AV-Play: Co-Designing VR Games to Study Audiovisual Integration in Children with ADHD

Paper Title

AV-Play: Co-Designing VR Games to Study Audiovisual Integration in Children with ADHD

Publication Info

• Topic area: Therapeutic VR game design for children with ADHD, focusing on audiovisual integration and attention training.
• Keywords: ADHD, audiovisual integration, VR games, co-design, therapeutic games, EEG, eye tracking, attention training, child engagement, neurodevelopmental disorders.

Background and Problem

• Problem / challenge: Children with ADHD face significant challenges in processing speech in noisy environments due to disrupted audiovisual (AV) integration and visuospatial attention. Existing interventions lack clinical efficacy or fail to engage children effectively. There are no VR games specifically targeting auditory processing disorders in ADHD, and prior designs often neglect neural mechanisms.
• Significance: Addressing these issues can improve speech comprehension, social skills, and academic performance in children with ADHD. Engaging and clinically valid tools are needed to bridge the gap between neuroscience insights and practical interventions.
• Motivation and related work: Prior therapeutic games have targeted ADHD symptoms like inattention but rarely address sensory processing deficits. Existing VR interventions often focus on diagnostic simulations or rigid training protocols, lacking engaging gameplay. This paper builds on the potential of VR to combine clinical rigor with child-friendly design, leveraging multimodal measurements like EEG and eye tracking.

Solution

• Proposed approach: AV-Play, a VR therapeutic game co-designed with stakeholders (children, neuroscientists, and clinicians) to train audiovisual integration and visuospatial attention in children with ADHD.
• Novelty:
  1. Development of a clinically informed VR game integrating EEG and eye tracking to target AV integration and attention.
  2. Introduction of child-friendly interaction modalities (Click, Pump, Drag) and adjustable difficulty levels.
  3. Multi-phase co-design process balancing clinical fidelity and child engagement.
  4. Validation of eye tracking as a proxy for EEG in measuring attentional focus.
• Procedure and key techniques:
  • Phase 1: Designer-Doctor collaboration to define clinical requirements and core game mechanics.
  • Phase 2: Doctor-Child formative testing to refine interaction modalities and usability.
  • Phase 3: Designer-Doctor-Child finalization of difficulty parameters and VR-EEG configuration.
  • Gameplay involves rescuing animals by interacting with bubbles in a fantasy environment, with task-relevant audiovisual cues and distractors.

Results

• Concrete findings:
  • Eye tracking and EEG showed strong alignment, validating gaze as a proxy for neural attention.
  • Click mode yielded the highest performance (70% WP), while Drag mode had the lowest.
  • ADHD participants performed worse than neurotypical (NT) children, especially in complex interaction modes.
  • Weighted performance (WP) decreased with increasing difficulty: Easy (~80%), Medium (~70–75%), Hard (~50%).
• Advantage over baselines:
  • Combines clinical precision with engaging gameplay, unlike prior interventions.
  • Demonstrates the feasibility of using eye tracking for scalable, at-home attention monitoring.
• Experiments / evaluation:
  • Participants: 11 children (6 ADHD, 5 NT), aged 7–12.
  • Data collected: in-game performance, EEG, eye tracking, and qualitative feedback.
  • Metrics: Weighted Performance (WP), reaction times, gaze dwell time, and SSVEP signals.
• Limitations and future work:
  • Small sample size limits generalizability.
  • Future work includes longitudinal studies, adaptive difficulty, and expanded game content for older children and home use.

Summary

This study introduces AV-Play, a VR therapeutic game co-designed to train audiovisual integration and visuospatial attention in children with ADHD. The game integrates EEG and eye tracking to measure attentional engagement, with child-friendly interaction modalities and adjustable difficulty levels. Results show strong alignment between gaze and neural attention, validating eye tracking as a practical proxy for EEG. ADHD participants showed reduced performance and greater susceptibility to distractions compared to NT children, highlighting the need for simplified interactions and adaptive difficulty. The findings demonstrate the potential of AV-Play as a scalable, engaging, and clinically grounded intervention for neurodivergent populations. Future work will focus on longitudinal studies, adaptive algorithms, and expanded content to enhance usability and therapeutic impact.