The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls.
Method:
Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored (n = 33 per group).
Results:
ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices.
Conclusions:
Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.
AlbrechtB.Uebel-von SanderslebenH.WiedmannK.RothenbergerA. (2015). ADHD history of the concept: The case of the continuous performance test. Current Developmental Disorders Reports, 2, 10−22.
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
3.
AnastopoulosA. D.DuPaulG. J.WeyandtL. L.Morrissey-KaneE.SommerJ. L.RhoadsL. H.MurphyK. R.GormleyM. J.GudmundsdottirB. G. (2018). Rates and patterns of comorbidity among first-year college students with ADHD. Journal of Clinical Child and Adolescent Psychology, 47(2), 236−247. https://doi.org/10.1080/15374416.2015.1105137
4.
ArecesD.CueliM.GarciaT.Gonzalez-CastroP.RodriguezC. (2018). Using brain activation (nir-HEG/Q-EEG) and execution measures (CPTs) in a ADHD assessment protocol. Journal of Visualized Experiments, 134, 56796. https://doi.org/10.3791/56796
5.
BarbaresiW. J.WeaverA. L.VoigtR. G.KillianJ. M.KatusicS. K. (2018). Comparing methods to determine persistence of childhood ADHD into adulthood: A prospective, population-based study. Journal of Attention Disorders, 22(6), 571−580. https://doi.org/10.1177/1087054715618791
6.
BarkleyR. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65−94. http://www.ncbi.nlm.nih.gov/pubmed/9000892
7.
BarkleyR. A. (2015). Comorbid psychiatric disorders and psychological maladjustment in adults with ADHD. In BarkleyR. A. (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed., pp. 343−355). Guilford Press.
8.
Ben-SheetritJ.TaskerH.AvnatL.GolubchikP.WeizmanA.ManorI. (2017). Possible age-related progression of attentional impairment in ADHD and its attenuation by past diagnosis and treatment. Journal of Attention Disorders, 1−8. Advance online publication. https://doi.org/10.1177/1087054717743328
9.
BergerC. L. A.BrawY.ElbaumT.WagnerM.RassovskyY. (2019). Detection of feigned ADHD Using the MOXO-d-CPT. Journal of Attention Disorders, 1−16. Advance online publication. https://doi.org/10.1177/1087054719864656
10.
BergerI.CassutoH. (2014). The effect of environmental distractors incorporation into a CPT on sustained attention and ADHD diagnosis among adolescents. Journal of Neuroscience Methods, 222, 62−68. https://doi.org/10.1016/j.jneumeth.2013.10.012
11.
BergerI.SlobodinO.AboudM.MelamedJ.CassutoH. (2013). Maturational delay in ADHD: Evidence from CPT. Frontiers in Human Neuroscience, 7, 1−11. https://doi.org/10.3389/fnhum.2013.00691
12.
BezeauS.GravesR. (2001). Statistical power and effect sizes of clinical neuropsychology research. Journal of Clinical and Experimental Neuropsychology, 23(3), 399−406. https://doi.org/10.1076/jcen.23.3.399.1181
13.
BojkoA. A. (2009). Informative or misleading? Heatmaps deconstructed. In 13th International conference on human-computer interaction, San Diego, CA.
14.
ButzbachM.FuermaierA. B. M.AschenbrennerS.WeisbrodM.TuchaL.TuchaO. (2019). Basic processes as foundations of cognitive impairment in adult ADHD. Journal of Neural Transmission (Vienna, Austria: 1996), 126(10), 1347−1362. https://doi.org/10.1007/s00702-019-02049-1
15.
CassutoH.Ben-SimonA.BergerI. (2013). Using environmental distractors in the diagnosis of ADHD. Frontiers in Human Neuroscience, 7, 1−11. https://doi.org/10.3389/fnhum.2013.00805
16.
CoeB. C.MunozD. P. (2017). Mechanisms of saccade suppression revealed in the anti-saccade task. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 372(1718), 20160198. https://doi.org/10.1098/rstb.2016.0192
17.
CohenJ. (1992). A power primer. Psychological Bulletin, 112(1), 155−159.
18.
DobrakowskiP.LebeckaG. (2020). Individualized neurofeedback training may help achieve long-term improvement of working memory in children with ADHD. Clinical EEG and Neuroscience, 51(2), 94−101. https://doi.org/z10.1177/1550059419879020
19.
ElbaumT.WagnerM.BotzerA. (2017). Cyclopean, dominant, and non-dominant gaze tracking for smooth pursuit gaze interaction. Journal of Eye Movement Research, 10(1), 1−14. https://doi.org/Artn210.16910/Jemr.10.1.2
20.
FergusonC. J. (2009). An effect size primer: A guide for clinicians and researchers. Professional Psychology-Research and Practice, 40(5), 532−538. https://doi.org/10.1037/a0015808
21.
FirstM. B.WilliamsJ. B. W.KargR. S.SpitzerR. L. (2015). Structured clinical interview for DSM-5- research version (SCID-5 for DSM-5, research version; SCID-5-RV). American Psychiatric Association.
22.
FriedM.TsitsiashviliE.BonnehY. S.SterkinA.Wygnanski-JaffeT.EpsteinT.PolatU. (2014). ADHD subjects fail to suppress eye blinks and microsaccades while anticipating visual stimuli but recover with medication. Vision Research, 101, 62−72. https://doi.org/10.1016/j.visres.2014.05.004
23.
FuermaierA. B. M.FrickeJ. A.de VriesS. M.TuchaL.TuchaO. (2018). Neuropsychological assessment of adults with ADHD: A Delphi consensus study. Applied Neuropsychology: Adult, 26(5), 1−15. https://doi.org/10.1080/23279095.2018.1429441
24.
GotoY.HatakeyamaK.KitamaT.SatoY.KanemuraH.AoyagiK.SugitaK.AiharaM. (2010). Saccade eye movements as a quantitative measure of frontostriatal network in children with ADHD. Brain & Development, 32(5), 347−355. https://doi.org/10.1016/j.braindev.2009.04.017
25.
GreenbergL. M.HolderC.KindschiC. L.DupuyT. R. (2018). Test of variables of attention (T.O.V.A.): Clinical manual. The TOVA Company.
26.
HallC. L.ValentineA. Z.GroomM. J.WalkerG. M.SayalK.DaleyD.HollisC. (2016). The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: A systematic review. European Child and Adolescent Psychiatry, 25(7), 677−699. https://doi.org/10.1007/s00787-015-0798-x
27.
HeatonK. J.WilliamsonJ. R.LammertA. C.FinkelsteinK. R.HavenC. C.SturimD.SmaltC. J.QuatieriT. F. (2020). Predicting changes in performance due to cognitive fatigue: A multimodal approach based on speech motor coordination and electrodermal activity. The Clinical Neuropsychologist, 34(6), 1190−1214. https://doi.org/10.1080/13854046.2020.1787522
28.
HolmqvistK.NyströmM.AnderssonR.DewhurstR.JarodzkaH.Van de WeijerJ. (2011). Eye tracking: A comprehensive guide to methods and measures. Oxford University Press.
JacobyN.LavidorM. (2018). Null tDCS effects in a sustained attention task: The modulating role of learning. Frontiers in Psychology, 9(476), 1−9. https://doi.org/10.3389/fpsyg.2018.00476
31.
KesslerR. C.AdlerL. A.GruberM. J.SarawateC. A.SpencerT.Van BruntD. L. (2007). Validity of the world health organization adult ADHD self-report scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52−65. https://doi.org/10.1002/mpr.208
32.
LozanoÓ. M.CarmonaJ.Muñoz-SilvaA.Fernández-CalderónF.Díaz-BataneroC.Sanchez-GarciaM. (2020). Adult ADHD self-report scale comprehensive psychometric study in a Spanish SUD sample. Journal of Attention Disorders, 24, 1674–1684. https://doi.org/10.1177/1087054716664410
33.
LozuponeM.La MontagnaM.D’UrsoF.DanieleA.GrecoA.SeripaD.LogroscinoG.BellomoA.PanzaF. (2019). The role of biomarkers in psychiatry (ch. 7). In GuestP. C. (Ed.), Reviews on biomarker studies in psychiatric and neurodegenerative disorders (pp. 135−162). Springer.
34.
MarshallP.HoelzleJ.NikolasM. (2019). Diagnosing attention-deficit/hyperactivity disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process. The Clinical Neuropsychologist, 1−34. Advance online publication. https://doi.org/10.1080/13854046.2019.1696409
35.
MullerA.VetschS.PershinI.CandrianG.BascheraG. M.KropotovJ. D.KasperJ.RehimH. A.EichD. (2020). EEG/ERP-based biomarker/neuroalgorithms in adults with ADHD: Development, reliability, and application in clinical practice. World Journal of Biological Psychiatry, 21(3), 172–182. https://doi.org/10.1080/15622975.2019.1605198
36.
O’BrienR. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality & Quantity, 41(5), 673−690. https://doi.org/10.1007/s11135-006-9018-6
37.
O’DriscollG. A.DepatieL.HolahanA. L.Savion-LemieuxT.BarrR. G.JolicoeurC.DouglasV. I. (2005). Executive functions and methylphenidate response in subtypes of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(11), 1452−1460. https://doi.org/10.1016/j.biopsych.2005.02.029
38.
ParsonsT. D.RizzoA. S. (2019). A review of virtual classroom environments for neuropsychological assessment (ch. 11). In RizzoA. S.BouchardS. (Eds.), Virtual reality for psychological and neurocognitive interventions (pp. 247−265). Springer.
39.
PetterssonR.SoderstromS.NilssonK. W. (2018). Diagnosing ADHD in adults: An examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. Journal of Attention Disorders, 22(11), 1019−1031. https://doi.org/10.1177/1087054715618788
40.
RobertsW.FillmoreM. T.MilichR. (2011). Linking impulsivity and inhibitory control using manual and oculomotor response inhibition tasks. Acta Psychologica, 138(3), 419−428. https://doi.org/10.1016/j.actpsy.2011.09.002
41.
RogersD. C.DittnerA. J.RimesK. A.ChalderT. (2017). Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach. The British Journal of Clinical Psychology, 56(1), 33−52. https://doi.org/10.1111/bjc.12119
42.
RossiniE. D.O’ConnorM. A. (1995). Retrospective self-reported symptoms of attention-deficit hyperactivity disorder: Reliability of the Wender Utah rating scale. Psychological Reports, 77(3 Pt 1), 751−754. https://doi.org/10.2466/pr0.1995.77.3.751
RuxtonG. D. (2006). The unequal variance t-test is an underused alternative to Student’s t-test and the Mann-Whitney U test. Behavioral Ecology, 17(4), 688−690. https://doi.org/10.1093/beheco/ark016
45.
SedgwickJ. A. (2018). University students with attention deficit hyperactivity disorder (ADHD): A literature review. Irish Journal of Psychological Medicine, 35(3), 221−235. https://doi.org/10.1017/ipm.2017.20
46.
ShahafG.NitzanU.ErezG.MendelovicS.BlochY. (2018). Monitoring attention in ADHD with an easy-to-use electrophysiological index. Frontiers in Human Neuroscience, 12, 1−9. https://doi.org/10.3389/fnhum.2018.00032
47.
SlobodinO.BlankersM.Kapitany-FovenyM.KayeS.BergerI.JohnsonB.DemetrovicsZ.van den BrinkW.van de GlindG. (2020). Differential diagnosis in patients with substance use disorder and/or attention-deficit/hyperactivity disorder using continuous performance test. European Addiction Research, 26(3), 151−162. https://doi.org/10.1159/000506334
48.
SlobodinO.DavidovitchM. (2019). Gender differences in objective and subjective measures of ADHD among clinic-referred children. Frontiers in Human Neuroscience, 13, 441. https://doi.org/10.3389/fnhum.2019.00441
49.
ThomeJ.EhlisA. C.FallgatterA. J.KrauelK.LangeK. W.RiedererP.RomanosM.TaurinesR.TuchaO.UzbekovM.GerlachM. (2012). Biomarkers for attention-deficit/hyperactivity disorder (ADHD). A consensus report of the WFSBP task force on biological markers and the world federation of ADHD. World Journal of Biological Psychiatry, 13(5), 379−400. https://doi.org/10.3109/15622975.2012.690535
50.
TsalY.ShalevL.MevorachC. (2005). The diversity of attention deficits in ADHD: The prevalence of four cognitive factors in ADHD versus controls. Journal of Learning Disabilities, 38(2), 142−157. http://www.ncbi.nlm.nih.gov/pubmed/15813596
51.
VakilE.MassM.SchiffR. (2019). Eye movement performance on the stroop test in adults with ADHD. Journal of Attention Disorders, 23(10), 1160−1169. https://doi.org/10.1177/1087054716642904
52.
WardM. F.WenderP. H.ReimherrF. W. (1993). The Wender Utah rating-scale - an aid in the retrospective diagnosis of childhood attention-deficit hyperactivity disorder. American Journal of Psychiatry, 150(6), 885−890.
53.
ZoharA. H.KonfortesH. (2010). Diagnosing ADHD in Israeli adults: The psychometric properties of the adult ADHD self report scale (ASRS) in Hebrew. The Israel Journal of Psychiatry and Related Sciences, 47(4), 308−315. https://www.ncbi.nlm.nih.gov/pubmed/21270505
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