Mechanisms of VR-enhanced fNIRS neurofeedback training in ADHD: A pilot randomized controlled trial

Abstract

<p>This pilot RCT investigates the distinct contributions of virtual reality (VR) and fNIRS-based neurofeedback training (NFT) to ADHD symptom reduction and cognitive improvement in children. Building on our team’s prior RCT, this study isolates the effects of VR versus neurofeedback mechanisms.</p><p>Twelve children with ADHD (ages 6–12) were randomized to three groups: NFT-3D (fNIRS-NFT in VR; <em>n</em> = 3); NFT-2D (fNIRS-NFT without VR; <em>n</em> = 6); and 3D-only (VR without NFT; <em>n</em> = 3). All groups completed 16 training sessions over 8 weeks.</p><p>Preliminary ANCOVA results (covarying baseline scores) revealed that the NFT-3D group showed significantly greater reductions in parent-reported behavioral (<em>F</em> = 10.73, <em>p</em> =.047, <em>η_p²</em> = .79) and cognitive dysregulation (<em>F</em> = 164.97, <em>p</em> = .001, <em>η_p²</em> = .98) compared to the 3D-only group. No significant differences were observed between NFT-3D and NFT-2D (<em>ps</em> > .05). Within-group analyses demonstrated improvements in ADHD symptoms and cognitive performance in both neurofeedback groups, with NFT-3D showing larger cognitive gains. The 3D-only group improved in parent-reported behavior but not in objective cognitive measures.</p><p>These findings suggest that neurofeedback drives core therapeutic effects, while VR enhances ecological validity and engagement, highlighting the potential of integrating neurofeedback with VR for ADHD treatment.</p>