Researchers use virtual reality games to detect ADHD symptoms in children

Minor tweaks could expand its scope of applications to other conditions, such as autism.
Mert Erdemir
A boy with a VR headset
A boy with a VR headset


Researchers used virtual reality (VR) games to diagnose attention-deficit hyperactivity disorder (ADHD) through differences in eye movements, according to a press release published by Aalto University. This method could potentially be utilized as a basis for ADHD treatment and, with minor tweaks, to assess other conditions like autism.

ADHD is a common attention disorder that affects six million U.S. children between the ages of 3 and 17 years, according to a national survey of parents.

Despite decades of research into empirical indicators, ADHD is still diagnosed through questionnaires, interviews, and subjective observation. However, the reliability of the results is questionable, and standard behavioral tests do not demonstrate how children handle everyday situations.

VR games could be the key to ADHD diagnosis

A team of researchers from Aalto University, the University of Helsinki, and Ko Akademi University created a VR game named EPELI. The game is designed that can be employed to detect ADHD symptoms in children by simulating real-life events.

As their next step, the research team examined children's eye movements in two VR games and used machine learning to look for abnormalities in children with ADHD. The youngsters played EPELI, the previously developed game, and a second game named Shot the Target, in which the player is directed to locate things in the environment and "shoot" them by gazing at them.

The study included 73 children, 37 of which were diagnosed with ADHD, while 36 were included in the control group.

"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," says Liya Merzon, a doctoral researcher at Aalto University.

An enjoyable alternative to standard neuropsychological tests

One of the advantages of the new method is that children find it more interesting than standard neuropsychological tests, according to Juha Salmitaival, an Academy Research Fellow at Aalto.

"Those who are interested can use EPELI as an aid in their clinical work," says Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at Helsinki University Hospital (HUH).

"The experience has been very positive. All of the neuropsychologists who answered a feedback survey after the first pilot said they had benefit from using virtual reality methods as a complementary tool in their work."

"The game provides a list of tasks that simulate everyday life, such as brushing your teeth and eating a banana. The player has to remember the tasks despite distractions in the environment, such as a TV being on," says Topi Siro, the developer of EPELI.

"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."

Its applications might go beyond assessing symptoms

Researchers hope that VR games will have larger therapeutic implications. They might be utilized to help with ADHD rehabilitation in addition to assessing symptoms.

"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. There’s already an approved game for ADHD rehabilitation in the US," states Salmitaival.

Some modifications might enable this technique to be used for examining language problems, brain trauma, adult ADHD, cerebral palsy symptoms, and even aging-related memory deterioration.

‘Our partners in Geneva are studying aging-related diseases. Key opportunities on the horizon include early detection of Parkinson’s and Alzheimer’s diseases,’ says Salmitaival.

The study was published in Scientific Reports.

Study abstract:

Eye movements and other rich data obtained in virtual reality (VR) environments resembling situations where symptoms are manifested could help in the objective detection of various symptoms in clinical conditions. In the present study, 37 children with attention deficit hyperactivity disorder and 36 typically developing controls (9–13 y.o) played a lifelike prospective memory game using head-mounted display with inbuilt 90 Hz eye tracker. Eye movement patterns had prominent group differences, but they were dispersed across the full performance time rather than associated with specific events or stimulus features. A support vector machine classifier trained on eye movement data showed excellent discrimination ability with 0.92 area under curve, which was significantly higher than for task performance measures or for eye movements obtained in a visual search task. We demonstrated that a naturalistic VR task combined with eye tracking allows accurate prediction of attention deficits, paving the way for precision diagnostics.

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