How can we improve the assessment of ADHD beyond traditional behavior-based tools? What role can immersive technologies play in providing a more objective, accurate, and ecologically valid evaluation? And how can we detect real attention problems—rather than environmental or emotional distractions—more precisely?
In the webinar “Neurodevelopmental disorders and Modern Assessment Paradigms” clinical psychologist Dr. Christopher Nicholls addresses the current limitations in neuropsychological diagnostics and proposes a future-oriented approach: combining advanced neurotechnologies like virtual reality (VR) with robust theoretical frameworks such as the RDoC model and CHC theory.
Moving beyond rating scales: the need for objective assessment
Dr. Nicholls begins by critically examining the historical reliance on behavioral observation and rating scales for diagnosing conditions like ADHD. While these tools are still widely used, he emphasizes their low correlation with actual performance-based cognitive measures, highlighting a key challenge in clinical practice: what we see or are told about a patient does not always match how their brain actually functions.
Drawing on decades of clinical experience, Dr. Nicholls argues for a shift toward data-driven, ecologically valid methods. He advocates for tools that don’t just tell us how someone appears to function, but that measure how their cognitive systems operate in action.
Dimensional models and lifespan variability
A major theme in the webinar is the growing interest in dimensional models of neurodevelopmental disorders, which challenge the categorical logic of the DSM. Dr. Nicholls refers to frameworks like the NIH’s Research Domain Criteria (RDoC), which offer a more nuanced understanding of cognition, emotion, and behavior across development.
He also highlights findings from neuroimaging and NIH Toolbox research showing that cognitive functions evolve differently across individuals, making rigid age-stage models insufficient. This reinforces the need for adaptable assessment tools that account for individual variability throughout the lifespan.
Virtual reality: enhancing ecological validity and engagement
In this context, Dr. Nicholls introduces VR-based cognitive assessment tools, specifically those developed by Nesplora, as part of the solution. These tools simulate realistic environments—such as classrooms or everyday settings—while collecting detailed performance data on attention, working memory, inhibition, and executive function.
Some of the tests presented include:
- Nesplora Aula: A VR-based continuous performance task for children that simulates a real classroom with visual and auditory distractors.
- Nesplora Aquarium: Designed for adults, evaluating attentional performance in an immersive underwater setting.
- Nesplora Ice Cream: A complex executive function test involving decision-making, planning, and flexibility.
- Nesplora Memory Suite: Measures working memory in naturalistic contexts.
A case for integrated assessment: technology and clinical insight
Rather than replacing traditional assessments, Dr. Nicholls argues for an integrated model that combines clinical expertise with technological tools. A compelling case example illustrates this point: a young girl had been diagnosed with ADHD based on behavior, but VR testing (Aula) and qEEG data revealed normal attention and an auditory processing issue. The actual diagnosis? A severe hearing impairment—not ADHD.
This kind of integrated evaluation avoids misdiagnosis, prevents inappropriate treatment, and fosters better psychoeducation with families. Moreover, Nesplora tools include internal validity indicators to ensure participants are engaged and responding accurately—something many traditional tests lack.
Toward a new standard in clinical neuropsychology
Dr. Nicholls concludes the session by calling for a paradigm shift in neuropsychological evaluation: one that prioritizes ecological validity, performance accuracy, and technological integration—without losing clinical depth.
Dr. Nicholls discusses recent findings shared at the INS 2023 conference, where researchers used VR tools to identify cognitive profiles that transcend traditional DSM diagnostic categories. This positions virtual reality not only as a tool for better assessment but also as a bridge toward more personalized intervention planning.
About the speakers
Christopher J. Nicholls, Ph.D. Clinical Psychologist | Neuropsychologist.
Christopher Nicholls is a clinical neuropsychologist located in Scottsdale, Arizona, who has several decades of experience in working with neurodevelopmental disorders. Dr. Nicholls is board certified by the American Board of Professional Psychology and the American Board of Pediatric Neuropsychology. He is a Fellow of the American Psychological Association and the National Academy of Neuropsychology, and has held adjunct faculty appointments in psychology and pediatrics at several major universities.
Kylie Isaacs. Psychologist | Psychometrists
Kylie is an alumna of Arizona State University, where she earned dual Bachelor of Science degrees in Psychology and Anthropology. She is currently pursuing her Master of Business Administration degree from Southern New Hampshire University. Kylie Isaacs also collaborates with Nesplora, which goal is to increase awareness of its assessment tests within the United States, and to coordinate normative data gathering, research and the use of VR tests within healthcare, education and service industries in America.
Neurodevelopmental disorders and Modern Assessment Paradigms with Dr. Nicholls and Kylie Isaacs
Table of contents
- 0:00 – Welcome and Introduction
- 2:17 – What are neurodevelopmental disorders?
- 3:02 – Historical evolution of diagnostic criteria (DSM, case-based to rule-based)
- 6:08 – The limits of behavior-based diagnosis and Barkley’s position
- 9:20 – Validity concerns and challenges with traditional tests
- 12:50 – Emerging dimensional models of ADHD
- 15:10 – NIH’s RDoC framework and lifespan variability
- 17:09 – NIH Toolbox and the need for comprehensive tools
- 20:40 – Real-world challenges and the role of engaging assessments
- 22:56 – Introduction to Nesplora’s virtual reality tests
- 26:22 – Breakdown of each Nesplora test (Aula, Aquarium, Ice Cream, Suite)
- 33:19 – Nesplora validity measures
- 35:18 – Clinical case example
- 36:43 – Cross-diagnostic utility and INS study findings
- 38:48 – Key takeaways on modern neuropsychological assessment
- 39:23 – Q&A session: sensitivity, side effects, engagement, future outlook
Want to learn more?
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?If you’re curious about how new tools are reshaping neuropsychology, we’ve put together a free resource that dives deeper into the science and practice behind these assessments. Explore how VR can transform the way we understand attention, executive functions, and cognitive performance.
📘 FREE EBOOK: ADHD assessment in children and adults: symptomatology and evaluation with VR
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