Attention-deficit hyperactivity disorder (ADHD) is a mental disorder characterized by a substantial variability in symptoms, which may involve attention, hyperactivity and impulsivity to varying degrees. It is the most commonly diagnosed disorder in childhood and adolescence (4-7% of the population). In 65% of cases, this condition continues into adulthood [1] or it might only be diagnosed at this age. Currently, the DSM-5-TR divides this disorder into three main subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined [2]. The classifications are often inaccurate due to the heterogeneity of symptoms among individuals. To ensure effective treatment, current guidelines advise a comprehensive approach that combines psycho-social and pharmacotherapeutic interventions. Methylphenidate (MPH) is commonly recommended as the primary or co-primary medication; its effectiveness has been demonstrated both in children and adults with ADHD [3]. Few studies have investigated the relationship between the neuropsychological profile of ADHD patients and the quality/quantity of improvement in response to MPH treatment.
Based on this background, the use of virtual reality can provide an additional medical tool capable of improving diagnostic precision.
15 patients from the clinical population afferent to the Neurodivergences Outpatient Clinic for ADHD in Adults at the Psychiatry Unit of the University Hospital of Messina, Italy, were recruited in the study. All subjects were screened by a psychiatric clinical examination and a DIVA 2.0 screening test for ADHD [4] to confirm the diagnostic hypothesis. Each patient was furtherly assessed with Nesplora Aquarium, a VR-based continuous performance test [5] specifically designed to examine eight different subtypes of attentional processes and working memory in adults. Then, the sample started pharmacological treatment with MPH and underwent periodical clinical and neuropsychological assessments including Nesplora Aquarium after three and six months to assess treatment response.
The use of MPH was differently effective according to specific neuropsychological profiles. Amongst all eight profiles (attention, hit discrepancy, processing, vigilance, inhibitory control, switching, perseverations and working memory) obtained via Nesplora Aquarium, better treatment response was associated with «inhibitory control» and «switching» profiles. Other profiles showed less marked improvements, which is compatible with a different treatment response to MPH depending on patients’ neuropsychological features. No substantial changes emerged in the response to treatment at 3 and 6 months follow-ups.
MPH treatment was related with a good overall therapeutic response; nevertheless, specific neuropsychological profiles (inhibitory control and switching) responded better than others. Pharmacological treatment may in fact provide different more or less satisfactory results depending on the type of patient to whom it is administered. Future studies should address the identification of a custom “patient profile” with the aim of reaching a better knowledge on possible correlations between such profiles and specific treatments (mono- or co-treatment with other drugs like NDRI or mood stabilizers) for providing a more tailored, patient-centered pharmacological treatment for ADHD patients.
In this study, the researchers used Nesplora Attention Adults Aquarium to conduct an initial assessment and monitor treatment progress over time.
Vincenzo Messina, Giulia Fangano, Rosa De Stefano, Carmela Mento, Clemente Cedro, Maria Rosaria Anna Muscatello, THE USE OF VIRTUAL REALITY AS A TOOL TO ASSESS ADHD NEUROPSYCHOLOGICAL PROFILES AND THEIR SPECIFIC RESPONSE TO MPH TREATMENT – A PILOT STUDY IN AN ITALIAN ADULT POPULATION, International Journal of Neuropsychopharmacology, Volume 28, Issue Supplement_1, February 2025, Pages i114–i115, https://doi.org/10.1093/ijnp/pyae059.198
Este proyecto ha recibido financiación de la Unión Europea del programa de investigación e innovación
Horizon 2020 bajo el acuerdo Nº 733901
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