JMIR Publications

ABSTRACT

Background:

Virtual reality serious games, due to their high level of freedom and realism, influence the rehabilitation training of inhibitory control abilities in children with ADHD. Although reward feedback has a motivating effect on improving inhibitory control, the effectiveness and differences between various forms of rewards lack empirical research.

Objective:

To investigate the effectiveness of different forms of reward feedback on the inhibitory control abilities of children with attention deficits in a virtual reality serious game environment.

Methods:

This study focuses on children who meet the diagnostic criteria for ADHD tendencies, employing a 2 (material rewards: coin reward, token reward) × 2 (psychological rewards: verbal encouragement, badge reward) factorial between-subject design (N=84), with a control group (N=15) for pre- and post-test experiments. The experimental group received virtual reality feedback reinforcement training, while the control group underwent conventional virtual reality training without feedback. The training period lasted 0.5 months, with each intervention session lasting 25 minutes, occurring twice daily with an interval of at least 5 hours for 28 sessions. Before and after training, the SNAP-IV scale, stop signal task, inhibition conflict task, and Simon task were administered to assess the hyperactivity index and the three components of inhibitory control ability. The pre-test included the SNAP-IV scale and three task tests to obtain baseline data; the post-test involved repeating the above tests after completing all training. Data were entered and analyzed using SPSS software. Independent sample t-tests were performed on the experimental and control groups' pre- and post-test task results to determine whether significant differences existed between group means. Paired sample t-tests were also conducted on the SNAP-IV scale's pre-and post-test results to assess the intervention effect's significance.

Results:

Reward feedback was more effective than no reward feedback in improving behaviors related to attention deficits in children. Material rewards showed significant effects in the Stop-Signal Task (F=13.043, p=.001), Inhibition Conflict Task (F=7.34, p=.008), and SNAP-IV test (F=69.232, p<.001); mental rewards showed significant effects in the Stop-Signal Task (F=38.537, p<.001) and SNAP-IV test (F=70.775, p<.001); the interaction between the two showed significant effects in the Stop-Signal Task (F=4.468, p=.04) and SNAP-IV test (F=23.847, p<.001).

Conclusions:

Combining of material and psychological rewards within a virtual reality platform can effectively improve attention deficit behaviors in children with ADHD, enhancing their inhibitory control abilities. Among these, coin rewards are more effective than token rewards, and verbal encouragement outperforms badge rewards. The combined feedback of coin rewards and verbal encouragement yields the most significant improvement in inhibitory control abilities.