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
Authors: Messina *Vincenzo , Fangano Giulia , De Stefano Rosa , Mento Carmela , Cedro Clemente , Muscatello Maria Rosaria Anna 
Published: February 2025

Abstract

Background
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.

Aims & Objectives
Based on this background, the use of virtual reality can provide an additional medical tool capable of improving diagnostic precision.

Methods
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.

Results
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.

Discussion & Conclusion
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.

References
[1]Retz, W. et al. (2020) 'Methylphenidate treatment of adult ADHD patients improves the degree of ADHD severity under routine conditions,' Journal of Neural Transmission, 127(10), pp. 1427–1434. https://doi.org/10.1007/s00702-020-02226-7.
[2]Association, A.P. (2022) Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/appi.books.9780890425787.
[3]Buitelaar, J.K. et al. (2011) 'Functional improvement and correlations with symptomatic improvement in adults with attention deficit hyperactivity disorder receiving long-acting methylphenidate, Psychological Medicine, 42(1), pp. 195–204. https://doi.org/10.1017/s0033291711000845.
[4]Ramos-Quiroga, J.A. et al. (2016) 'Criteria and Concurrent Validity of DIVA 2.0: A Semi-Structured Diagnostic Interview for Adult ADHD,' Journal of Attention Disorders, 23(10), pp. 1126–1135. https://doi.org/10.1177/1087054716646451.
[5]Baader, A. et al. (2020) 'A Within-Sample comparison of two innovative neuropsychological tests for assessing ADHD,' Brain Sciences, 11(1), p. 36. https://doi.org/10.3390/brainsci11010036.