Towards inclusive developmental neuroimaging: personalising virtual-reality (VR) and diffuse optical tomography (DOT) assessment for neurodivergent young children

Wearable neuroimaging methods hold considerable promise for identifying early biomarkers of neurodevelopmental conditions, yet their application to neurodivergent young children remains limited by significant participation barriers. We investigated inclusion rates and parental experiences in a combined virtual reality and diffuse optical tomography platform. Fifty-four 3-to-7-year-olds across three groups, neurotypical, elevated likelihood of Attention Deficit Hyperactivity Disorder (ADHD), and autistic were tested twice. Neurotypical and ADHD children engaged at consistently high rates, with near-ceiling task completion and equipment tolerance. Engagement in the autistic group was markedly more variable, shaped by equipment-related sensory sensitivities, particularly the shutter glasses and the cap, that persisted across visits despite targeted adaptations. Parental insights corroborated these findings: anticipated and experienced equipment concerns differed significantly across groups and remained elevated for autistic families throughout both visits. Signal quality in the autistic group was correspondingly lower and declined between visits, partly attributable to cap loosening for more sensitive children. Drawing on iterative parental co-design and industry partnership, we developed a four-phase personalisation framework covering pre-visit preparation, in-session adaptations, and engagement with device developers. We provide the first evidence base for inclusive wearable neuroimaging in neurodivergent children and a replicable framework for moving the field beyond one-size-fits-all protocols.