Measuring Attentional Distraction in Children With ADHD Using Virtual Reality Technology With Eye-Tracking.

Jared D Stokes,Albert Rizzo,Julie B Schweitzer,Joy J Geng

doi:10.3389/frvir.2022.855895

Abstract

Objective:Distractions inordinately impair attention in children with Attention-Deficit Hyperactivity Disorder (ADHD) but examining this behavior under real-life conditions poses a challenge for researchers and clinicians. Virtual reality (VR) technologies may mitigate the limitations of traditional laboratory methods by providing a more ecologically relevant experience. The use of eye-tracking measures to assess attentional functioning in a VR context in ADHD is novel. In this proof of principle project, we evaluate the temporal dynamics of distraction via eye-tracking measures in a VR classroom setting with 20 children diagnosed with ADHD between 8 and 12 years of age.Method:We recorded continuous eye movements while participants performed math, Stroop, and continuous performance test (CPT) tasks with a series of “real-world” classroom distractors presented. We analyzed the impact of the distractors on rates of on-task performance and on-task, eye-gaze (i.e., looking at a classroom whiteboard) versus off-task eye-gaze (i.e., looking away from the whiteboard).Results:We found that while children did not always look at distractors themselves for long periods of time, the presence of a distractor disrupted on-task gaze at task-relevant whiteboard stimuli and lowered rates of task performance. This suggests that children with attention deficits may have a hard time returning to tasks once those tasks are interrupted, even if the distractor itself does not hold attention. Eye-tracking measures within the VR context can reveal rich information about attentional disruption.Conclusions:Leveraging virtual reality technology in combination with eye-tracking measures is well-suited to advance the understanding of mechanisms underlying attentional impairment in naturalistic settings. Assessment within these immersive and well-controlled simulated environments provides new options for increasing our understanding of distractibility and its potential impact on the development of interventions for children with ADHD.

Highlights

Distractibility in daily life is considered a major public health concern with distractions having a significant negative impact on attention
Distractibility by extraneous stimuli is so readily associated with attentiondeficit/hyperactivity disorder (ADHD), that it is one of the 18 items listed in the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM 5; American Psychiatric Association, 2013) ADHD criteria
To examine the consistency of the measure within participants, we looked at between task correlations of gaze distraction index which indicated significant/trending positive correlations between AX-continuous performance task (CPT), math, and Stroop tasks (Figure 5)

Summary

Introduction

Distractibility in daily life is considered a major public health concern (see http://www.distraction.gov/) with distractions having a significant negative impact on attention. Distractibility can be a significant contributor to the high cost associated with educating children with severe attentional impairments (Doshi et al, 2012). This cost can be seen in the need for children with ADHD to have academic accommodations, such as testing ADHD children in a room by themselves and/or extended test time, to mitigate the impact of distractibility on academic performance. Distractibility can lead to other impairments in sustained attention (Adams et al, 2009; Slobodin et al, 2018) and executive functioning that likely have cascading consequences in the performance of daily activities. Given that ADHD is so common, with 5.9% of youth meeting diagnostic criteria for ADHD (Willcutt et al, 2012) and the lack of widespread accessible treatments with evidence for sustained, long-term effectiveness (Sonuga-Barke et al, 2014; Cortese et al, 2018), there is a need for better characterization of how distractibility impacts performance to better inform the development of targeted treatment approaches

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Conclusion