Virtual Reality in Neuropsychological Assessment: A Conversation with Dr. Nicholls

How can virtual reality transform the way we diagnose ADHD and other neurodevelopmental conditions? What are the ethical challenges and opportunities that new technologies like VR and AI bring into the clinical practice of neuropsychology? Dr. Nichols, a seasoned clinical neuropsychologist, has spent decades witnessing the evolution of assessment methods—from long and rigid batteries of paper-and-pencil tests to highly engaging, ecologically valid VR-based evaluations. In a recent interview with Phil Sarpong, he shared his reflections on the past, present, and future of neuropsychological assessment.

From CPTs to Virtual Reality

Traditional continuous performance tests (CPTs) for ADHD are often tedious and disconnected from real life. As Dr. Nichols puts it, “These are just shoot me boring horrible tests that people want to throw at you after a few minutes.” Virtual reality tools such as Nesplora Aula, by contrast, place children in a simulated classroom full of distractions—whispering classmates, paper airplanes, a teacher at the blackboard, even a firetruck passing by outside. This immersive context keeps children engaged and provides richer, more ecologically valid data.

From ADHD Subtypes to Brain Systems

Assessment today goes beyond identifying a single diagnosis. Nichols highlights that ADHD is not limited to two subtypes, but at least four, including inattentive, hyperactive-impulsive, concentration deficit disorder, and emotional regulation disorder. At the same time, neuropsychology has shifted from focusing on isolated brain areas to understanding broader neural networks. The goal is no longer to test functions in isolation, but to evaluate how systems work together in real contexts—something VR helps make possible.

Validity and Ethics in the Age of AI

One major advantage of VR-based assessments is the inclusion of validity indicators that detect lack of effort or simulation. Nichols notes that this addresses a common problem in clinical and forensic contexts, where self-reports are not always reliable. On artificial intelligence, he is optimistic but cautious: “I like AI. I think it’s very helpful, but I think there needs to be a very huge red light that says be careful. Stop and think, check your work, talk with other people, go to conferences, read the literature.” For him, VR should become part of the standard toolkit in clinical training, helping the field move away from outdated practices and embrace technologies that reflect today’s realities.

Beyond ADHD: New Applications

The potential of VR extends well beyond ADHD. Nichols envisions its use in health psychology, forensic evaluation, and education. In court, for example, VR can provide objective evidence of processing speed or working memory deficits—far more persuasive than subjective complaints. In academic settings, VR can also help students understand their learning strengths and challenges. As Nichols explains, early collaborations with colleges aim to integrate VR assessments into wellness programs, supporting students’ academic success.

Dr. Nichols – Clinical Neuropsychologist

Dr. Nichols is a clinical neuropsychologist with extensive experience across medical centers, teaching hospitals, and private practice. Over the years, he has been an advocate for moving neuropsychology beyond traditional methods, embracing ecological validity and technological innovation. He has contributed to the integration of VR-based platforms such as Nesplora into clinical assessment, advancing research on ADHD subtypes, executive functions, and culturally sensitive testing. Beyond clinical work, he mentors graduate students, lectures at national and international conferences, and promotes ethical reflection on the use of artificial intelligence in healthcare.

Can VR Diagnose ADHD? The Next Generation of Neuropsychology Testing with Dr. Nicholls, PhD

 

Table of contents

0:00 Intro 2:25 Walk us through your journey to becoming a neurospychologist 3:30 How has neuropsychology shifted over the years? 5:45 What are you excited about regarding VR testing? 8:20 What is a typical battery for ADHD? 10:30 How important are measures from family/friends in diagnosing? 12:07 How has your conceptualization changed regarding diagnosing ADHD? 15:00 What about AI? 19:25 Will VR replace traditional forms of assessment? 22:00 Does VR testing add or take away from neuropsychology assessment? 26:00 What is the learning curve to learn VR testing for clinicians? 35:00 How would you implement neuropsych training in graduate school? 37:00 How could VR embed into health, forensic, or other specialities of psychology? 42:00 What advice would you give to aspiring neuropsychologists? 45:00 What still excites you about the field? 47:00 What is your favorite neuropsychology test? 49:00 What do you for your self, body, mind, or spirit?

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How can we truly differentiate ADHD symptoms from other conditions? And how can virtual reality help us make evaluations more accurate and engaging, both for children and adults?

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📘 FREE EBOOK: ADHD assessment in children and adults: symptomatology and evaluation with VR

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