How are children with ADHD’s brains different? Scans taken while VR gaming give new insight

In a new study, children played a virtual reality game while in an MRI scanner – the brains of children with ADHD showed a notable increase in functional connectivity, a result which could help us more readily understand the condition.

In a novel study, researchers from several European universities used Virtual Reality gaming to study brain network activity in children with clinically diagnosed ADHD. Until now, ADHD in both children and adults has primarily been studied using brain imaging in a resting state, rather than while actively engaging in tasks where overt symptoms are expressed.

‘‘Taking pictures of the brain while memory and attention are being loaded in a virtual world gives us a deeper understanding of what’s going on,’ explains Juha Salmitaival (aka Salmi), visiting professor at Aalto University. ‘During the virtual reality game, there were clear differences in brain network activation for kids with ADHD, particularly in the deep structures of the brain and their connection to cortical areas.’

While during functional MRI (fMRI) scanning, subjects were immersed in a world of challenges mimicking those faced by people in the real world. The game was projected onto a mirror, allowing children to play whilst their brain activity was scanned. The results were then compared with scans taken while they were doing more passive activities like watching a video or simply resting.

‘Interestingly, while at rest, there was no detectable difference between the groups, and there was little difference during video viewing,’ says Salmi, findings which also highlight the value of this novel way of collecting neuroimaging data.

‘We used to think that abnormal development is mostly a matter of background activity in specific, limited brain regions. But these findings indicate that it’s more to do with inter-regional communication between brain regions. We found that alterations in brain activity in individuals with ADHD are driven by the human-environment interaction,’ says Salmi. In practice, this means that psychological testing for ADHD in the clinic, or even just brain imaging research more generally, should take place in situations where the individual is actually doing something that would spark symptoms.

Salmi hopes the study will spark more extensive research, believing that this method could also help us find out what’s behind the sharp rise in ADHD diagnoses and in the development of non-pharmacological treatments.

Games and apps are changing our brains

It’s not lost on the researchers that gaming in a virtual environment is an excellent way to explore what’s going on in our brains in a world of screens and social media.

‘The brain is a complex system that always tries to adapt to its environment, therefore it’s likely being shaped by TikTok, Snapchat and other apps and games as well,’ says Salmi. Similarly, the virtual world contains toys that can trigger impulsivity, like musical instruments, a soft drink in the fridge or the chance to take a virtual shower.

‘If the environment is fast paced, with people jumping from one thing to another like a grasshopper, the brain tries to get better at jumping from one stimulus to another,’ he adds. ‘But if we become grasshoppers, we can no longer concentrate for two hours when there are very few stimuli. Scanning the brain while it’s active could also give us fresh insight into how our brains are changing.’

Future studies for the team include researching children’s brains using smart suits and motion sensors, as well as exploring symptoms in adults in set ups that more closely simulate daily life. He foresees that in the future, symptoms could also be quantified at home, for example using augmented reality glasses.

Salmi also points out that while fMRI is at this stage too costly to be used for mainstream diagnostic purposes, as we build more knowledge in this way, diagnosing neuropsychiatric conditions should also become more straightforward.

In addition to Aalto researchers, the study involved researchers from HUS, the University of Helsinki, the University of Oulu and the Lyon Neuroscience Research Centre in France. The virtual game, Epeli was developed by a Finnish company called Peili Vision.

The peer-reviewed study ‘Real-world goal-directed behavior reveals aberrant functional brain connectivity in children with ADHD’ was recently published in PLOS One, available online at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0319746

Read more about the Epeli virtual game https://www.aalto.fi/en/news/virtual-reality-game-to-objectively-detect-adhd