Objective: The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls. Method: Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored ( n = 33 per group). Results: ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices. Conclusions: Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.

Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability ( n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.

Clinical decision-making may be enhanced when combining psychophysiological sensors with computerized neuropsychological tests. The current study explored the utility of integrating an eye tracker with a commercially available continuous performance test (CPT), the MOXO-dCPT. As part of the study, the performance of adult attention-deficit/hyperactivity disorder (ADHD) patients and healthy controls (n = 43, n = 42, respectively) was compared in the integrated system. More specifically, the MOXO-dCPT has four stages, which differ in their combinations of ecological visual and auditory dynamic distractors. By exploring the participants’ performance in each of the stages, we were able to show that: (a) ADHD patients spend significantly more time gazing at irrelevant areas of interest (AOIs) compared to healthy controls; (b) visual distractors are particularly effective in impacting ADHD patients’ eye movements, suggesting their enhanced utility in diagnostic procedures; (c) combining gaze direction data and conventional CPT indices enhances group prediction, compared to the sole use of conventional indices. Overall, the findings indicate the utility of eye tracker-integrated CPTs and their enhanced diagnostic precision. They also suggest that the use of attention-grabbing visual distractors may be a promising path for the evolution of existing CPTs by shortening their duration and enhancing diagnostic precision.

Objective: The current study assessed the utility of eye-movements measures, gathered while participants performed a commercially available Continuous Performance Test (CPT), to detect feigned ADHD-associated cognitive impairment. Method: Healthy simulators ( n = 37), ADHD patients ( n = 33), and healthy controls ( n = 36) performed an eye-tracker integrated MOXO-dCPT and a stand-alone validity indicator. Results: Simulators gazed significantly longer at regions that were irrelevant for successful MOXO-dCPT performance compared to ADHD patients and healthy controls. This eye-movement measure, however, had lower sensitivity than traditional MOXO-dCPT indices. Discussion: Gaze direction measures, gathered while performing a CPT, show initial promise as validity indicators. Traditional CPT measures, however, are more sensitive and therefore offer a more promising path for the establishment of CPT-based validity indicators. The current study is an initial exploration of the issue and further evaluation of both theoretical and practical aspects is mandated.