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REVIEW 3 major objections 4 minor 123 references

Understood: Real-Time Communication Support for Adults with ADHD Using Mixed Reality

T0 review · 3 major / 4 minor · reviewed 2026-08-06 · deepseek-v4-flash

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Pith's one-line read A mixed-reality system with real-time summaries and word hints shortens pauses and off-topic episodes for adults with ADHD, a 10-person study reports.

desk verdict A promising MR support system for adults with ADHD whose two headline effects rest on under-reported outcome definitions; worth serious refereeing but needs a measurement audit. read the letter →

arxiv 2507.18151 v2 pith:LVWVIRGW submitted 2025-07-24 cs.HC

Shizhen Zhang , Shengxin Li , Quan Li This is my paper
classification cs.HC
keywords ADHDMixedRealityCommunicationSupportConversationalFluencyHoloLensReal-TimeSummarizationWordSuggestionOff-TopicDetection
verification ladder T0 review T1 audit T2 compute T3 formal

The pith

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The reading

Understood is a mixed-reality system, worn on a HoloLens 2 headset, that tries to help adults with ADHD hold smoother conversations by putting three aids directly in their field of view: a running summary of what has been said, short word suggestions for moments when speech stalls, and a subtle color cue when the speaker drifts off topic. In a within-subjects lab study with ten ADHD adults, the paper reports that using the system significantly shortened the average duration of pauses (from about 6.2 to 4.2 seconds) and the average time spent off topic (from about 49 to 34 seconds), while self-reported usability stayed high. The authors read this as evidence that real-time, user-triggered assistive technology can help adults with ADHD recover faster from conversational disruptions, offering a complement to therapist-delivered training such as cognitive behavioral therapy and social skills training.

What carries the argument

The load-bearing object is Understood itself: a HoloLens 2 mixed-reality application whose three support panels are rendered in the user's field of view and called up by gaze. A GPT-4o backend repeatedly generates a 4-to-12-word summary of the most recent utterance, up to six words of suggested continuation from the full dialogue history, and a yes/no topic-relevance judgment that turns a trigger element red when the speaker goes off topic. The user study pairs this system with a divergent-to-convergent conversation task and supplementary spoken information, designed to reproduce working-memory load, disfluency, and attentional drift, and compares each participant with and without the system.

What would settle it

Take the recorded conversations and have independent human coders, blind to condition, mark every pause and off-topic episode from the audio, without seeing the system's cues or logs. If the with-system advantage in average pause and off-topic duration shrinks to noise, the reported fluency gain was an artifact of the scoring pipeline rather than a real change in conversation.

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Extended reading notes

Core claim

The central claim is that a mixed-reality communication assistant can improve conversational fluency for adults with ADHD without disrupting the interaction. Understood combines GPT-4o-powered conversation summarization, subsequent-word suggestion, and off-topic detection, all activated by the user glancing at a trigger element rather than by intrusive notifications. In the reported within-subjects comparison, participants using the system paused for significantly shorter stretches and returned from off-topic episodes significantly faster, though the number of pauses and off-topic responses did not differ between conditions. The paper interprets these results as showing that the system supports quicker recovery from the moments where ADHD-related executive dysfunction breaks the conversational flow, while leaving the frequency of those moments unchanged.

Load-bearing premise

The finding depends on the pause and off-topic durations being measured objectively from the recordings; the paper does not say who annotated them, how, or whether the same GPT-4o model that produces the off-topic reminders also judges off-topic duration, so the 'with system' condition could be favored by the measurement itself.

Editorial extensions

If this is right

  • If the recovery-time result holds, a wearable assistive layer can reduce the social cost of ADHD communication difficulties in everyday settings, even when it does not reduce how often those difficulties occur.
  • Because all support is user-triggered and time-limited, the system can be offered as a daily-life complement to therapist-mediated interventions rather than a replacement for skill-building therapy.
  • The significant usability ratings suggest such a system could be adopted by adults who do not have access to regular cognitive behavioral therapy or social skills training.
  • The design pattern of gaze-activated, fading panels with minimalist visuals gives a concrete template for other real-time assistive communication tools.
  • The reported faster recovery, if replicated, implies that the value of such systems should be measured by recovery time and off-topic duration, not only by event frequency.

Reading between the lines

Editorial extensions of the paper, not claims the author makes directly.

  • The study does not separate two explanations for faster recovery: the content of the suggestions and summaries versus the mere presence of an attention-focusing cue. A sham condition with generic or random prompts would test whether the specific AI content is necessary.
  • Because the off-topic detector's red cue and the study's off-topic-duration metric both depend on judging topic relevance, an independent annotation protocol with human raters blind to condition would be the natural confirmation that the measured effect is not an artifact of measurement.
  • If the recovery benefit transfers to unstructured real-world conversations, the same architecture could plausibly be adapted to other populations with conversational disfluency, such as second-language speakers, without redesigning the core interaction.
  • The reported reliance on the suggestion feature suggests a longitudinal test is needed: whether extended use improves independent fluency after the device is removed, or creates dependence that disappears when support is withdrawn.
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Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, and a circularity audit.

Referee Report

3 major / 4 minor

Summary. The paper presents Understood, a Mixed Reality (MR) system on the Microsoft HoloLens 2 that provides real-time conversation summarization, context-aware word suggestions, and off-topic detection with subtle reminders to support adults with ADHD in face-to-face communication. The design is grounded in semi-structured interviews with clinicians and adults with ADHD, followed by a participatory design workshop that produced five design goals. In a within-subjects study, ten adults with ADHD completed two conversation tasks, one with and one without the system. The authors report significant reductions in average pause duration (4.22±0.86 s vs. 6.17±0.76 s, p=0.002) and average off-topic duration (34.27±9.25 s vs. 49.12±6.40 s, p=0.014), alongside high usability ratings and generally favorable qualitative feedback. The paper also discusses design tensions such as support vs. self-reliance and positions the system as a complement to therapist-mediated interventions.

Significance. If the effectiveness results are credible, Understood is a valuable contribution to accessibility-oriented HCI: it addresses a real gap for adults with ADHD, uses a participatory and neurodiversity-affirming design process, and the system implementation is made openly available. The study design (within-subjects, counterbalanced, mixed methods) is appropriate for an initial evaluation, and the qualitative data provide useful design insights. However, the central quantitative claims currently rest on two performance metrics whose measurement procedure is not documented, which undermines the interpretability of the findings. The multiple-comparison issue further tempers the strength of the statistical claims. With the measurement protocol clarified and the analysis adjusted or repositioned as exploratory, the paper would provide a solid foundation for future work.

major comments (3)
  1. [§5.3 (User Performance) and §4.2.2 (Off-topic Detection Panel)] The two statistically significant outcomes, Average Pause Duration and Average Off-Topic Duration, lack any operational definition, extraction protocol, or annotation procedure. The paper does not state how pauses and off-topic episodes were defined (e.g., minimum pause threshold, episode boundaries), who annotated the recordings, whether annotators were blinded to condition, or whether inter-rater reliability was computed. This is load-bearing because the system itself contains a real-time GPT-4o-based off-topic classifier (§4.2.2), and if the off-topic metric in the With condition is derived from that classifier's logs, the comparison is partly circular and measures the detector's thresholds and latency rather than user recovery. The authors should report a codebook, apply the identical protocol to both conditions, and provide reliability statistics or, at minimum, a precise description of how each metric was derived from the video/audio recordings.
  2. [§5.3 (Statistical Analysis)] Four paired Wilcoxon tests are reported without adjustment for multiple comparisons. The off-topic duration result (p=0.014) does not survive a Bonferroni correction at alpha=0.0125, while the number of pauses and number of off-topics comparisons are non-significant. The authors should either apply a correction, pre-register a small set of primary hypotheses, or explicitly label these results as exploratory. As reported, the evidence for the central fluency claim is weaker than the p-values alone suggest.
  3. [§5.2 (Procedure)] The control condition is described as 'without it' but the manuscript does not state whether participants wore the HoloLens device during that condition. If the headset was not worn, the comparison conflates the system's assistance with the physical presence of the MR device, which may affect conversational behavior through social evaluation, gaze, or novelty effects. Please clarify whether the headset was worn and inactive in the without-Understood condition, or discuss this confound in the limitations.
minor comments (4)
  1. [§3.1.4] There is a spacing error in 'AsP3 explained' (should be 'As P3 explained'), and the sentence 'While medical treatments such as Concerta [77] can have been shown to alleviate communication difficulties' contains a grammatical error ('can have been shown') that should be corrected.
  2. [§5.2.1] The phrase 'including both their own input and that of the the researcher' contains a duplicated article 'the'; also, 'in the divergent phase... with allows for multiple valid answers' in §5.3.1 appears to be missing a word ('which allows for' or similar).
  3. [Figure 9] The figure label 'Random&Even Assignment' would benefit from a space and a more descriptive caption; as printed, it is difficult to parse alongside the surrounding text.
  4. [§4.3 and §5.2] The statement that 'All spoken dialogue is processed in real time and is neither stored locally nor retained post-session' seems to conflict with the later statement that 'All study sessions were conducted in person and recorded – with participant consent – for subsequent analysis.' Please clarify whether the system's audio processing pipeline and the external session recordings are separate, and how consent covered both.

Circularity Check

1 steps flagged · score 4.0 of 10

The off-topic-duration claim may reduce to the system's own GPT-4o detector: the paper never documents how the two significant fluency metrics were measured, and the only described off-topic operationalization is the internal classifier that also issues the reminder.

  1. other [Section 5.3 (Regarding User Performance), metrics list; Section 4.2.2 (Off-topic Detection Panel); Appendix C.3]
    "There was a notable reduction in Average Pause Duration (With: 4.22±0.86 seconds; Without: 6.17±0.76 seconds; p = 0.002) and Average Off-Topic Duration (With: 34.27±9.25 seconds; Without: 49.12±6.40 seconds; p = 0.014). ... Our system continuously monitors ongoing speech and context. It sends the combined input to GPT-4o to assess topic relevance (the prompt is given in subsection C.3). If off-topic content is detected, the trigger gradually shifts to a deeper red hue, serving as a soft visual alert."

    Section 5.3 reports the significant Off-Topic Duration reduction but never defines how off-topic episodes were segmented or scored in either condition — no codebook, annotator count, blinding, or inter-rater reliability. The only operationalization of 'off-topic' in the paper is the GPT-4o binary judgment in §4.2.2 (prompt C.3: report 'Yes' if the utterance deviates). If the With-condition metric is computed from that same detector, the measured 'recovery' is the user responding to the system's own red cue, and the duration is bounded by the detector's thresholds and latency: the outcome variable is defined by the intervention's internal classifier.

full rationale

The paper's derivation chain is: formative interviews → design goals (DG1–DG5) → system features → within-subjects evaluation. Most of that chain is self-contained and non-circular: the design goals are grounded in interview data, the system implements those goals, and the usability claims rest on standard questionnaire items (SUS/NASA-TLX adaptations). The abstract's effectiveness claim, however, rests almost entirely on two paired comparisons — Average Pause Duration (p = 0.002) and Average Off-Topic Duration (p = 0.014) — and the paper nowhere documents how either metric was extracted, segmented, or scored. The off-topic metric is the more serious case: the only off-topic operationalization described anywhere in the paper is the GPT-4o classifier in §4.2.2 (prompt in C.3, output 'Yes'/'No'), and no independent annotation procedure is reported. If the With-condition duration is read from that same classifier's logs, the 'improvement' is the user responding to the system's own red cue, so the outcome variable is defined by the intervention's internal model — a partial, condition-specific circularity. Because the paper is silent on the measurement protocol, this identity cannot be verified or refuted from the text, which is why I do not place the score at 6 (confirmed reduction by construction); independent offline annotation remains a live possibility. The pause metric is also unanchored: the paper's own limitation acknowledges reliance on the HoloLens single-source microphone and Azure speech services (§6.5), and no capture or segmentation protocol for the without-condition audio is given, so asymmetric measurement between conditions is possible. The one same-author citation ([96], Trinity, used only to inform the study procedure alongside four external references) is minor and not load-bearing. Statistical concerns — four Wilcoxon tests without multiple-comparison correction, where the off-topic p = 0.014 would not survive a Bonferroni threshold of 0.0125 — belong to correctness risk rather than circularity. Overall, the design and usability portions are genuinely self-contained, but the central quantitative fluency claim is entangled with an undocumented metric that may be the system's own judgment, justifying a moderate circularity score rather than a clean 0–2.

Assumptions & free parameters 4 free parameters · 4 assumptions · 0 invented entities

The system's design depends on several hand-set constants (panel timeout, refresh rate, word-count limits) and on external model behavior, but it introduces no new physical or conceptual entities. The evaluation rests on assumptions about the reliability of the measures and the representativeness of the participant sample.

free parameters (4)
  • Auxiliary panel display duration = 5 seconds
    Panels automatically fade after five seconds; chosen by the design team to balance readability and non-intrusiveness, not derived from user data.
  • Word suggestion refresh interval = 1 second
    System sends GPT-4o requests every 1 second; a hand-set latency/completeness tradeoff.
  • Summarization length bound = 4 to 12 words
    Prompt instructs GPT-4o to output 4 to 12 keyword-style terms; a design heuristic.
  • Word suggestion length bound = under 6 words
    Prompt restricts suggestions to short phrases (<6 words) to limit cognitive load.
assumptions (4)
  • domain assumption The three communication challenges (working memory deficits, disfluency, attentional anchoring failures) are the key barriers for adults with ADHD and are the right targets for a support system.
    Derived from interviews with 4 clinicians and 12 adults with ADHD (Section 3.1), but these are a small, self-selected sample.
  • domain assumption Azure AI Speech and GPT-4o provide sufficiently accurate speech-to-text and language generation for real-time support; no independent accuracy evaluation is reported.
    System relies on external cloud services (Section 4.3); hallucination rates are acknowledged in Section 5.3.
  • standard math Wilcoxon matched-pairs signed-ranks tests are appropriate for the four paired performance metrics with N=10.
    Standard nonparametric test for paired data; no normality assumption required.
  • domain assumption Participants recruited from a local university adequately represent the broader adult ADHD population for the purposes of this lab study.
    Acknowledged as a limitation in Section 6.5; sample is young (mean 21.3) and university-based.

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Cite this review

Pith. "Pith review of Understood: Real-Time Communication Support for Adults with ADHD Using Mixed Reality." pith.science (2026). https://pith.science/paper/LVWVIRGW

@misc{pith2026250718151,
  author       = {Pith},
  title        = {Pith review of: Understood: Real-Time Communication Support for Adults with ADHD Using Mixed Reality},
  year         = {2026},
  howpublished = {\url{https://pith.science/paper/LVWVIRGW}},
  note         = {Machine review of arXiv:2507.18151}
}
read the original abstract

Adults with Attention Deficit Hyperactivity Disorder (ADHD) often experience communication challenges, primarily due to executive dysfunction and emotional dysregulation, even after years of social integration. While existing interventions predominantly target children through structured or intrusive methods, adults lack tools that translate clinical strategies into daily communication support. To address this gap, we present Understood, a Mixed Reality (MR) system implemented on Microsoft HoloLens 2, designed to assist adults with ADHD in real-world communication. Through formative semi-structured interviews and a design workshop, we identified critical communication barriers and derived design goals for the system. Understood combines three key features: (1) real-time conversation summarization to reduce cognitive load, (2) context-aware subsequent word suggestions during moments of disfluency, and (3) topic shifting detection and reminding to mitigate off-topic transitions. A within-subjects user study and expert interviews demonstrate that Understood effectively supports communication with high usability, offering a complement to therapist-mediated interventions.

Figures

Figures reproduced from arXiv: 2507.18151 by the authors.

Figure 1
Figure 1. Example scenario using Understood. (A) Individuals with ADHD may face difficulties navigating real-world commu￾nication scenarios, often struggling with attention regulation and conversational flow. (B) To seek support, the user adopts the HoloLens headset and activates Understood. The system provides real-time conversation summarization, context-aware subsequent word suggestions, and topic shifting detections and r… view at source ↗
Figure 2
Figure 2. An overview of the formative study procedure. The blue boxes are different research activities while the gray boxes [PITH_FULL_IMAGE:figures/full_fig_p004_2.png] view at source ↗
Figure 3
Figure 3. An overview of communication challenges encoun [PITH_FULL_IMAGE:figures/full_fig_p005_3.png] view at source ↗
Figures from the paper (8 more)
Figure 4
Figure 4. Figure 4: Storyboard No.4: Provides real-time word sugges [PITH_FULL_IMAGE:figures/full_fig_p007_4.png]
Figure 5
Figure 5. Figure 5: Overview of the full interaction flow in [PITH_FULL_IMAGE:figures/full_fig_p009_5.png]
Figure 6
Figure 6. Figure 6: Example of Auxiliary Functions Selection: A) The [PITH_FULL_IMAGE:figures/full_fig_p009_6.png]
Figure 8
Figure 8. Figure 8: Conversation Phase Interface: A) No gaze directed [PITH_FULL_IMAGE:figures/full_fig_p010_8.png]
Figure 7
Figure 7. Figure 7: An example usage scenario of Understood under a real-world setting. Icon Function Description Self Summarization Summarize user’s speech Other Summarization Summarize partner’s speech Word Suggestions Suggest subsequent words Off-topic Detection Detect if speech is off…
Figure 9
Figure 9. Figure 9: User study and procedure for evaluating the effectiveness and usability of [PITH_FULL_IMAGE:figures/full_fig_p012_9.png]
Figure 10
Figure 10. Figure 10: User study results of (A) User Performance with [PITH_FULL_IMAGE:figures/full_fig_p014_10.png]
Figure 11
Figure 11. Figure 11: Summarized version of the storyboards used in our design workshop. [PITH_FULL_IMAGE:figures/full_fig_p021_11.png]

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Works this paper leans on

123 extracted references · 71 canonical work pages

  1. [1]

    Abdelrahman Abouelenin, Atabak Ashfaq, Adam Atkinson, Hany Awadalla, Nguyen Bach, Jianmin Bao, Alon Benhaim, Martin Cai, Vishrav Chaudhary, Congcong Chen, et al. 2025. Phi-4-mini technical report: Compact yet powerful multimodal language models via mixture-of-loras.arXiv preprint arXiv:2503.01743 (2025)

    arXiv 2025

  2. [2]

    Lynda A Anderson and Patricia A Sharpe. 1991. Improving patient and provider communication: a synthesis and review of communication interventions. Patient Education and Counseling 17, 2 (1991), 99–134

    1991

  3. [3]

    Kevin M Antshel and Amy K Olszewski. 2014. Cognitive behavioral therapy for adolescents with ADHD. Child and Adolescent Psychiatric Clinics 23, 4 (2014), 825–842

    2014

  4. [4]

    Kristy L Armitage, Adam Bulley, and Jonathan Redshaw. 2020. Developmental origins of cognitive offloading. Proceedings of the Royal Society B 287, 1928 (2020), 20192927

    2020

  5. [5]

    American Psychiatric Association et al. 2013. Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association

    2013

  6. [6]

    Lorian Baker and Dennis P Cantwell. 1992. Attention deficit disorder and speech/language disorders. Comprehensive mental health care (1992)

    1992

  7. [7]

    Russell A Barkley. 2004. Attention-deficit/hyperactivity disorder and self- regulation. Handbook of self-regulation 302 (2004)

    2004

  8. [8]

    2007.ADHD in adults: What the science says

    Russell A Barkley, Kevin R Murphy, and Mariellen Fischer. 2007.ADHD in adults: What the science says . Guilford Press, Chapter 13, 407–410

    2007

Show all 123 references
  1. [9]

    Marcella Bellani, Anna Moretti, Cinzia Perlini, and Paolo Brambilla. 2011. Lan- guage disturbances in ADHD. Epidemiology and Psychiatric Sciences 20, 4 (2011), 311–315

    2011

  2. [10]

    Carlos Bermejo, Tristan Braud, Ji Yang, Shayan Mirjafari, Bowen Shi, Yu Xiao, and Pan Hui. 2020. VIMES: A Wearable Memory Assistance System for Automatic Information Retrieval. In Proceedings of the 28th ACM International Conference on Multimedia (Seattle, WA, USA) (MM ’20). A...

    2020

  3. [11]

    A Marije Boonstra, Jaap Oosterlaan, Joseph A Sergeant, and Jan K Buitelaar. 2005. Executive functioning in adult ADHD: a meta-analytic review. Psychological medicine 35, 8 (2005), 1097–1108

    2005

  4. [12]

    John Brooke et al. 1996. SUS-A quick and dirty usability scale.Usability evaluation in industry 189, 194 (1996), 4–7

    1996

  5. [13]

    Runze Cai, Nuwan Nanayakkarawasam Peru Kandage Janaka, Shengdong Zhao, and Minghui Sun. 2023. ParaGlassMenu: Towards Social-Friendly Subtle Inter- actions in Conversations. In Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems . 1–21

    2023

  6. [14]

    Arthur Caye, James M Swanson, David Coghill, and Luis Augusto Rohde. 2019. Treatment strategies for ADHD: an evidence-based guide to select optimal treat- ment. Molecular psychiatry 24, 3 (2019), 390–408

    2019

  7. [15]

    Franceli L Cibrian, Kimberley D Lakes, Sabrina EB Schuck, and Gillian R Hayes

  8. [16]

    Cummings

    David Glenn Clark and Jeffrey L. Cummings. 2003. Chapter 25 - Aphasia. In Neu- rological Disorders (Second Edition) (second edition ed.), Thomas Brandt, Louis R. Caplan, Johannes Dichgans, H. Christoph Diener, and Christopher Kennard (Eds.). Academic Press, San Diego, 265–275....

    2003 doi

  9. [17]

    Kameron K Clayton, Meenakshi M Asokan, Yurika Watanabe, Kenneth E Hancock, and Daniel B Polley. 2021. Behavioral approaches to study top-down influences on active listening. Frontiers in Neuroscience 15 (2021), 666627. 9https://www.irasutoya.com/

    2021

  10. [18]

    Linda M Collins, Susan A Murphy, Vijay N Nair, and Victor J Strecher. 2005. A strategy for optimizing and evaluating behavioral interventions. Annals of Behavioral Medicine 30, 1 (2005), 65–73

    2005

  11. [19]

    Humphrey Curtis, Adam D G Jenkins, Seray B Ibrahim, and Timothy Neate. 2024. Looking Past Screens: Exploring Mixed Reality and Discreet AAC Devices. In Proceedings of the 26th International ACM SIGACCESS Conference on Computers and Accessibility (St. John’s, NL, Canada)(ASSETS...

    2024

  12. [20]

    David Daley, Saskia Van der Oord, Maite Ferrin, Marina Danckaerts, Manfred Doepfner, Samuele Cortese, Edmund JS Sonuga-Barke, European ADHD Guidelines Group, et al . 2014. Behavioral interventions in attention- deficit/hyperactivity disorder: a meta-analysis of randomized cont...

    2014

  13. [21]

    Vollebregt, Ute Strehl, and Sandra K

    Jessica Van Doren, Martijn Arns, Hartmut Heinrich, Madelon A. Vollebregt, Ute Strehl, and Sandra K. Loo. 2019. Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. European Child & Adolescent Psychiatry 28, 3 (2019), 293–305. doi:10.1007/s00787-01...

    2019 doi

  14. [22]

    Bethan M Edwards, Monica Busse, Teena J Clouston, and Ben Hannigan. 2024. Real-world occupational therapy interventions for early-stage dementia: Charac- teristics and contextual barriers. Dementia (2024), 14713012241272815

    2024

  15. [23]

    Amira Mohamed El Tohamy, Shaymaa Rushdy, Marwa Gamal, and Alaa Noureldeen Kora. 2019. Context Focused Therapy for Children: Theory, Principle and Protocol. BioScientific Review 1, 2 (2019), 13–20

    2019

  16. [24]

    Yasmin Elsahar, Sijung Hu, Kaddour Bouazza-Marouf, David Kerr, and Annysa Mansor. 2019. Augmentative and Alternative Communication (AAC) Advances: A Review of Configurations for Individuals with a Speech Disability. Sensors (Basel) 19, 8 (2019), 1911. doi:10.3390/s19081911 Rev...

    2019 doi

  17. [25]

    Stefanie Enriquez-Geppert, Diede Smit, Miguel Garcia Pimenta, and Martijn Arns

  18. [26]

    Elena Even-Simkin. 2024. Assessment of pragmatic skills in adults with ADHD. Language and Health 2, 1 (2024), 66–78. doi:10.1016/j.laheal.2024.02.002

    2024 doi

  19. [27]

    Lior Fink, Leorre Newman, and Uriel Haran. 2024. Let me decide: Increasing user autonomy increases recommendation acceptance. Computers in Human Behavior 156 (2024), 108244

    2024

  20. [28]

    Lydia Furman. 2005. What is attention-deficit hyperactivity disorder (ADHD)? Journal of child neurology 20, 12 (2005), 994–1002

    2005

  21. [29]

    Phil Garnham. 2017. Get to grips with accessible web typography. https://www. creativebloq.com/features/master-accessible-web-typography

    2017

  22. [30]

    Jenny Gibson, Catherine Adams, Elaine Lockton, and Jonathan Green

  23. [31]

    Ömer Gökel and Gökmen Dağlı. 2017. Effects of social skill training program on social skills of young people. Eurasia Journal of Mathematics, Science and Technology Education 13, 11 (2017), 7365–7373

    2017

  24. [32]

    Steve Graham, Karen R Harris, and Robert Reid. 1992. Developing self-regulated learners. Focus on Exceptional children 24, 6 (1992)

    1992

  25. [33]

    Sandra Grinschgl, Frank Papenmeier, and Hauke S Meyerhoff. 2021. Conse- quences of cognitive offloading: Boosting performance but diminishing memory. Quarterly Journal of Experimental Psychology 74, 9 (2021), 1477–1496

    2021

  26. [34]

    Daya Guo, Dejian Yang, Haowei Zhang, Junxiao Song, Ruoyu Zhang, Runxin Xu, Qihao Zhu, Shirong Ma, Peiyi Wang, Xiao Bi, et al . 2025. Deepseek-r1: Incentivizing reasoning capability in llms via reinforcement learning. arXiv preprint arXiv:2501.12948 (2025)

    2025 arXiv

  27. [35]

    Gunnar Harboe and Elaine M Huang. 2015. Real-world affinity diagramming practices: Bridging the paper-digital gap. In Proceedings of the 33rd annual ACM conference on human factors in computing systems . 95–104

    2015

  28. [36]

    Sandra G Hart. 1986. NASA task load index (TLX). (1986)

    1986

  29. [37]

    Lundervold

    Wenche Andersen Helland, Maj-Britt Posserud, Turid Helland, Mikael Heimann, and Astri J. Lundervold. 2016. Language Impairments in Chil- dren With ADHD and in Children With Reading Disorder. Journal of Attention Disorders 20, 7 (2016), 581–589. doi:10.1177/1087054712461530 arX...

    2016 doi

  30. [38]

    Kizilcec, Dominic DiFranzo, Zhila Aghajari, Hannah Mieczkowski, Karen Levy, Mor Naaman, Jeffrey Hancock, and Malte F

    Jess Hohenstein, Rene F. Kizilcec, Dominic DiFranzo, Zhila Aghajari, Hannah Mieczkowski, Karen Levy, Mor Naaman, Jeffrey Hancock, and Malte F. Jung

  31. [39]

    Aaron Hurst, Adam Lerer, Adam P Goucher, Adam Perelman, Aditya Ramesh, Aidan Clark, AJ Ostrow, Akila Welihinda, Alan Hayes, Alec Radford, et al. 2024. GPT-4o System Card. arXiv preprint arXiv:2410.21276 (2024)

    2024 arXiv

  32. [40]

    Dimitra V Katsarou, Efthymia Efthymiou, Georgios A Kougioumtzis, Maria So- fologi, and Maria Theodoratou. 2024. Identifying Language Development in Understood: Real-Time Communication Support for Adults with ADHD Using Mixed Reality UIST ’25, September 28-October 1, 2025, Busa...

    2024

  33. [41]

    Martin A Katzman, Timothy S Bilkey, Pratap R Chokka, Angelo Fallu, and Larry J Klassen. 2017. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry 17 (2017), 1–15

    2017

  34. [42]

    Keshav, Kevin Vogt-Lowell, Arshya Vahabzadeh, and Ned T

    Neha U. Keshav, Kevin Vogt-Lowell, Arshya Vahabzadeh, and Ned T. Sahin

  35. [43]

    Jeff Klingner, Barbara Tversky, and Pat Hanrahan. 2011. Effects of visual and verbal presentation on cognitive load in vigilance, memory, and arithmetic tasks. Psychophysiology 48, 3 (2011), 323–332

    2011

  36. [44]

    Michael J Kofler, Jamie A Spiegel, Elia F Soto, Lauren N Irwin, Erica L Wells, and Kristin E Austin. 2019. Do working memory deficits underlie reading problems in attention-deficit/hyperactivity disorder (ADHD)? Journal of abnormal child psychology 47 (2019), 433–446

    2019

  37. [45]

    JJS Kooij, MH Francken, TI Bron, and Dora Wynchank. 2019. DIVA-5. Wywiad diagnostyczny ADHD u dorosłych, Haga (2019)

    2019

  38. [46]

    Sandra JJ Kooij, Susanne Bejerot, Andrew Blackwell, Herve Caci, Miquel Casas- Brugué, Pieter J Carpentier, Dan Edvinsson, John Fayyad, Karin Foeken, Michael Fitzgerald, et al. 2010. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adu...

    2010

  39. [47]

    Children 6, 6 (2019)

    Digital Attention-Related Augmented-Reality Game: Significant Corre- lation between Student Game Performance and Validated Clinical Measures of Attention-Deficit/Hyperactivity Disorder (ADHD). Children 6, 6 (2019). doi:10.3390/children6060072

    2019 doi

  40. [48]

    Gary W Ladd and Jacquelyn Mize. 1983. A cognitive–social learning model of social-skill training. Psychological review 90, 2 (1983), 127

    1983

  41. [49]

    Wayne Leahy and John Sweller. 2016. Cognitive load theory and the effects of transient information on the modality effect. Instructional science 44 (2016), 107–123

    2016

  42. [50]

    Andrés Lucero. 2015. Using affinity diagrams to evaluate interactive prototypes. In Human-Computer Interaction–INTERACT 2015: 15th IFIP TC 13 International Conference, Bamberg, Germany, September 14-18, 2015, Proceedings, Part II 15 . Springer, 231–248

    2015

  43. [51]

    Dalton Maag. 2018. BBC Reith. https://www.daltonmaag.com/portfolio/custom- fonts/bbc-reith.html

    2018

  44. [52]

    Rebecca Kornmehl. 2025. The Power of Autonomy for Neurodivergent Tal- ent. https://www.theresultscoach.com.au/blog/the-power-of-autonomy-for- neurodivergent-talent

    2025

  45. [53]

    Markowitsch

    Hans J. Markowitsch. 2003. Chapter 27 - Memory: Disturbances and Therapy. In Neurological Disorders (Second Edition) (second edition ed.), Thomas Brandt, Louis R. Caplan, Johannes Dichgans, H. Christoph Diener, and Christopher Ken- nard (Eds.). Academic Press, San Diego, 287–3...

    2003 doi

  46. [54]

    Rhonda Martinussen and Rosemary Tannock. 2006. Working memory impair- ments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal of clinical and experimental neu- ropsychology 28, 7 (2006), 1073–1094

    2006

  47. [55]

    Margaret E Mathers. 2006. Aspects of language in children with ADHD: Applying functional analyses to explore language use. Journal of Attention Disorders 9, 3 (2006), 523–533

    2006

  48. [56]

    Yuki Matsuura, Tsutomu Terada, Tomohiro Aoki, Susumu Sonoda, Naoya Isoyama, and Masahiko Tsukamoto. 2019. Readability and legibility of fonts considering shakiness of head mounted displays. In Proceedings of the 2019 ACM International Symposium on Wearable Computers (London, U...

    2019

  49. [57]

    Luke Maras and Elizabeth Hill. 2024. The effect (s) of medication on language in Attention Deficit-Hyperactivity Disorder: A scoping review protocol. (2024)

    2024

  50. [58]

    Amori Yee Mikami. 2015. Social skills training for youth with ADHD. (2015)

    2015

  51. [59]

    Amori Yee Mikami, Sophie Smit, and Adri Khalis. 2017. Social skills training and ADHD—what works? Current psychiatry reports 19 (2017), 1–9

    2017

  52. [60]

    OpenAI. 2025. OpenAI o3-mini System Card. https://cdn.openai.com/o3-mini- system-card-feb10.pdf

    2025

  53. [61]

    Janet M Ossmann and Neil W Mulligan. 2003. Inhibition and attention deficit hyperactivity disorder in adults. The American journal of psychology 116, 1 (2003), 35–50

    2003

  54. [62]

    Alison McInnes, Tom Humphries, Sheilah Hogg-Johnson, and Rosemary Tannock

  55. [63]

    Marine Pagliari, Valérian Chambon, and Bruno Berberian. 2022. What is new with Artificial Intelligence? Human–agent interactions through the lens of social agency. Frontiers in psychology 13 (2022), 954444

    2022

  56. [64]

    Pezhman Raeisian Parvari, Damian Schofield, Jolanda Tromp, and Chung Văn Lê. 2025. Confident Talk, AI and VR-Powered Speech Support for Enhancing Communication in Individuals with ADHD. In Advances in Information and Communication, Kohei Arai (Ed.). Springer Nature Switzerland...

    2025

  57. [65]

    Adnan Rajeh, Shabbir Amanullah, K Shivakumar, and Julie Cole. 2017. Interven- tions in ADHD: A comparative review of stimulant medications and behavioral therapies. Asian journal of psychiatry 25 (2017), 131–135

    2017

  58. [66]

    Thomas M Reimers, David P Wacker, and Gina Koeppl. 1987. Acceptability of behavioral interventions: A review of the literature. School Psychology Review 16, 2 (1987), 212–227

    1987

  59. [67]

    Evan F Risko and Sam J Gilbert. 2016. Cognitive offloading. Trends in cognitive sciences 20, 9 (2016), 676–688

    2016

  60. [68]

    Amy Wanyu Ou, Christian Stöhr, and Hans Malmström. 2024. Academic com- munication with AI-powered language tools in higher education: From a post- humanist perspective. System 121 (2024), 103225. doi:10.1016/j.system.2024. 103225

    2024 doi

  61. [69]

    Elise Roy. 2016. When we design for disability, we all benefit | Elise Roy. https: //youtu.be/g2m97gPI70I

    2016

  62. [70]

    Steven A Safren. 2006. Cognitive-behavioral approaches to ADHD treatment in adulthood. Journal of clinical Psychiatry 67 (2006), 46

    2006

  63. [71]

    Mike Scaife and Yvonne Rogers. 1996. External cognition: how do graphical representations work? International journal of human-computer studies 45, 2 (1996), 185–213

    1996

  64. [72]

    Helena Sehlin, Britt Hedman Ahlström, Gerhard Andersson, and Elisabet Wentz

  65. [73]

    Lucas M Silva, Franceli L Cibrian, Elissa Monteiro, Arpita Bhattacharya, Jesus A Beltran, Clarisse Bonang, Daniel A Epstein, Sabrina EB Schuck, Kimberley D Lakes, and Gillian R Hayes. 2023. Unpacking the lived experiences of smartwatch mediated self and co-regulation with ADHD...

    2023

  66. [74]

    Fereshteh Roshani, Reza Piri, Ayyoub Malek, Tanja Maria Michel, and Manouchehr Seyedi Vafaee. 2020. Comparison of cognitive flexibility, appropri- ate risk-taking and reaction time in individuals with and without adult ADHD. Psychiatry Research 284 (2020), 112494

    2020

  67. [75]

    Tobias Sonne, Jörg Müller, Paul Marshall, Carsten Obel, and Kaj Grønbæk. 2016. Changing family practices with assistive technology: MOBERO improves morn- ing and bedtime routines for children with ADHD. In Proceedings of the 2016 CHI conference on human factors in computing sy...

    2016

  68. [76]

    Thomas J Spencer, Lenard A Adler, Richard H Weisler, and Sharon H Youcha. 2008. Triple-bead mixed amphetamine salts (SPD465), a novel, enhanced extended- release amphetamine formulation for the treatment of adults with ADHD: a randomized, double-blind, multicenter, placebo-con...

    2008

  69. [77]

    Janssen United States. 2023. CONCERTA Prescribing Information. https: //www.janssenlabels.com/package-insert/product-monograph/prescribing- information/CONCERTA-pi.pdf

    2023

  70. [78]

    Evropi Stefanidi, Johannes Schöning, Yvonne Rogers, and Jasmin Niess. 2023. Children with ADHD and their care ecosystem: designing beyond symptoms. In Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems . 1–17

    2023

  71. [79]

    Ole Jakob Storebø, Mette Elmose Andersen, Maria Skoog, Signe Joost Hansen, Erik Simonsen, Nadia Pedersen, Britta Tendal, Henriette E Callesen, Erlend Faltinsen, and Christian Gluud. 2019. Social skills training for attention deficit hyperactivity disorder (ADHD) in children ag...

    2019

  72. [80]

    Craig BH Surman, Joseph Biederman, Thomas Spencer, Carolyn A Miller, Katie M McDermott, and Stephen V Faraone. 2013. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. ADHD Attention Deficit and Hypera...

    2013

  73. [81]

    Mary V Solanto. 2011. Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction. Guilford Press

    2011

  74. [82]

    Rosemary Tannock. 2018. ADHD and communication disorders. Oxford textbook of attention deficit hyperactivity disorder (2018), 261–272

    2018

  75. [83]

    Maria Theodoratou. 2024. Communication issues in co-occurring ADHD and autism spectrum disorders. Evaluative approaches and targeted interventions: mini review. Postępy Psychiatrii i Neurologii (Advances in Psychiatry and Neurol- ogy) 33, 3 (September 2024), 188–195. doi:10.51...

    2024

  76. [84]

    Khai N Truong, Gillian R Hayes, and Gregory D Abowd. 2006. Storyboarding: an empirical determination of best practices and effective guidelines. In Proceedings of the 6th conference on Designing Interactive systems . 12–21

    2006

  77. [85]

    Quentin Vantrepotte, Bruno Berberian, Marine Pagliari, and Valérian Chambon

  78. [86]

    Steeven Villa, Yannick Weiss, Mei Yi Lu, Moritz Ziarko, Albrecht Schmidt, and Jasmin Niess. 2024. Envisioning Futures: How the Modality of AI Recommenda- tions Impacts Conversation Flow in AR-enhanced Dialogue. In Proceedings of the 26th International Conference on Multimodal ...

    2024

  79. [87]

    Paul H Wender, Lorraine E Wolf, and Jeanette Wasserstein. 2001. Adults with ADHD: An overview. Annals of the New York academy of sciences 931, 1 (2001), 1–16

    2001

  80. [88]

    Paul G Swingle. 2008. Biofeedback for the brain: How neurotherapy effectively treats depression, ADHD, autism, and more . Rutgers university press

    2008

  81. [89]

    Carol Westby and Silvana MR Watson. 2021. ADHD and communication disorders. The handbook of language and speech disorders (2021), 529–570

    2021

  82. [90]

    Sarah Wilkes-Gillan, Alycia Cantrill, Lauren Parsons, Cally Smith, and Reinie Cordier. 2017. The pragmatic language, communication skills, parent–child rela- tionships, and symptoms of children with ADHD and their playmates 18-months after a parent-delivered play-based interve...

    2017

  83. [91]

    Wilkinson

    Krista M. Wilkinson. 1998. Profiles of language and communication skills in autism. Mental Retardation and Developmental Disabilities Research Reviews 4 (1998), 73–79. https://api.semanticscholar.org/CorpusID:17828976

    1998

  84. [92]

    Gareth Ford Williams. 2020. A Guide to Understanding What Makes a Typeface Accessible. https://medium.com/the-readability-group/a-guide- to-understanding-what-makes-a-typeface-accessible-and-how-to-make- informed-decisions-9e5c0b9040a0

    2020

  85. [93]

    Cognition 222 (2022), 105020

    Leveraging human agency to improve confidence and acceptability in human-machine interactions. Cognition 222 (2022), 105020

    2022

  86. [94]

    Chauncey Wilson. 2013. Brainstorming and beyond: a user-centered design method . Newnes

    2013

  87. [95]

    Ka Po Wong and Jing Qin. 2023. Effectiveness of Social Virtual Reality Training in Enhancing Social Interaction Skills in Children With Attention- Deficit/Hyperactivity Disorder: Protocol for a Three-Arm Pilot Randomized Controlled Trial. JMIR Research Protocols 12, 1 (2023), e48208

    2023

  88. [96]

    Klaus Wertenbroch, Rom Y Schrift, Joseph W Alba, Alixandra Barasch, Amit Bhattacharjee, Markus Giesler, Joshua Knobe, Donald R Lehmann, Sandra Matz, Gideon Nave, et al. 2020. Autonomy in consumer choice. Marketing letters 31 (2020), 429–439

    2020

  89. [97]

    Junjie Ye, Xuanting Chen, Nuo Xu, Can Zu, Zekai Shao, Shichun Liu, Yuhan Cui, Zeyang Zhou, Chao Gong, Yang Shen, et al. 2023. A comprehensive capability analysis of gpt-3 and gpt-3.5 series models.arXiv preprint arXiv:2303.10420 (2023)

    2023 arXiv

  90. [98]

    Liuchuan Yu, Huining Feng, Rawan Alghofaili, Boyoung Byun, Tiffany O’Neal, Swati Rampalli, Yoosun Chung, Vivian Genaro Motti, and Lap-Fai Yu. 2024. HoloAAC: A Mixed Reality AAC Application for People with Expressive Lan- guage Difficulties. In Virtual, Augmented and Mixed Real...

    2024

  91. [99]

    Wazeer Deen Zulfikar, Samantha Chan, and Pattie Maes. 2024. Memoro: Us- ing large language models to realize a concise interface for real-time memory augmentation. In Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems. 1–18. Understood: Real-Time Comm...

    2024

  92. [101]

    Danielle Willis, E Rebekah Siceloff, Melanie Morse, Emily Neger, and Kate Flory

  93. [102]

    Clinical Child and Family Psychology Review 22 (2019), 348–366

    Stand-alone social skills training for youth with ADHD: A systematic review. Clinical Child and Family Psychology Review 22 (2019), 348–366

    2019

  94. [105]

    Yuchen Wu, Shengxin Li, Shizhen Zhang, Xingbo Wang, and Quan Li. 2024. Trin- ity: Synchronizing Verbal, Nonverbal, and Visual Channels to Support Academic Oral Presentation Delivery. arXiv preprint arXiv:2411.17015 (2024)

    2024 arXiv

  95. [109]

    2, 2, 2, 3 6

    I do not like reading due to mental effort. 2, 2, 2, 3 6

  96. [110]

    2, 3, 3, 3 10

    I have difficulty on speaking fluently in a long sentence. 2, 3, 3, 3 10

  97. [111]

    2, 3, 3, 3 9

    I have difficulty concentrating on a conversation. 2, 3, 3, 3 9

  98. [112]

    2, 3, 3, 3 8

    I often change the subject of the conversation. 2, 3, 3, 3 8

  99. [113]

    2, 2, 3, 3 7

    I easily get distracted by the conversations of others. 2, 2, 3, 3 7

  100. [114]

    3, 3, 3, 3 9

    I have difficulty in filtering and/or selecting information. 3, 3, 3, 3 9

  101. [115]

    2, 2, 3, 3 6

    I talk during activities when this is not appropriate. 2, 2, 3, 3 6

  102. [116]

    1, 2, 2, 3 5

    I have difficulty in speaking softly. 1, 2, 2, 3 5

  103. [117]

    2, 2, 3, 3 8

    I have a tendency to talk too much. 2, 2, 3, 3 8

  104. [118]

    2, 2, 3, 3 6

    I do not give others room to interject during a conversation. 2, 2, 3, 3 6

  105. [119]

    2, 2, 3, 3 8

    I need a lot of words to say something. 2, 2, 3, 3 8

  106. [120]

    3, 3, 3, 3 11

    I have difficulty waiting my turn during conversations. 3, 3, 3, 3 11

  107. [121]

    2, 3, 3, 3 8

    I interrupt others frequently. 2, 3, 3, 3 8

  108. [122]

    2, 3, 3, 3 9

    I give people answers before they have finished speaking. 2, 3, 3, 3 9

  109. [123]

    Yes” if the utterance deviates from the topic, or “No

    I say things without thinking first. 2, 3, 3, 3 9 Table 3: The 15 statements derived from DIV A-5 regarding the communication challenges on individuals with ADHD, with the ratings by clinicians and occurrences on individuals with ADHD for each statement. B Summarized Storyboar...

    2025

  110. [2003]

    Journal of abnormal child psychology 31 (2003), 427–443

    Listening comprehension and working memory are impaired in attention- deficit hyperactivity disorder irrespective of language impairment. Journal of abnormal child psychology 31 (2003), 427–443

    2003

  111. [2013]

    Journal of Child Psy- chology and Psychiatry 54, 11 (2013), 1186–1197

    Social communication disorder outside autism? A diagnostic classifi- cation approach to delineating pragmatic language impairment, high func- tioning autism and specific language impairment. Journal of Child Psy- chology and Psychiatry 54, 11 (2013), 1186–1197. doi:10.1111/jcp...

    2013 doi

  112. [2018]

    BMC Psychiatry 18, 1 (2018), 15

    Experiences of an internet-based support and coaching model for adoles- cents and young adults with ADHD and autism spectrum disorder – a qualitative study. BMC Psychiatry 18, 1 (2018), 15. doi:10.1186/s12888-018-1599-9

    2018 doi

  113. [2019]

    Current Psychiatry Reports 21, 6 (2019), 46

    Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice. Current Psychiatry Reports 21, 6 (2019), 46. doi:10.1007/s11920-019- 1021-4 Review Article

    2019 doi

  114. [2022]

    The potential for emerging technologies to support self-regulation in children with ADHD: A literature review.International Journal of Child-Computer Interaction 31 (2022), 100421

    2022

  115. [2023]

    Scientific Reports 13, 1 (2023), 5487

    Artificial intelligence in communication impacts language and social relationships. Scientific Reports 13, 1 (2023), 5487. doi:10.1038/s41598-023-30938-9

    2023 doi

Pith tools

Reviewed August 6, 2026 · model on record in the stance chip above.