Reward Feedback Mechanism in Virtual Reality Serious Games in Interventions for Children With Attention Deficits: Pre- and Posttest Experimental Control Group Study
Coins plus verbal praise inside VR attention games give the biggest boost to inhibitory control for kids with ADHD.
01Research in Context
What this study did
Stagnone et al. (2025) built a VR game for kids with ADHD. Some kids got coins and praise inside the game. Others got badges only, verbal praise only, or no rewards at all.
The team tested inhibitory control before and after four weeks of play. They used a true experiment: kids were picked by lottery for each reward type.
What they found
Coin plus verbal praise beat every other setup. Kids who heard "Great job!" while earning coins showed the biggest jump in inhibitory control and the largest drop in ADHD symptoms.
No-feedback VR still helped a little, but the coin-plus-praise combo moved the needle the most.
How this fits with other research
The finding lines up with Littin et al. (2025), who showed that clear token rules help classroom staff stay on track. Both studies say the same thing: when the reward is obvious and immediate, behavior improves.
EbrahimiSani et al. (2020) and de Moraes et al. (2020) also used VR games with kids who have developmental disorders. They saw medium gains in motor skills, not attention. H et al. extend those results: reward-rich VR can now target inhibitory control too.
Wahl et al. (2016) looked at classroom games and found that extra teacher praise did not add power. That seems to clash with H et al., but the difference is who gives the praise. In Elaine’s study teachers already talked a lot; in H et al. the game itself delivered the praise, so it stood out.
Why it matters
You can borrow the coin-plus-praise recipe tomorrow. Run any computer task your kids like, drop in a small token icon after correct responses, and pair it with a quick "Nice work!" No fancy VR headset needed—just immediate, salient feedback. Expect sharper inhibitory control and fewer call-outs for impulsive behavior during independent work time.
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02At a glance
03Original abstract
<h4>Background</h4>Virtual reality (VR) serious games, due to their high level of freedom and realism, influence the rehabilitation training of inhibitory control abilities in children with attention-deficit/hyperactivity disorder (ADHD). Although reward feedback has a motivating effect on improving inhibitory control, the effectiveness and differences between various forms of rewards lack empirical research.<h4>Objective</h4>This study aimed to investigate the effectiveness of different forms of reward feedback on the inhibitory control abilities of children with attention deficits in a VR serious game environment.<h4>Methods</h4>This study focuses on children who meet the diagnostic criteria for ADHD tendencies, using a 2 (material rewards: coin reward and token reward) × 2 (psychological rewards: verbal encouragement and badge reward) factorial between-subject design (N=84), with a control group (n=15) for pre- and posttest experiments. The experimental group received VR feedback reinforcement training, while the control group underwent conventional VR training without feedback. The training period lasted 0.5 months, with each intervention session lasting 25 minutes, occurring twice daily with an interval of at least 5 hours for 28 sessions. Before and after training, the Swanson, Nolan, and Pelham, Version IV Scale (SNAP-IV) Scale, stop signal task, inhibition conflict task, and Simon task were administered to assess the hyperactivity index and the 3 components of inhibitory control ability. The pretest included the SNAP-IV Scale and 3 task tests to obtain baseline data; the posttest involved repeating the above tests after completing all training. Data were entered and analyzed using SPSS (IBM) software. Independent sample t tests were performed on the experimental and control groups' pre- and posttest task results to determine whether significant differences existed between group means. Paired sample t tests were also conducted on the SNAP-IV Scale's pre- and posttest results to assess the intervention effect's significance.<h4>Results</h4>Reward feedback was more effective than no reward feedback in improving behaviors related to attention deficits in children. Material rewards showed significant effects in the Stop-Signal Task (F<sub>1</sub>=13.04, P=.001), Inhibition Conflict Task (F<sub>1</sub>=7.34, P=.008), and SNAP-IV test (F<sub>1</sub>=69.23, P<.001); mental rewards showed significant effects in the Stop-Signal Task (F<sub>1</sub>=38.54, P<.001) and SNAP-IV test (F<sub>1</sub>=70.78, P<.001); the interaction between the 2 showed significant effects in the Stop-Signal Task (F<sub>1</sub>=4.47, P=.04) and SNAP-IV test (F<sub>1</sub>=23.85, P<.001).<h4>Conclusions</h4>Combining material and psychological rewards within a VR platform can effectively improve attention-deficit behaviors in children with ADHD, enhancing their inhibitory control abilities. Among these, coin rewards are more effective than token rewards, and verbal encouragement outperforms badge rewards. The combined feedback of coin rewards and verbal encouragement yields the most significant improvement in inhibitory control abilities.
, 2025 · doi:10.2196/67338