The Eyes Have It: A Meta-analysis of Oculomotor Inhibition in Attention-Deficit/Hyperactivity Disorder

Chamorro, Yaira; Betz, Linda T.; Philipsen, Alexandra; Kambeitz, Joseph

doi:10.1016/j.bpsc.2021.05.004

Cited by 14 publications

(7 citation statements)

References 84 publications

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“…Another possibility for improvement of the present VSR implementation is to complement the existing measurement methods with additional ones. Further insights into the participant’s distractibility could, for instance, be gained by eye-tracking recordings, which would allow to track at which distractors participants look closely and which they ignore, especially given the observation of impaired oculomotor inhibition in ADHD ( Chamorro et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, ADHD is not only a disease of childhood and adolescence but often also of adulthood. On a neuropsychological level, adults with ADHD show deficits in a variety of cognitive domains, including sustained attention, interference control, behavioral inhibition, and perceptual speed ( Chamorro et al, 2021 ; Hervey et al, 2004 ; Woods et al, 2002 ). Among the neuropsychological tests most commonly employed, is the continuous performance task (CPT; Rosvold et al, 1956 ).…”

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confidence: 99%

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Multimodal Virtual Reality-Based Assessment of Adult ADHD: A Feasibility Study in Healthy Subjects

Wiebe

Kannen

et al. 2022

Assessment

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Neuropsychological assessments are often surprisingly inaccurate in mapping clinically-reported attention-deficit hyperactivity disorder (ADHD) symptoms, presumably due to their low ecological validity. Virtual reality (VR) might offer a potential solution for this problem, given its capability to generate standardized and yet highly realistic virtual environments. As the first adaptation of existing virtual classroom scenarios to an adult population, we developed a Virtual Seminar Room (VSR) for multimodal characterization of ADHD symptoms. To test its feasibility, N = 35 healthy participants were immersed into the VSR via a head-mounted display and carried out a VR-embedded continuous performance task (CPT) under varying levels of distractions in two experimental blocks (24 min each). CPT performance, electroencephalography (EEG) measures, and head movements (actigraphy) were simultaneously recorded and analyzed offline. Although CPT performance remained constant throughout the task, head movements increased significantly from Block 1 to Block 2. In addition, EEG theta (4–7 Hz) and beta (13–30 Hz) power was higher during Block 1 than Block 2, and during distractor-present than distractor-absent phases. Moreover, P300 amplitudes were higher during Block 1 than Block 2, and P300 latencies were prolonged in distractor-absent compared with distractor-present phases. Although the paradigm awaits further improvements, this study confirms the general feasibility of the VSR and provides a first step toward a multimodal, ecologically valid, and reliable VR-based adult ADHD assessment.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Multimodal Virtual Reality-Based Assessment of Adult ADHD: A Feasibility Study in Healthy Subjects

Wiebe

Kannen

et al. 2022

Assessment

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“…One additional measure that could increase the diagnostic potential of the VSR might be eye tracking. In a traditional, monitor‐based CPT, Lev et al (2022) found that adults with ADHD spent significantly more time looking at distractors and task‐irrelevant regions than HC, compatible with evidence of oculomotor distractibility in ADHD (Chamorro et al, 2021). Moreover, studies investigating gaze behaviour in the virtual classroom found that, in children with ADHD, distractors disrupted on‐task gaze (Stokes et al, 2022) and field‐of‐view shifts partially mediated the relationship between hyperactive–impulsive symptoms and task performance (Mangalmurti et al, 2020).…”

Section: Introductionmentioning

confidence: 86%

Multimodal assessment of adult attention‐deficit hyperactivity disorder: A controlled virtual seminar room study

Wiebe,

Aslan,

Brockmann

et al. 2023

Clin Psychology and Psychoth

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In the assessment of adult attention‐deficit hyperactivity disorder (ADHD) symptoms, the diagnostic value of neuropsychological testing is limited. Partly, this is due to the rather low ecological validity of traditional neuropsychological tests, which usually present abstract stimuli on a computer screen. A potential remedy for this shortcoming might be the use of virtual reality (VR), which enables a more realistic and complex, yet still standardized test environment. The present study investigates a new VR‐based multimodal assessment tool for adult ADHD, the virtual seminar room (VSR). Twenty‐five unmedicated ADHD patients, 25 medicated ADHD patients, and 25 healthy controls underwent a virtual continuous performance task (CPT) in the VSR with concurrent visual, auditive, and audiovisual distractions. Simultaneously, head movements (actigraphy), gaze behaviour (eye tracking), subjective experience, electroencephalography (EEG), and functional near‐infrared spectroscopy (fNIRS) were recorded. Significant differences between unmedicated patients with ADHD and healthy controls were found in CPT performance, head actigraphy, distractor gaze behaviour, and subjective experience. Moreover, CPT performance parameters demonstrated potential utility for assessing medication effects within the ADHD population. No group differences were found in the Theta‐Beta‐Ratio (EEG) or dorsolateral‐prefrontal oxy‐haemoglobin (fNIRS). Overall, the results are very promising regarding the potential of the VSR as an assessment tool for adult ADHD. In particular, the combined assessment of CPT, actigraphy, and eye tracking parameters appears to be a valid approach to more accurately capture the heterogeneous symptom presentation of the disorder.

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“…In this context, it is highly useful that humans are naturally inclined to pursue shifts in overt attention, i.e., physically directing their eyes to stimuli [38]. In ADHD, oculomotor inhibition, i.e., the ability to select relevant information and to reflexively suppress attending irrelevant or distracting stimuli, has been discussed as a potential biomarker of the disorder [39].…”

Section: Introductionmentioning

confidence: 99%

Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder

et al. 2023

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Background Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial interindividual heterogeneity that challenges the systematic assessment and treatment. Considering mixed evidence from previous neurofeedback research, we present a novel feedback system that relies on gaze behavior to detect signs of inattention while performing a neuropsychological attention task in a virtual seminar room. More specifically, an audiovisual feedback was given whenever participants averted their gaze from the given task. Methods Eighteen adults with ADHD and 18 healthy controls performed a continuous performance task (CPT) in virtual reality under three counterbalanced conditions in which either gaze-based feedback, sham feedback, or no feedback was provided. In all conditions, phases of high and low virtual distraction alternated. CPT errors and reaction times, proportions of gaze dwell times (e.g., task focus or distraction focus), saccade characteristics, EEG theta/beta ratios, head movements, and an experience sampling of ADHD symptoms were analyzed. Results While patients can be discriminated well from healthy controls in that they showed more omission errors, higher reaction times, higher distraction-related dwell times, and more head movements, the feedback did not immediately improve task performance. It was also indicated that sham feedback was rather associated with an aggravation of symptoms in patients. Conclusions Our findings demonstrate sufficient suitability and specificity for this holistic ADHD symptom assessment. Regarding the feedback, a single-session training was insufficient to achieve learning effects based on the proposed metacognitive strategies. Future longitudinal, multi-session trials should conclusively examine the therapeutic efficacy of gaze-based virtual reality attention training in ADHD. Trial registration drks.de (identifier: DRKS00022370).

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The Eyes Have It: A Meta-analysis of Oculomotor Inhibition in Attention-Deficit/Hyperactivity Disorder

Cited by 14 publications

References 84 publications

Multimodal Virtual Reality-Based Assessment of Adult ADHD: A Feasibility Study in Healthy Subjects

Multimodal Virtual Reality-Based Assessment of Adult ADHD: A Feasibility Study in Healthy Subjects

Multimodal assessment of adult attention‐deficit hyperactivity disorder: A controlled virtual seminar room study

Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder

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