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

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.