Assessment of executive function in adolescence: a comparison of traditional and virtual reality tools

Paper-pencil type tests are traditionally used in the assessment of executive functions (EF); however, concerns have been raised as to whether these represent actual functioning in everyday life. Virtual reality (VR) environments offer a novel alternative for the assessment of cognitive function and therefore have the potential to enhance the evaluation of EF by presenting individuals with stimuli that come closer to reproducing everyday situations. The aims of this study were to (1) establish which traditional paper-pencil EF tests from the Delis-Kaplan Executive Function System (D-KEFS) are associated with performance on a VR-Stroop task and (2) compare D-KEFS tests and the VR-Stroop task in their ability to predict everyday EF and behavior, as measured by the Behavioral Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). Thirty-eight typically developing adolescents aged between 13 and 17 years completed the ClinicaVR: Classroom-Stroop, and five D-KEFS subtests (Trail Making, Tower, Twenty Questions, Verbal Fluency and Color-Word Interference). Their parents completed the BRIEF and CBCL questionnaires. The results indicate that performance on the VR-Stroop task correlates with both traditional forms of EF assessment (D-KEFS, BRIEF). In particular, performance on the VR-Stroop task was closely associated with performance on a paper-pencil inhibition task. Furthermore, VR-Stroop performance more accurately reflected everyday behavioral EF than paper-pencil tasks. VR appears to offer an ecological perspective on everyday functioning and could be seen as complementary to traditional tests in the assessment of complex cognitive abilities.