{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:11:05Z","timestamp":1786122665575,"version":"build-2736575974"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta\u2212analysis aimed to comprehensively evaluate the impact of virtual reality (VR)\u2212based interventions on core symptoms and cognitive function, and to examine their effectiveness for Attention\u2212Deficit\/Hyperactivity Disorder (ADHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted across multiple databases, including Embase, Web of Science (WOS), PubMed, The Cochrane Library, ProQuest, EBSCOhost, from their inception up to May 2026. The search aimed to identify randomized controlled trials (RCTs) investigating the impact of VR on core symptoms and cognitive function in patients with ADHD. The Physiotherapy Evidence Database (PEDro) scale was employed to assess the quality of the literature, while the revised Cochrane risk\u2212of\u2212bias tool (ROB\u22122) was used to evaluate the overall risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) profiler method was utilized to further assess the quality of evidence. Meta\u2212analysis, sensitivity analysis, and publication bias testing were performed using Review Manager 5.4.1 and Stata 18.0 software. Effect sizes were calculated using the standardized mean difference (SMD) and 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      23 RCTs with 1,102 participants were included. Meta\u2212analysis showed that VR interventions significantly reduced core ADHD symptoms [inattention: SMD\u202f=\u202f\u22120.80, 95% CI (\u22121.13, \u22120.48),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u202f=\u202f79%; hyperactivity\/impulsivity: SMD\u202f=\u202f\u22120.57, 95% CI (\u22120.87, \u22120.27),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f76%; total symptoms: SMD\u202f=\u202f\u22120.47, 95% CI (\u22120.78, \u22120.16),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f54%],and significantly improved cognitive functions [inhibition: SMD\u202f=\u202f\u22120.36, 95% CI (\u22120.56, \u22120.15),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u202f=\u202f37%; working memory: SMD\u202f=\u202f\u22120.23, 95% CI (\u22120.40, \u22120.07),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0%; cognitive flexibility: SMD\u202f=\u202f\u22120.23, 95% CI (\u22120.43, \u22120.04),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05,\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u202f=\u202f0%]. Subgroup analysis revealed that for children under 12\u202fyears of age, mid\u2212term (5\u20138\u202fweeks), moderate\u2212duration (20\u201330\u202fmin), high\u2212frequency (\u22653 sessions\/week) interventions using mixed cognitive\u2212physical or cognitive\u2212based VR significantly improve core symptoms in patients with ADHD, with immersive VR producing more consistent broad symptom relief; cognitive functions require long\u2212term (\u22659\u202fweeks) interventions with long duration (&amp;gt;30\u202fmin) per session. Lower frequency (1\u20132 sessions\/week) appears more beneficial than higher frequency, and non\u2212immersive VR may be more effective than immersive for inhibition and working memory. Cognitive improvements are most evident in children under 12\u202fyears.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VR interventions significantly reduce core ADHD symptoms and improve cognitive functions, with differential dose\u2013response patterns. Optimal protocols differ between symptoms and cognitive outcomes. VR represents a promising complementary approach for ADHD, pending confirmation through high\u2212quality, long\u2212term RCTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier PROSPERO (CRD420261340074).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1835922","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:24:21Z","timestamp":1786101861000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of virtual reality based intervention on core symptoms and cognitive functions in attention\u2212deficit hyperactivity disorder: a systematic review and meta\u2212analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Huaibo","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Physical Education, Nanjing University of Finance and Economics Hongshan College","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuncong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Research, China University of Mining and Technology","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Strength and Conditioning Training College, Beijing Sports University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diandong","family":"Lang","sequence":"additional","affiliation":[{"name":"School of Physical Education and Health, Linyi University","place":["Linyi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Education Teaching, Shanghai Sanda University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0116407","DOI":"10.1371\/journal.pone.0116407","article-title":"Effect of treatment modality on long\u2212term outcomes in attention\u2212deficit\/hyperactivity disorder: a systematic review","volume":"10","author":"Arnold","year":"2015","journal-title":"PLoS One"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"12382","DOI":"10.1038\/s41598\u2212018\u221230067\u22128","article-title":"Acute physical activity enhances executive functions in children with ADHD","volume":"8","author":"Benzing","year":"2018","journal-title":"Sci. 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