Development of an innovative approach using portable eye tracking to assist ADHD screening: a machine learning study

Abstract

Introduction: Attention-deficit/hyperactivity disorder (ADHD) affects a significant proportion of the pediatric population, making early detection crucial for effective intervention. Eye movements are controlled by brain regions associated with neuropsychological functions, such as selective attention, response inhibition, and working memory, and their deficits are related to the core characteristics of ADHD. Herein, we aimed to develop a screening model for ADHD using machine learning (ML) and eye-tracking features from tasks that reflect neuropsychological deficits in ADHD. Methods: Fifty-six children (mean age 8.38 ± 1.58, 45 males) diagnosed with ADHD based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition were recruited along with seventy-nine typically developing children (TDC) (mean age 8.80 ± 1.82, 33 males). Eye-tracking data were collected using a digital device during the performance of five behavioral tasks measuring selective attention, working memory, and response inhibition (pro-saccade task, anti-saccade task, memory-guided saccade task, change detection task, and Stroop task). ML was employed to select relevant eye-tracking features for ADHD, and to subsequently construct an optimal model classifying ADHD from TDC. Results: We identified 33 eye-tracking features in the five tasks with the potential to distinguish children with ADHD from TDC. Participants with ADHD showed increased saccade latency and degree, and shorter fixation time in eye-tracking tasks. A soft voting model integrating extra tree and random forest classifiers demonstrated high accuracy (76.3%) at identifying ADHD using eye-tracking features alone. A comparison of the model using only eye-tracking features with models using the Advanced Test of Attention or Stroop test showed no significant difference in the area under the curve (AUC) (p = 0.419 and p=0.235, respectively). Combining demographic, behavioral, and clinical data with eye-tracking features improved accuracy, but did not significantly alter the AUC (p=0.208). Discussion: Our study suggests that eye-tracking features hold promise as ADHD screening tools, even when obtained using a simple digital device. The current findings emphasize that eye-tracking features could be reliable indicators of impaired neurobiological functioning in individuals with ADHD. To enhance utility as a screening tool, future research should be conducted with a larger sample of participants with a more balanced gender ratio.