Distraction is a growing and large public health problem with estimated societal harm due to distracted driving alone at $123 billion1. In the age of texting, social media and computer pop-ups, distractions are unavoidable. There are no known interventions specifically developed to reduce distractions from interfering with attention. This project will test a treatment that combines virtual reality (VR) technology with habituation learning and exposure therapy to reduce the ability of distractors to interfere with learning and attention in children who are highly susceptible to being distracted. We will test the treatment in children with symptoms of attention- deficit/hyperactivity disorder (ADHD) as they represent an enriched sample experiencing impairing distractibility that interferes with their daily functioning. We hypothesize that children who suffer from severe distractibility can learn to ignore the distractors and improve their attention in VR therapy that simulates environments requiring focused attention. Our neural targets are both proactive and reactive control mechanisms used to suppress distractor processing. We will assess how well VR therapy is at modulating distractor suppression via saccade metrics and measure the frequency of oculomotor capture by distractors as well as the efficiency of distractor suppression before and after therapy. Changes in head movement toward distractors, parent and teacher ADHD rating scales and improved performance on attention-demanding tasks will further assess success of the therapy and its ability to generalize to novel environments. Children will practice computer exercises at home using a VR headset that simulates a classroom environment with a high rate of distractors. Children will be performing attention-demanding tasks as if they were in a classroom with the intensity and rate of presentation of the personalized distractions (e.g., peers talking, teacher walking by) adapted according to the child?s performance. With today?s low-cost VR-gaming technology, children will be able to participate in habituation treatment sessions at-home, several times a week, using a lightweight and comfortable VR gaming headset. In this ?fast fail? test of the VR therapy, the R61 phase will assess the preliminary success and feasibility of VR training to modify saccades to distractors in an adaptive training versus waitlist control trial. The R33 phase will commence if the R61 trial results indicate saccade metrics change in response to the VR treatment. Consistent with the RFA, the R33 will test the link between the degree of the VR therapy?s target engagement and functional outcomes (parent & teacher ratings) and feasibility. The R33 will compare an adaptive distractor training, non-adaptive distractor training and a waitlist control arm in children with high rates of distractibility. Data from this trial will determine whether to go forward for a subsequent confirmatory study in a larger, R01 project. Future studies will include new VR scenarios besides the classroom and a longer test of maintenance effects of the therapy. This project is consistent with the NIMH Strategic Plan: Objective 3: Strive for Prevention and Cures,? by developing new precision treatments based on neuroscience and behavioral science.
Problems with distraction are ubiquitous in the 21st century, but for people with mental illness they can have devastating effects, including impairing school and social performance, lowering high school graduation rates and increasing the incidence of serious accidents. Consistent with the RFA-MH-16-406 and NIMH priorities, our goal is to improve our understanding of distractibility and develop a targeted treatment for it. The proposed intervention is based on models of habituation combined with virtual reality technology to improve attention in the face of distraction in situations relevant for children with impairing distractibility (e.g., attention- deficit/hyperactivity disorder), such as the classroom setting but will likely be effective in helping persons experiencing other clinical disorders and perhaps the general population.