(1) Background: We made a comprehensive evaluation of executive functions (EFs) and attention processes in a group of adolescents and young adults with mild intellectual disability (ID). (2) Methods: 27 adolescents and young adults (14 females and 13 males) with ID, aged between 15.1 and 23 years (M = 17.4; SD = 2.04), were compared to a control group free of cognitive problems and individually matched for gender and age. (3) Results: As for EFs, individuals with ID were severely impaired on all subtests of the Behavioral Assessment of Dysexecutive Syndrome (BADS) battery. However, we also found appreciable individual differences, with eight individuals (approximately 30%) scoring within normal limits. On the attention tests, individuals with ID were not generally slower but presented specific deficits only on some attention tests (i.e., Choice Reaction Times, Color Naming and Color–Word Interference, and Shifting of Attention for Verbal and for Visual Targets).The role of a global factor (i.e., cognitive speed) was modest in contributing to the group differences; i.e., when present, group differences were selectively associated with specific task manipulations, not global differences in cognitive speed. (4) Conclusions: The study confirmed large group differences in EFs; deficits in attentional processing were more specific and occurred primarily in tasks taxing the selective dimension of attention, with performance on intensive tasks almost entirely spared.

Background: The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD‐11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD‐11 and the fidelity of its application in international clinical settings were also assessed.Methods: A total of 116 children and adolescents (5–18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD‐11 guidance for combining severity levels.Results: Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co‐occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co‐occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels.Conclusions: The ICD‐11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

Extended reality (XR) platforms may support cognitive and functional interventions in mild cognitive impairment (MCI), but their clinical feasibility depends on perceived usability, comfort, and user acceptance. This exploratory pilot study examined subjective acceptability of three integrated XR device–task configurations: a non-immersive Touch TV configuration, a semi-immersive Cave Automatic Virtual Environment (CAVE) configuration, and a fully immersive head-mounted display (HMD) configuration. The study included 21 individuals with MCI and 10 cognitively healthy controls. Participants experienced all three device–task configurations in randomized order and completed the Digital Immersion Satisfaction Questionnaire (Qu.G.I.D.), an ad hoc instrument assessing digital literacy, perceived ease of use, preference, and willingness to use the configurations for future applications. Perceived ease of use scores were generally high and did not differ significantly between groups. Repeated-measures exploratory analyses showed no statistically robust configuration effect for perceived ease of use or preference scores. CAVE was numerically the most frequently selected device–task configuration for future applications, but this difference was not statistically significant when non-mutually exclusive selections were analyzed using Cochran’s Q. Digital literacy was not positively associated with Touch TV preference. Because device type, level of immersion, interaction modality, and task content were not experimentally separable, these findings cannot determine whether ratings reflected hardware characteristics or the specific activities performed. The results should therefore be interpreted as preliminary descriptive self-report acceptability and acceptability data, not as evidence of comparative device–task configurations effectiveness. Larger, balanced, counterbalanced studies using validated usability scales, objective performance metrics, interaction-quality measures, and cybersickness assessment are required before hypotheses for future controlled studies can be formulated.

Virtual reality (VR) is evolving from a platform for cognitive exercises into an instrumented rehabilitation environment capable of simultaneously delivering treatment and quantifying behavior. This critical narrative review examines how behavioral, ocular, kinematic, physiological, and neurophysiological signals can be transformed into clinically meaningful digital measures, candidate biomarkers, adaptive interventions, and real-world functional outcomes. PubMed/MEDLINE, Scopus, and IEEE Xplore were searched from database inception to 20 September 2026, supplemented by backward and forward citation searching and targeted searches. Clinical, methodological, validation, and directly relevant technical studies were considered, including studies in healthy participants when methodologically informative. Of 690 records identified, 145 duplicates were removed; 545 unique records were screened and 303 formed the candidate evidence pool for critical narrative appraisal. Behavioral and interaction-derived measures are the most established, while eye tracking, kinematic sensing, autonomic monitoring, EEG, and fNIRS provide complementary information on attention, strategy, workload, and engagement. Quantitatively, combined hand- and eye-tracking features distinguished mild cognitive impairment from healthy controls with 93.3% accuracy, 100% sensitivity, and 83.3% specificity, while immersive VR life-skills training produced real-world functional gains of d = 1.00 post-training and d = 1.12 at 1-week follow-up. However, most sensor-derived variables remain digital measures or candidate biomarkers rather than clinically validated biomarkers; physiology-informed closed-loop adaptation is uncommon, and evidence that such adaptation produces sustained ADL or assisted-living benefits is lacking. Progress now depends on standardized reporting, external and multicenter validation, clinically interpretable adaptive models, and objective demonstration of real-world transfer.