Children with attention-deficit/hyperactivity disorder often have trouble automatically keeping track of where others are looking. Recent research published in attention disorders journal revealed that this difficulty stems from challenges in processing the entire face rather than an inability to notice simple eye movements. These results help explain the social difficulties that children with disabilities sometimes experience and point to potential support strategies in the classroom.
Attention Deficit/Hyperactivity Disorder is primarily known for symptoms such as impulsivity, hyperactivity, and overall lack of concentration. However, people with this condition often experience atypical social interactions and have trouble reading nonverbal cues.
In everyday conversations, people naturally follow the gaze of others. This behavior helps individuals seamlessly understand what interests their friends and teachers.
Psychologists divide the human attention system into two different categories. The first is endogenous attention. This is a deliberate, goal-oriented process driven by a person’s own expectations and prior knowledge.
The second type is exogenous attention. This is an automatic, reflex-like response to something noticeable in the environment, such as a sudden light or loud sound.
When a person watches another person move their eyes, both types of attention are evoked simultaneously. Social and intentional thought processes occur, but there are also reflexive reactions to the physical movements of the eyes.
Children with attention-deficit/hyperactivity disorder often miss social cues, leading researchers to wonder how they process eye movements. Past research suggests that they may not pay attention in the same way as neurotypical children.
Jiaqi Wang, a researcher at China’s Guangxi Normal University, teamed up with a team of colleagues to investigate this very phenomenon. The researchers wanted to separate out the reflexive and automatic parts of attention to see if it worked differently in children with this disorder.
To measure this automatic response, the researchers looked for a specific psychological response called reinstatement inhibition. This reaction occurs when a person’s attention is drawn to a specific location, but nothing happens there for a short period of time.
When a target finally appears in that location, a person’s brain actually reacts slower than if the target appeared in a completely new location. The brain basically marks the first spot as old news and resists looking back at it.
This slowed response is thought to be an evolutionary mechanism that encourages humans to explore new locations rather than checking the same locations over and over again. Because this delayed response occurs only through automatic, reflexive attention, it serves as a perfect measuring stick for researchers.
If a child shows this delayed response after seeing a gaze cue, it means that the child’s brain automatically processed the eye movements. If not, it indicates that the automatic attention system is malfunctioning.
To test these responses, Wang and his research team designed a precise computer-based experiment. They recruited a group of children diagnosed with attention-deficit/hyperactivity disorder and a matched group of neurotypical children.
The children sat in front of a screen and saw pictures of normal, neutral human faces. The eyes of the face may suddenly turn to the left or right.
After a certain time delay, a small star symbol appeared on the screen. This target appears either on the side your face is looking at or on the exact opposite side.
Children were instructed to press buttons on the keyboard as quickly as possible to indicate where the star would appear. The researchers tracked response times down to the millisecond to capture subtle differences in cognitive processing.
With a very short time delay, children in both groups found the star faster when they turned their faces in the correct direction. This means that all children successfully shifted their initial attention based on gaze cues.
When the researchers extended the delay time for stars to appear beyond two seconds, the results were completely different. The neurotypical children ultimately showed the expected slowing of their responses. This means that their automatic attention system is fully activated.
Children with the disorder showed no such slowed response. This lack of inhibitory response indicates that the ability to automatically direct attention to human gaze is impaired.
Wang and his team needed to figure out exactly why this failure occurred. Two completely different visual details automatically grab your attention when the face looks away.
One of the details is the simple physical change of the black pupil moving against the white background of the eye. Another detail is that the brain recognizes a complete, intact human face as a social entity.
To separate these two visual details, the researchers conducted a second experiment using the exact same computer task. This time, I turned all the face photos upside down.
Turning your face upside down confuses your brain’s ability to process it as a fully human face. However, the physical contrast of the dark pupil moving over the white of the eye is fully visible and remains intact.
In this second experiment, children with attention-deficit/hyperactivity disorder ultimately showed automatic blunted responses. The upside-down face removed the complex social context, allowing children to reflexively respond to simple physical movements of the eyes.
The results pinpointed the exact cause of the children’s visual tracking difficulties. They have no trouble seeing and reacting to basic eye movements, but their brains have a hard time automatically processing those movements when embedded in a normal, correctly oriented face.
The researchers concluded that a lack of the ability to process complete, intact faces disrupts these children’s automatic social reflexes. This particular impairment helps explain why they may miss subtle nonverbal cues during fast-paced social interactions.
Although this study provides deep insight into social attention, the authors acknowledged some limitations to their study. Because the sample size of children was relatively small, some of the broader statistical comparisons were not statistically significant.
Future studies should include much larger groups of participants to confirm these patterns more reliably. The researchers aim to recruit more than 100 children per group in future projects to maximize statistical power.
Attention disorders often share overlapping features with autism spectrum symptoms. Some of the children studied may have had undiagnosed traits associated with autism.
These overlapping characteristics may independently influence how children process social cues and eye movements. Future studies should screen for these specific characteristics to determine the exact cause of attentional differences.
Researchers also relied heavily on interviews with parents to confirm children’s behavioral diagnoses. In the future, we plan to incorporate direct assessments from school teachers to ensure that behavioral symptoms are consistent across settings.
The study, “Impaired extrinsic attentional orienting to gaze cues in children with ADHD: Evidence from feedback inhibition,” was authored by Jiaqi Wang, Aijun Wang, Jiacan Gu, Shizhong Cai, and Ming Zhang.
