Attention-Deficit/Hyperactivity Disorder (ADHD): Integrating the MOXO-dCPT with an Eye Tracker Enhances Diagnostic Precision

Abstract

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.

Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study

“…An example for this type of measure is given by the Processing Speed Index (PSI) from the Wechsler intelligence test, which measures the ability to quickly and correctly discriminate simple visual information ( Hedvall et al, 2013 ; Sherwell et al, 2014 ; Cook et al, 2018 ). Similarly, the PS (timing) metric of MOXO-CPT measures the number of correct responses given while the target stimulus is still presented on the screen ( Elbaum et al, 2020 ; Peled et al, 2020 ).…”

Feigned ADHD Associated Cognitive Impairment: Utility of Integrating an Eye-tracker and the MOXO-dCPT

“…A multivariate ANOVA (MANOVA) was used to compare the groups in the MOXO-dCPT indices (attentiveness, timeliness, impulsivity, hyperactivity). Density heat-maps, based on groups' aggregated durations of fixations, were then created using the Data-Viewer software (SR Research Ltd) with parameter settings like those used in Elbaum et al (2020). Analyses were conducted using IBM SPSS version 26, with two-tailed p < .05 considered statistically significant.…”

“…Red indicates that more attention was directed toward the location. The heat maps were generated using a Gaussian filter based on parameter settings used by Elbaum et al (2020); SD of 0.6, a low activity cutoff of 3.4%, and a duration density maximum value of 30% (i.e., full red represents duration density of 30% and above).…”

“…As detailed in Elbaum et al (2020), the participants' field of view was divided into two AOIs; areas in which the MOXO-dCPT stimuli (targets and non-targets) are presented and areas outside of the task AOI (target AOI and distractibility AOI, respectively). An eye-movement distractibility scale (%) operationalized the extent to which the participant's visual attention was directed toward AOIs that are irrelevant for successful MOXO-dCPT performance (i.e., proportion of time spent gazing at the distractibility AOI).…”

“…Any gaze deviations from this central AOI can therefore only impair performance, making CPTs particularly amendable for integration with an eye-tracker. Intial studies indicated the utility of eye-movements, gathered while participants performed a CPT, to differentiate ADHD patients and healthy controls (Elbaum et al, 2020; Lev et al, 2020). Moreover, eye-movements are associated with deception (Gamer & Pertzov, 2018) and, importantly, the feigning of cognitive impairment.…”