The researchers used virtual reality games, eye tracking and machine learning to show that differences in eye movements can be used to detect ADHD, potentially providing a tool for more accurate diagnosis of attention deficits. Their approach could also be used as the basis for ADHD therapy, and with some modifications, to assess other conditions, such as autism.
ADHD is a common attention disorder that affects approximately 6% of children worldwide. Despite decades of searching for objective markers, the diagnosis of ADHD still relies on questionnaires, interviews, and subjective observations. Results can be ambiguous, and standard behavioral tests don’t reveal how children handle everyday situations. Recently, a team of researchers from Aalto University, University of Helsinki and Åbo Akademi University developed a virtual reality game called EPELI that can be used to assess ADHD symptoms in children in simulating everyday life situations.
Now the team has tracked children’s eye movements in a virtual reality game and used machine learning to look for differences in children with ADHD. The new study involved 37 children diagnosed with ADHD and 36 children in a control group. The children played EPELI and a second game, Shoot the Target, in which the player must locate objects in the environment and “shoot” them by looking at them.
We tracked children’s natural eye movements as they performed different tasks in a virtual reality game, and it turned out to be an effective way to detect ADHD symptoms. ADHD children’s gaze stopped longer on different objects in the environment, and their gaze jumped faster and more often from one place to another. This could indicate a delay in the development of the visual system and poorer information processing than other children.
Liya Merzon, PhD student, Aalto University
Brushing your teeth with distractions
Project manager Juha Salmitaival, a researcher at the Aalto Academy, explains that part of the game’s strength lies in its motivating value. “It’s not just new technology to objectively assess ADHD symptoms. Children also find the game more interesting than standard neuropsychological tests,” he says.
Salmitaival designed EPELI together with Professor Matti Laine of Åbo Akademi University and Erik Seesjärvi, PhD researcher at the University of Helsinki and clinical neuropsychologist at the University Hospital of Helsinki (HUH). The game is available for neuropsychologists working in pediatric neurology and pediatrics psychiatry to HEH.
“Those who are interested can use EPELI as an aid in their clinical work,” says Seesjärvi. “The experience has been very positive. All the neuropsychologists who responded to a satisfaction survey after the first pilot declared having benefited from the use of virtual reality methods as a complementary tool in their work.
Development of the EPELI game was led by Topi Siro, an Aalto alumnus who now works at Peili Vision Oy. “The game features a list of tasks that simulate daily life, such as brushing your teeth and eating a banana. The player must remember tasks despite distractions in the environment, such as a television on. The game measures everything: how many clicks the child has on commands and how efficiently they perform tasks. Efficiency correlates with day-to-day functioning, whereas children with ADHD often struggle,” says Siro.
Motivation for rehabilitation
Researchers envision broader therapeutic applications for virtual reality games. Beyond symptom assessment, gambling could also be used as an aid to ADHD rehabilitation. “We want to develop a gamification-based digital therapy that can help kids with ADHD get excited about doing things they wouldn’t otherwise. There is already an approved game for ADHD rehabilitation in the United States,” says Salmitaival. The team is exploring rehabilitation possibilities in a project with researchers from the University of Oulu.
Linda Henriksson, a senior lecturer at Aalto University who also participated in the study, notes the exceptional potential of virtual reality for such applications. “I see virtual reality as an interesting tool, as it can be used to precisely control what is happening in the world of stimuli while collecting information about behavior in a natural situation,” says Henriksson, an expert from the how the brain processes images. information.
The researchers have already identified other potential applications for EPELI in the assessment of a wide range of difficulties related to everyday challenges. For example, it could be used to measure problems with activity planning and flexibility in people with autism. With modifications, this approach could also be used to assess language problems, brain trauma, ADHD in adults, symptoms related to cerebral palsy, and even memory deterioration with age. “Our partners in Geneva are studying age-related diseases. Among the main opportunities on the horizon are the early detection of Parkinson’s and Alzheimer’s diseases,” says Salmitaival.
The research used the MAGICS infrastructure, a project led by Aalto and specialized in virtual technologies. The research was funded by the Academy of Finland, the Aalto Brain Center and several foundations. The paper was published in Scientific reports.
Merzon, L. et al. (2022) Eye movement behavior in a real-world virtual reality task reveals ADHD in children. Scientific reports. doi.org/10.1038/s41598-022-24552-4.