Virtual Reality in the Rehabilitation of Attention Deficit / Hyperactivity Disorder. Instrument Construction Principles

Article excerpt

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric childhood disorders. Good clinical practices are therefore needed regarding both assessment and therapy. In which assessment is concerned, valid instruments are available, one of the last developments in the field being the virtual reality guided assessment (VirtualClassroom). Regarding intervention, the multimodal, cognitive behavioral therapy (CBT) oriented approach is the most frequently employed. However, this approach has some limitations, one of them concerning ecological validity. Our VR-based intervention addresses this issue, by providing a high ecological validity therapeutic tool. We do not propose a new therapeutic paradigm. We instead move the intervention from the clinician's office into the virtual classroom, where we still use cognitive restructuring and the behavioral techniques of the classic intervention. This paper highlights the implementation of the psychotherapeutic principles of ADHD therapy in the VR environment. The different features of this instrument are designed to address specific cognitive-behavioral modifications involved in the therapeutic process.

Keywords: VR, ADHD, CBT, psychotherapy

Virtual reality (VR) is being increasingly used in a number of psychotherapy and rehabilitation contexts (Glanz, Rizzo, & Graap, 2003). An important feature of VR is its capacity to deliver environments that allow precise control of complex, immersive, and dynamic three-dimensional stimulus presentations, where sophisticated interaction, behavioral tracking and performance recording is possible (Rizzo, 2006). These environments can be used for assessment, training or treatment purposes, and can address situations that are not easily deliverable or controllable in the "real-world", leading to enhanced ecological validity.

Treatment in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is among the most prevalent psychiatric childhood disorders, affecting 8% to 10% of children (Baren, 2002) and persisting into adolescence in approximately 80% of cases (Baren, 1998; Schubiner, Robin, & Neustern, 1996). However, ADHD is largely considered a childhood disorder, so most patients are diagnosed during childhood. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) definition of ADHD requires symptoms to be present before the age of 7 years (DSM-IV-TR, 2000). Accurate ADHD diagnosis in this age group is particularly important because of the impact of untreated ADHD on adolescents, their immediate family, and society as a whole. If the condition remains untreated, the adolescent is likely to underachieve in school, leading to poor employment prospects (Baren, 2002). Relationships with family, peers, teachers, and employers are likely to be fraught with difficulties, further impacting on educational and employment prospects and leading to poor social relationships (Baren, 2002). Adolescents with ADHD are more likely to become involved in risk-taking behaviors such as reckless driving, risky sexual activities, substance abuse, and criminality (Barkley, Fischer, Edelbrock, & Smallish, 1990) which may negatively affect their life into adulthood.

Clinical research and consensus guidelines on the treatment of ADHD over the past few years have increasingly clarified the most effective treatment approaches. A recent review of evidence based psychosocial treatments for children and adolescents with ADHD indicates that there is adequate evidence for behavioral parent training and behavioral school interventions that has resulted in such treatments being classified as empirically validated interventions (Chronis, Jones, & Raggi, 2006). Both behavioral parent training and classroom behavior management involve teaching parents and teachers to use behavior modification strategies based on social learning principles, such as praise, positive attention and rewards to increase positive behavior, and ignoring, timeout and non - physical disciplining strategies to decrease unwanted behavior. …