Virtual reality programs targeting executive functions and social cognition evaluation and/or rehabilitation in children with ADHD or ASD—A narrative review

Doulou, Filippia; Piolino, Pascale; Angeard, Nathalie · 2025 · Crossref

DOI: 10.3389/fpsyg.2025.1583052

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Summary

This narrative review evaluates the efficacy and methodological characteristics of virtual reality (VR) programs designed to assess or rehabilitate executive functions (EFs) and social cognition, specifically theory of mind (ToM), in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). The study addresses the limitations of traditional neuropsychological assessments, which often lack ecological validity and fail to generalize skills to real-world contexts. By leveraging VR’s capacity for immersive, controlled, and interactive environments, the authors aim to determine whether these technologies effectively target core cognitive and social impairments in neurodevelopmental disorders. The authors conducted a systematic search of PubMed and Science Direct for studies published between 1996 and 2022. Using keywords related to EFs, ToM, social training, ADHD, ASD, and VR, they screened 2,908 records, ultimately including 75 studies that met specific criteria: targeting pediatric populations with ADHD or ASD, and utilizing VR for assessment or training of social or executive skills. The review analyzed methodological dimensions, including study design, sample characteristics, and VR features such as immersion levels (low vs. high), interaction types, user perspective (first- vs. third-person), and sense of presence. The findings indicate that VR serves as a viable tool for both assessment and training in these clinical populations. Studies involving children with ADHD predominantly focused on assessing and training attentional impairments, whereas interventions for ASD primarily targeted social skills and emotion recognition. However, the review highlights significant heterogeneity across the included studies. There was substantial variability in clinical designs, including the number and duration of training sessions, as well as in VR program characteristics, such as the hardware used, the degree of immersion, and the level of interactivity. This lack of standardization complicates cross-study comparisons and the identification of optimal intervention parameters. The authors conclude that while VR shows promise for enhancing cognitive and social impairments in pediatric clinical populations, the field requires more systematic evaluation. The current variability in VR designs and clinical protocols underscores the need to define which specific features—such as ecological validity, sense of presence, or feedback mechanisms—contribute most to effectiveness. Furthermore, future research must prioritize assessing the generalization of trained skills to naturalistic settings to ensure that improvements in virtual environments translate to real-world functional gains.

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