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16 Improving episodic future thinking (EFT) in children with ADHD through VR game-based training

Published online by Cambridge University Press:  08 May 2026

Li Zheng
Affiliation:
Rensselaer Polytechnic Institute
Mei Si
Affiliation:
Rensselaer Polytechnic Institute
Tingting Ma Qilu
Affiliation:
Hospital of Shandong University Hospital of Shandong University
Aihua Cao Qilu
Affiliation:
Hospital of Shandong University Hospital of Shandong University
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Abstract

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Objectives/Goals: This study investigates how VR-based Episodic Future Thinking (EFT) training enhances prospection and self-regulation mechanisms in children with ADHD by engaging neural processes of future-oriented planning within ecologically valid virtual contexts. Methods/Study Population: This randomized controlled trial included 80 typically developing children aged 4–10 years, randomly assigned to a VR intervention group (n=40) receiving 10 days of gamified Episodic Future Thinking (EFT) combined with conventional executive function training, or an active control group (n=40) receiving only conventional training. Intervention efficacy was evaluated using pre- and post-tests with five standardized measures: the Behavior Rating Inventory of Executive Function (BRIEF), grade-specific Executive Function Assessment Scales (Grades 1–3 or 4–5), Children’s Executive Functioning Inventory (CHEXI), Achenbach Child Behavior Checklist (CBCL), and Vanderbilt ADHD Diagnostic Rating Scale (VADRS). Results/Anticipated Results: Mixed-design ANOVA revealed that the VR-EFT intervention significantly enhanced cognitive and emotional regulation, while traditional training showed advantages in behavioral control and planning, reflecting the dual-system nature of executive functions. BRIEF and EFAS results were consistent, showing significant gains in inhibition, emotional control, planning, and working memory (η²=0.06–0.17). CHEXI indicated that the VR group improved in working memory and regulation, whereas the control group performed better in behavioral-level planning and inhibition. CBCL and Vanderbilt results showed reduced aggression, hyperactivity, and oppositional symptoms (η²=0.056–0.138), highlighting VR-EFT’s efficacy in enhancing self-regulation and reducing externalizing behaviors. Discussion/Significance of Impact: Findings suggest that VR-based Episodic Future Thinking (EFT) training effectively strengthens children’s cognitive–emotional executive functions and self-regulation. By integrating future-oriented cognition into intervention models, it provides a novel, evidence-based approach to enhancing executive development.

Information

Type
Contemporary Research Challenges
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2026. The Association for Clinical and Translational Science