Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 6, 2025
Open Peer Review Period: Oct 6, 2025 - Dec 1, 2025
Date Accepted: Jan 19, 2026
(closed for review but you can still tweet)
Multimodal Virtual Reality Assessment of Medication Effects in Attention-Deficit/Hyperactivity Disorder and Its Distinction from Depression: Cross-Sectional Study
ABSTRACT
Background:
Over the past two decades, virtual reality (VR)-based neuropsychological tasks have gained traction as tools for objectively assessing symptoms of attention-deficit/hyperactivity disorder (ADHD), offering enhanced ecological validity by simulating naturalistic environments. To complement realistic settings with an ecologically valid task, we recently developed the Virtual Email Sorting Task (VEST), which immerses participants into an office environment where they sort emails while being exposed to distractors.
Objective:
The present study examined the VEST’s sensitivity to medication effects and its specificity in differentiating ADHD from other psychiatric disorders that share overlapping cognitive symptoms, such as major depressive disorder (MDD).
Methods:
23 unmedicated individuals with ADHD, 23 medicated individuals with ADHD, and 16 unmedicated individuals with MDD completed the VEST. During alternating distractor phases (DP) and non-distractor phases (NDP), we recorded the participant's task performance, head, torso, and leg actigraphy, eye movements, and brain activity using functional near-infrared spectroscopy (fNIRS), and subjective symptom ratings. Data were analyzed using mixed-design ANOVAs.
Results:
Processing time variability increased over time in participants with MDD and unmedicated ADHD, while for medicated participants with ADHD it only increased during DP. Moreover, both ADHD groups exhibited increased head movements during DP compared to NDP, an effect not observed in the MDD group. Also, higher scores in three out of four subjective ADHD symptom intensity ratings were reported in at least one of the ADHD groups compared to the MDD group. No significant group differences were found in actigraphy measures of the arm and torso, fNIRS brain activity, or eye-tracking data.
Conclusions:
Our findings highlight the potential of the VEST to differentiate between ADHD and MDD, as well as to detect medication-related effects within ADHD. The results underscore the value of multimodal and ecological assessment approaches including distractors in the evaluation of attentional and behavioral symptoms. Clinical Trial: The study was preregistered on July 20, 2023, in the German Clinical Trials Register (https://www.drks.de/, trial-ID: DRKS00031259).
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