A naturalistic virtual reality task reveals difficulties in time-based prospective memory and strategic time-monitoring in children with ADHD

Seesjärvi, Erik; Zuber, Sascha; Joly-Burra, Emilie; Kliegel, Matthias; Salmi, Juha · 2025 · OpenAlex-citations

DOI: 10.1038/s41598-025-08944-w

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Summary

This study investigates the mechanisms underlying time-based prospective memory (TBPM) deficits in children with attention-deficit/hyperactivity disorder (ADHD). TBPM is critical for independent daily functioning, requiring individuals to execute planned actions at specific times. While previous research established that children with ADHD perform worse on TBPM tasks than typically developing peers, the underlying behavioral pathways—specifically regarding time-monitoring strategies—remained unclear. Prior studies often relied on artificial laboratory paradigms and focused solely on the frequency of clock checks, failing to distinguish between overall monitoring effort and the strategic allocation of attention as the target time approaches. To address these limitations, the authors utilized a naturalistic virtual reality task to examine whether TBPM difficulties in ADHD stem from insufficient time monitoring or a lack of strategic deployment of monitoring resources. The researchers employed the Executive Performance in Everyday LIving (EPELI) task, a VR environment where children navigate a virtual apartment to complete everyday chores. The study included 71 children with ADHD and 71 typically developing controls, aged 9–13 years, matched for age and sex. Participants performed 13 scenarios involving ongoing tasks and embedded TBPM tasks (e.g., turning off a stove after 30 seconds). The study measured TBPM performance, absolute clock-checking frequency, and relative clock-checking (a metric for strategic monitoring defined as the ratio of checks in the final interval before the target time to total checks). Structural equation modeling was used to analyze whether absolute and relative clock-checking mediated the effect of ADHD status on TBPM performance. The results demonstrated that children with ADHD exhibited significantly lower TBPM performance compared to typically developing peers. Crucially, the groups did not differ in the absolute frequency of clock checks, indicating that children with ADHD monitored time just as often as their peers. However, children with ADHD showed significantly lower relative clock-checking scores, revealing a deficit in strategic time monitoring; they failed to increase their monitoring frequency as the target time approached. Mediation analysis confirmed that the degree of strategic time monitoring fully mediated the effect of ADHD on TBPM performance, accounting for 22.1% of the variance. When combined with absolute clock-checking and ADHD status, these factors explained 53.9% of the variance in TBPM performance. These findings clarify that TBPM deficits in children with ADHD are not caused by a failure to monitor time, but rather by an inability to strategically allocate attentional resources to critical moments. This distinction is significant for clinical practice, as it suggests that interventions should focus on training strategic time-monitoring behaviors rather than simply encouraging more frequent checking. By identifying strategic monitoring as the key mechanism, the study provides a target for therapies aimed at helping individuals with ADHD manage their schedules and improve independent daily functioning.

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• prospective memory interruptions