Brain Dive: Virtual Reality Exposes Unprecedented Patterns in ADHD

Researchers used virtual reality (VR) and functional magnetic resonance imaging (fMRI) technology to study how the brains of children with ADHD function in different situations. They compared three scenarios: an interactive task in a virtual environment, watching a video, and resting. The results showed that children with ADHD had greater brain connectivity in several areas, especially in subcortical regions, when they were performing interactive activities.

Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders, affecting between 3% and 7% of children. This disorder manifests itself through three main types of symptoms: inattention, hyperactivity, and impulsivity.

Children with inattention have difficulty organizing activities, following instructions, and remembering daily commitments. Hyperactivity is characterized by excessive movement and uncontrolled energy, while impulsivity translates into rash actions without considering the consequences.

These symptoms can vary in intensity and combination, leading to the classification of ADHD into three types: predominantly inattentive, predominantly hyperactive/impulsive, and the combined subtype, which includes aspects of the first two.

Regardless of the type, ADHD can impair school performance, affect social relationships, and make it difficult to complete daily tasks. Research indicates that ADHD has a complex origin, involving genetic factors and changes in the structure and functioning of the brain.

Neuroimaging studies show that children with ADHD present changes in the functional connectivity of the brain, that is, in the way different brain regions communicate.

These changes mainly affect areas responsible for controlling attention, regulating emotions, and planning actions. Structural changes are also observed in regions such as the cingulate cortex, amygdala, thalamus, and brain stem, among others.

Initially, ADHD was thought to be linked to problems in a single brain system, but more recent studies show that it affects several brain networks at the same time.

Studies on ADHD use different approaches to analyze brain activity. One of the most common methods is functional magnetic resonance imaging (fMRI), which allows measuring brain activity while the child is at rest or performing a specific task.

This technique helps identify differences in functional connectivity between children with ADHD and those without the disorder. In a resting state, for example, brain activity reflects basic brain function, while during task execution, it is possible to observe how different brain regions work together in real time.

Studies show that children with ADHD have different brain connectivity patterns depending on their age and predominant symptoms, which may explain the diversity of the disease profiles. In recent years, a new approach called naturalistic neuroscience has been used to study ADHD.

Unlike traditional methods, this approach analyzes brain activity under more realistic conditions, simulating everyday situations. This can be done, for example, by showing engaging videos or using virtual reality environments.

These techniques help to understand how the brain reacts in scenarios that are closer to real life, increasing the accuracy of diagnoses and improving understanding of symptoms.

One of the most innovative experiments in this area is the Executive Performance in Everyday Living (EPELI) game, a virtual environment where children perform everyday tasks inside a virtual apartment.

Example of the Executive Performance in Everyday Living (EPELI) game

This game allows you to observe in detail how ADHD symptoms manifest themselves in the execution of common tasks, such as forgetting instructions, acting impulsively or having difficulties with organization.

The results showed that the accuracy of the game in identifying children with ADHD is very high, making it a promising tool for assessment and possible interventions.

By comparing three different experimental conditions, an interactive task in virtual reality, passive video viewing and a resting state, the researchers observed significant differences in the brain activity of children with ADHD.

This figure shows the brain network identified through NBS (Network-Based Statistics) analysis that is positively associated with task effectiveness in the EPELI game in the group of typically developing (TD) children. The figure presents connections between different brain regions that play an important role in children's performance in the EPELI game. (A) Anatomical Representation: Shows different views of the brain (left, right, front, back, top, and bottom), with red dots representing brain areas and lines indicating significant connections between them. (B) Alluvial Diagram: A graph that visually organizes the connections between different brain regions, making it easier to identify which areas are most interconnected. Each brain region is identified by name and laterality (left "L" or right "R"), while numbers indicate how many significant connections that area has.

During the virtual reality task, children with ADHD showed stronger functional connectivity than children without the disorder, especially in subcortical areas of the brain.

During video viewing, the differences were smaller, and in the resting state, no significant differences were observed. This suggests that ADHD symptoms are more related to brain activity during interactive and dynamic situations than during rest.

The figure shows differences in functional connectivity (FC) between children with ADHD (Attention Deficit Hyperactivity Disorder) and typically developing (TD) children during a video viewing task. ADHD > TD → “ADHD greater than Typical Development” (indicating greater functional connectivity in the ADHD group compared to the TD group). The image shows different views of the brain (left, right, top, front, bottom, and back), highlighting in red the areas with greater functional connectivity in the ADHD group. The black lines indicate connections between these regions.

These findings are important because they reinforce the idea that ADHD is a disorder that manifests itself differently depending on the context. Studies that use naturalistic approaches, such as virtual reality, provide a more accurate portrayal of how symptoms affect children’s daily functioning.

In addition, these techniques can help develop new forms of treatment and intervention, tailored to the individual needs of each child. Naturalistic neuroscience is revolutionizing the way we understand ADHD and may pave the way for more accurate diagnoses and more effective treatments in the future.

READ MORE:

Real-world goal-directed behavior reveals aberrant functional brain connectivity in children with ADHD

Liya Merzon, Sofia Tauriainen, Ana Triana, Tarmo Nurmi, Hanna Huhdanpää,

Minna Mannerkoski, Eeva T. Aronen, Mikhail Kantonistov, Linda Henriksson,

Emiliano Macaluso, and Juha Salmi

PLoS ONE 20 (3): e0319746. 

https://doi.org/10.1371/journal.pone.0319746

Abstract: 

Functional connectomics is a popular approach to investigate the neural underpinnings of developmental disorders of which attention deficit hyperactivity disorder (ADHD) is one of the most prevalent. Nonetheless, neuronal mechanisms driving the aberrant functional connectivity resulting in ADHD symptoms remain largely unclear. Whereas resting state activity reflecting intrinsic tonic background activity is only vaguely connected to behavioral effects, naturalistic neuroscience has provided means to measure phasic brain dynamics associated with overt manifestation of the symptoms. Here we collected functional magnetic resonance imaging (fMRI) data in three experimental conditions, an active virtual reality (VR) task where the participants execute goal-directed behaviors, a passive naturalistic Video Viewing task, and a standard Resting State condition. Thirty-nine children with ADHD and thirty-seven typically developing (TD) children participated in this preregistered study. Functional connectivity was examined with network-based statistics (NBS) and graph theoretical metrics. During the naturalistic VR task, the ADHD group showed weaker task performance and stronger functional connectivity than the TD group. Group differences in functional connectivity were observed in widespread brain networks: particularly subcortical areas showed hyperconnectivity in ADHD. More restricted group differences in functional connectivity were observed during the Video Viewing, and there were no group differences in functional connectivity in the Resting State condition. These observations were consistent across NBS and graph theoretical analyses, although NBS revealed more pronounced group differences. Furthermore, during the VR task and Video Viewing, functional connectivity in TD controls was associated with task performance during the measurement, while Resting State activity in TD controls was correlated with ADHD symptoms rated over six months. We conclude that overt expression of the symptoms is correlated with aberrant brain connectivity in ADHD. Furthermore, naturalistic paradigms where clinical markers can be coupled with simultaneously occurring brain activity may further increase the interpretability of psychiatric neuroimaging findings.