| Sumario: | Purpose: This study aimed to evaluate the usability of a virtual reality-based ecological assessment tool, SmartAction-VR, from the perspective of children and adolescents. Materials and Methods: A cross-sectional study included 72 participants (36 children and adolescents with ADHD and 36 neurotypicals; mean age 12.70 ± 2.18 years; 60.5% boys). Usability was assessed using the System Usability Scale (SUS), and simulator sickness was measured with the Paediatric Simulator Sickness Questionnaire (Peds-SSQ) following interaction with SmartAction-VR. Results: Both groups reported high usability (SUS > 81). Peds-SSQ scores revealed significant increases in neck discomfort (p = 0.011) and dizziness (p = 0.021) in the neurotypical group after using SmartAction-VR, whereas the ADHD group showed no significant changes. Conclusions: SmartAction-VR demonstrates high usability among children and adolescents with ADHD. Minor refinements could further improve ease of use and overall user experience. These findings indicate that SmartAction-VR may represent a feasible approach for ecological performance-based assessment in a virtual environment. IMPLICATIONS FOR REHABILITATION: SmartAction-VR can complement conventional evaluation methods by providing performance-based data within a virtual environment that demonstrated high usability and acceptability. The positive usability experience observed among paediatric participants suggests that SmartAction-VR may be appropriate for use without causing fatigue or cybersickness. Incorporating SmartAction-VR could help maintain motivation and engagement during assessment, particularly for children with ADHD, as its interactive and gamified design aligns with usability principles that support participation.
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