Virtual reality-assisted prediction of adult ADHD based on eye tracking, EEG, actigraphy and behavioral indices: a machine learning analysis of independent training and test samples

Given the heterogeneous nature of attention-deficit/hyperactivity disorder (ADHD) and the absence of established biomarkers, accurate diagnosis and effective treatment remain a challenge in clinical practice. This study investigates the predictive utility of multimodal data, including eye tracking, EEG, actigraphy, and behavioral indices, in differentiating adults with ADHD from healthy individuals. Using a support vector machine model, we analyzed independent training (n = 50) and test (n = 36) samples from two clinically controlled studies. In both studies, participants performed an attention task (continuous performance task) in a virtual reality seminar room while encountering virtual distractions. Task performance, head movements, gaze behavior, EEG, and current self-reported inattention, hyperactivity, and impulsivity were simultaneously recorded and used for model training. Our final model based on the optimal number of features (maximal relevance minimal redundancy criterion) achieved a promising classification accuracy of 81% in the independent test set. Notably, the extracted EEG-based features had no significant contribution to this prediction and therefore were not included in the final model. Our results suggest the potential of applying ecologically valid virtual reality environments and integrating different data modalities for enhancing robustness of ADHD diagnosis.