Elevating hope among children with Attention deficit and hyperactivity disorder through virtual reality.

Children with attention deficit and hyperactivity disorder (ADHD) suffer from a variety of emotional and social difficulties including high levels of depression, anxiety, poor regulation, other executive malfunctions, and lack of satisfying social experiences (Bird et al., 1993; Greene et al., 2001; Gillberg et al., 2004; Barkley, 2006; Klimkeit et al., 2006; Daviss, 2008; Elia et al., 2008; McQuade and Hoza, 2008; Anastopoulos et al., 2011; Larson et al., 2011). Pharmaceutical treatment of ADHD may be effective for ameliorating the manifestations of ADHD but there may also be a need for supplementary psychotherapeutic interventions (Chronis et al., 2006). Engendering hope is an ancillary supportive therapy that can provide individuals with ADHD the positive coping skills and appropriate psychic framework for handling the challenges that they confront. Hope, in this context, is a psychological construct that relates to the ability of individuals to set themselves meaningful goals, to find channels to reach these goals, and to consistently work toward achieving these goals (Snyder et al., 1991). A potential tool for instilling hope in patients with ADHD is virtual reality (VR) (Riva, 2005). VR is an advanced form of human-computer interface that allows the user to interact with, and feel present within a computer generated environment. Similar to Descartes' deceiving god but with nobler intentions, researchers are utilizing models of immersive virtual therapy that enable individuals with physical/mental challenges such as chronic pain to set meaningful goals and visualize alternative realities where their pain or disability is minimized (Magora et al., 2006). For example, Hoffman et al. (2011) have presented VR systems that facilitate distraction thereby reducing perceived pain in individuals undergoing painful medical procedures such as non-pharmacologic analgesic for acute burn pain (Hoffman et al., 2011). In addition, we have recently introduced a combined VR-biofeedback system that allows individuals with chronic headache to learn to reduce their physiological arousal, following which, they can their view virtual image as headache free (Shiri et al., 2012a). Utilizing VR for generating hope in ADHD children whom have significant difficulties in creating and holding images is especially challenging as it based on forming a durable interface with computer-based VR programs. Recently, we have utilized a self-face recognition paradigm to enhance the verisimilitude of a VR-generated substituted reality (Shiri et al., 2012a, 2013). Self-face recognition programs have been successfully utilized for post-stroke disability and pain reduction. Self-face recognition creates a unique cerebral activity pattern which does not occur even when significant others, such as family members are recognized. Viewing a smile has the potential of activating brain structures that are related to reward and positive emotions. Positive emotions may enhance creative thinking and improve cognitive processes, necessary for effective coping with various challenges (Muehlberger et al., 2011). Although specific relationships between activation of reward structures and positive emotions need to be examined utilizing brain imaging techniques, a recent study suggested that static pictures of emotional facial expressions activate brain structures that are involved in the processing of emotional stimuli (Johnson et al., 2010). Similarly, a sequence of emotional facial expressions changes occur, different brain networks are involved. For example, it was found that the onset of happy and the offset of angry expressions induced significant activation in the left dorsal striatum (Johnson et al., 2010). These findings would suggest that the VR paradigm may be useful for children with ADHD as the interaction of salient brain activity created by self-face recognition together with the activation of reward brain centers produce a platform that is both cerebrally robust and emotionally positive for self-confidence and growth.