The Effect of Spatial Uncertainty on Visual Search in Older School-Aged Children with and without ADHD.

OBJECTIVE: Numerous studies support that simple visual search tests may not be sufficient to differentiate children with and without attention-deficit/hyperactivity disorder (ADHD), especially for older school-aged children. This study aimed to explore whether the high spatial uncertainty visual search tasks can effectively discriminate older school-aged children with ADHD from their typically developing (TD) peers.

METHOD: In a randomized, two-period crossover design, 122 school-aged children (61 ADHD and 61 TD subjects), aged 10-12 years old, were measured using comparable visual search tasks with structured and unstructured layouts.

RESULTS: First, the discriminant effectiveness of unstructured visual search tasks, which are associated with high-level spatial uncertainty, is superior to structured ones. Second, combining accuracy and speed into a Q score is a more sensitive measure than accuracy or time calculated alone in visual search tasks. A more in-depth ROC analysis showed that all variables could accurately identify ADHD from their TD peers under unstructured visual search tasks, with the index of the Q score performing best (AUR = 0.956). Third, the development of detectability, which represents the ability to distinguish between target and non-target, is approaching maturity in 10-12-year-old children with ADHD. However, these children showed severe deficits in dealing with disorganized distractors when performing visual search tasks with high-level spatial uncertainty.

CONCLUSIONS: The findings of this study support that older school-aged children with ADHD demonstrate less efficient search performance than their TD peers in complex/difficult visual search tasks, especially under higher spatial uncertainty.