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, Dr. Nichols explains, are often tedious and disconnected from real-life situations:“These are just shoot me boring horrible tests that people want to throw at you after a few minutes.”By contrast, virtual reality tools such as Nesplora Aula place the child in a simulated classroom full of distractions—whispering classmates, paper airplanes, a teacher at the blackboard, even a firetruck passing by outside.
“Throughout all this, you have to ignore the distractions, stay focused, and we measure all these variables. I’ve never had somebody want to quit in the middle. They want to keep going. When I said, ‘Okay, time’s up,’ they said, ‘No, let’s do more.’”
From ADHD subtypes to brain systems: the role of Virtual Reality
Assessment today goes beyond identifying a diagnosis. Nichols stresses the importance of recognizing the variety of ADHD profiles:“They’re not two subtypes, there are at least four. So we have inattentive, we have hyperactive impulsive, but we also have sluggish cognitive temporal—what they now call a concentration deficit disorder. And then there’s another subtype called the emotionally reactive disorder.”At the same time, neuropsychology has moved away from focusing on isolated brain areas.
“The brain is really made up of neural circuitries and networks. The old localization concepts really don’t hold. What we need to be doing is measuring systems within the brain.”
Validity and Ethics in the age of AI
One of the strongest advantages of VR tools like the Nesplora tests is the inclusion of embedded validity indicators:“Kids lie. Parents don’t try. And if in fact they score poorly on those embedded validity indices, the results don’t really make sense and they’re not realistic.”At the same time, Nichols warns against over-reliance on AI:
“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 Dr. Nichols, VR should become part of the standard toolkit for clinicians in training:
“My hope is that this is going to become the new normal and there’s going to be an expectation that neuropsychologists move away from the tests that their supervisor taught them by candle light 100 years ago. Let’s move into the current world and use the technologies that are available to us.”
Applications of Virtual Reality beyond ADHD
The potential of VR is not limited to developmental disorders. Nichols envisions applications in health psychology, forensic psychology, and education. For example, in forensic contexts:“It’s one thing to say I have a slower speed of processing. It’s an entirely different thing to show that through the use of some kind of engaging process that measures your processing speed and shows compared to other people where do you stand.”And in education:
“We’re currently connecting with a local community college who would like to incorporate these kinds of tests into their overall student wellness programming. We’re thinking this tells you about how you learn, what your strengths are, and are there some things that you can do to enhance your performance in college.”
