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Methylphenidate Effect in Children With ADHD Can Be Measured by an Ecologically Valid Continuous Performance Test Embedded in Virtual Reality

  • Yehuda Pollak, Hanan Barhoum Shomaly, Patrice L. Weiss, Albert A. Rizzo and Varda Gross-Tsur...


Background: Continuous performance tasks (CPTs) embedded in a virtual reality (VR) classroom environment have been shown to be a sensitive and user-friendly assessment tool to detect cognitive deficits related to attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to compare the performance of children with ADHD on a VR-CPT while on and off treatment with methylphenidate (MPH) and to compare the VR-CPT to a cgrrently used CPT, Test of Variables of Attention (TOVA).

Methods:Twenty-seven children with ADHD underwent the VR-CPT, the same CPT without VR (no VR-CPT), and theTOVA, 1 hour after the. ingestion of either placebo or 0.3 mg/kg MPH, in a double-blind, placebo-controlled, crossover design. Immediately following CPT, subjects described their subjective experiences on the Short Feedback Questionnaire.

Results: MPH reduced omission errors to a greater extent on the VR-CPT compared to the no VR-CPT and the TOVA, and decreased other CPT measures on all types of CPT to a similar degree. Children rated the VR-CPT as more enjoyable compared to the other types of CPT.

Conclusions: It is concluded that the VR-CPT is a sensitive and user-friendly assessment tool in measuring the response to MPH in children with ADHD.


Corresponding author

Yehuda Pollak, PhD, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 91031, Israel; Tel: 972-50-4071263, Fax, 972-2-6422481; e-mail:,


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1.Biederman, J, Faraone, SV. Attention-deficit hyperactivity disorder. Lancet 2005;366:237248.
2.Riccio, CA, Waldrop, JJM, Reynolds, CR, Lowe, P. Effects of stimulants on the continuous performance test (CPT): Implications for CPT use and Interpretation. J Neuropsychiatry Clin Neurosci. 2001;13:326335.
3.Committee on Quality Improvement, Subcommittee on Attentlon-Deficit/Hyperactivity Disorder. Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficlt/hyperactlvity disorder. Pediatrics. 2000;105:11581170.
4.Brewls, A. Social and biological measures of hyperactivity and inattention: are they describing similar underlying constructs of child behavior? Soc Biol. 2002;49:99115.
5.Greenberg, LM, Waldman, I. Developmental normative data on the test of variables of attention (T.O.V.A.). J Child Psychol Psychiatry. 1993;34:10191030.
6.Pollak, Y, Weiss, PL, Rlzzo, AA, et al.The utility of a continuous performance test embedded In virtual reality in measuring ADHD-related deficits. J Dev Behav Pediatr. 2009;30:26.
7.Wann, JP, Mon-Willlams, M. What does virtual reality need? Human factors issues in the design of three dimensional computer environments. Int J Hum Comput Stud. 1996;44:829847.
8.Schultheis, MT, Hlmelsteln, J, Rizzo, AA. Virtual reality and neuropsychology: upgrading the current tools. J Head Trauma Rehabil. 2002;17:378394.
9.Rlzzo, AA, Buckwalter, JC, Van der Zaag, C. Virtual environment applications in clinical neuropsychology. In: Stanney, KM, ed. The Handbook of Virtual Environments. New York, NY: Erlbaum Publishing; 2002:10271064.
10.Mantovanl, F, Castelnuovo, G. Sense of presence in virtual training: Enhancing skills acquisition and transfer of knowledge through learning experience in virtual environments. In: Riva, G, Davide, F, Ijsselsteijn, WA, eds. Being There: Concepts, Effects and Measurement of User Presence in Synthetic Environments. Amsterdam, The Netherlands: IOS Press; 2003:168181.
11.Stanney, KM, Salvendy, G, Deislnger, J, et al.Aftereffects and sense of presence in virtual environments: Formulation of a research and development agenda. Report sponsored by the Life Sciences Division at NASA Headquarters. Int J Hum Comput Interact. 1998;10:135187.
12.Rlzzo, AA, Bowerly, T, Buckwalter, JG, et al.The virtual classroom: A virtual reality environment for the assessment of attention deficit hyperactivity disorder. The ADHD Report. 2001;9:913.
13.Rlzzo, AA, Bowerly, T, Buckwalter, JG, Klimchuk, D, Mitura, R, Parsons, TD. A virtual reality scenario for all seasons: The virtual classroom. CNS Spectr. 2006;11:3544.
14.Barkley, RA, Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York, NY: Guilford Press; 1990.
15.DuPaul, JT, Power, TJ, McGoey, KE, et al.Reliability and validity of parent and teacher ratings of attentlon-deficlt/hyperactivity disorder symptoms. J Psychoeduc Assess. 1998;16:5568.
16.Kizony, R, Katz, N, Weiss, PL. Adapting an immersive virtual reality system for rehabilitation. J Visual Comput Animat. 2003;14:261268.
17.Klorman, R, Salzman, LF, Bauer, LO, Coons, HW, Borgstedt, AD, Halpern, WI. Effects of two doses of methylphenldate on cross-situatlonal and borderline hyperactive children's evoked potentials. Electroencephalogr Clin Neurophysiol. 1983;56(2):169185.
18.Kavale, K. The efficacy of stimulant drug treatment for hyperactivity: a meta-analysis. J Learn Disabil. 1982;15:280289.
19.Losier, BJ, McGrath, PJ, Klein, RM. Error patterns of the continuous performance test in non-medicated and medicated samples of children with and without ADHD: a meta-analytic review. J Child Psychol Psychiatry. 1996;37:971987.
20.Epstein, JN, Conners, CK, Hervey, AS, et al.Assessing medication effects in the MTA study using neuropsychological outcomes. J Child Psychol Psychiatry. 2006;47:446456.
21.Klorman, R, Brumaghim JT Salzman, LF, et al.Effects of methylphenldate on attention-deficit hyperactivity disorder with and without aggressive/noncompliant features. J Abnorm Psychol. 1988;97:413422.
22.Luman, M, Oosterlaan, J, Sergeant, JA. The impact of reinforcement contingencies on AD/HD: A review and theoretical appraisal. Clin Psychol Rev. 2005;25:183213.
23.Parsons, TD, Bowerly, T, Buckwalter, JG, Rizzo, AA. A controlled clinical comparison of attention performance in children with ADHD in a virtual reality classroom compared to standard neuropsychological methods. Child Neuropsychol. 2007;13:363381.
24.Gal, E, Baumlnger, N, Goren-Bar, D, Pianesi, F, et al.Enhancing social communication of children with high functioning autism through a co-located Interface. Artif Intell Soc. 2009;24:7584.
25.Yalon-Chamovitz, S, Weiss, PL. Virtual Reality as a leisure activity for young adults with physical and Intellectual disabilities. Res Dev Disabil. 2008;29:273287.

Methylphenidate Effect in Children With ADHD Can Be Measured by an Ecologically Valid Continuous Performance Test Embedded in Virtual Reality

  • Yehuda Pollak, Hanan Barhoum Shomaly, Patrice L. Weiss, Albert A. Rizzo and Varda Gross-Tsur...


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