[A press release from University of Navarra Hospital via Basque Research; more information, including a 1:21 minute demonstration video, is available here]

University of Navarra Hospital presents new tool for facilitating diagnosis of Attention Deficit Disorder and Hyperactivity

2011/10/10

The team of specialists at the Neuropaediatrícs Unit of the University of Navarra Hospital has taken part, with the Nesplora company, in the design of “AULA”, a novel test aimed at providing a more precise and complete diagnosis for Attention Deficit Hyperactivity Disorder (ADHD).

The new tool is based on the development of sophisticated software that introduces the child to a virtual scenario similar to a school classroom. According to the company, “the tool is designed to evaluate the processes of attention and help in diagnosing the disorders caused by the deficit”. The test was tried on a sample of 1,500 children between the ages of 6 and 16.

As is known, ADHD is caused by a neurobiological dysfunction and has a prevalence of between 5% and 7% of the child and adolescent population. “ADHD patients have problems of attention, impulsiveness and excess of activity, which can result in deficient school performance, as well as problems of behaviour and difficulties in family and social relations”, pointed out Hospital experts.

The team of specialists at the Neuropaediatrícs Unit of the University of Navarra Hospital who contributed to the design of this AULA tool have more than 25 years’ experience in diagnosing and treating ADHD. The director of the company which designed the new test, Flavio Banterla, stressed that “on planning this project, we decided to contact the Neuropaediatrícs team at the Hospital, being one of the most recognised at both national and international level as regards learning disorders. We were met with professionals highly committed to making progress with evaluation tools”.

Description of test and its exercises

The perspective obtained using the 3D graphic design places the patient in one of the chairs in this aula (classroom), the tool consisting of special spectacles equipped with movement sensors and earphones, is fitted to the child. The device introduces the patient to a school virtual reality: being amongst other pupils and with a teacher who provides explanations on a board. “The software updates the perspective of the classroom depending on the movements of the head, providing the individual with the sensation of being in the classroom”, explained members of the Nesplora company.

On the virtual board a series of stimuli is presented, by means of the earphones, to which the child responds with a button and guided by the instructions of the teacher. The test involves two evaluation exercises. “In the first”, they explained, “the child has to click the mouse each time the stimulus presented is different from the target stimulus (which has been described to the patient beforehand)”. On the other hand, in the second exercise, the button has to be pressed each time the target stimulus is heard or seen.

During the test, the software directly receives objective and quantified data on the degree and manner of compliance with the different types of exercises. The computer programme processes these results in order to offer, in a brief space of time (about 20 minutes), a complete report for the specialist.

Factors evaluated in a “highly ecological” environment

Amongst the principal aspects evaluated by the new tool is the tendency to distraction, deviation in focusing attention, and divided attention between simultaneous auditory and visual signals. Moreover, it measures motor activity and guarantees the cooperation of the patient as its use is similar to a computer videogame – highly attractive for children.

“A really important element provided by AULA is that it introduces the child into a virtual environment very like a real school, with possible factors of distraction that might be found in a real classroom”, emphasised doctor Rocío Sánchez-Carpintero of the Hospital. According to the company, the presence of numerous “distractors”, typical of a real classroom – for example, a classmate calling attention or a knock on the (virtual) classroom door -, “enables placing the patient in an environment similar to the real situation in which the patient suffers from the disorder”.

Doctor Nerea Crespo, child psychiatrist at the Hospital, stressed the novelty of the test, “especially in neuropsychological evaluation because, apart from providing information about the cognitive functions of the individual – such as the attention held or the control of impulsiveness, also evaluated with other tests -,  it is undertaken in a highly `ecological´ situation, very similar to reality. Thanks to this novel aspect, we have managed to get a very real idea of the behaviour of the child”. This, for the specialist, has meant a very important step “because there is currently no neuropsychological evaluation based on virtual reality”.

“In a nutshell”, pointed out Doctor Sánchez-Carpintero, “what was being sought in designing this test was something more than that obtained through existing tests”.

The director of the company which designed the new test, Flavio Banterla, pointed out, “the classical methods for the evaluation of behaviour can benefit from current   technological advances. AULA has been designed with the aim of enhancing tools for helping in the diagnosis of ADHD, in order to improve the quality of life of sufferers”.

Measurement of auditory and visual attention

Amongst the most important novel aspects obtained with the new tool, the hospital specialists highlight the simultaneous measurement of auditory and visual attention, as well as their independent quantification, “this being a very important factor in evaluating attention, as it enables identifying in which exact moments distractions are taking place with this child, and what manner of processing is taking place with these episodes”, underpinned Doctor Sánchez-Carpintero. In this way, “when we were cooperating in the design of the tests, we gave special attention to incorporating auditory measurement, given that conventional tests were largely based on the visual”, she explained.

This differentiated data provides information of particular relevance for the specialists. “It is an important advance not only in the diagnosis, but also in the prescription of the treatment, i.e. in the action to be taken with a specific patient. It provides us with highly valuable information about whether it is more effective to work on the visual aspect with this child, when we have been orientated with the test that better responds to visual stimuli, or the case is one of a child who better captures auditory stimuli”, explained the neuropaediatrician.

Discerning the degree of attention

Another important aspect provided by AULA is, given its special characteristics, “the quantified test for motor activity but, moreover, it achieves the discerning of provides information about the degree of attention paid by the child when he or she is immobile, looking at the focus of interest – the board; i.e. it provides data about the quality of attention”, stated child psychologist Ms Nerea Crespo. This is a highly relevant question “especially in the evaluation of patients that show attention deficit without hyperactivity, a disorder that turns out to be more difficult to detect and evaluate”, stated Doctor Sánchez-Carpintero. The specialist believes, in this context, that the new tool is “an important advantage, as it provides a series of objective measurements of executive functions (inhibition of distractors, control of impulsiveness and sustained and divided selective attention) that complete what we need to know as specialists about the behaviour patterns of the child in family, school and social spheres, and on which we fundamentally base the diagnosis.”  Moreover, she added, “capturing the quality and degree of attention of the patient enables us, subsequent to initiating the diagnosis and treatment, to carry out a tendency comparison of the progress of this patient and to identify which parameters have improved”.

In brief, the specialist team at the Hospital concluded that, while it is the overall set of tests, evaluations and interviews with the patient that manages to provide a complete diagnosis, “the new tool provides much valuable information that facilitates a more detailed diagnosis of this disorder”.

Contact:
Jesús Zorrilla Ruiz
Clínica Universidad de Navarra

Contact details:
jzorrilla@unav.es
(+34) 948-296.497 / 948-255.400