Effectiveness of virtual reality based intervention on core symptoms and cognitive functions in attention-deficit...

This systematic review and meta-analysis aimed to comprehensively evaluate the impact of virtual reality (VR)-based interventions on core symptoms and cognitive function, and to examine their effectiveness for Attention-Deficit/Hyperactivity Disorder (ADHD).

A comprehensive search was conducted across multiple databases, including Embase, Web of Science (WOS), PubMed, The Cochrane Library, ProQuest, EBSCOhost, from their inception up to May 2026. The search aimed to identify randomized controlled trials (RCTs) investigating the impact of VR on core symptoms and cognitive function in patients with ADHD. The Physiotherapy Evidence Database (PEDro) scale was employed to assess the quality of the literature, while the revised Cochrane risk-of-bias tool (ROB-2) was used to evaluate the overall risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) profiler method was utilized to further assess the quality of evidence. Meta-analysis, sensitivity analysis, and publication bias testing were performed using Review Manager 5.4.1 and Stata 18.0 software. Effect sizes were calculated using the standardized mean difference (SMD) and 95% confidence intervals (CI).

23 RCTs with 1,102 participants were included. Meta-analysis showed that VR interventions significantly reduced core ADHD symptoms [inattention: SMD = -0.80, 95% CI (-1.13, -0.48), p < 0.05, I²  = 79%; hyperactivity/impulsivity: SMD = -0.57, 95% CI (-0.87, -0.27), p < 0.05, I ² = 76%; total symptoms: SMD = -0.47, 95% CI (-0.78, -0.16), p < 0.05, I ² = 54%],and significantly improved cognitive functions [inhibition: SMD = -0.36, 95% CI (-0.56, -0.15), p < 0.05, I²  = 37%; working memory: SMD = -0.23, 95% CI (-0.40, -0.07), p < 0.05, I ² = 0%; cognitive flexibility: SMD = -0.23, 95% CI (-0.43, -0.04), p < 0.05, I²  = 0%]. Subgroup analysis revealed that for children under 12 years of age, mid-term (5-8 weeks), moderate-duration (20-30 min), high-frequency (≥3 sessions/week) interventions using mixed cognitive-physical or cognitive-based VR significantly improve core symptoms in patients with ADHD, with immersive VR producing more consistent broad symptom relief; cognitive functions require long-term (≥9 weeks) interventions with long duration (>30 min) per session. Lower frequency (1-2 sessions/week) appears more beneficial than higher frequency, and non-immersive VR may be more effective than immersive for inhibition and working memory. Cognitive improvements are most evident in children under 12 years.

VR interventions significantly reduce core ADHD symptoms and improve cognitive functions, with differential dose-response patterns. Optimal protocols differ between symptoms and cognitive outcomes. VR represents a promising complementary approach for ADHD, pending confirmation through high-quality, long-term RCTs.

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD420261340074).