Neurophysiological Patterns of Attention and Distraction during Realistic Virtual-Reality Classroom Learning in Adults with and without ADHD.

Many people, and particularly those diagnosed with ADHD, report difficulties maintaining attention and proneness to distraction during classroom learning. However, the behavioral, neural and physiological basis of attention in realistic learning contexts is not well understood, since current clinical and scientific tools used for evaluating and quantifying the constructs of "distractibility" and "inattention", are removed from the real-life experience in organic classrooms. Here we introduce a novel Virtual Reality (VR) platform for studying students' brain activity and physiological responses as they immerse in realistic frontal classroom learning. Using this approach, we studied whether adults with and without ADHD (N=49) exhibit differences in neurophysiological metrics associated with sustained attention, such as speech-tracking of the teacher's voice, power of alpha-oscillations and levels of arousal, as well as responses to potential disturbances by background sound-events in the classroom. Under these ecological conditions, we find that adults with ADHD exhibit higher auditory neural response to background sounds relative to their control-peers, which also contributed to explaining variance in the severity of ADHD symptoms, together with higher power of alpha-oscillations and more frequent gaze-shifts around the classroom. These results are in-line with higher sensitivity to irrelevant stimuli in the environment and increased mind-wandering/boredom. At the same time, both groups exhibited similar learning outcomes and showed similar neural tracking of the teacher's speech. This suggests that in this context, attention may not operate as a zero-sum game and that allocating some resources to irrelevant stimuli does not always detract from performing the task at hand. Given the dire need for more objective, dimensional and ecologically-valid measures of attention and its real-life deficits, this work provides new insights into the neurophysiological manifestations of attention and distraction experienced in real-life contexts, while challenging some prevalent notions regarding the nature of attentional challenges experienced by those with ADHD.