Objective To investigate the eye-tracking characteristics of emotional face processing in children with attention-deficit/hyperactivity disorder (ADHD), in order to provide insights for improving clinical intervention effects in ADHD children. Methods From February to August 2025, 83 children with ADHD and 74 age-matched typically developed (TD) children were recruited from the Child Early Development Clinic of Guangzhou Women and Children′s Medical Center Affliated to Guangzhou Medical University. Eye-tracking technology was used to present emotional facial stimuli, and four core eye-tracking metrics (including total fixation duration and number of fixations) were collected. Independent samples t-tests, chi-square test, and mixed-design analysis of variance were applied to compare differences in eye-tracking data between the two groups. Results Compared with TD children, children with ADHD showed shorter total fixation duration and fewer fixations on the eye region, as well as longer time to first fixation on the eye region (P＜0.05). During the processing of different emotional faces, children with ADHD showed shorter total fixation duration for angry and sad faces (t＝-3.051,-2.101, P <0.05), fewer fixations for angry and fearful faces(t＝-2.022,-3.105, P<0.05), and longer time to first fixation for angry, sad, and fearful faces (t=3.283, 2.183, 2.227, P<0.05). In addition, their recognition accuracy for angry and sad expressions was significantly lower than that of TD children (χ2＝ 3.451, 3.530, P <0.001). Significant group × emotion interaction effects existed on total fixation duration (F＝4.10, P＝0.003, ηp2＝0.026), number of fixations (F＝3.58, P＝0.007, ηp2＝0.023), and time to first fixation (F＝3.01, P＝0.018, ηp2＝0.019). Conclusions Compared with TD children, children with ADHD exhibit different attentional patterns during the recognition and processing of emotional faces, particularly for negative emotional faces, as reflected by reduced attentional engagement, and abnormal recognition/processing of faces with specific emotions. This suggests that ADHD children may have specific attentional biases or processing delays in emotional face processing, which may provide neurocognitive evidence for understanding their emotional and social difficulties.
Key words
attention-deficit/hyperactivity disorder /
eye-tracking /
facial processing /
social cognition /
emotion recognition /
children
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