Virtual Reality to Improve Social Perspective Taking
Condition: Conduct Disorder; Child; Adolescent; Attention Deficit and Disruptive Behavior Disorders; Child Behavior Disorders; Virtual Reality; Social Perception; Magnetic Resonance Imaging
MeSH terms: Mental Disorders; Problem Behavior; Conduct Disorder; Attention Deficit and Disruptive Behavior Disorders; Child Behavior Disorders
Study type: Interventional

Summary: 
      This project will examine how virtual reality treatment that provides users with the
      alternate perspective of a virtual interpersonal interaction impacts psychological and
      neurobiological markers of social perspective taking in children with a disruptive behavior
      disorder. The investigators anticipate that experiencing a virtual encounter from a
      counterpart's point-of-view improves a child's perspective taking and alters brain function
      related to imagining another person's pain.
    

Detailed description: 
      Oppositional defiant disorder (ODD) and conduct disorder (CD), collectively known as
      disruptive behavior disorders (DBDs), involve persistent physical or verbal confrontations,
      antisocial behavior, and emotional outbursts. Despite a range of biological and environmental
      risk factors for DBD, social-cognitive impairments are a common link, and improving these
      deficits should be beneficial for all patients with DBD.

      Children and adolescents with DBD have deficits in social perspective taking that contribute
      significantly to these behavior problems. Perspective taking is the ability to perceive the
      world from another person's point of view, including making inferences about the
      capabilities, feelings, and expectations of others. Perspective taking requires substantial
      motivation and cognitive resources and can be difficult to achieve, particularly for
      children. A failure to understand or value another person's perspective inhibits helping
      behavior without clear direct benefits. Perspective taking skills are related to empathic
      concern, which encompasses feelings of sympathy and concern for unfortunate others, and
      theory of mind, the ability to accurately infer others' mental states, such as intentions.
      Negative attribution biases are more likely in individuals with poor theory of mind. Thus,
      improving children's perspective-taking skills should allow them to better understand a
      counterpart's thinking and intentions, increasing empathic concern, and reducing hostile
      attribution biases-and therefore improving the likelihood that prosocial behavior occurs.

      In the brain, perspective taking engages circuitry underlying empathic concern and theory of
      mind. In fMRI studies, imagining pain to the self or other, often in conjunction with images
      depicting painful scenarios, engages the brain's salience network. Dorsal ACC and bilateral
      anterior insula, the regions most commonly activated in response to other's pain, also show
      strong responses to self-perspective pain. However, in youth with DBD, there is a decreased
      response to other-perspective pain in dACC and anterior insula, despite no change or a
      heightened response to self-perspective pain.

      Software interventions have shown some promise to improve perspective taking. In particular,
      VR has exciting therapeutic potential to address perspective-taking deficits because it
      provides naturalistic yet controlled environments in which users can experience interactions
      from multiple viewpoints. VR interventions typically provide better generalization to
      real-world behavioral changes compared to traditional methods. VR has an advantage over
      traditional interventions because it provides an embodied experience that is a middle ground
      between therapy room settings and the real world (e.g., school, home) where problematic
      behaviors occur.

      In this investigation, the investigators will build upon a current VR design using an Oculus
      Quest virtual reality headset. After experiencing virtual interpersonal conflicts in a school
      cafeteria setting, participants will re-experience scenarios in one of two manners: an
      enriched perspective from the virtual counterpart's point-of-view, with internal dialogue and
      background information; or a control perspective, which replays the original point-of-view.
      During this proof-of-concept phase, the primary target is social perspective taking. The
      investigators will assess functional engagement of this target by quantifying (1) the ability
      to recognize and understand the virtual counterpart's perspective; and (2) the neural
      response (in pain circuitry) to pain experienced by the virtual counterpart, a common marker
      for perspective taking that is abnormal in DBD.
    

Intervention name(s): Virtual reality perspective taking training; Virtual reality control perspective
Intervention type(s): Device; Device
Intervention description(s): Virtual reality system provides first-person perspective of a virtual social interaction in a school cafeteria as the subject attempts to complete a goal. A virtual counterpart interferes with this goal. In the alternate perspective condition, participants will then experience the scenario again from the counterpart's perspective, including internal thoughts of the virtual counterpart.; Virtual reality system provides first-person perspective of a virtual social interaction in a school cafeteria as the subject attempts to complete a goal. A virtual counterpart interferes with this goal. In the control perspective condition, participants will then experience the scenario again from identical perspective.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This project will examine how levels of a virtual reality treatment that provides users with the alternate perspective of an interpersonal interaction impacts psychological and neurobiological markers of perspective taking. Following the initial screening visit, participants will be randomly assigned to different VR perspective conditions, stratified by sex, presence/absence of ADHD diagnosis, and ODD/CD diagnosis, via an a priori randomization chart. An equal number of youth will be randomly assigned to either the alternate perspective condition or control condition. Visits 1 and 2 will be identical for both groups. At Visit 3, the initial VR scenarios and assessments will be identical. The participant will then re-experience the VR scenarios depending on their assigned condition. Additional VR assessments and the MRI scan will be identical for both groups.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: virtual reality; perspective taking; conduct disorder; oppositional defiant disorder; functional magnetic resonance imaging; child; adolescent