Fluctuations of Attention During Self-paced Naturalistic Goal-Directed Behavior in Attention-Deficit/Hyperactivity Disorder

Temporal fluctuations of attention detected with strictly controlled neuropsychological tests is an important objective behavioral marker for attention-deficit/hyperactivity disorder (ADHD). This study examined whether intraindividual variability in response latencies is also detectable in more realistic open-ended virtual contexts where the participants can freely interact with the surroundings when performing instructed everyday tasks from memory. Three ex-Gaussian parameters, μ, σ, and τ, were derived from response latencies in 2 tasks obtained from 2 datasets comprising 9- to 13-year-old children (72 with ADHD and 71 typically developing controls). In the Executive Performance in Everyday LIving (EPELI) task, participants performed instructed household chores in a virtual apartment. In the other task, a continuous performance test (CPT), was used to examine whether previous findings were replicated in this sample. Children with ADHD had shorter response latencies than controls in the EPELI task, while group differences in τ reflecting occasional sluggish responses depended on whether the trials were task-relevant (smaller τ in children with ADHD) or task-irrelevant (larger τ in children with ADHD). CPT results replicated previous observations of longer response latencies and larger τ in children with ADHD compared with control children. Intraindividual variability in the naturalistic EPELI task, however, explained more of the symptom variability than the CPT. This study demonstrates that task context and stimulus relevance considerably influence how intraindividual variability in attention is manifested in children with ADHD. Virtual reality tasks provide a promising avenue for ecologically relevant quantification of this common cognitive deficit in neuropsychiatric disorders. Temporal fluctuation of cognitive functioning is a behavioral marker for attention-deficit/hyperactivity disorder (ADHD). This study examined data from 72 children with ADHD and 71 children without ADHD, to identify whether cognitive fluctuation can be detected in both a classical experimental task and a novel naturalistic virtual reality task. Results showed that while cognitive fluctuations were observed in both tasks, intra-individual variability was dependent on task context, with ADHD children responding faster in the naturalistic task than the experimental task. Importantly, temporal fluctuation of cognitive function from the naturalistic task explained more symptom variabi