Clinical Summary
Clinical Summary: Novel Interactive Eye-Tracking Game for Training Attention in Children With Attention-Deficit/Hyperactivity Disorder
Children with attention-deficit/hyperactivity disorder often need nonpharmacologic options, especially when medication response is incomplete or adverse effects limit use. This study tests whether a home-based eye-tracking game can improve objective measures of attention and oculomotor control beyond playing the same game with a mouse.
Design
The 28 participants were randomly separated into 2 groups: experimental group and age-matched control group.
N
28 individuals
Population
28 children aged 8–15 years (18 aged < 12 y and 10 aged ≥ 12 y) previously diagnosed with ADHD (DSM-5 criteria)
Duration
3 weeks
Key Findings
- In the frog task, impulsivity showed significant differences between pretest and posttest in the eye-tracker group (P = .0067), whereas there were no significant differences in the mouse group (P = .3349); pretests of both groups did not significantly differ (P = .6585).
- In the frog task, reaction time showed significant group differences (F1,665 = 11.69, P = .0007) and a significant group-by-time point interaction effect (F1,665 = 8.465, P = .0037); at posttest, the eye-tracker group responded faster than the mouse group (P < .0001), and only the eye-tracker group improved from pretest to posttest (P < .05).
- In the frog task, the number of fixations showed significant group differences (F1,930 = 6.015, P = .0144), time point differences (F1,930 = 10.23, P = .0014), and a group-by-time point interaction (F1,930 = 5.553, P = .0187); the eye-tracker group decreased fixations posttest versus pretest (P < .01) and had fewer fixations than the mouse group at posttest (P < .01).
- In the word recognition task, short-word reaction time showed significant group differences (F1,579 = 9.717, P = .0019) and a significant group-by-time point interaction (F1,579 = 18.93, P = .0001); at posttest, the eye-tracker group was faster than the mouse group (P < .0001), with reaction time decreasing in the eye-tracker group (P < .01) but increasing in the mouse group (P < .05).
- Age and comorbid dyslexia did not significantly affect the main outcomes, while acceptability varied by age: 78% of children < 12 years of age enjoyed the game, but among children ≥ 12 years of age, 50% did not enjoy it and 40% had no specific opinion about enjoyability.
Clinical Bottom Line
A 3-week home-based eye-tracking version of RECOGNeyes improved objective measures of impulsivity, fixation control, and reaction time in children with ADHD, while the same game played with a mouse did not. The active ingredient appears to be gaze-contingent oculomotor training rather than game exposure alone.
Practice Implications
- Consider gaze-contingent digital training as an adjunct for children with attention-deficit/hyperactivity disorder when families want nonpharmacologic options, since the benefit was seen with the eye-tracking version and not with the mouse version of the same game.
- Track objective attention and oculomotor outcomes such as impulsivity, fixation patterns, and reaction time, because probability of ADHD, severity of ADHD, hyperactivity, and errors did not change despite improvement in attentional control measures.
- Set expectations that the intervention tested was brief and structured: 3 weeks, 3 times per week for 30 minutes, in a home-based format with equipment provided to families.
- Discuss age fit before recommending this type of intervention, as enjoyment was higher in children < 12 years of age (78%) and lower in children ≥ 12 years of age, where 50% did not enjoy the game and 40% had no specific opinion.
