like, near transfer versus far transfer of skills, where, a lot of times we wanna look as, like, okay, is this just going to be improving in the lab versus is this going to be improving when we're not in the lab? And I will say they did find in the lab we have great improvement. They have not had as much good data about that far transfer, yet Yeah. Doing a longitudinal study, a really long, long longitudinal study is hard to do.

4:36which, yeah. So they looked, they went through the different papers, I don't remember how many papers they had in total. They had a whole bunch of different kinds. So they had, 11 randomized control trial papers. They had, MC my thing says, they had 22 studies total, Yes. Sorry, yeah, you're right. 22 studies and 11 randomized control trial studies within that Yeah. Yeah, so then eight quasi experimental and three that were like kind of more Yeah.

5:10And the label kind of things and the studies were actually, some of them were conducted in South Korea, Italy, Germany, Switzerland, and China, as well as Portugal, Spain, Iran, Israel, and France. So it was quite well-distributed in terms of cultures, where these studies were coming from Yeah. And, two of the things I appreciate too about this, they were talking about this more as a, in the, multimodal sense where we're not using this to replace any particular treatment.

5:39It's being like, "This is going to… You're gonna do this with medication or with some other therapy or something." Because while this works, or this is, has promising results, I should say, doesn't work, is that I don't wanna, overstate, but it has promising results. They're like, "Yeah, you often get better results when you combine this things with two, more than one, therapy." 100%. And it's, it's interesting, it felt like they, whoever's writing this paper, were particularly interested in figuring out how to get it to help people with ADHD, which is not always the case.

6:14Some papers are more just observational, they're just trying to get the information. This paper was, like, very much about, yeah, they're like, "Oh, we'll use all the tools in the toolbox. Why wouldn't we?" And it was very refreshing Yeah. And, uh, VR does have this, like, advantage of it's very novel, so it does have this… It's especially for, like, kids that might not wanna be doing traditional therapies, this could be a very good intervention to be, "Oh, I want to go and do this," not a, "I have to go Yeah.

6:47And you could see that in the drop-off rates. Like, the drop-off rates were pretty low, um, which was very helpful because one of the biggest problems we have is that the only people who benefit from the interventions are the people who stay in the interventions. And often you'll see in other papers, they'll be like, "And then the ADHD group all dropped out." Yeah. Yeah, and so I think, uh, yeah, 'cause we had what? A… Yeah, the adherence rates were, like, often, like, 85% or higher, which is just, like, unheard of for most studies.

7:21Yeah. Like sometimes if, especially if it's a longer study, the adherence rate can be like 50%. And then you're sort of left wondering, well, did the people who stay just have an unusual ability to m- manage their, you know, 'cause we're looking at perseverance and ability to focus and all of the things, and you're almost like losing the people who drop out to be able to even do this particular study Yeah. So yeah, having this as a, especially in a, the idea of like, we're gonna do this as a multimodal, so this is just one part of your treatment, if that's keeping you involved in doing your treatment in general, that's a huge boon exactly.

8:04Yeah. So overall, the findings were really, really positive Yeah. which again was a, a very surprised why, 'cause again, this was a, listener submitted study. I had not heard anything about VR in this field before, so I was really interested in that, oh, this is happening and it's just not loud they found that it was really helpful with attention. it was working memory. They, they found it was good when it was added to things as well. There was lots of… I think pretty much everything that could be positive was positive in terms of the results, you know?

8:41It was, it was, it was one study, and this is at, not at all, I'm not gonna say this means anything, but one study also, reported superior memory improvement compared to the pharmacological treatment group, which for them was just a, like, a now imagine if we did both situation Yeah. So, do want to include some of the caveats that we should, like we did talk a little bit about the near and far, transfer rates and that, yeah, we don't, we don't know s- have any data that says that this is great for in the classroom versus it just in the clinic . Um, and that, a lot of the papers, didn't include comorbidities or anything.

9:23So it, while it is nice to have a very strict like, "Hey, this is ADHD only," we all know that ADHD comes with friends, and so it's Cloud can be hard if you, don't have that, full experience there yeah. And kind of to our point around, attrition rates, they also found that participants in the VR groups generally reported higher satisfaction. and I think that's worth mentioning because I feel like a lot of times adherence and compliance and ability to continue to do things is important.

9:59And also, we have a life and we wanna live it, and we want it to be good, and managing your ADHD can often feel difficult and complicated and sometimes impossible. And so it was nice to hear that people enjoyed this one. They enjoyed the VR Yeah. and just slightly off-topic question here, have you ever done any VR stuff in Yes. So I, one of the things, so when VR first came out, we went to those VR like gaming spaces and did it, and then, we bought a VR and we used it up until our kids became toddlers because, it's not the best when you've got kids running around under your feet.

10:40Yeah, they, you, really, it's, you don't know your surroundings very quickly Yeah, It's very… Nothing knocks you out of your, thing like being like, "Oh, a toddler just ran past me." yeah, I was gonna say 'cause yeah, I have some experience, but anything where I moved, I immediately got incredibly motion Oh no, really? yeah. So I could do like Beat Saber or something and be like, "Okay, I'm standing still and doing stuff. This works great." And then be like, "Okay, this game you- it's gonna just move you forward a little bit."

11:11I'm like, "Oh, no." Yeah. I, I mostly did the standing still stuff. I, Beat Saber was my favorite as well. I know some people who like r- like tried, saw videos of people living in VR. I do feel like, and this is a bit off topic, but, you know, at the time it was such a big thing, everyone was talking about it. I think now AR, like, like combined real and virtual reality are probably gonna be the next, like the, the move. which is maybe less helpful for ADHD because it's less focused.

11:43There was something almost mindful about being in… I couldn't see my phone. Yeah, well, I, I could see with, AR having that, the augmented reality where you have, like, the layer over being, like, something to, like, kind of be like, "Hey, your eyes are no longer where you wanted That is true and, like, giving, like, a correction into the right direction. Like, you, having just, like, little… I wouldn't want it to be a lot, but it'd be like, oh, like, a little vibration when I'm like, "Oh, I looked over there and But not a lot.

12:14Like, we don't wanna start, you know, monitoring people or anything like that. Yeah, I don't need like a shock bracelet going off like, "You need to pay attention." Yeah, especially 'cause brain breaks, brain breaks are important. But it was interesting. I mean, they did mention some of the side effects that you mentioned, so a few… They were very like, "But it's no big deal," and I was like, "But it is to the people who had it." they had heaviness in the head 'cause of the head-mounted device, mild dizziness.

12:40They said more dream activity, which wild that they wanted to know about that. and then simulator sickness as well, so a couple of people Well, I just wanna mention one more time that this was a listener-submitted paper, and if you have a paper that you think we should talk about, please send it in. We would love to do more of these Hello everyone. If you have enjoyed listening to this episode, then you might like to listen to my podcast, The ADHD Skills Lab, where we go and deep dive into more of the research, and also we focus on ADHD support for business owners, whether you're aspiring or you have your own company.

13:18Um, and if you have your own company and you wish that you had somebody who would just build these systems for you so you could stop figuring out what to do all the time, well, that's what we do. We are mentor and operator together. So if you wanna learn a little bit more about that, you can find me at Unconventional Organization. Thanks for listening.