# Exploring early-stage orienting behavior using an eye tracker for attention deficit hyperactivity disorder classification

## TL;DR

The study uses eye-tracking to explore attention patterns in children with ADHD, revealing distinct gaze behaviors that could help classify the disorder.

## Contribution

The study introduces gaze-based features as potential early classification markers for ADHD, using eye-tracking data alone with high accuracy.

## Key findings

- Eye movement data alone achieved 84% accuracy in classifying ADHD.
- Children with ADHD showed prolonged inter-saccadic fixations and reduced saccade frequency.
- Prolonged fixation during target detection correlated with inattention and hyperactivity.

## Abstract

Exploring early-stage orienting behavior is essential for elucidating the behavioral mechanisms underlying attentional shifts in attention deficit hyperactivity disorder (ADHD). However, traditional tasks lacking eye-tracking data often obscure these mechanisms. This study investigates low-level attentional shifting in ADHD using a simplified gaze-cueing task and explores classification markers via eye movement. Eye-tracking data were analyzed from 27 typically developing children and 19 children diagnosed with ADHD. We constructed a logistic regression model for classification purposes. Eye movement data alone yielded an accuracy of 0.84, comparable to the accuracy achieved using combined eye-tracking and behavioral data (0.87), underscoring the sensitivity of gaze-based features. Children with ADHD exhibited significantly prolonged inter-saccadic fixations in non-target regions (p = .02, d = 0.80) and marginally reduced saccade frequency (p = .06, d = − 0.52) during target detection, indicating delayed attentional shifting and diminished goal-directed attention. Prolonged fixation during target detection behavior emerged as the strongest predictor, correlating with both inattention and hyperactivity (r = .46; r = .36; both p < .01). Additionally, children with ADHD demonstrated lower response to joint attention and a greater reliance on peripheral vision. These findings highlight distinct gaze patterns under low cognitive load, revealing subtle mechanisms of executive dysfunction and potential early classification markers.

The online version contains supplementary material available at 10.1038/s41598-026-41419-0.