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Oren Yehezkel, Anna Sterkin, Maria Lev, Uri Polat; Digital self-assessment application for identifying ADHD symptoms. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2215.
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© ARVO (1962-2015); The Authors (2016-present)
ADHD is a common neurobehavioral disorder. ADHD is diagnosed by clinicians using subjective tools, sometimes supported by a computerized test. However, since this diagnosis requires visiting a clinic and is affected by external factors such as intelligence and fatigue, many cases remain undiagnosed through adulthood. There is a societal burden associated with undiagnosed ADHD, creating a need for objective tools for ADHD preliminary self-assessment, prompting seeking professional clinical diagnosis if relevant.<br /> Here we aimed at testing whether we can manipulate spatial and temporal stimulation to identify ADHD symptoms in adults. To this end, we used a short, self-administered tool based on dynamic crowded visual stimulation to identify ADHD symptoms. Various studies demonstrated the usefulness of crowded conditions for measuring visual performance in aging adults and children.
Measurements using a prototype dynamic digital assessment tool, currently developed by GlassesOff™, on smartphones, which reliably measure functional near visual acuity (VA), were compared between diagnosed-ADHD and control groups: 24 ADHD subjects (aged 16-28 years, with an ADHD diagnosis performed by a neurologist or psychiatrist) and 18 controls (aged 20-30 years), all corrected to normal vision (worst binocular VA 0.04 logMAR). Stimuli consisted of matrices composed of 25 letters "E" (5×5), each with a randomly chosen orientation having 4 options. Two variations of inter-letter-spacing within the matrix were used (0.4 and 1 letter size). Participants were requested to identify the orientation of the central letter. VA thresholds were determined using a staircase measuring the minimal detectable letter size, under crowding conditions and the stimulus presentation ranged from 34 to 120 msec.
Despite normal VA on the clinical static ETDRS chart, our self-administered test showed a large and significant VA reduction in ADHD subjects compared with controls: 62, 79, and 64% for 34, 60, and 120 msec, respectively, equivalent to about 2 ETDRS lines. Similar results were obtained for 0.4-letter spacing.
Our self-administered dynamic digital tool may be used for objective assessment of ADHD symptoms. We suggest that under-development of visual functions, which is present in children under regular conditions, persist in adults with ADHD symptoms and that this becomes apparent under spatial and temporal loading conditions.
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