From lab to everyday life: investigating attention and executive function deficits in a naturalistic paradigm

Bridging the gap between experimental research and real-world settings is essential for understanding attention and executive function deficits in everyday life, as traditional experimental paradigms often fail to capture such challenges faced by individuals with e.g., attention deficit hyperactivity disorder (ADHD). This doctoral thesis utilized a novel virtual reality (VR) paradigm, EPELI (Executive Performance in Everyday LIfe), to explore how ADHD symptoms manifest, how they can be objectively measured and how they are reflected at the neuronal level in environments that mimic everyday life. Study I integrated a function-led approach, eye tracking, computational modeling, and machine learning to improve the detection of complex attention patterns in ADHD. The study demonstrated that eye-movement metrics obtained in the naturalistic EPELI task outperformed the previously established task performance measures in predicting ADHD. Study II investigated intra-individual variability (IIV) of response latencies in the naturalistic EPELI task and compared it to IIV in a traditional continuous performance test (CPT). The study revealed distinct temporal patterns of attentional fluctuations in ADHD, depending on the behavioral context (task-relevant vs. task-irrelevant behaviors) and task. The results demonstrated that EPELI effectively captures real-world behaviors associated with ADHD and provides novel insights into IIV across different contexts. Study III examined functional connectivity (FC) of brain activity in children with ADHD across three experimental conditions: naturalistic goal-directed tasks (EPELI), passive video viewing, and resting state. Results showed that altered FC in ADHD was most pronounced during goal-directed tasks, underscoring the task-dependent nature of ADHD-related aberrant brain activity. Furthermore, VRbased tasks provide opportunities for novel understanding of brain-behavior relationships in a naturalistic context by correlating FC patterns with ongoing task performance. Study IV examined attention deficits in adults with ADHD using the adult online version of EPELI. Adults with ADHD showed partially similar behavioral patterns in EPELI task to children with ADHD in Studies I-III, though the effects were less pronounced and gender dependent. The study highlights potential of video games and remote testing for detecting impulsive behaviors and inefficient strategies in adults with ADHD. The research demonstrated the advantages of naturalistic paradigms like EPELI in detecting ADHDrelated behavioral and neuronal patterns, offering promising avenues for enhancing diagnostics and understanding of ADHD and improving quality of life for those affected by the condition.