Artificial Intelligence Versus Virtual Reality Teaching for Children and Adolescents With ADHD

This study was an open-label, randomized, parallel-group controlled trial designed to compare the effects of artificial intelligence (AI)-assisted teaching and immersive virtual reality (VR)-based smart classroom teaching on core symptoms and executive function in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Participants aged 8 to 15 years were recruited from an outpatient ADHD clinic and were required to meet diagnostic criteria for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Eligible participants were randomly assigned in a 1:1 ratio to either the AI-assisted teaching group or the VR-based teaching group using a computer-generated randomization sequence prepared by an independent statistician. Due to the nature of the digital interventions, participants were not blinded to group allocation; however, outcome assessments were conducted by trained evaluators who were blinded to treatment assignment.

Both groups received structured teaching interventions for 12 weeks, with three sessions per week and each session lasting approximately 45 minutes. The AI-assisted teaching intervention was delivered using a tablet-based adaptive learning system incorporating eye-tracking, behavioral analysis, and real-time feedback to dynamically adjust task difficulty and learning pace based on individual performance and attention patterns. The VR-based teaching intervention was delivered using immersive virtual reality technology to simulate classroom and task-based learning scenarios, with an emphasis on interactive learning and emotional regulation in a low-distraction environment.

Primary outcomes included changes in core ADHD symptoms as measured by the ADHD Rating Scale (ADHD-RS). Secondary outcomes included changes in executive function assessed using the Behavior Rating Inventory of Executive Function (BRIEF), parent-report version. Outcome measures were assessed at baseline prior to intervention initiation, at the end of the 12-week intervention period, and at a 3-month post-intervention follow-up.

All study procedures were approved by the Ethics Committee of Tongren Hongxin Kangxin Traditional Chinese Medicine Hospital, and written informed consent was obtained from parents or legal guardians, with assent obtained from participating children when appropriate. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Inclusion criteria

• Children and adolescents aged 8 to 15 years.
• Diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), confirmed by two qualified child psychiatrists.
• Total score of 25 or higher on the ADHD Rating Scale (ADHD-RS).
• Intelligence quotient (IQ) of 80 or above as assessed by the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV).
• Stable clinical status for at least 30 days prior to enrollment, with adherence to standard first-line or second-line treatment regimens, and no planned changes in treatment during the study period.
• Ability to participate in structured digital teaching sessions.
• Written informed consent provided by a parent or legal guardian, with assent obtained from the participant when appropriate.

Exclusion criteria

• Presence of neurodevelopmental or neurological disorders other than ADHD, such as cerebral palsy or epilepsy.
• Diagnosis of severe psychiatric disorders, including schizophrenia.
• Significant sensory impairments (e.g., hearing impairment) that could interfere with study participation.
• Lack of response to two or more different classes of ADHD medications.
• History of suspected substance abuse or dependence within the past 6 months.
• Physical conditions or motor impairments that would prevent participation in the teaching interventions.
• Current suicidal ideation or severe suicidal behavior as determined by the investigator.
• Receipt of other structured psychological or educational interventions during the study period.
• Any other condition that, in the opinion of the investigator, would make participation in the study inappropriate.