Eye movement behavior in a real-world virtual reality task reveals ADHD in children

Abstract

Eye movements and other rich data obtained in virtual reality (VR) environments resembling situations where symptoms are manifested could help in the objective detection of various symptoms in clinical conditions. In the present study, 37 children with attention deficit hyperactivity disorder and 36 typically developing controls (9–13 y.o) played a lifelike prospective memory game using head-mounted display with inbuilt 90 Hz eye tracker. Eye movement patterns had prominent group differences, but they were dispersed across the full performance time rather than associated with specific events or stimulus features. A support vector machine classifier trained on eye movement data showed excellent discrimination ability with 0.92 area under curve, which was significantly higher than for task performance measures or for eye movements obtained in a visual search task. We demonstrated that a naturalistic VR task combined with eye tracking allows accurate prediction of attention deficits, paving the way for precision diagnostics.

Assessment of goal-directed behavior and prospective memory in adult ADHD with an online 3D videogame simulating everyday tasks

“…Group differences between ADHD adults and neurotypical controls: Consistent with the two studies conducted in children (Seesjärvi et al, 2022a;Merzon et al, 2022), we observed that ADHD participants were overall more active in interacting with the virtual environment than controls. In previous studies, we have interpreted higher numbers of actions in ADHD participants to reflect impulsive behavior associated with irrelevant objects, as in the child version much of these extraneous actions relate to interacting with attractive objects (e.g., toys, instruments or devices like TV).…”

“…In a previous child study with VR goggles, we recorded the gameplay videos and further labeled the actions based on the object salience. However, the group differences appeared not to be explained by stimulus-driven capture of attention (see Merzon et al, 2022). The present findings align with this, as there were group differences also related to exploratory actions that do not specifically relate to object interaction.…”

“…In our child studies, Task efficacy has been the most sensitive measure in differentiating ADHD participants from controls (Seesjärvi et al, 2021;Merzon et al, 2022). As Task efficacy is a ratio between total score and all actions and as there was no group effect in total score, this difference mainly comes from differences in task-irrelevant behavior.…”

“…This could be one reason why objective methods are generally considered to have a limited role in clinical characterization of ADHD (Barkley & Murphy, 2011, see also Gualtieri & Johnson, 2005). It has been proposed that more ecologically valid paradigms simulating real-world situations where the symptoms are manifested are needed to quantify the challenges that individuals with ADHD may encounter in their everyday lives (Barkley, 1991;Parsons et al, 2017; see also Seesjärvi et al, 2022a;Merzon et al, 2022). Some of the symptoms, especially hyperactivity, are diminished during the course of development, making detection of ADHD more difficult in adults than in children (Biederman et al 2000).…”

“…In addition to EPELI, the participants conducted a Continuous Performance Test (CPT) version, a paradigm that can be considered as the gold-standard neuropsychological task in the ADHD assessment (see Albrecht et al, 2015). As this is the first EPELI study in an adult ADHD population, we decided to use the measures validated in our studies on children (see also Merzon et al, 2022 for a replication of Seesjärvi et al, 2022a) as the main dependent variables.…”