Oculomotor deficits in attention deficit hyperactivity disorder (ADHD): A systematic review and comprehensive meta-analysis

No Effects of Auditory and Visual White Noise on Oculomotor Control in Children with ADHD

BACKGROUND

White noise stimulation has demonstrated efficacy in enhancing working memory in children with ADHD. However, its impact on other executive functions commonly affected by ADHD, such as inhibitory control, remains largely unexplored. This research aims to explore the effects of two types of white noise stimulation on oculomotor inhibitory control in children with ADHD.

METHOD

Memory guided saccade (MGS) and prolonged fixation (PF) performance was compared between children with ADHD (N = 52) and typically developing controls (TDC, N = 45), during auditory and visual white noise stimulation as well as in a no noise condition.

RESULTS

Neither the auditory nor the visual white noise had any beneficial effects on performance for either group.

CONCLUSIONS

White noise stimulation does not appear to be beneficial for children with ADHD in tasks that target oculomotor inhibitory control. Potential explanations for this lack of noise benefit will be discussed.

Compressed cerebro-cerebellar functional gradients in children and adolescents with attention-deficit/hyperactivity disorder

Both cortical and cerebellar developmental differences have been implicated in attention-deficit/hyperactivity disorder (ADHD). Recently accumulating neuroimaging studies have highlighted hierarchies as a fundamental principle of brain organization, suggesting the importance of assessing hierarchy abnormalities in ADHD. A novel gradient-based resting-state functional connectivity analysis was applied to investigate the cerebro-cerebellar disturbed hierarchy in children and adolescents with ADHD. We found that the interaction of functional gradient between diagnosis and age was concentrated in default mode network (DMN) and visual network (VN). At the same time, we also found that the opposite gradient changes of DMN and VN caused the compression of the cortical main gradient in ADHD patients, implicating the co-occurrence of both low- (visual processing) and high-order (self-related thought) cognitive dysfunction manifesting in abnormal cerebro-cerebellar organizational hierarchy in ADHD. Our study provides a neurobiological framework to better understand the co-occurrence and interaction of both low-level and high-level functional abnormalities in the cortex and cerebellum in ADHD.

Effects of Auditory and Visual White Noise on Oculomotor Inhibition in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Crossover Study

BACKGROUND

In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition.

OBJECTIVE

This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children.

METHODS

Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study.

RESULTS

Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024.

CONCLUSIONS

This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56388.

Antisaccade error rates in first-episode psychosis, ultra-high risk for psychosis and unaffected relatives of schizophrenia: A systematic review and meta-analysis

BACKGROUND

Antisaccade, which is described as looking at the opposite location of the target, is an eye movements paradigm used for assessing cognitive functions in schizophrenia. Initiation and sustainment of saccades in antisaccade are managed by frontal and parietal cortical areas. Antisaccade abnormalities are well-established findings in schizophrenia. However, studies in the early phases of psychotic disorders and clinical/familial risk for psychosis reported inconsistent findings. The current systematic review aimed to review the results of studies investigating antisaccade error rates in first-episode psychosis (FEP), individuals with ultra-high-risk for psychosis (UHRP), and familial-high-risk for psychosis (FHRP) compared to healthy controls.

METHOD

A meta-analysis of 17 studies was conducted to quantitatively review antisaccade errors in FEP, UHR-P and FHRP. The error rate (Hedges'g) was compared between the total of 860 FEP, UHRP, FHRP, and 817 healthy controls. Hedges' g for effect size, I2 for estimating the percentage of variability, and publication bias were evaluated through the R software.

RESULTS

The outcomes of this meta-analysis suggested that FEP is associated with a robust deficit in the antisaccade error rate (g = 1.16, CI = 0.95-1.38). Additionally, both the clinical and familial high-risk groups showed small but significant increases in AS errors (g = 0.26, CI = 0.02-0.52 and g = 0.34, CI = 0.13-0.55, respectively).

CONCLUSION

The large effect size estimated for FEP was compatible with previously reported results in chronic schizophrenia patients. Additionally, relatives had abnormalities with small to medium effect sizes and significant differences. The current findings suggest that antisaccade errors might be a potential endophenotype for psychotic disorders.

Objective Parameters in Attention Deficit Hyperactivity Disorder: Eye and Head Movements

OBJECTIVE

We aimed to evaluate eye and head movements, which are objective parameters in ADHD. Method: While the children were watching the course video task, which included the relevant (teacher and smart board) and irrelevant (any regions outside the relevant area) areas of interest, their eye movements were evaluated through eye tracking, and video recordings were made simultaneous. Head position estimation was made using through video recordings. The proportion of total fixation duration on areas of interest (PFDAOI) and saccade count, amplitude, velocity for eye movements, number of total head movements and angular change of head movement in x-y-z axes for head movements were compared.

RESULTS

Children with ADHD had lower PFDAOI on the relevant area, and had more saccade and head movements The angular change of head movement in the x-axis was higher in the ADHD group.

CONCLUSION

In the assessment of ADHD, the eye and head movements may be particulary useful.

Don't look now! Social elements are harder to avoid during scene viewing

Regions of social importance (i.e., other people) attract attention in real world scenes, but it is unclear how automatic this bias is and how it might interact with other guidance factors. To investigate this, we recorded eye movements while participants were explicitly instructed to avoid looking at one of two objects in a scene (either a person or a non-social object). The results showed that, while participants could follow these instructions, they still made errors (especially on the first saccade). Crucially, there were about twice as many erroneous looks towards the person than there were towards the other object. This indicates that it is hard to suppress the prioritization of social information during scene viewing, with implications for how quickly and automatically this information is perceived and attended to.

Development of an innovative approach using portable eye tracking to assist ADHD screening: a machine learning study

Introduction

Attention-deficit/hyperactivity disorder (ADHD) affects a significant proportion of the pediatric population, making early detection crucial for effective intervention. Eye movements are controlled by brain regions associated with neuropsychological functions, such as selective attention, response inhibition, and working memory, and their deficits are related to the core characteristics of ADHD. Herein, we aimed to develop a screening model for ADHD using machine learning (ML) and eye-tracking features from tasks that reflect neuropsychological deficits in ADHD.

Methods

Fifty-six children (mean age 8.38 ± 1.58, 45 males) diagnosed with ADHD based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition were recruited along with seventy-nine typically developing children (TDC) (mean age 8.80 ± 1.82, 33 males). Eye-tracking data were collected using a digital device during the performance of five behavioral tasks measuring selective attention, working memory, and response inhibition (pro-saccade task, anti-saccade task, memory-guided saccade task, change detection task, and Stroop task). ML was employed to select relevant eye-tracking features for ADHD, and to subsequently construct an optimal model classifying ADHD from TDC.

Results

We identified 33 eye-tracking features in the five tasks with the potential to distinguish children with ADHD from TDC. Participants with ADHD showed increased saccade latency and degree, and shorter fixation time in eye-tracking tasks. A soft voting model integrating extra tree and random forest classifiers demonstrated high accuracy (76.3%) at identifying ADHD using eye-tracking features alone. A comparison of the model using only eye-tracking features with models using the Advanced Test of Attention or Stroop test showed no significant difference in the area under the curve (AUC) (p = 0.419 and p=0.235, respectively). Combining demographic, behavioral, and clinical data with eye-tracking features improved accuracy, but did not significantly alter the AUC (p=0.208).

Discussion

Our study suggests that eye-tracking features hold promise as ADHD screening tools, even when obtained using a simple digital device. The current findings emphasize that eye-tracking features could be reliable indicators of impaired neurobiological functioning in individuals with ADHD. To enhance utility as a screening tool, future research should be conducted with a larger sample of participants with a more balanced gender ratio.

Similar Gap-Overlap Profiles in Children with Fragile X Syndrome and IQ-Matched Autism

PURPOSE

Fragile X syndrome (FXS) is a single-gene disorder characterized by moderate to severe cognitive impairment and a high association with autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Atypical visual attention is a feature of FXS, ASD, and ADHD. Thus, studying early attentional patterns in young children with FXS can offer insight into early emerging neurocognitive processes underlying challenges and contribute to our understanding of common and unique features of ASD and ADHD in FXS.

METHODS

The present study examined visual attention indexed by the gap-overlap paradigm in children with FXS (n = 39) compared to children with ASD matched on intellectual ability and age (n = 40) and age-matched neurotypical controls (n = 34). The relationship between gap-overlap performance and intellectual ability, ASD, and ADHD across groups was characterized. Saccadic reaction times (RT) were collected across baseline, gap, and overlap conditions.

RESULTS

Results indicate no group differences in RT for any conditions. However, RT of the ASD and NT groups became slower throughout the experiment whereas RT of the FXS group did not change, suggesting difficulties in habituation for the FXS group. There was no relationship between RT and intellectual ability, ADHD, or ASD symptoms in the FXS and ASD groups. In the NT group, slower RT was related to elevated ADHD symptoms only.

CONCLUSION

Taken together, findings suggest that the social attention differences documented in FXS and ASD may be due to other cognitive factors, such as reward or motivation, rather than oculomotor control of visual attention.

Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations

Working memory is integral to a range of critical cognitive functions such as reasoning and decision-making. Although alterations in working memory have been observed in neurodivergent populations, there has been no review mapping how cognitive load is measured in common neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia. This scoping review explores the neurophysiological measures used to study cognitive load in these specific populations. Our findings highlight that electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are the most frequently used methods, with a limited number of studies employing functional near-infrared spectroscopy (fNIRs), magnetoencephalography (MEG) or eye-tracking. Notably, eye-related measures are less commonly used, despite their prominence in cognitive load research among neurotypical individuals. The review also highlights potential correlates of cognitive load, such as neural oscillations in the theta and alpha ranges for EEG studies, blood oxygenation level-dependent (BOLD) responses in lateral and medial frontal brain regions for fMRI and fNIRS studies and eye-related measures such as pupil dilation and blink rate. Finally, critical issues for future studies are discussed, including the technical challenges associated with multimodal approaches, the possible impact of atypical features on cognitive load measures and balancing data richness with participant well-being. These insights contribute to a more nuanced understanding of cognitive load measurement in neurodivergent populations and point to important methodological considerations for future neuroscientific research in this area.

A novel intervention for treating adults with ADHD using peripheral visual stimulation

Objective

Stimulation of the peripheral visual field has been previously reported as beneficial for cognitive performance in ADHD. This study assesses the safety and efficacy of a novel intervention involving peripheral visual stimuli in managing attention deficit hyperactivity disorder (ADHD).

Methods

One hundred and eight adults, 18-40 years old, with ADHD, were enrolled in a two-month open-label study. The intervention (i.e., Neuro-glasses) consisted of standard eyeglasses with personalized peripheral visual stimuli embedded on the lenses. Participants were assessed at baseline and at the end of the study with self-report measures of ADHD symptoms (the Adult ADHD Self-Report Scale; ASRS), and executive functions (The Behavior Rating Inventory of Executive Function Adult Version; BRIEF-A). A computerized test of continuous performance (The Conners' Continuous Performance Test-3; CPT-3) was tested at baseline with standard eyeglasses and at the end of study using Neuro-glasses. The Clinical Global Impression-Improvement scale (CGI-I) was assessed at the intervention endpoint. Safety was monitored by documentation of adverse events.

Results

The efficacy analysis included 97 participants. Significant improvements were demonstrated in self-reported measures of inattentive symptoms (ASRS inattentive index; p = 0.037) and metacognitive functions concerning self-management and performance monitoring (BRIEF-A; p = 0.029). A continuous-performance test (CPT-3) indicated significant improvement in detectability (d'; p = 0.027) and reduced commission errors (p = 0.004), suggesting that the Neuro-glasses have positive effects on response inhibition. Sixty-two percent of the participants met the response criteria assessed by a clinician (CGI-I). No major adverse events were reported.

Conclusion

Neuro-glasses may offer a safe and effective approach to managing adult ADHD. Results encourage future controlled efficacy studies to confirm current findings in adults and possibly children with ADHD.Clinical trial registration: https://www.clinicaltrials.gov/, Identifier NCT05777785.

Effects of others' gaze and facial expression on an observer's microsaccades and their association with ADHD tendencies

BACKGROUND

The aim of this study was to examine the effect of others' gaze on an observer's microsaccades. We also aimed to conduct preliminary investigations on the relationship between the microsaccadic response to a gaze and a gazer's facial expression and attention-deficit/hyperactivity disorder (ADHD) tendencies.

METHODS

Twenty healthy undergraduate and graduate students performed a peripheral target detection task by using unpredictable gaze cues. During the task, the participants' eye movements, along with changes in pupil size and response times for target detection, were recorded. ADHD tendencies were determined using an ADHD questionnaire.

RESULTS

We found that consciously perceiving the gaze of another person induced the observer's attention; moreover, microsaccades were biased in the direction opposite to the gaze. Furthermore, these microsaccade biases were differentially modulated, based on the cognitive processing of the facial expressions of the gaze. Exploratory correlation analysis indicated that microsaccade biases toward gazes with fearful expressions may specifically be correlated with participant characteristics, including inattention.

CONCLUSIONS

Our findings support that microsaccades reflect spatial attention processing and social cognitive processing. Moreover, the exploratory correlation analysis results suggested the potential benefit of using microsaccade bias toward spatial attention to assess pathophysiological responses associated with ADHD tendencies.

Relationship between autonomic arousal and attention orienting in children and adolescents with ADHD, autism and co-occurring ADHD and autism

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) may be characterized by different profiles of visual attention orienting. However, there are also many inconsistent findings emerging from the literature, probably due to the fact that the potential effect of autonomic arousal (which has been proposed to be dysregulated in these conditions) on oculomotor performance has not been investigated before. Moreover, it is not known how visual attention orienting is affected by the co-occurrence of ADHD and autism in people with a double diagnosis.

METHODS

99 children/adolescents with or without ADHD and/or autism (age 10.79 ± 2.05 years, 65% boys) completed an adapted version of the gap-overlap task (with baseline and overlap trials only). The social salience and modality of stimuli were manipulated between trials. Eye movements and pupil size were recorded. We compared saccadic reaction times (SRTs) between diagnostic groups and investigated if a trial-by-trial association existed between pre-saccadic pupil size and SRTs.

RESULTS

Faster orienting (shorter SRT) was found for baseline compared to overlap trials, faces compared to non-face stimuli and-more evidently in children without ADHD and/or autism-for multi-modal compared to uni-modal stimuli. We also found a linear negative association between pre-saccadic pupil size and SRTs, in autistic participants (without ADHD), and a quadratic association in children with ADHD (without autism), for which SRTs were slower when intra-individual pre-saccadic pupil size was smallest or largest.

CONCLUSION

Our findings are in line with previous literature and indicate a possible effect of dysregulated autonomic arousal on oculomotor mechanisms in autism and ADHD, which should be further investigated in future research studies with larger samples, to reliably investigate possible differences between children with single and dual diagnoses.

Mining attention distribution paradigm: Discover gaze patterns and their association rules behind the visual image

BACKGROUND AND OBJECTIVE

Attention allocation reflects the way of humans filtering and organizing the information. On one hand, different task scenarios seriously affect human's rule of attention distribution, on the other hand, visual attention reflecting the cognitive and psychological process. Most of the previous studies on visual attention allocation are based on cognitive models, predicted models, or statistical analysis of eye movement data or visual images, however, these methods are inadequate to provide an inside view of gaze behavior to reveal the attention distribution pattern within scenario context. Moreover, they seldom study the association rules of these patterns. Therefore, we adopted the big data mining approach to discover the paradigm of visual attention distribution.

METHODS

We applied the data mining method to extract the gaze patterns to discover the regularities of attention distribution behavior within the scenario context. The proposed method consists of three components, tasks scenario segmented and clustered, gaze pattern mining, and association rule of frequent pattern mining.

RESULTS

The proposed approach is tested on the operation platform. The complex operation task is simultaneously segmented and clustered with the TICC-based method and evaluated by the BCI index. The operator's eye movement frequent patterns and their association rule are discovered. The results demonstrate that our method can associate the eye-tracking data with the task-oriented scene data.

DISCUSSION

The proposed method provides the benefits of being able to explicitly express and quantitatively analyze people's visual attention patterns. The proposed method can not only be applied in the field of aerospace medicine and aviation psychology, but also can likely be applied to computer-aided diagnosis and follow-up tool for neurological disease and cognitive impairment related disease, such as ADHD (Attention Deficit Hyperactivity Disorder), neglect syndrome, social attention differences in ASD (Autism spectrum disorder).

Listen up! ADHD slows spoken-word processing in adverse listening conditions: Evidence from eye movements

BACKGROUND

Cognitive skills such as sustained attention, inhibition and working memory are essential for speech processing, yet are often impaired in people with ADHD. Offline measures have indicated difficulties in speech recognition on multi-talker babble (MTB) background for young adults with ADHD (yaADHD). However, to-date no study has directly tested online speech processing in adverse conditions for yaADHD.

AIMS

Gauging the effects of ADHD on segregating the spoken target-word from its sound-sharing competitor, in MTB and working-memory (WM) load.

METHODS AND PROCEDURES

Twenty-four yaADHD and 22 matched controls that differ in sustained attention (SA) but not in WM were asked to follow spoken instructions presented on MTB to touch a named object, while retaining one (low-load) or four (high-load) digit/s for later recall. Their eye fixations were tracked.

OUTCOMES AND RESULTS

In the high-load condition, speech processing was less accurate and slowed by 140ms for yaADHD. In the low-load condition, the processing advantage shifted from early perceptual to later cognitive stages. Fixation transitions (hesitations) were inflated for yaADHD.

CONCLUSIONS AND IMPLICATIONS

ADHD slows speech processing in adverse listening conditions and increases hesitation, as speech unfolds in time. These effects, detected only by online eyetracking, relate to attentional difficulties. We suggest online speech processing as a novel purview on ADHD. WHAT THIS PAPER ADDS?: We suggest speech processing in adverse listening conditions as a novel vantage point on ADHD. Successful speech recognition in noise is essential for performance across daily settings: academic, employment and social interactions. It involves several executive functions, such as inhibition and sustained attention. Impaired performance in these functions is characteristic of ADHD. However, to date there is only scant research on speech processing in ADHD. The current study is the first to investigate online speech processing as the word unfolds in time using eyetracking for young adults with ADHD (yaADHD). This method uncovered slower speech processing in multi-talker babble noise for yaADHD compared to matched controls. The performance of yaADHD indicated increased hesitation between the spoken word and sound-sharing alternatives (e.g., CANdle-CANdy). These delays and hesitations, on the single word level, could accumulate in continuous speech to significantly impair communication in ADHD, with severe implications on their quality of life and academic success. Interestingly, whereas yaADHD and controls were matched on WM standardized tests, WM load appears to affect speech processing for yaADHD more than for controls. This suggests that ADHD may lead to inefficient deployment of WM resources that may not be detected when WM is tested alone. Note that these intricate differences could not be detected using traditional offline accuracy measures, further supporting the use of eyetracking in speech tasks. Finally, communication is vital for active living and wellbeing. We suggest paying attention to speech processing in ADHD in treatment and when considering accessibility and inclusion.

Association between ADHD and vision problems. A systematic review and meta-analysis

AIM

To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function.

METHOD

Based on a pre-registered protocol (PROSPERO: CRD42021256352), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 16th November 2021, with no language/type of document restrictions. We included observational studies reporting at least one measure of vision in people of any age meeting DSM/ICD criteria for ADHD and in people without ADHD; or the prevalence of ADHD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random effects meta-analyses were used for data synthesis.

RESULTS

We included 42 studies in the narrative synthesis and 35 studies in the meta-analyses (3,250,905 participants). We found meta-analytic evidence of increased risk of astigmatism (OR = 1.79 [CI: 1.50, 2.14]), hyperopia and hypermetropia (OR = 1.79 [CI: 1.66, 1.94]), strabismus (OR = 1.93 [CI: 1.75, 2.12]), unspecified vision problems (OR = 1.94 [CI: 1.38, 2.73]) and reduced near point of convergence (OR = 5.02 [CI: 1.78, 14.11]); increased lag (Hedge's g = 0.63 [CI: 0.30, 0.96]) and variability (Hedge's g = 0.40 [CI: 0.17, 0.64]) of the accommodative response; and increased self-reported vision problems (Hedge's g = 0.63 [CI: 0.44, 0.82]) in people with ADHD compared to those without ADHD (with no significant heterogeneity). We also found meta-analytic evidence of no differences between people with and without ADHD on retinal nerve fiber layer thickness (Hedge's g = -0.19 [CI: -0.41, 0.02]) and refractive error (Hedge's g = 0.08 [CI: -0.26, 0.42]) (with no significant heterogeneity).

DISCUSSION

ADHD is associated with some self-reported and objectively ascertained functional vision problems, but not with structural alterations of the eye. Further studies should clarify the causal relationship, if any, between ADHD and problems of vision.

TRIAL REGISTRATION

PROSPERO registration: CRD42021256352.

Reading performance in children with ADHD: an eye-tracking study

Reading disabilities have a profound impact on the academic performance and achievement of children. Although oculomotor pattern abnormalities during reading in children with dyslexia are well known, those in individuals with attention deficit and hyperactive disorders (ADHD) - who also frequently exhibit a reading impairment - remain largely undetermined. The objective of the present study was to evaluate the peculiarities of oculomotor pattern abnormalities during a reading task. An eye-tracker was used to record eye movements in four distinct groups of children with neurodevelopmental disorders: children with dyslexia, children with ADHD with and without comorbid dyslexia, and in a group of typically developing children (TD). Ninety-six children participated in the study (24 children per group, IQ- and age-matched groups). The duration of fixation, the total reading time, and the number of forward and backward saccades were similar in children with dyslexia and ADHD + dyslexia, but were significantly different from those observed in children with ADHD and with TD. Our findings suggest a link between dyslexia and oculomotor reading impairments in both children with dyslexia and children with ADHD + dyslexia, indicating that the oculomotor pattern in children with ADHD without comorbid dyslexia is similar to that observed in TD children. We suggest that an objective eye movement recording during a reading task could help clinicians to better evaluate the possible presence of comorbid dyslexia in children with ADHD. Furthermore, children with ADHD with and without comorbid dyslexia could also have working memory deficiencies. Further studies are needed to confirm this finding.

Eye-tracking training improves the learning and memory of children with learning difficulty

Children who experience difficulty in learning at mainstream schools usually are provided with remediation classes after school to facilitate their learning. The present study aims to evaluate an innovative eye-tracking training as possible alternative remediation. Our previous findings showed that children who received eye-tracking training demonstrated improved attention and inhibitory control, and the present randomized controlled study aims to evaluate if eye-tracking training can also enhance the learning and memory of children. Fifty-three primary school students with learning difficulty (including autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorder, specific language impairment and borderline intellectual functioning) were recruited and randomly assigned to either the Eye-tracking Training group or the after-school remediation class. They were assessed on their learning and memory using the Hong Kong List Learning Test before and after 8-month training. Twenty weekly parallel sessions of training, 50 min per session, were provided to each group. Children who received the eye-tracking training, not those in the control group, showed a significant improvement in memory as measured by the delayed recall. In addition, the Eye-Tracking Training group showed significantly faster learning than the control group. Also, the two groups showed a significant improvement in their reading abilities. In sum, eye-tracking training may be effective training for enhancing the learning and memory of children with learning difficulties.