Virtual reality game to objectively detect AD

Virtual reality game to objectively detect AD

Screenshot of EPELI and analysis panel

image: The player’s view (left) and the visual distinctiveness of the image (right, with characteristic areas in yellow). The red circle shows where the player is looking.
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Credit: left: Peili Vision Oy, right: Liya Merzon / Aalto University

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 precise diagnosis of attention deficit disorder. Their approach can also be used as the basis for an ADHD therapy, and with certain modifications, to assess other conditions, such as autism.

ADHD is a common attention disorder that affects approximately six percent of the world’s children. Despite decades of searching for objective markers, ADHD diagnosis is still based on questionnaires, interviews and subjective observation. The results can be ambiguous, and standard behavioral tests do not reveal how children manage everyday situations. Recently, a team consisting of researchers from Aalto University, the University of Helsinki and Åbo Akademi University developed a virtual reality game called EPELI that can be used to assess ADHD symptoms in children by simulating situations from everyday life.

Now the team tracked the eye movements of children 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 is instructed to locate objects in the environment and “shoot” them by looking at them. This short video shows an example of EPELI gameplay, player reactions and the research findings.

‘We monitored children’s natural eye movements while they performed different tasks in a virtual reality game, and this was an effective way to detect ADHD symptoms. The ADHD children’s gaze stayed longer on different objects in the environment, and their gaze jumped from one place to another faster and more often. This may indicate a delay in the development of the visual system and weaker information processing than other children,’ said Liya Merzon, a doctoral researcher at Aalto University.

Brush your teeth with distractions

Project leader Juha Salmitaival, an Academic Research Fellow at Aalto, explains that part of the game’s power is its motivational value. ‘This is not just a new technology to objectively assess ADHD symptoms. Children also find the game more interesting than standard neuropsychological tests,’ he says.

Salmitaival conceived EPELI together with Professor Matti Laine of Åbo Akademi University and Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at the Helsinki University Hospital (HUH). The game is available to neuropsychologists working in pediatric neurology and pediatric psychiatry at HUH.

“Those who are interested can use EPELI as a tool in their clinical work,” says Seesjärvi. ‘The experience was very positive. All the neuropsychologists who answered a feedback survey after the first pilot said that they benefited from using virtual reality methods as a complementary tool in their work.’

EPELI game development was led by Topi Siro, an Aalto alum now working at Peili Vision Oy. ‘The game provides a list of tasks that simulate everyday life, such as brushing your teeth and eating a banana. The player must remember the tasks despite distractions in the environment, such as a TV that is 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,’ says Siro.

Motivation for rehabilitation

The researchers envision broader therapeutic applications for virtual reality games. In addition to assessing symptoms, play can also be used as a tool for ADHD rehabilitation. ‘We want to develop a gamification-based digital therapy that can help children with ADHD get excited about things they wouldn’t otherwise do. There is already an approved game for ADHD rehabilitation in the US,’ says Salmitaival. The team is investigating 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 control exactly what happens in the stimulus world and at the same time collect information about behavior in a natural situation,” says Henriksson, an expert in how the brain visual processing information.

Researchers have already identified other potential applications for EPELI in assessing a wide range of problems with everyday challenges. For example, it can be used to measure problems in planning and flexibility of activities in people with autism. With modifications, this approach can also be used to assess language problems, brain trauma, adult ADHD, symptoms related to cerebral palsy and even the decline of memory with age. ‘Our partners in Geneva study aging-related diseases. Key opportunities on the horizon include early detection of Parkinson’s and Alzheimer’s diseases,’ says Salmitaival.

The research used the MAGICS infrastructure, an Aalto-led project specializing in virtual technologies. The research was funded by the Academy of Finland, the Aalto think tank and various foundations. The paper was published in Scientific reports.

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