Use of eye tracking to improve the identification of attention-deficit/hyperactivity disorder in children

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. Although it requires timely detection and intervention, existing continuous performance tests (CPTs) have limited efficacy. Research suggests that eye movement could offer important diagnostic information for ADHD. This study aimed to compare the performance of eye-tracking with that of CPTs, both alone and in combination, and to evaluate the effect of medication on eye movement and CPT outcomes. We recruited participants into an ADHD group and a healthy control group between July 2021 and March 2022 from among children aged 6-10 years (n = 30 per group). The integration of eye-tracking with CPTs produced higher values for the area under the receiver operating characteristic (AUC, 0.889) compared with using CPTs only (AUC, 0.769) for identifying patients with ADHD. The use of eye-tracking alone showed higher performance compare with the use of CPTs alone (AUC of EYE: 0.856, AUC of CPT: 0.769, p = 0.029). Follow-up analysis revealed that most eye-tracking and CPT indicators improved significantly after taking an ADHD medication. The use of eye movement scales could be used to differentiate children with ADHD, with the possibility that integrating eye movement scales and CPTs could improve diagnostic precision.

Figure 1

Study flowchart of children aged 6–10 years with or without ADHD.

Figure 2

Comparison of gaze distribution in the selective attention test between the ADHD and control groups and within the ADHD group with or without medication. (A) Distribution of heat maps for gaze distribution. (B) Distribution of gaze fixation times. ADHD, attention-deficit/hyperactivity disorder.

Figure 3

ROC curves for models identifying patients with ADHD. The AUCs for computerised CAT, eye-tracking, and both combined are compared to assess performance. ADHD attention-deficit/hyperactivity disorder; AUC, area under the receiver operating characteristic curve; CAT, comprehensive attention test; ROC, receiver operating characteristic.