The Use of Virtual Reality and the Contribution of NESPLORA in the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Literature Review

Abstract

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder characterized by a persistent and marked pattern of inattention and/or hyperactivity-impulsivity that interferes with social, academic, or occupational functioning. ADHD is one of the most common neuropsychiatric conditions in childhood but can persist into adulthood. ADHD diagnosis is multidimensional and currently relies on clinical criteria, interviews, behavioral questionnaires, neuropsychological tests, and subjective rating scales. However, these tools may present several limitations related to the subjectivity of evaluations and the low ecological validity of the contexts in which they are administered. This systematic review aims to comprehensively analyze the scientific literature concerning the use of VR (e.g., Nesplora AULA, Aquarium, Ice Cream VR) in the diagnosis, neuropsychological assessment, and treatment monitoring of ADHD in children, adolescents, and adults.

Methods: A systematic review was conducted following the PRISMA 2020 guidelines, identifying 20 empirical studies published between 2012 and 2025 through databases including PubMed, Scopus, SciELO, PsycINFO, Google Scholar, social networks such as ResearchGate, and the official Nesplora website. Inclusion criteria selected studies utilizing Nesplora or VR-based tools in ADHD populations (both developmental and adult).

Results: VR-based tools demonstrated good discriminative ability between ADHD and neurotypical populations, as well as among different clinical presentations (inattentive, hyperactive-impulsive, combined). Indicators such as omissions, commissions, response time variability, inhibitory control, and cognitive switching proved predictive of diagnosis and sensitive to change following pharmacological treatment (e.g., methylphenidate). Psychometric data reported adequate reliability, external validity, and clinical acceptability, along with good diagnostic sensitivity and utility of Nesplora in therapeutic monitoring.

Conclusions: VR tools, such as Nesplora, show promising potential for the diagnosis and neuropsychological assessment of ADHD, as well as for more sensitive monitoring of therapeutic outcomes, consistent with a personalized clinical approach. Nevertheless, further longitudinal and comparative studies with other standardized tests are needed to consolidate clinical reliability and generalizability.