Currently submitted to: JMIR Serious Games
Date Submitted: May 27, 2026
Open Peer Review Period: May 29, 2026 - Jul 24, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Adding VR-Based Episodic Future Thinking Training to Executive-Function Training for Children With ADHD: A Randomized Controlled Trial
ABSTRACT
Background:
Attention-deficit/hyperactivity disorder (ADHD) is associated with persistent impairments in executive functioning. Although pharmacological and behavioral interventions reduce core symptoms, complementary cognitive approaches are needed to enhance higher-order self-regulation. Episodic future thinking (EFT) is closely linked to executive control but has rarely been integrated as an additive component of executive-function (EF) training in pediatric ADHD. Virtual reality (VR) provides an ecologically valid platform for embedding EFT within immersive, consequence-based environments.
Objective:
The objective of this study was to evaluate the effectiveness of adding a virtual reality–based episodic future thinking (VR-EFT) module to conventional executive-function training for children with ADHD.
Methods:
In this randomized controlled trial, 80 children aged 5–12 years with ADHD were assigned to EF-only training (n = 40) or EF training plus a VR-based EFT module (n = 40) delivered over 2 weeks (six sessions per week). Executive functioning was assessed pre- and post-intervention using the Behavior Rating Inventory of Executive Function (BRIEF), the Executive Function Assessment Scale (EFAS), and the Childhood Executive Functioning Inventory (CHEXI).
Results:
Significant main effects of Assessment Occasion indicated overall improvement following EF training (ps < .01). Significant Assessment Occasion × Training Condition interactions were observed for the BRIEF and EFAS, reflecting greater pre-to-post improvements in the EF + VR-EFT group, particularly in higher-order executive domains. CHEXI outcomes demonstrated a more mixed pattern, with some domains showing significant interaction effects whereas others improved similarly across training conditions.
Conclusions:
Adding a VR-based episodic future thinking module to conventional EF training resulted in selective improvements in several higher-order executive processes. The findings indicate domain-specific additive effects rather than generalized executive-function enhancement. Clinical Trial: ClinicalTrials.gov NCT07591896
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