Pupil size tracks attentional performance in Attention-Deficit/Hyperactivity disorder
Open accessAbstract
Attention-deficit/hyperactivity disorder (ADHD) diagnosis is based on reported symptoms, which carries the potential risk of over- or under-diagnosis. A biological marker that helps to objectively define the disorder, providing information about its pathophysiology, is needed. A promising marker of cognitive states in humans is pupil size, which reflects the activity of an 'arousal' network, related to the norepinephrine system. We monitored pupil size from ADHD and control subjects, during a visuo-spatial working memory task. A sub group of ADHD children performed the task twice, with and without methylphenidate, a norepinephrine-dopamine reuptake inhibitor. Off-medication patients showed a decreased pupil diameter during the task. This difference was no longer present when patients were on-medication. Pupil size correlated with the subjects' performance and reaction time variability, two vastly studied indicators of attention. Furthermore, this effect was modulated by medication. Through pupil size, we provide evidence of an involvement of the noradrenergic system during an attentional task. Our results suggest that pupil size could serve as a biomarker in ADHD.
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Pupil size was reduced among off-medication children and adolescents with ADHD performing a visuo-spatial working memory task compared to controls, but the difference was absent when on-medication.
“Pupil size was reduced among off-medication children and adolescents with ADHD performing a visuo-spatial working memory task (Wainstein et al., 2017), compared to controls, but the difference was absent when on-medication (see paragraphs 3.3 and 4.6 for a discussion about the effects of medication).”
From Is autonomic nervous system function atypical in Attention Deficit Hyperactivity Disorder (ADHD)? A systematic review of the evidence (2020) · cites this paper as Wainstein et al., 2017
A correlation between within-trial pupil size and performance (i.e., accuracy and RTV) was found in the ADHD group.
“Moreover, a correlation between within-trial pupil size and performance (i.e., accuracy and RTV) was found in the ADHD group, suggesting the presence of signs of hypoactivation of the ANS in ADHD and specific difficulties in allocating a constant and appropriate level of attentional resources during tasks involving executive function abilities, which may be improved by medication.”
From Is autonomic nervous system function atypical in Attention Deficit Hyperactivity Disorder (ADHD)? A systematic review of the evidence (2020) · cites this paper as Wainstein et al., 2017
Wainstein et al. (2017) found increased pupil size during a cognitive task when children and adolescents with ADHD were on medication, compared to when they were not.
“The only study using pupillometry (Wainstein et al., 2017) found increased pupil size during a cognitive task, when children and adolescents with ADHD were on medication, compared to when they were not.”
From Is autonomic nervous system function atypical in Attention Deficit Hyperactivity Disorder (ADHD)? A systematic review of the evidence (2020) · cites this paper as Wainstein et al., 2017
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“The only study using pupillometry (Wainstein et al., 2017) found increased pupil size during a cognitive task, when children and adolescents with ADHD were on medication, compared to when they were not.”
BackgroundInfluentialCampos-Arteaga, G., Forcato, C., Wainstein, G., Lagos, R., Palacios-García, I., Artigas, C., Morales, R., Pedreira, M. E., & Rodríguez, E. (2020) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2020.107279 · Cited by 19 · see citing works
Self-citationAttention and impulsivity assessment using virtual reality games
Mendez-Encinas, D., Sujar, A., Bayona, S., & Delgado-Gomez, D. (2023) · Scientific Reports · doi:10.1038/s41598-023-40455-4 · Cited by 15 · see citing works
- Authors
- Wainstein, G., Rojas-Líbano, D., Crossley, N. A., Carrasco, X., Aboitiz, F., & Ossandón, T.
- Affiliations
- Pontificia Universidad Católica de Chile (CL)
- Hospital Luis Calvo Mackenna (CL)
- Corresponding author
- Ossandón, T.
- Venue
- Scientific Reports
- Published
- 2017-08-15
- Volume
- 7
- Issue
- 1
- Pages
- 8228-8228
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC5557799
- OpenAlex
- W2743854648
- Cited by
- 116
- References
- 46
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 15 · 2023: 13 · 2022: 19 · 2021: 10 · 2020: 14 · 2019: 9 · 2018: 5
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- Funders
- Comisión Nacional de Investigación Científica y Tecnológica (PIA ACT1414, ACT1414, 1140996)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- attention deficit hyperactivity disorder, pupil size, biomarkers, noradrenergic system, methylphenidate, visuospatial working memory, reaction time variability, attentional performance, children
- MeSH terms
- Attention, Attention Deficit Disorder with Hyperactivity, Behavior, Humans, Psychomotor Performance, Pupil, Case-Control Studies
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