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

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.