What’s New in Psychology?

A Game to Objectively Identify ADHD  

Jim Windell

            As we are all quite aware, ADHD is a common attention disorder that affects around six percent of the world's children. In the U.S., the estimated number of children aged three to 17 who were ever diagnosed with ADHD, according to a national survey of parents, is about six million – or 9.8% of children and teens. But, despite decades of searching for objective markers, ADHD diagnosis is still based on questionnaires, interviews and subjective observation. Consequently, the results of diagnostic evaluations can be ambiguous. Standard behavioral tests typically do not reveal how children manage everyday situations.

           Recently, however, a team consisting of researchers from Aalto University, the University of Helsinki, and Åbo Akademi University developed a virtual reality game that can be used to assess ADHD. The game, called EPELI, simulates situations from everyday life.

           The team of researchers tracked the eye movements of children in the virtual reality game and used machine learning to look for differences in children with ADHD. The study, which was recently published in Scientific Reports, involved 37 children diagnosed with ADHD and 36 children in a control group. All of the children played EPELI and a second game, Shoot the Target, in which the player is instructed to locate objects in the environment and “shoot” them by looking at them.

           According to Liya Merzon, a doctoral researcher at Aalto University, in Espoo, Finland, “We tracked children's natural eye movements as they performed different tasks in a virtual reality game, and this proved to be an effective way of detecting ADHD symptoms. The ADHD children's gaze paused longer on different objects in the environment, and their gaze jumped faster and more often from one spot to another. This might indicate a delay in visual system development and poorer information processing than other children.”

           Project lead Juha Salmitaival, can Academy Research Fellow at Aalto University, conceived EPELI together with Professor Matti Laine from Åbo Akademi University and Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at Helsinki University Hospital. The game is available to neuropsychologists working in pediatric neurology and pediatric psychiatry at HUH.

            "Those who are interested can use EPELI as an aid in their clinical work," says Seesjärvi. “The experience has been very positive. All of the neuropsychologists who answered a feedback survey after the first pilot said they had benefited from using virtual reality methods as a complementary tool in their work.”

           EPELI game development was led by Topi Siro, an Aalto University alumnus who now works at Peili Vision Oy. “The game provides a list of tasks that simulate everyday life, such as brushing your teeth and eating a banana,” Siro says. “The player has to remember the tasks despite distractions in the environment, such as a TV being on. The game measures everything: how much the child clicks on the controls and how efficiently they perform the tasks. Efficiency correlates with everyday functioning, whereas children with ADHD often have challenges.”

           The researchers envision broader therapeutic applications for virtual reality games. Beyond assessing symptoms, gaming could also be used as an aid to ADHD rehabilitation. “We want to develop a gamification-based digital therapy that can help children with ADHD get excited about doing things they wouldn’t otherwise do,” commented Salmitaival.

           There’s already an approved game for ADHD rehabilitation in the U.S. The team is exploring rehabilitation possibilities in a project with researchers at the University of Oulu.

           Linda Henriksson, a senior lecturer at Aalto University who was also involved in the study, notes the exceptional potential of virtual reality for such applications. “I see virtual reality as an interesting tool, because it can be used to precisely control what happens in the stimulus world while at the same time collecting information about behavior in a natural situation.”

           To read the original article, find it with this reference:

Merzon, L., Pettersson, K., Aronen, E. T., Huhdanpää, H., Seesjärvi, E., Henriksson, L., MacInnes, W. J., Mannerkoski, M., Macaluso, E., & Salmi, J. (2022). Eye movement behavior in a real-world virtual reality task reveals ADHD in children. Scientific reports, 12(1), 20308. https://doi.org/10.1038/s41598-022-24552-4