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Impaired Exogenous Attentional Orienting to Gaze Cues in Children with ADHD: Evidence from Inhibition of Return

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Title: Impaired Exogenous Attentional Orienting to Gaze Cues in Children with ADHD: Evidence from Inhibition of Return
Language: English
Authors: Jiaqi Wang, Aijun Wang (ORCID 0000-0003-4981-3400), Jiacan Gu, Shizhong Cai, Ming Zhang
Source: Journal of Attention Disorders. 2026 30(4):527-541.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 15
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Attention Deficit Hyperactivity Disorder, Eye Movements, Attention, Cues, Inhibition, Visual Stimuli, Children, Early Adolescents
DOI: 10.1177/10870547251405543
ISSN: 1087-0547
1557-1246
Abstract: Objective: To examine whether children with attention-deficit/hyperactivity disorder (ADHD) can produce attentional orienting in response to gaze cues, and to identify which type of attentional orienting is impaired and why. Method: Two experiments employed a gaze cue-target paradigm using inhibition of return (IOR) as an indicator of exogenous attentional orienting. Experiment 1 used normal upright gaze faces as cues. Experiment 2 used inverted gaze faces as cues. Results: When normal gaze faces were used as the gaze cue, no IOR effect was observed in children with ADHD (Experiment 1); whereas when inverted gaze faces were used as the gaze cue, the IOR effect was produced in children with ADHD (Experiment 2). Conclusion: These results indicated that the ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment resulted from their reduced ability to exogenously orient to the intact face. These findings provide new evidence of social cognitive deficits and attentional orienting deficits in children with ADHD, and help provide support for children in educational settings.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1499934
Database: ERIC
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  Value: <anid>AN0192008572;gs001apr.26;2026Mar05.05:44;v2.2.500</anid> <title id="AN0192008572-1">Impaired Exogenous Attentional Orienting to Gaze Cues in Children With ADHD: Evidence From Inhibition of Return </title> <p>Objective: To examine whether children with attention-deficit/hyperactivity disorder (ADHD) can produce attentional orienting in response to gaze cues, and to identify which type of attentional orienting is impaired and why. Method: Two experiments employed a gaze cue–target paradigm using inhibition of return (IOR) as an indicator of exogenous attentional orienting. Experiment 1 used normal upright gaze faces as cues. Experiment 2 used inverted gaze faces as cues. Results: When normal gaze faces were used as the gaze cue, no IOR effect was observed in children with ADHD (Experiment 1); whereas when inverted gaze faces were used as the gaze cue, the IOR effect was produced in children with ADHD (Experiment 2). Conclusion: These results indicated that the ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment resulted from their reduced ability to exogenously orient to the intact face. These findings provide new evidence of social cognitive deficits and attentional orienting deficits in children with ADHD, and help provide support for children in educational settings.</p> <p>Keywords: ADHD; gaze cue; inhibition of return; exogenous attention; endogenous attention</p> <hd id="AN0192008572-2">Introduction</hd> <p>In social interactions, the direction of eye gaze is an important indicator of others' attentional interest ([<reflink idref="bib40" id="ref1">40</reflink>]; [<reflink idref="bib51" id="ref2">51</reflink>]), and can induce observers to shift attention to that gaze direction ([<reflink idref="bib13" id="ref3">13</reflink>]; [<reflink idref="bib51" id="ref4">51</reflink>]). When the gaze direction is consistent with the target position, the speed of detecting the target is increased significantly; in contrast, when they are inconsistent, the speed of detecting is slower, a phenomenon known as the "gaze cueing effect" ([<reflink idref="bib19" id="ref5">19</reflink>]). As a special type of attentional orienting cue, the gaze cue has been widely investigated to determine whether it triggers endogenous attention or exogenous attention ([<reflink idref="bib3" id="ref6">3</reflink>]; [<reflink idref="bib6" id="ref7">6</reflink>]; [<reflink idref="bib21" id="ref8">21</reflink>]; [<reflink idref="bib42" id="ref9">42</reflink>]; [<reflink idref="bib68" id="ref10">68</reflink>]; [<reflink idref="bib77" id="ref11">77</reflink>]). Specifically, endogenous attention involves top-down control based on goals, expectations, or prior knowledge, while exogenous attention is driven by the salience of external stimuli and operates in a bottom-up manner ([<reflink idref="bib4" id="ref12">4</reflink>]; [<reflink idref="bib32" id="ref13">32</reflink>]; [<reflink idref="bib60" id="ref14">60</reflink>]). On the one hand, the process of gaze following involves intentional inference mechanisms, and the development of this ability depends on top-down experience factors ([<reflink idref="bib3" id="ref15">3</reflink>]), suggesting that the gaze cue elicited orienting behavior is endogenous attention. On the other hand, when the stimulus onset asynchrony (SOA) between the gaze cue and the target is extended to 2,400 ms, individuals show slower responses to targets appearing at the cued location compared to the opposite location, known as the inhibition of return (IOR) effect ([<reflink idref="bib20" id="ref16">20</reflink>]; [<reflink idref="bib21" id="ref17">21</reflink>]; [<reflink idref="bib61" id="ref18">61</reflink>]), which is induced only by the exogenous cue ([<reflink idref="bib37" id="ref19">37</reflink>]; [<reflink idref="bib61" id="ref20">61</reflink>]), thus this attentional orienting is exogenous. Taken together, the gaze cue is a special attentional orienting cue with social characteristics, and the attentional orienting induced by gaze contains both exogenous and endogenous properties.</p> <p>ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity ([<reflink idref="bib2" id="ref21">2</reflink>]). Additionally, individuals with ADHD also show atypical social cognitive functioning ([<reflink idref="bib15" id="ref22">15</reflink>]; [<reflink idref="bib71" id="ref23">71</reflink>]), which may be attributed to their inability to adequately perceive and respond to social cues from others ([<reflink idref="bib47" id="ref24">47</reflink>]). Researchers have therefore focused on their ability of attentional orienting to the gaze cue with social properties ([<reflink idref="bib28" id="ref25">28</reflink>]; [<reflink idref="bib45" id="ref26">45</reflink>]; [<reflink idref="bib79" id="ref27">79</reflink>]). When the gaze cue was non-predictive that triggered the exogenous system ([<reflink idref="bib32" id="ref28">32</reflink>]), individuals with ADHD produced significantly less facilitating effect than healthy individuals ([<reflink idref="bib79" id="ref29">79</reflink>]), or even no facilitating effect ([<reflink idref="bib45" id="ref30">45</reflink>]). In contrast, when the gaze cue was predictive that engaged the endogenous system ([<reflink idref="bib32" id="ref31">32</reflink>]), individuals with ADHD produced significant facilitating effect for targets appearing on the left side of the visual field ([<reflink idref="bib28" id="ref32">28</reflink>]). These studies imply that the impaired gaze cueing effect in individuals with ADHD may be a result of difficulty in generating exogenous orienting based on the gaze cue, but the ability to perform top-down attentional orienting based on the gaze cue is not impaired.</p> <p>However, previous studies only focused on whether individuals with ADHD can produce the facilitating effect to the gaze cue ([<reflink idref="bib28" id="ref33">28</reflink>]; [<reflink idref="bib45" id="ref34">45</reflink>]; [<reflink idref="bib79" id="ref35">79</reflink>]). Considering that the gaze cue has both exogenous and endogenous orienting components ([<reflink idref="bib3" id="ref36">3</reflink>]; [<reflink idref="bib20" id="ref37">20</reflink>]), and that both attentional orienting processes are able to elicit the facilitating effect ([<reflink idref="bib4" id="ref38">4</reflink>]; [<reflink idref="bib31" id="ref39">31</reflink>]), simply focusing on the facilitating effect cannot separate the two types of attentional orienting triggered by the gaze cue. Based on previous studies, the IOR effect reflects exogenous attentional orienting ([<reflink idref="bib37" id="ref40">37</reflink>]; [<reflink idref="bib61" id="ref41">61</reflink>]; [<reflink idref="bib62" id="ref42">62</reflink>]; [<reflink idref="bib63" id="ref43">63</reflink>]; [<reflink idref="bib73" id="ref44">73</reflink>]; [<reflink idref="bib75" id="ref45">75</reflink>]). It has been found in typically developing (TD) children and adolescents that extending the SOA to 2,400 ms resulted in a significant IOR effect at the location directed by the gaze cue ([<reflink idref="bib36" id="ref46">36</reflink>]), suggesting that they are able to produce exogenous attentional orienting to the gaze cue. In addition, no IOR effect was found in autism spectrum disorder (ASD) children, who also have abnormal social-cognitive functioning ([<reflink idref="bib47" id="ref47">47</reflink>]), reflecting deficits in reflexive attentional orienting to socially relevant information. Given that attentional orienting to the gaze cue in individuals with ADHD may have endogenous and exogenous functional dissociations ([<reflink idref="bib28" id="ref48">28</reflink>]; [<reflink idref="bib45" id="ref49">45</reflink>]; [<reflink idref="bib79" id="ref50">79</reflink>]), it is possible to examine the IOR effect in individuals with ADHD to explore whether their exogenous attentional orienting ability is impaired or not.</p> <p>Furthermore, two factors are involved in the process of exogenous attentional orienting elicited by gaze cues, that is, changes in the light-dark contrast between the iris and the sclera produced by eye movement in the gaze cue ([<reflink idref="bib65" id="ref51">65</reflink>]; [<reflink idref="bib76" id="ref52">76</reflink>], [<reflink idref="bib77" id="ref53">77</reflink>]), and the integrity of faces ([<reflink idref="bib42" id="ref54">42</reflink>]). Inverting the conventional pattern of contrast between the white sclera and the dark iris (i.e., the iris became white) severely reduced accuracy in judging the direction of eye gaze ([<reflink idref="bib65" id="ref55">65</reflink>]) and led to a reversal of the direction of exogenous attentional orienting induced by gaze cues ([<reflink idref="bib76" id="ref56">76</reflink>], [<reflink idref="bib77" id="ref57">77</reflink>]). Additionally, inverted gaze faces severely reduced, but did not completely eliminate the exogenous attentional orienting induced by the gaze cue ([<reflink idref="bib42" id="ref58">42</reflink>]). Other studies have confirmed the neural dissociation between eye movement perception and intact face processing in the gaze cue ([<reflink idref="bib14" id="ref59">14</reflink>]; [<reflink idref="bib18" id="ref60">18</reflink>]; [<reflink idref="bib30" id="ref61">30</reflink>]; [<reflink idref="bib58" id="ref62">58</reflink>]; [<reflink idref="bib59" id="ref63">59</reflink>]; [<reflink idref="bib76" id="ref64">76</reflink>]). The two are processed in different neural pathways and combined within an extended nervous system, with the intraparietal sulcus guiding reflexive spatial attention ([<reflink idref="bib30" id="ref65">30</reflink>]; [<reflink idref="bib76" id="ref66">76</reflink>]). According to previous studies, children with ADHD have deficits in the processing of localized eye information as well as intact faces ([<reflink idref="bib12" id="ref67">12</reflink>]; [<reflink idref="bib33" id="ref68">33</reflink>]; [<reflink idref="bib46" id="ref69">46</reflink>]; [<reflink idref="bib84" id="ref70">84</reflink>]). Localized eye information is difficult to capture the attention of children with ADHD ([<reflink idref="bib46" id="ref71">46</reflink>]). In addition, individuals with ADHD showed lower recognition accuracy in a face recognition test task ([<reflink idref="bib12" id="ref72">12</reflink>]) and abnormalities in N170 amplitude, an event-related potential (ERP) component associated with whole face processing ([<reflink idref="bib33" id="ref73">33</reflink>]; [<reflink idref="bib34" id="ref74">34</reflink>]; [<reflink idref="bib84" id="ref75">84</reflink>]). Therefore, deficits in the processing of localized eye information as well as intact faces in children with ADHD may contribute to their impaired ability to produce exogenous attentional orienting to the gaze cue, and the present study aims to further investigate what factors contribute to this impairment.</p> <p>To examine which type of attentional orienting is impaired in children with ADHD elicited by the gaze cue and the reasons for the impairment, the present study used the gaze cue-target paradigm, manipulating SOA (500 ms vs. 1,200 vs. 2,400 ms) and cue validity (valid vs. invalid), with the IOR effect as an indicator of the exogenous attentional orienting produced ([<reflink idref="bib63" id="ref76">63</reflink>]; [<reflink idref="bib75" id="ref77">75</reflink>]). Specifically, a valid cue refers to a cue that correctly indicates the location of the subsequent target, whereas an invalid cue indicates the opposite location ([<reflink idref="bib20" id="ref78">20</reflink>]; [<reflink idref="bib21" id="ref79">21</reflink>]; [<reflink idref="bib61" id="ref80">61</reflink>]). The study included two experiments. Experiment 1 explored which attentional orienting elicited by the gaze cue is impaired in children with ADHD. Based on previous studies ([<reflink idref="bib12" id="ref81">12</reflink>]; [<reflink idref="bib33" id="ref82">33</reflink>]; [<reflink idref="bib45" id="ref83">45</reflink>], [<reflink idref="bib46" id="ref84">46</reflink>]; [<reflink idref="bib79" id="ref85">79</reflink>]; [<reflink idref="bib84" id="ref86">84</reflink>]), we hypothesized that TD children would show a facilitating effect at short SOAs (e.g., 500 ms), and an IOR effect at longer SOAs (e.g., 1,200 or 2,400 ms). In contrast, children with ADHD were expected to show a facilitating effect at short SOAs (e.g., 500 ms), and a diminished or absent IOR effect at longer SOAs (e.g., 1,200 or 2,400 ms), indicating impaired exogenous attentional orienting to gaze cues. To further examine whether this impairment in children with ADHD is caused by their impaired processing of localized eye information, or impaired processing of the intact face, or both, the present study conducted Experiment 2 with inverted face material, based on Experiment 1. Although inverted faces are effective in disrupting the structural integrity of the face ([<reflink idref="bib49" id="ref87">49</reflink>]), they still retaining the light-dark contrast changes produced by eye movements in the gaze cue. Based on previous studies ([<reflink idref="bib42" id="ref88">42</reflink>]; [<reflink idref="bib65" id="ref89">65</reflink>]), we hypothesized that under longer SOAs, if the IOR effect occurred, children with ADHD could produce exogenous attentional orienting to eye movement information, and thus the impaired ability to produce exogenous attentional orienting to the gaze cue was largely caused by deficits in the processing of intact faces. If the IOR effect did not occur, it would suggest that this impaired ability was caused by the processing deficits for localized eye information or both.</p> <hd id="AN0192008572-3">Experiment 1</hd> <p></p> <hd id="AN0192008572-4">Methods</hd> <p></p> <hd id="AN0192008572-5">Participants</hd> <p>First, we used MorePower 6.0.4, a tool more suitable for power analysis in complex multi-factor mixed designs ([<reflink idref="bib9" id="ref90">9</reflink>]), to calculate the sample size required to detect the three-way interaction for a 2 (group) × 3 (SOA) × 2 (cue validity) repeated measures analysis of variance (ANOVA; estimated effect size η<subs>p</subs>² =.06, α =.05, power = 0.9). It was estimated that a sample size of 52 participants per group would be sufficient to detect an effect of the specified size. However, since the present study focused on the gaze cue-induced attentional orienting effects within each group, that is, the pattern of differences between valid and invalid cue conditions, for each of the ADHD and TD children at different SOAs, we further used G*Power 3.1.9.7 ([<reflink idref="bib16" id="ref91">16</reflink>]) to estimate the sample size required for a 3 (SOA) × 2 (cue validity) repeated measures ANOVA within each subject group (estimated effect size <emph>f</emph> = 0.25, α =.05, power = 0.9) and adopted this sample size estimate. It was estimated that a sample size of 24 participants per group would be sufficient to detect an effect of the specified size. A total of 73 children aged between 6 and 13 years were recruited for the study, consisting of 39 children diagnosed with ADHD and 34 age- and sex-matched TD children. To gather participants for the study, children with ADHD were enrolled from the local children's hospital, while controls were recruited from local primary schools. The diagnosis of ADHD was identified by qualified psychiatrists following a clinical interview with parents based on criteria listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; [<reflink idref="bib2" id="ref92">2</reflink>]; [<reflink idref="bib74" id="ref93">74</reflink>]), and the possibility of comorbid conduct disorder, anxiety, depression, oppositional defiant disorder and ASD was ruled out according to DSM-5. During the DSM-5-based parent interview, the psychiatrists also inquired about the child's school performance (e.g., "Does the child have difficulty sustaining attention in class?" and "Does the child frequently leave their seat?") to ensure cross-setting validation of the diagnosis. In addition, all children with ADHD met the diagnostic criteria as assessed by the parents' completion of the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV; [<reflink idref="bib72" id="ref94">72</reflink>]). The parent form of the SNAP-IV consists of 26 items divided into three subscales: inattention (Items 1–9), hyperactivity/impulsivity (Items 10–18), and oppositional defiant disorder (Items 19–26). A 4-point score (<emph>not at all, just a little, some, or very much</emph>) was used for each item, and mean scores for each subscale were calculated. Higher scores indicate more severe symptoms. In each subscale, a score of 2 (<emph>some</emph>) or 3 (<emph>very much</emph>) on at least six items indicates the presence of this behavioral symptom. A child with symptoms of inattention or hyperactivity/impulsivity, but without oppositional defiant disorder, meets the diagnostic criteria for ADHD ([<reflink idref="bib22" id="ref95">22</reflink>]; [<reflink idref="bib72" id="ref96">72</reflink>]). The reliability and validity of the SNAP-IV parent form have been demonstrated by previous studies ([<reflink idref="bib22" id="ref97">22</reflink>]; [<reflink idref="bib29" id="ref98">29</reflink>]). Similarly, after parents completed the parent form of the SNAP-IV, the psychiatrists asked them each item from the teacher form of the SNAP-IV ([<reflink idref="bib23" id="ref99">23</reflink>]; [<reflink idref="bib72" id="ref100">72</reflink>]) to inquire about their child's behavior at school (e.g., "Does your child often fail to pay close attention to details or make careless mistakes in schoolwork or other activities?", "Does your child often answer questions before they have been completed?", "Does your child deliberately do things to disturb others?"). This served as an auxiliary assessment to further confirm the cross-setting validity of the diagnosis.</p> <p>All children with ADHD had to meet these criteria to be included in the present study: (a) diagnosed with ADHD by qualified psychiatrists based on the DSM-5 criteria and met diagnostic criteria on the SNAP-IV; (b) right-handed; (c) normal hearing and normal or corrected-to-normal vision; (d) normal intelligence quotient (IQ >25%), as assessed by the Raven's Progressive Matrices (RPM); (e) drug naive; and (f) no additional history of neurological or psychiatric disorders. TD group had the same inclusion criteria as the ADHD group, except for the diagnosis of ADHD. Interviews with parents and teachers of TD children were conducted based on the diagnostic criteria for ADHD in the DSM-5, they confirmed that the TD children exhibited neither ADHD symptoms (inattention and hyperactivity/impulsivity) nor academic or other behavioral problems, either at home or in the school setting. In each group, children with poor accuracy (accuracy lower than 90%) or severe hyperactive behavior during the experiment (difficulty remaining seated or repeatedly moving the response keyboard) were excluded (eight children with ADHD and two TD children). Therefore, a total of 31 children with ADHD (mean age: 9.00 ± 1.81 years; 27 males and 4 females) and 32 TD children (mean age: 8.97 ± 1.28 years; 24 males and 8 females) were ultimately included in the study. No significant differences were found between the groups with respect to age (<emph>t</emph><subs>61</subs> = 0.08, <emph>p</emph> =.94), sex ratio (χ<sups>2</sups><subs>1</subs> = 1.49, <emph>p</emph> =.22) or IQ (<emph>t</emph><subs>61</subs> = 1.06, <emph>p</emph> =.29). The demographic and diagnostic information of the participants is shown in Table 1.</p> <p>Table 1. Participant Demographic and Diagnostic Information for Experiment 1 (M ± SD).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Measure</th><th align="center">ADHD</th><th align="center">TD</th></tr></thead><tbody><tr><td>Proportion of males (%)</td><td>87.10</td><td>75.00</td></tr><tr><td>Proportion of females (%)</td><td>12.90</td><td>25.00</td></tr><tr><td>Age</td><td>9.00 ± 1.81</td><td>8.97 ± 1.28</td></tr><tr><td>IQ (%)</td><td>83.26 ± 15.85</td><td>87.09 ± 12.83</td></tr><tr><td colspan="3">SNAP-IV</td></tr><tr><td>Inattention (nine items)</td><td>2.15 ± 0.24 (1.60–2.80)</td><td>N/A</td></tr><tr><td> Hyperactivity/impulsivity (nine items)</td><td>1.34 ± 0.60 (0.30–2.20)</td><td>N/A</td></tr><tr><td> Oppositional defiant disorder (eight items)</td><td>0.67 ± 0.29 (0.10–1.10)</td><td>N/A</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. The parent form of the SNAP-IV is rated on a 4-point scale (0 = not at all, 3 = very much). Higher scores indicate greater symptom severity. The scale comprises nine items for inattention, nine items for hyperactivity/impulsivity, and eight items for oppositional defiant disorder. Values in parentheses represent the score ranges for the ADHD group. N/A = not applicable, as the SNAP-IV scale was not administered to TD children.</p> <p>Parents of all children participating in the study provided informed consent in accordance with the standards of the Declaration of Helsinki. All participants were voluntary and received a packet of cartoon stickers in return at the end of the experiment. This study was approved by the local ethics committee (protocol code SUDA20220714H02, date of approval: 14 July 2022).</p> <hd id="AN0192008572-6">Apparatus and Stimuli</hd> <p>Participants were seated approximately 65 cm from a 32″ LCD monitor with a screen resolution of 2,560 × 1,440 pixels and a refresh rate of 120 Hz. The entire experiment was presented with E-prime 3.0 software (Psychology Software Tools, Inc., Pittsburgh, PA, USA) on a black background.</p> <p>The photographs of real faces were selected from the NimStim face stimulus set ([<reflink idref="bib78" id="ref101">78</reflink>]). A total of eight faces (four males and four females) were selected in a neutral expression. These faces were originally in direct gaze. The pictures were adjusted with Adobe Photoshop 2019 by cutting the pupils of the eyes and pasting them at the end of the eyes to form the averted gaze (left and right), converting the image format from RGB to Greyscale, and intercepting the face images with an elliptical window of the same size (300 × 420 pixels) to remove external features such as hair, ears, etc. The face pictures subtended a vertical angle of 11.42° and 7.63° of horizontal visual angle. The fixation cross (0.7° × 0.7°) located in the center of the screen. And the white asterisk (0.7° × 0.7°) served as the target, positioned 8.6° to the left or right of the center of the screen.</p> <hd id="AN0192008572-7">Design and Procedure</hd> <p>This experiment was a 2 (group: children with ADHD vs. TD children) × 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) mixed design. In cue valid trials, the gaze cue was oriented to the target location; in cue invalid trials, the two were opposite.</p> <p>The experimental procedure is depicted in Figure 1. At the beginning of each trial, the fixation cross was presented for 600 ms in the center of the monitor, followed by a face appeared for 1,000 ms. Then, the eyes of the face turned to the left or right (the gaze cue) for 150 ms. After that, the fixation cross was presented again for 150, 550, or 1,750 ms. Before the target was presented, the face with direct gaze was shown again for 200 or 500 ms (to ensure that the observer's attention returns to the center and to reduce the impact of the sudden appearance of the central face on subsequent reactions; [<reflink idref="bib19" id="ref102">19</reflink>]; [<reflink idref="bib20" id="ref103">20</reflink>]). The target then appeared on the left or right side (side probability: 50%). The SOA from the presentation of the gaze cue to the presentation of the target could be as long as 500 ms (i.e., 150 + 150 + 200), 1,200 ms (i.e., 150 + 550 + 500), or 2,400 ms (i.e., 150 + 1,750 + 500). The participants were instructed to determine the location of the target as quickly and accurately as possible within a limit of 1,200 ms using two buttons. Participants were required to press the "F" key with their left hand if the target appeared on the left side, and the "J" key with their right hand if the target appeared on the right side. Participants were instructed to remain seated in position and keep their attention on the center of the screen for the entire experiment.</p> <p>Graph: Figure 1. Procedure of Experiment 1 in a sample trial. The fixation cross was first presented for 600 ms, and the face with direct gaze was presented for 1,000 ms. Then, the eyes of the face turned to the left or right to serve as a gaze cue that appeared for 150 ms. After a 150, 550, or 1,750 ms delay, the face with direct gaze was shown again for 200 or 500 ms, and an asterisk was presented as the target on the left or right side. In cue valid trials, the gaze cue was oriented to the target location; in cue invalid trials, the two were opposite. Note. ISI = interstimulus interval.</p> <p>Following one practice block with 24 trials, each participant completed three experimental blocks for a total of 288 trials (i.e., 3 SOA × 2 cue validity × 48 repetitions). There were 96 trials for each block. The participants were allowed to take a 1 min break between every two blocks. The total time for the experiment was approximately 30 min.</p> <hd id="AN0192008572-8">Data Analysis</hd> <p>The accuracy (ACC) and response time (RT) values of participants were recorded during the experiment and then statistically analyzed. The average ACC was calculated for each experimental condition. Trials were excluded from the RT analysis if they involved no responses, incorrect responses, extreme responses (RTs below 200 ms), or RTs deviating more than 3 standard deviations from the mean RT based on criteria for each participant. This resulted in the exclusion of 4.2% of trials for children with ADHD and 4.0% for TD children. No significant differences were found between the groups with respect to the number of excluded trials (<emph>t</emph><subs>61</subs> = 0.40, <emph>p</emph> =.69). Moreover, within each group, the number of excluded trials showed no significant differences across different cue validity conditions or different SOA conditions (see Supplemental Material for details). The mean of RTs of the remaining trials was calculated, and we conducted a 2 (group: children with ADHD vs. TD children) × 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVA on mean RTs, age was controlled as a covariate. Since the present experiment focused on the gaze cue-induced attentional orienting effects, that is, the pattern of differences between valid and invalid cue conditions, for each of the ADHD and TD children at different SOAs, we conducted two separate 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVAs for the two groups, age was controlled as a covariate. Given that two independent analyses were conducted (one for each group), the resulting <emph>p</emph>-values for the interaction effects in each ANOVA were Bonferroni-corrected (the original <emph>p</emph>-value multiplied by 2), effects with corrected <emph>p</emph>-values of less than.05 were considered significant ([<reflink idref="bib53" id="ref104">53</reflink>]). After that, post hoc tests based on Bonferroni correction were performed. If the two-way interaction was not significant in the group, to further examine the gaze cue-induced attentional orienting effects at different SOAs, paired-sample <emph>t</emph>-tests were performed on the RTs of the cue valid condition versus the cue invalid condition at each SOA. Given that three independent analyses were conducted (one for each SOA), the resulting <emph>p</emph>-values in each paired-sample t-test were Bonferroni-corrected (the original <emph>p</emph>-value multiplied by 3), effects with corrected <emph>p</emph>-values of less than.05 were considered significant ([<reflink idref="bib53" id="ref105">53</reflink>]). It is important to note that if the RTs in the cue valid condition were significantly faster than in the cue invalid condition, the facilitating effect occurred; if the RTs in the cue valid condition were significantly slower than in the cue invalid condition, the IOR effect occurred ([<reflink idref="bib61" id="ref106">61</reflink>]).</p> <hd id="AN0192008572-9">Results</hd> <p>Mean accuracy was above 96% for all experimental conditions, so no analysis of variance was necessary. The means of accuracy and RTs to different conditions in children with ADHD and TD children, as well as statistical data for all ANOVA models, are detailed in the Supplemental Material. With regard to RTs, we conducted a 2 (group: children with ADHD vs. TD children) × 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVA, age was controlled as a covariate. The interaction between group, SOA and cue validity was not significant, <emph>F</emph> < 1, <emph>p</emph> =.56, η<subs>p</subs>² =.02. The interaction between SOA and cue validity was significant, <emph>F</emph>(<reflink idref="bib2" id="ref107">2</reflink>, 59) = 3.31, <emph>p</emph> =.043, η<subs>p</subs>² =.10. No other main effects (<emph>p</emph>s >.30) or interactions (<emph>p</emph>s >.64) were present.</p> <p>Since the present experiment focused on the gaze cue-induced attentional orienting effects, that is, the pattern of differences between valid and invalid cue conditions, for each of the ADHD and TD children at different SOAs, we conducted two separate 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVAs for the two groups, age was controlled as a covariate. For children with ADHD, no main effects (<emph>p</emph>s >.12) or interaction (<emph>p</emph> =.21) were present. To further examine the gaze cue-induced attentional orienting effects in children with ADHD at different SOAs, paired-sample t-tests were performed on the RTs of the cue valid condition versus the cue invalid condition at each SOA (see Figure 2). The results showed that the RTs of the cue valid condition were faster than that of the cue invalid condition at the 500 ms SOA (501 ms vs. 511 ms), <emph>t</emph>(<reflink idref="bib30" id="ref108">30</reflink>) = -2.50, original <emph>p</emph> =.018, corrected <emph>p</emph> =.054, Cohen's <emph>d</emph> = 0.45, suggesting a facilitating effect; there was no significant difference at the 1,200 ms SOA (476 ms vs. 478 ms), <emph>t</emph>(<reflink idref="bib30" id="ref109">30</reflink>) = -0.47, original <emph>p</emph> =.64, Cohen's <emph>d</emph> = 0.09; and at the 2,400 ms SOA (466 ms vs. 464 ms), <emph>t</emph>(<reflink idref="bib30" id="ref110">30</reflink>) = 0.49, original <emph>p</emph> =.63, Cohen's <emph>d</emph> = 0.09.</p> <p>Graph: Figure 2. The magnitude of the RTs under each condition in Experiment 1. Error bars denote the SE..05 <# p <.10, * p <.05, ** p <.01.</p> <p>For TD children, the interaction between SOA and cue validity was significant (see Figure 2), <emph>F</emph>(<reflink idref="bib2" id="ref111">2</reflink>, 29) = 4.55, original <emph>p</emph> =.019, corrected <emph>p</emph> =.038, η<subs>p</subs>² =.24. Simple effect analysis revealed a significant effect of cue validity at the 500 ms SOA (489 ms vs. 503 ms), <emph>t</emph>(<reflink idref="bib31" id="ref112">31</reflink>) = -2.97, <emph>p</emph> =.006, Cohen's <emph>d</emph> = 0.53, suggesting a facilitating effect; and at the 2,400 ms SOA (463 ms vs. 457 ms), <emph>t</emph>(<reflink idref="bib31" id="ref113">31</reflink>) = 2.19, <emph>p</emph> =.036, Cohen's <emph>d</emph> = 0.39, suggesting an IOR effect; no difference at the 1,200 ms SOA (468 ms vs. 466 ms), <emph>t</emph>(<reflink idref="bib31" id="ref114">31</reflink>) = 0.71, <emph>p</emph> =.48, Cohen's <emph>d</emph> = 0.13. No main effects (<emph>p</emph>s >.76) were present (Table 2).</p> <p>Table 2. Statistical Data of the Effects of Cue Validity in Each SOA Condition for Each Participants Group in Experiment 1.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">SOA</th><th align="center" colspan="3">ADHD</th><th align="center" colspan="3">TD</th></tr><tr><th align="center"><italic>t</italic></th><th align="center"><italic>p</italic></th><th align="center">Cohen's <italic>d</italic></th><th align="center"><italic>t</italic></th><th align="center"><italic>p</italic></th><th align="center">Cohen's <italic>d</italic></th></tr></thead><tbody><tr><td>500 ms</td><td>−2.50</td><td>.018</td><td>0.45</td><td>−2.97</td><td>.006</td><td>0.53</td></tr><tr><td>1,200 ms</td><td>−0.47</td><td>.64</td><td>0.09</td><td>0.71</td><td>.48</td><td>0.13</td></tr><tr><td>2,400 ms</td><td>0.49</td><td>.63</td><td>0.09</td><td>2.19</td><td>.036</td><td>0.39</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. The <emph>p</emph>-value for the ADHD group is prior to Bonferroni correction.</p> <hd id="AN0192008572-10">Experiment 2</hd> <p></p> <hd id="AN0192008572-11">Methods</hd> <p></p> <hd id="AN0192008572-12">Participants</hd> <p>The methods and results for sample size estimation are the same as in Experiment 1. A total of 62 children aged between 6 and 13 years were recruited for the study, consisting of 32 children diagnosed with ADHD and 30 age- and sex-matched TD children. The recruitment criteria for children with ADHD and TD were the same as in Experiment 1. In each group, children with poor accuracy (accuracy lower than 90%) or severe hyperactive behavior during the experiment (difficulty remaining seated or repeatedly moving the response keyboard) were excluded (three children with ADHD and one TD child). Therefore, a total of 29 children with ADHD (mean age: 8.62 ± 2.03 years; 22 males and 7 females) and 29 TD children (mean age: 8.93 ± 1.71 years; 22 males and 7 females) were ultimately included in the study. No significant differences were found between the groups with respect to age (<emph>t</emph><subs>56</subs> = 0.63, <emph>p</emph> = 0.53), sex ratio (χ<sups>2</sups><subs>1</subs> = 0.00, <emph>p</emph> = 1.00) or IQ (<emph>t</emph><subs>56</subs> = 0.82, <emph>p</emph> =.42). Participants in Experiment 2 were different individuals from those in Experiment 1. The demographic and diagnostic information of the participants is shown in Table 3.</p> <p>Table 3. Participant Demographic and Diagnostic Information for Experiment 2 (M ± SD).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Measure</th><th align="center">ADHD</th><th align="center">TD</th></tr></thead><tbody><tr><td>Proportion of males (%)</td><td>75.90</td><td>75.90</td></tr><tr><td>Proportion of females (%)</td><td>24.10</td><td>24.10</td></tr><tr><td>Age</td><td>8.62 ± 2.03</td><td>8.93 ± 1.71</td></tr><tr><td>IQ (%)</td><td>86.17 ± 10.69</td><td>88.21 ± 8.11</td></tr><tr><td colspan="3">SNAP-IV</td></tr><tr><td> Inattention (nine items)</td><td>2.15 ± 0.31 (1.60–2.80)</td><td>N/A</td></tr><tr><td> Hyperactivity/impulsivity (nine items)</td><td>1.33 ± 0.54 (0.50–2.50)</td><td>N/A</td></tr><tr><td> Oppositional defiant disorder (eight items)</td><td>0.61 ± 0.29 (0.10–1.10)</td><td>N/A</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note</emph>. The parent form of the SNAP-IV is rated on a 4-point scale (0 = not at all, 3 = very much). Higher scores indicate greater symptom severity. The scale comprises nine items for inattention, nine items for hyperactivity/impulsivity, and eight items for oppositional defiant disorder. Values in parentheses represent the score ranges for the ADHD group. N/A = not applicable, as the SNAP-IV scale was not administered to TD children.</p> <p>Parents of all children participating in the study provided informed consent in accordance with the standards of the Declaration of Helsinki. All participants were voluntary and received a packet of cartoon stickers in return at the end of the experiment. This study was approved by the local ethics committee (protocol code SUDA20220714H02, date of approval: 14 July 2022).</p> <hd id="AN0192008572-13">Apparatus and Stimuli</hd> <p>The face pictures used in Experiment 1 were each rotated 180° to produce inverted face stimuli, which were used as stimulus materials for Experiment 2. The other apparatuses and stimuli matched those in Experiment 1.</p> <hd id="AN0192008572-14">Design and Procedure</hd> <p>This experiment was a 2 (group: children with ADHD vs. TD children) × 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) mixed design. The procedure of this experiment (see Figure 3) was the same as that of Experiment 1.</p> <p>Graph: Figure 3. Procedure of Experiment 2 in a sample trial. The fixation cross was first presented for 600 ms, and the inverted face with direct gaze was presented for 1,000 ms. Then, the eyes of the inverted face turned to the left or right to serve as a gaze cue that appeared for 150 ms. After a 150, 550, or 1,750 ms delay, the inverted face with direct gaze was shown again for 200 or 500 ms, and an asterisk was presented as the target on the left or right side. In cue valid trials, the gaze cue was oriented to the target location; in cue invalid trials, the two were opposite. Note. ISI = interstimulus interval</p> <hd id="AN0192008572-15">Data Analysis</hd> <p>Data analysis steps were the same as in Experiment 1. Based on the trial exclusion criteria, 3.8% of trials for children with ADHD and 4.5% for TD children were excluded. No significant differences were found between the groups with respect to the number of excluded trials (<emph>t</emph><subs>56</subs> = 1.39, <emph>p</emph> =.17). Moreover, within each group, the number of excluded trials showed no significant differences across different cue validity conditions or different SOA conditions (see Supplemental Material for details).</p> <hd id="AN0192008572-16">Results</hd> <p>Mean accuracy was above 95% for all experimental conditions, so no analysis of variance was necessary. The means of accuracy and RTs to different conditions in children with ADHD and TD children, as well as statistical data for all ANOVA models, are detailed in the Supplemental Material. With regard to RTs, we conducted a 2 (group: children with ADHD vs. TD children) × 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVA, age was controlled as a covariate. The interaction between group, SOA and cue validity was not significant, <emph>F</emph>(<reflink idref="bib2" id="ref115">2</reflink>, 54) = 1.37, <emph>p</emph> =.26, η<subs>p</subs>² =.05. The interaction between SOA and cue validity was significant, <emph>F</emph>(<reflink idref="bib2" id="ref116">2</reflink>, 54) = 9.11, <emph>p</emph> <.001, η<subs>p</subs>² =.25. No other main effects (<emph>p</emph>s >.19) or interactions (<emph>p</emph>s >.32) were present (Table 4).</p> <p>Table 4. Statistical Data of the Effects of Cue Validity in Each SOA Condition for Each Participants Group in Experiment 2.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">SOA</th><th align="center" colspan="3">ADHD</th><th align="center" colspan="3">TD</th></tr><tr><th align="center"><italic>t</italic></th><th align="center"><italic>p</italic></th><th align="center">Cohen's <italic>d</italic></th><th align="center"><italic>t</italic></th><th align="center"><italic>p</italic></th><th align="center">Cohen's <italic>d</italic></th></tr></thead><tbody><tr><td>500 ms</td><td>−1.32</td><td>.20</td><td>0.25</td><td>−2.82</td><td>.009</td><td>0.52</td></tr><tr><td>1,200 ms</td><td>2.69</td><td>.012</td><td>0.50</td><td>0.25</td><td>.80</td><td>0.05</td></tr><tr><td>2,400 ms</td><td>1.72</td><td>.10</td><td>0.32</td><td>3.19</td><td>.004</td><td>0.59</td></tr></tbody></table> </ephtml> </p> <p>Since the present experiment focused on the gaze cue-induced attentional orienting effects, that is, the pattern of differences between valid and invalid cue conditions, for each of the ADHD and TD children at different SOAs, we conducted two separate 3 (SOA: 500 ms vs. 1,200 ms vs. 2,400 ms) × 2 (cue validity: valid vs. invalid) repeated-measures ANOVAs for the two groups, age was controlled as a covariate. For children with ADHD, the interaction between SOA and cue validity was significant (see Figure 4), <emph>F</emph>(<reflink idref="bib2" id="ref117">2</reflink>, 26) = 4.49, original <emph>p</emph> =.021, corrected <emph>p</emph> =.042, η<subs>p</subs>² =.26. Simple effect analysis revealed a significant effect of cue validity at the 1,200 ms SOA (483 ms vs. 473 ms), <emph>t</emph>(<reflink idref="bib28" id="ref118">28</reflink>) = 2.69, <emph>p</emph> =.012, Cohen's <emph>d</emph> = 0.50, suggesting an IOR effect; no difference at the 500 ms SOA (511 ms vs. 517 ms), <emph>t</emph>(<reflink idref="bib28" id="ref119">28</reflink>) = -1.32, <emph>p</emph> =.20, Cohen's <emph>d</emph> =.25; and no difference at the 2,400 ms SOA (467 ms vs. 459 ms), <emph>t</emph>(<reflink idref="bib28" id="ref120">28</reflink>) = 1.72, <emph>p</emph> =.10, Cohen's <emph>d</emph> = 0.32. No main effects (<emph>p</emph>s >.62) were present.</p> <p>Graph: Figure 4. The magnitude of the RTs under each condition in Experiment 2. Error bars denote the SE.* p <.05. ** p <.01.</p> <p>For TD children, the interaction between SOA and cue validity was significant (see Figure 4), <emph>F</emph>(<reflink idref="bib2" id="ref121">2</reflink>, 26) = 4.70, original <emph>p</emph> =.018, corrected <emph>p</emph> =.036, η<subs>p</subs>² =.27. Simple effect analysis revealed a significant effect of cue validity at the 500 ms SOA (505 ms vs. 515 ms), <emph>t</emph>(<reflink idref="bib28" id="ref122">28</reflink>) = -2.82, <emph>p</emph> =.009, Cohen's <emph>d</emph> = 0.52, suggesting a facilitating effect; and at the 2,400 ms SOA (475 ms vs. 464 ms), <emph>t</emph>(<reflink idref="bib28" id="ref123">28</reflink>) = 3.19, <emph>p</emph> =.004, Cohen's <emph>d</emph> = 0.59, suggesting an IOR effect; no difference at the 1,200 ms SOA (487 ms vs. 486 ms), <emph>t</emph>(<reflink idref="bib28" id="ref124">28</reflink>) = 0.25, <emph>p</emph> = 0.80, Cohen's <emph>d</emph> = 0.05. No main effects (<emph>p</emph>s >.17) were present.</p> <hd id="AN0192008572-17">General Discussion</hd> <p>The present study used the gaze cue-target paradigm to examine which type of attentional orienting is impaired in children with ADHD elicited by the gaze cue and the reasons for the impairment. The results from Experiment 1 showed that children with ADHD showed an attentional facilitating effect at 500 ms SOA and no IOR effect at 2,400 ms SOA, suggesting that children with ADHD were able to make attentional shifts to the gaze cue, whereas their ability to produce exogenous attentional orienting was impaired. The results from Experiment 2 showed the IOR effect in children with ADHD at 1,200 ms SOA when gaze faces were presented inverted, suggesting that children with ADHD were able to produce exogenous attentional orienting to lower-order physical properties possessed by the eye stimuli in the gaze cue. Combined results from Experiment 1 and Experiment 2 suggest that the ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment results from their reduced ability to exogenously orient to the intact face.</p> <p>One of the aims of this study was to investigate what type of attentional orienting is impaired in children with ADHD induced by gaze cues. Consider that in studies of spatial cueing effect, both exogenous and endogenous cues can trigger the facilitating effect ([<reflink idref="bib4" id="ref125">4</reflink>]; [<reflink idref="bib31" id="ref126">31</reflink>]), whereas the IOR effect reflects an exogenous attentional orienting ([<reflink idref="bib37" id="ref127">37</reflink>]; [<reflink idref="bib61" id="ref128">61</reflink>]; [<reflink idref="bib62" id="ref129">62</reflink>]; [<reflink idref="bib63" id="ref130">63</reflink>]; [<reflink idref="bib75" id="ref131">75</reflink>]). We therefore used IOR as an indicator of the production of exogenous attentional orienting to isolate the different nature of attentional orienting effects triggered by the gaze cue. Results from Experiment 1 showed that children with ADHD induced a facilitating effect at 500 ms SOA, which is consistent with the findings of previous studies ([<reflink idref="bib27" id="ref132">27</reflink>]; [<reflink idref="bib28" id="ref133">28</reflink>]), whereas the IOR effect indicating exogenous attentional orienting did not occur at 2,400 ms SOA. These results suggest that children with ADHD are able to make attentional shifts to the gaze cue, but their ability to produce exogenous attentional orienting is impaired. Previous research has demonstrated that attentional orienting produced by the gaze cue possesses both exogenous ([<reflink idref="bib77" id="ref134">77</reflink>]) and endogenous ([<reflink idref="bib35" id="ref135">35</reflink>]; [<reflink idref="bib41" id="ref136">41</reflink>]) properties, and this characteristic has been further supported by [<reflink idref="bib69" id="ref137">69</reflink>] who has proposed a dual-pathway model of gaze cue processing. In this model, one is a cortical pathway from early visual areas to the superior temporal sulcus and intraparietal sulcus, and the other is a subcortical pathway including the amygdala ([<reflink idref="bib1" id="ref138">1</reflink>]), superior colliculus, and thalamo-occipital ([<reflink idref="bib69" id="ref139">69</reflink>]). While the cortical and subcortical pathways are the neural basis for the generation of endogenous and exogenous attention, respectively ([<reflink idref="bib50" id="ref140">50</reflink>]). On the one hand, individuals with ADHD have abnormal functioning of the superior colliculus ([<reflink idref="bib57" id="ref141">57</reflink>]), and the process of unconscious perception of gaze faces similarly involves subcortical structures that include the thalamus ([<reflink idref="bib55" id="ref142">55</reflink>]; [<reflink idref="bib85" id="ref143">85</reflink>]), which may imply that individuals with ADHD have difficulty in processing gaze faces automatically, and further impacts on the ability to generate exogenous attentional orienting to the gaze cue. On the other hand, previous studies have suggested that associative learning of gaze direction with its implicit social value is an important factor in the endogenous attentional orienting produced by the gaze cue ([<reflink idref="bib3" id="ref144">3</reflink>]; [<reflink idref="bib8" id="ref145">8</reflink>]; [<reflink idref="bib81" id="ref146">81</reflink>], [<reflink idref="bib82" id="ref147">82</reflink>]). With development, children with ADHD are able to acquire how to attribute mental states to the gaze cue provider using theories of mind ([<reflink idref="bib8" id="ref148">8</reflink>]; [<reflink idref="bib44" id="ref149">44</reflink>]), whereby top-down processing of the gaze face leads to endogenous attentional orienting ([<reflink idref="bib28" id="ref150">28</reflink>]). Taken together, children with ADHD have an impaired ability to produce exogenous attentional orienting to the gaze cue, but are still able to make attentional shifts, which may be attributed to endogenous attentional orienting.</p> <p>Given that two factors are involved in the process of exogenous attentional orienting elicited by the gaze cue, the lower-order physical properties possessed by eye light-dark contrast ([<reflink idref="bib76" id="ref151">76</reflink>]) and the integrity of the face pattern ([<reflink idref="bib42" id="ref152">42</reflink>]), another aim of the present study is to further explore the reasons for impaired exogenous attention in children with ADHD. We used inverted face material to disrupt the structural integrity of the face ([<reflink idref="bib49" id="ref153">49</reflink>]) in Experiment 2, retained the light-dark contrast changes produced by eye movements in the gaze cue. The results showed that children with ADHD produced an IOR effect at 1,200 ms SOA, which demonstrated that they are able to produce exogenous attentional orienting to changes in light-dark contrast induced by eye movements. Different from previous findings, [<reflink idref="bib46" id="ref154">46</reflink>] asked participants to make orientation judgments about target words and found that children with ADHD were not disturbed by the direction of gaze in localized eye stimuli, suggesting that children with ADHD have difficulty with attentional orienting to localized eye stimuli. This may be due to the fact that in [<reflink idref="bib46" id="ref155">46</reflink>] study, it was more difficult to elicit reflexive attentional orienting by directly presenting averted gaze pictures as distractor stimuli. Whereas, in the present study, the direct gaze pictures were first presented as priming stimuli, followed by the averted gaze pictures, which led to dynamic changes in the contrast between the iris and sclera in the eye stimuli, and was more likely to elicit exogenous attentional orienting in children with ADHD ([<reflink idref="bib51" id="ref156">51</reflink>]). In addition, Experiment 2 used inverted faces as gaze cues, reduced the integrity of the face pattern ([<reflink idref="bib49" id="ref157">49</reflink>]), and retained only the lower-order physical properties possessed by the eye's light-dark contrast, which might result in the reduced social nature of the gaze cue and thus enable reflexive attentional orienting in children with ADHD. This finding also provides further evidence for the exogenous attentional deficit for socially relevant information in children with ADHD.</p> <p>Combining the results of the two experiments, our current study found that the ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment resulted from their reduced ability to exogenously orient to the intact face. Previous research has found impairment of intact face processing in children with ADHD, with significantly lower accuracy in the face matching task ([<reflink idref="bib12" id="ref158">12</reflink>]) and in the facial emotion recognition task ([<reflink idref="bib7" id="ref159">7</reflink>]; [<reflink idref="bib70" id="ref160">70</reflink>]; [<reflink idref="bib86" id="ref161">86</reflink>]) compared to TD children. Additionally, in ERP studies, individuals with ADHD have N170 amplitude abnormalities in face and emotion processing ([<reflink idref="bib33" id="ref162">33</reflink>]; [<reflink idref="bib52" id="ref163">52</reflink>]; [<reflink idref="bib84" id="ref164">84</reflink>]), while the N170 component has been demonstrated to be sensitive to intact face recognition ([<reflink idref="bib34" id="ref165">34</reflink>]). Specifically, [<reflink idref="bib84" id="ref166">84</reflink>] found that adolescents with ADHD showed greater N170 amplitudes, while [<reflink idref="bib52" id="ref167">52</reflink>] and [<reflink idref="bib33" id="ref168">33</reflink>] reported that adults with ADHD produced lower N170 amplitudes to intact face stimuli than normal individuals. Overall, these studies indicated an abnormal pattern of individuals with ADHD in intact face processing, which may diminish social cognitive abilities ([<reflink idref="bib7" id="ref169">7</reflink>]; [<reflink idref="bib67" id="ref170">67</reflink>]), thus contributing to their attentional orienting deficits to socially relevant information ([<reflink idref="bib45" id="ref171">45</reflink>]).</p> <p>In addition, the results from Experiment 2 showed that children with ADHD produced the IOR effect at 1,200 ms SOA and no facilitating effect at 500 ms SOA, whereas TD children produced the IOR effect at 2,400 ms SOA and facilitating effect at 500 ms SOA. Previous studies in which healthy individuals produced IOR to the gaze cue were mostly at 2,400 ms SOA ([<reflink idref="bib20" id="ref172">20</reflink>]; [<reflink idref="bib36" id="ref173">36</reflink>]). These results suggested that under the condition of eye stimuli as the gaze cue, children with ADHD produced the IOR effect earlier and may have a deficit in producing facilitating effect. According to previous studies, hyperactivation of the superior colliculus is observed in individuals with ADHD ([<reflink idref="bib10" id="ref174">10</reflink>]; [<reflink idref="bib57" id="ref175">57</reflink>]), and the superior colliculus is closely associated with attentional distraction ([<reflink idref="bib24" id="ref176">24</reflink>]; [<reflink idref="bib25" id="ref177">25</reflink>]; [<reflink idref="bib54" id="ref178">54</reflink>]). Abnormalities in the functioning of the superior colliculus in individuals with ADHD results in decreased attentional stability and increased responses to distractors ([<reflink idref="bib57" id="ref179">57</reflink>]). Therefore, in Experiment 2 of the present study, following the presentation of the gaze cue, children with ADHD may have difficulty maintaining attention at the cued location and produce attentional disengagement earlier compared to TD children. Based on the "reorienting hypothesis" of IOR, attentional disengagement from the cued location is a sufficient and necessary condition for the production of IOR ([<reflink idref="bib39" id="ref180">39</reflink>]; [<reflink idref="bib48" id="ref181">48</reflink>]), thus children with ADHD produced the IOR effect at a shorter SOA. However, in previous studies, an earlier time course of the IOR effect on non-social cues has not been found in individuals with ADHD ([<reflink idref="bib17" id="ref182">17</reflink>]; [<reflink idref="bib43" id="ref183">43</reflink>]; [<reflink idref="bib83" id="ref184">83</reflink>]), which may be due to their social cognitive deficits that reduce the attentional stability to social stimuli ([<reflink idref="bib15" id="ref185">15</reflink>]; [<reflink idref="bib71" id="ref186">71</reflink>]), and thus affect the time course of IOR production. Moreover, due to the association of superior colliculus with attentional orienting ([<reflink idref="bib26" id="ref187">26</reflink>]; [<reflink idref="bib66" id="ref188">66</reflink>]), hyperactivation of the superior colliculus in children with ADHD may lead to earlier attentional orienting to the cued location. Previous studies have found that the saccade latency to the target is shorter in children with ADHD than in TD children ([<reflink idref="bib38" id="ref189">38</reflink>]). Thus, in Experiment 2 of the present study, children with ADHD showed no facilitating effect at 500 ms SOA, possibly due to their faster attentional orienting to the gaze cue, which resulted in an attentional facilitating effect at shorter (less than 500 ms) SOA, as it remains to be further explored.</p> <p>In the present study, children with TD did not show a smaller facilitating effect when inverted faces were used as gaze cues than upright faces at 500 ms SOA, which is inconsistent with the results of previous study ([<reflink idref="bib42" id="ref190">42</reflink>]), they found that inverted faces significantly reduced the facilitating effect at 100 ms SOA. Two possible reasons are as follows. First, in the study by [<reflink idref="bib42" id="ref191">42</reflink>], inverted faces disrupted the structural integrity of faces ([<reflink idref="bib49" id="ref192">49</reflink>]; [<reflink idref="bib80" id="ref193">80</reflink>]), resulting in a decrease in the exogenous attentional orienting effect produced by the gaze cue. Moreover, they did not present the direct gaze face before the gaze cue, without the dynamic changes in contrast between the iris and sclera in the eye stimulus, which hindered the eye stimulus from inducing exogenous attentional orienting ([<reflink idref="bib51" id="ref194">51</reflink>]). In the current study, even though the structural integrity of the face was disrupted, the changes in light and dark contrast produced by eye movement enabled TD children to generate exogenous attentional orienting to the gaze cue, thereby producing a facilitating effect. Second, in the study by [<reflink idref="bib42" id="ref195">42</reflink>], the SOA was 100 ms, and they demonstrated through a series of experiments that the attentional orienting induced in this SOA by gaze cues was exogenous, and inverted faces impaired this exogenous attentional orienting. In the current study, the SOA that produced the facilitating effect was 500 ms. Since endogenous attention occurs later ([<reflink idref="bib56" id="ref196">56</reflink>]; [<reflink idref="bib61" id="ref197">61</reflink>]), we speculate that the facilitating effect produced in TD children at 500 ms SOA involved both exogenous and endogenous attentional orienting. Therefore, even though inverted faces reduced exogenous attentional orienting, the endogenous attentional orienting produced by the gaze cue could also lead to a facilitating effect.</p> <p>The gaze cue-target paradigm used in the present study belongs to a variant of the classic spatial cue-target paradigm ([<reflink idref="bib21" id="ref198">21</reflink>]; [<reflink idref="bib61" id="ref199">61</reflink>]). In studies of the classic spatial cue-target paradigm, a spatially salient stimulus is typically used as a cue to orient participants' attention to the periphery, and a central stimulus is presented after the cue to facilitate attentional disengagement from the cued location and promote the onset of the IOR effect ([<reflink idref="bib73" id="ref200">73</reflink>]). While in studies of the gaze cue-target paradigm, a face with gaze direction presented in the center is used as a cue to orient participants' attention to the periphery, and a direct gaze face is presented after the cue to also facilitate attentional disengagement from the location oriented by the direction of gaze cue ([<reflink idref="bib20" id="ref201">20</reflink>]; [<reflink idref="bib36" id="ref202">36</reflink>]). Despite the differences in the types of cues in the two paradigms (peripherally salient stimuli vs. social gaze faces), the core mechanisms both involve attentional disengagement and inhibition processes during exogenous attentional orienting. Previous studies have shown that peripheral cue-induced IOR is not impaired in children with ADHD, suggesting that their basic exogenous attentional orienting mechanisms are not impaired ([<reflink idref="bib43" id="ref203">43</reflink>]; [<reflink idref="bib83" id="ref204">83</reflink>]). However, given the social information processing deficits in individuals with ADHD ([<reflink idref="bib15" id="ref205">15</reflink>]; [<reflink idref="bib71" id="ref206">71</reflink>]), the present study used the gaze cue-target paradigm in order to examine whether their gaze cue-induced IOR effects are abnormal and their underlying mechanisms. The results showed that ADHD children failed to show significant gaze cue-induced IOR effects. This specific deficit indicates the attentional disengagement dysfunction in social gaze cue processing in children with ADHD, which may be closely related to the abnormal development of social cognitive neural networks ([<reflink idref="bib33" id="ref207">33</reflink>]; [<reflink idref="bib52" id="ref208">52</reflink>]; [<reflink idref="bib84" id="ref209">84</reflink>]). The present study provides new experimental evidence for understanding social functioning impairments in children with ADHD, suggesting that their exogenous attentional deficits are characterized by social domain specificity.</p> <p>Importantly, even though the results showed differences in the patterns of attentional orienting effects to gaze cues between children with ADHD and TD in Experiment 1 of the present study, the three-way interaction of group × SOA × cue validity was not significant. This may be due to the small sample size of each group in this study, which results in insufficient power of statistical test ([<reflink idref="bib11" id="ref210">11</reflink>]). A post-hoc power analysis using MorePower 6.0.4 ([<reflink idref="bib9" id="ref211">9</reflink>]), based on the observed effect size of the three-way interaction (η<subs>p</subs>² =.02) from the Experiment 1, was therefore conducted. The analysis revealed that approximately 120 participants per group would be required to detect this effect with 80% power at the α =.05 level. Consequently, future studies employing larger sample sizes (i.e., around 120 per group) would promote testing this difference more reliably. Additionally, it is vital to consider that ADHD and ASD often comorbid and the two may have overlapping neurobiological bases ([<reflink idref="bib5" id="ref212">5</reflink>]). Children with ADHD may exhibit subthreshold ASD characteristics, even without meeting the formal diagnostic criteria for ASD ([<reflink idref="bib64" id="ref213">64</reflink>]). Some of these subthreshold ASD characteristics, especially abnormalities related to social functioning and attentional orienting ([<reflink idref="bib5" id="ref214">5</reflink>]; [<reflink idref="bib47" id="ref215">47</reflink>]), may affect the attentional orienting ability of ADHD children to the gaze cue. Accordingly, the abnormal attentional orienting to the gaze cue observed in children with ADHD in the current study may be partially attributed to the presence of subthreshold ASD characteristics. Future studies should further assess ASD characteristics in the ADHD population to better distinguish the independent or interactive effects of ADHD and subthreshold ASD on abnormal attentional orienting to the gaze cue. In addition, although the parent interview based on the DSM-5 criteria and the teacher form of the SNAP-IV confirmed the children's behavior in school during the ADHD diagnostic process, practical constraints (difficulty communicating directly with school teachers during clinical diagnosis) prevented the present study from systematically collecting teacher interviews and teacher form of the SNAP-IV assessments for the ADHD group. Future research should incorporate teacher interviews and scale results to conduct more direct cross-setting validation, thereby more accurately determining the cross-setting validity of ADHD diagnoses. For TD children, although they were screened based on DSM-5 criteria through parent and teacher interviews, the present study did not collect SNAP-IV scale scores to further quantify and confirm the absence of subthreshold ADHD characteristics. This may have limited the magnitude of the observed group differences in the present study. Future research should collect standardized symptom assessments (e.g., parent and teacher forms of the SNAP-IV) for TD children to more comprehensively assess the symptom spectrum and enhance the objectivity of group comparisons.</p> <hd id="AN0192008572-18">Conclusion</hd> <p>The ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment resulted from their reduced ability to exogenously orient to the intact face.</p> <hd id="AN0192008572-19">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-jad-10.1177_10870547251405543 for Impaired Exogenous Attentional Orienting to Gaze Cues in Children With ADHD: Evidence From Inhibition of Return by Jiaqi Wang, Aijun Wang, Jiacan Gu, Shizhong Cai and Ming Zhang in Journal of Attention Disorders</p> <ref id="AN0192008572-20"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref138" type="bt">1</bibl> <bibtext> Aijun Wang</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-4981-3400</bibtext> </blist> <blist> <bibl id="bib2" idref="ref21" type="bt">2</bibl> <bibtext> The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Soochow University, China (protocol code SUDA20220714H02, date of approval: 14 July 2022).</bibtext> </blist> <blist> <bibl id="bib3" idref="ref6" type="bt">3</bibl> <bibtext> J. W., A. W., and M. Z. designed the research. J. W., J. G., and S. C. performed the research. S. C. and J. W. analyzed the data. J. W. and A. W. wrote the manuscript text. A. W. and M. Z. reviewed the manuscript.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref12" type="bt">4</bibl> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Planning Fund for Humanities and Social Sciences Research of the Ministry of Education (25YJA190014), Ministry of Hainan Provincial Key Laboratory of Child Cognition and Behavior Development Funding (2024KF03), Major Program of Philosophy and Social Sciences in Jiangsu Province (2024SJZD137), and the Suzhou Science and Technology Development Plan (People's Livelihood Science and Technology: SKY2022113). S.C. was supported by Suzhou Science and Technology Bureau Project (SKY2023188).</bibtext> </blist> <blist> <bibl id="bib5" idref="ref212" type="bt">5</bibl> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref7" type="bt">6</bibl> <bibtext> None of the data or materials for the experiments reported here is currently available, but will be provided upon request. None of the experiments was preregistered.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref159" type="bt">7</bibl> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref145" type="bt">8</bibl> <bibtext> * These authors contributed equally to this work.</bibtext> </blist> </ref> <ref id="AN0192008572-21"> <title> References </title> <blist> <bibtext> Akiyama T., Kato M., Muramatsu T., Umeda S., Saito F., Kashima H. (2007). Unilateral amygdala lesions hamper attentional orienting triggered by gaze direction. Cerebral Cortex, 17(11), 2593–2600. https://doi.org/10.1093/cercor/bhl166</bibtext> </blist> <blist> <bibtext> American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.</bibtext> </blist> <blist> <bibtext> Astor K., Lindskog M., Forssman L., Kenward B., Fransson M., Skalkidou A., Tharner A., Cassé J., Gredebäck G. (2020). 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European Child & Adolescent Psychiatry, 16(6), 398–404. https://doi.org/10.1007/s00787-007-0612-5</bibtext> </blist> </ref> <aug> <p>By Jiaqi Wang; Aijun Wang; Jiacan Gu; Shizhong Cai and Ming Zhang</p> <p>Reported by Author; Author; Author; Author; Author</p> <p></p> <p>Jiaqi Wang is a Doctoral Candidate in psychology at Guangxi Normal University. Her graduate research has primarily focused on the inhibition of return and multisensory integration in ADHD children.</p> <p>Aijun Wang, PhD, is an Associate Professor at Guangxi Normal University, Department of Psychology. His research interests are in cognitive mechanisms of audiovisual integration, cross-modal attention, and working memory in typically developing children and children with ADHD.</p> <p>Jiacan Gu is a Teacher at Yijianhe Experimental Primary School. Her research focuses on the cognitive mechanisms of attention and audiovisual integration in typically developing children and children with ADHD.</p> <p>Shizhong Cai, PhD, is an Associate Professor at Soochow University, Clinical Pediatrics School, and Associate Chief Physician at Children's Hospital of Soochow University. His research interests are developmental behavior and pediatric health disorders, including their treatment and prevention.</p> <p>Ming Zhang, PhD, is a Professor at Suzhou University of Science and Technology, Department of Psychology. His research focuses on the cognitive neural mechanisms of human attention.</p> </aug> <nolink nlid="nl1" bibid="bib40" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib51" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib21" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib42" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib68" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib77" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib32" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib60" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib61" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib37" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib15" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib71" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib47" firstref="ref24"></nolink> <nolink nlid="nl17" bibid="bib28" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib45" firstref="ref26"></nolink> <nolink nlid="nl19" bibid="bib79" firstref="ref27"></nolink> <nolink nlid="nl20" bibid="bib31" firstref="ref39"></nolink> <nolink nlid="nl21" bibid="bib62" firstref="ref42"></nolink> <nolink nlid="nl22" bibid="bib63" firstref="ref43"></nolink> <nolink nlid="nl23" bibid="bib73" firstref="ref44"></nolink> <nolink nlid="nl24" bibid="bib75" firstref="ref45"></nolink> <nolink nlid="nl25" bibid="bib36" firstref="ref46"></nolink> <nolink nlid="nl26" bibid="bib65" firstref="ref51"></nolink> <nolink nlid="nl27" bibid="bib76" firstref="ref52"></nolink> <nolink nlid="nl28" bibid="bib14" firstref="ref59"></nolink> <nolink nlid="nl29" bibid="bib18" firstref="ref60"></nolink> <nolink nlid="nl30" bibid="bib30" firstref="ref61"></nolink> <nolink nlid="nl31" bibid="bib58" firstref="ref62"></nolink> <nolink nlid="nl32" bibid="bib59" firstref="ref63"></nolink> <nolink nlid="nl33" bibid="bib12" firstref="ref67"></nolink> <nolink nlid="nl34" bibid="bib33" firstref="ref68"></nolink> <nolink nlid="nl35" bibid="bib46" firstref="ref69"></nolink> <nolink nlid="nl36" bibid="bib84" firstref="ref70"></nolink> <nolink nlid="nl37" bibid="bib34" firstref="ref74"></nolink> <nolink nlid="nl38" bibid="bib49" firstref="ref87"></nolink> <nolink nlid="nl39" bibid="bib16" firstref="ref91"></nolink> <nolink nlid="nl40" bibid="bib74" firstref="ref93"></nolink> <nolink nlid="nl41" bibid="bib72" firstref="ref94"></nolink> <nolink nlid="nl42" bibid="bib22" firstref="ref95"></nolink> <nolink nlid="nl43" bibid="bib29" firstref="ref98"></nolink> <nolink nlid="nl44" bibid="bib23" firstref="ref99"></nolink> <nolink nlid="nl45" bibid="bib78" firstref="ref101"></nolink> <nolink nlid="nl46" bibid="bib53" firstref="ref104"></nolink> <nolink nlid="nl47" bibid="bib27" firstref="ref132"></nolink> <nolink nlid="nl48" bibid="bib35" firstref="ref135"></nolink> <nolink nlid="nl49" bibid="bib41" firstref="ref136"></nolink> <nolink nlid="nl50" bibid="bib69" firstref="ref137"></nolink> <nolink nlid="nl51" bibid="bib50" firstref="ref140"></nolink> <nolink nlid="nl52" bibid="bib57" firstref="ref141"></nolink> <nolink nlid="nl53" bibid="bib55" firstref="ref142"></nolink> <nolink nlid="nl54" bibid="bib85" firstref="ref143"></nolink> <nolink nlid="nl55" bibid="bib81" firstref="ref146"></nolink> <nolink nlid="nl56" bibid="bib82" firstref="ref147"></nolink> <nolink nlid="nl57" bibid="bib44" firstref="ref149"></nolink> <nolink nlid="nl58" bibid="bib70" firstref="ref160"></nolink> <nolink nlid="nl59" bibid="bib86" firstref="ref161"></nolink> <nolink nlid="nl60" bibid="bib52" firstref="ref163"></nolink> <nolink nlid="nl61" bibid="bib67" firstref="ref170"></nolink> <nolink nlid="nl62" bibid="bib10" firstref="ref174"></nolink> <nolink nlid="nl63" bibid="bib24" firstref="ref176"></nolink> <nolink nlid="nl64" bibid="bib25" firstref="ref177"></nolink> <nolink nlid="nl65" bibid="bib54" firstref="ref178"></nolink> <nolink nlid="nl66" bibid="bib39" firstref="ref180"></nolink> <nolink nlid="nl67" bibid="bib48" firstref="ref181"></nolink> <nolink nlid="nl68" bibid="bib17" firstref="ref182"></nolink> <nolink nlid="nl69" bibid="bib43" firstref="ref183"></nolink> <nolink nlid="nl70" bibid="bib83" firstref="ref184"></nolink> <nolink nlid="nl71" bibid="bib26" firstref="ref187"></nolink> <nolink nlid="nl72" bibid="bib66" firstref="ref188"></nolink> <nolink nlid="nl73" bibid="bib38" firstref="ref189"></nolink> <nolink nlid="nl74" bibid="bib80" firstref="ref193"></nolink> <nolink nlid="nl75" bibid="bib56" firstref="ref196"></nolink> <nolink nlid="nl76" bibid="bib11" firstref="ref210"></nolink> <nolink nlid="nl77" bibid="bib64" firstref="ref213"></nolink>
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  Label: Title
  Group: Ti
  Data: Impaired Exogenous Attentional Orienting to Gaze Cues in Children with ADHD: Evidence from Inhibition of Return
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Jiaqi+Wang%22">Jiaqi Wang</searchLink><br /><searchLink fieldCode="AR" term="%22Aijun+Wang%22">Aijun Wang</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4981-3400">0000-0003-4981-3400</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jiacan+Gu%22">Jiacan Gu</searchLink><br /><searchLink fieldCode="AR" term="%22Shizhong+Cai%22">Shizhong Cai</searchLink><br /><searchLink fieldCode="AR" term="%22Ming+Zhang%22">Ming Zhang</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(4):527-541.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Eye+Movements%22">Eye Movements</searchLink><br /><searchLink fieldCode="DE" term="%22Attention%22">Attention</searchLink><br /><searchLink fieldCode="DE" term="%22Cues%22">Cues</searchLink><br /><searchLink fieldCode="DE" term="%22Inhibition%22">Inhibition</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Stimuli%22">Visual Stimuli</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Adolescents%22">Early Adolescents</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251405543
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To examine whether children with attention-deficit/hyperactivity disorder (ADHD) can produce attentional orienting in response to gaze cues, and to identify which type of attentional orienting is impaired and why. Method: Two experiments employed a gaze cue-target paradigm using inhibition of return (IOR) as an indicator of exogenous attentional orienting. Experiment 1 used normal upright gaze faces as cues. Experiment 2 used inverted gaze faces as cues. Results: When normal gaze faces were used as the gaze cue, no IOR effect was observed in children with ADHD (Experiment 1); whereas when inverted gaze faces were used as the gaze cue, the IOR effect was produced in children with ADHD (Experiment 2). Conclusion: These results indicated that the ability to produce exogenous attentional orienting to the gaze cue is impaired in children with ADHD and that this impairment resulted from their reduced ability to exogenously orient to the intact face. These findings provide new evidence of social cognitive deficits and attentional orienting deficits in children with ADHD, and help provide support for children in educational settings.
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  Data: 2026
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  Data: EJ1499934
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        Value: 10.1177/10870547251405543
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 527
    Subjects:
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Eye Movements
        Type: general
      – SubjectFull: Attention
        Type: general
      – SubjectFull: Cues
        Type: general
      – SubjectFull: Inhibition
        Type: general
      – SubjectFull: Visual Stimuli
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Early Adolescents
        Type: general
    Titles:
      – TitleFull: Impaired Exogenous Attentional Orienting to Gaze Cues in Children with ADHD: Evidence from Inhibition of Return
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            NameFull: Jiacan Gu
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            NameFull: Shizhong Cai
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            NameFull: Ming Zhang
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              Y: 2026
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            – TitleFull: Journal of Attention Disorders
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