The study targets children with diagnosed ADHD and aims to (1) develop a social virtual reality-based intervention, (2) investigate its effects on improving the social skills and executive functioning of inhibitions, emotional control and attention of the children compared to traditional social skills training and (3) evaluate the subjects acceptability and compliance with social VR training for enhancing social interaction skills. It is hypothesised that the social interaction skills of the participants in the social VR training group are likely to perform better than those in the traditional social skills training group. Participants in the waitlist control group will receive no change in social interaction skills compared with the two intervention groups.
The study will be a three-arm randomised controlled trial comparing the effects of social VR-based intervention with traditional social skills training on social skills and executive functioning of children with ADHD. Participants in the social VR intervention group and traditional social skill training group will receive 12 training sessions for 3 weeks (4 sessions per week), and participants in the waitlist control group will be asked to retain their usual lifestyles for 3 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE
Enrollment
90
There are a total of 12 training sessions for 3 weeks (4 sessions per week). Each session of the Social VR intervention lasts for a maximum of 20 minutes. The intervention contains three real-life virtual scenarios, including (1) a classroom and playground, (2) an MTR station and compartment, and (3) a supermarket and restaurant.
There are a total of 12 training sessions for 3 weeks (4 sessions per week). Each session lasts for a maximum of 20 minutes. Four modules will be covered in the 3-week training: (1) how to introduce yourself and basic social skills; (2) how to listen to others; (3) how to share with others; (4) learn to know how people feel and how to empathise.
Ka Po WONG
Hong Kong, Hong Kong
Riggio Social Skills Inventory Assessment
\[Protocol-to-Publication Realignment Explanation\]: In the initial protocol, trial feasibility (attendance/compliance) was registered as the primary focus. In the final published pilot RCT, to address the core therapeutic objective of this intervention, the evaluation was refined to focus on clinical efficacy. Therefore, this blinded clinical assessment of Social Skills was designated as a Primary Outcome to directly report behavioral improvements. This assessment uses the Riggio Social Skills Inventory to objectively evaluate participants' social interaction skills. The total score ranges from 10 to 40, where higher scores indicate better social interaction skills. The inventory consists of 10 items, each scored on a scale from 1 (Never) to 4 (Always). Scores for each item are summed to compute a total score, with higher total scores representing better outcomes in social skills. The inventory includes subscales that measure aspects of verbal and non-verbal communication.
Time frame: 3 weeks post-intervention
Social Skills Improvement System Rating Scales - Parent Version (SSIS-RS)
\[Protocol-to-Publication Realignment Explanation\]: Outcome Level: Shifted from a feasibility framework in the protocol to a primary clinical outcome in the published paper to evaluate targeted efficacy. Scale Upgrade: The tool was upgraded from the older SSRS-P (as planned in the protocol) to its revised version, the SSIS-RS, which provides updated contemporary clinical norms for children with ADHD. This assessment evaluates participants' self-control, assertiveness, and initiative and cooperation. The SSIS-RS consists of 3 subscales with a total of 31 items. A 3-point Likert scale (1 = Never, 2 = Sometimes, 3 = Often) is used for scoring. The total score ranges from 31 to 93, where higher scores indicate better social skills. Scores for each subscale are summed, contributing to the total score. The SSIS-RS is a validated instrument commonly adopted in clinical trials of psychiatric and neurological disorders.
Time frame: 3 weeks post-intervention
Acceptability and Compliance
\[Protocol-to-Publication Realignment Explanation\]: This parameter was originally listed as a Primary Outcome in the feasibility protocol. In the final published pilot RCT, all feasibility targets were successfully achieved (sample size of 90 randomized, accounting for the anticipated 25%-30% attrition rate). For structural reporting in the peer-reviewed paper, it was repositioned under secondary/feasibility outcomes while clinical efficacy took priority as the primary measure. The attendance of the participants during the trainings will be recorded. To verify the validity of the findings, training non-adherence of the participants will be terminated which will be stated in the consent form. The absence of any training session will be considered as non-adherence.
Time frame: After 3 weeks
Behaviour Rating Inventory of Executive Function
To assess the executive functioning of participants using the Behavior Rating Inventory of Executive Function (BRIEF), which will be scored by the participants' guardians. The subscales of inhibition (16 items) and emotional control (10 items) will be adopted in this study. A 3-point Likert scale (1 = Never, 2 = Sometimes, 3 = Often) is used to score. The total score ranges from 26 to 78, with higher scores indicating poor executive functions.
Time frame: 3 weeks post-intervention
Satisfaction of the Intervention
Satisfaction with the intervention was measured using a 7-point Likert scale (1 = very dissatisfied, 7 = very satisfied) administered at the last session of the VR training group. The total score ranges from 1 to 7, with higher scores indicating greater satisfaction.
Time frame: After the last session (after 3 weeks)
Simulator Sickness Questionnaire
To measure the motion sickness or physical discomfort of participants in VR environment. Nine items will be measured, including discomfort, fatigue, headache, eyestrain, sweating, nausea, difficulty concentrating, blurred vision and dizziness, with yes or no questions for each item.
Time frame: Assessments will be conducted at the end of each session of the VR intervention group (twelve sessions in total), with the total score reflecting cumulative discomfort experienced across all sessions.
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