Identifying Distracting Architectural Factors of the Therapeutic Environment and the Effect of Their Modification on Rehabilitation Outcomes in ADHD Children, The Implication of Eye Tracking System.
Journal of Clinical Physiotherapy Research,
Vol. 10 No. 1 (2025),
15 November 2025
,
Page 1-8
https://doi.org/10.22037/jcpr.v10i1.50882
Abstract
Introduction: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience heightened distractibility and sensory regulation difficulties that compromise their therapeutic engagement. Despite growing recognition of environmental influences on child behavior, limited research has objectively quantified how architectural factors impact rehabilitation outcomes. This study investigated the relationship between built environmental features and attentional performance among ADHD children and evaluated the effect of targeted spatial modifications on therapeutic engagement. Methods: A mixed-methods, within-subject design was implemented in two phases involving 36 children aged 8–12 years with clinically confirmed ADHD. Eye-tracking systems were used to measure fixation duration, saccadic frequency, and gaze dispersion during therapy sessions in baseline and modified environments. Environmental modifications included decluttering, neutral color adjustments, optimized lighting, and visual zoning. Standardized instruments, Short Sensory Profile 2 (SSP2), Conners Continuous Performance Test (CPT-3), and Strengths and Difficulties Questionnaire (SDQ), were administered pre- and post-intervention. Results: Results demonstrated significant reductions in fixation on irrelevant stimuli (p < 0.01), increased task-oriented gaze fixation (p < 0.05), and improved sensory regulation scores on the SSP2. Children showed fewer sensory over-responsivity behaviors (SSP2), improvement in sustained attention (CPT-3) and emotional regulation (SDQ). Engagement scores also increased significantly (p < 0.001). Conclusion: These findings confirm that physical space is a modifiable determinant of therapeutic success. Integrating environmental design with clinical practice supports an evidence-based framework for sensory-conscious rehabilitation. This interdisciplinary approach has implications for the design of therapy centers, classrooms, and inclusive educational environments optimized for neurodiverse children.
- ADHD, architecture, rehabilitation, eye tracking System, environmental psychology
How to Cite
References
1. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018; 5(2):175-186. Doi: 10.1016/S2215-0366(17)30167-0.
2. Jurek L, Duchier A, Gauld C, Hénault L, Giroudon C, Fourneret P, Cortese S, Nourredine M. Sensory Processing in Individuals With ADHD Compared With Control Populations: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2025; 64(10):1132–1147. DOI:10.1016/j.jaac.2025.02.019.
3. Hertzog D, Cermak S, Bar-Shalita T. Sensory modulation, physical activity and participation in daily occupations in young children. Can J Occup Ther. 2019; 86(2):106-113. DOI: 10.1177/0008417419831403
4. Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school. J Abnorm Child Psychol. 2009; 37(5):705–716. DOI: 10.1007/s10802-008-9295-8.
5. Irani N, Bavar C, Mirzakhani N, Daryabor A, Pashmdarfard M, Khademi Kalantari S. Effect of Interior Architecture of Rehabilitation Centers on the Outcome of Occupational Therapy for Children With Autism Spectrum Disorders. JRehab. 2024; 24(4):602–615. DOI:10.32598/RJ.24.4.3671.2
6. Nair AS, Priya RS, Rajagopal P, Pradeepa C, Senthil R, Dhanalakshmi S, Lai KW, Wu X, Zuo X. A case study on the effect of light and colors in the built environment on autistic children's behavior. Front Psychiatry. 2022; 30; 13:1042641. DOI: 10.3389/fpsyt.2022.1042641.
7. Sathyanarayanan H, Jiang Y, Caldas L, Cheshire C. Visual engagement and comfort perceptions in pediatric patient room design: a VR + eye-tracking study. J Environ Psychol. 2025; 18: 100636. DOI: 10.1016/j.chbr.2025.100636
8. Bodison SC, Parham LD. Specific Sensory Techniques and Sensory Environmental Modifications for Children and Youth With Sensory Integration Difficulties: A Systematic Review. Am J Occup Ther. 2018; 72(1):7201190040p1-7201190040p11. DOI: 10.5014/ajot.2018.029413.
9. Global Research on Developmental Disabilities Collaborators. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Glob Health. 2018; 6(10):e1100-e1121. Doi: 10.1016/S2214-109X (18)30309-7.
10. Stokes JD, Rizzo A, Geng JJ, Schweitzer JB. Measuring Attentional Distraction in Children With ADHD Using Virtual Reality Technology With Eye-Tracking. Front Virtual Real. 2022; 3:855895. DOI: 10.3389/frvir.2022.855895.
11. Rosas, H J, Sussman, A, Sekely, AC & Lavdas, AA. Using Eye Tracking to Reveal Responses to the Built Environment and Its Constituents. Applied Sciences. 2023; 13(21), 12071. DOI: 10.3390/app132112071
12. Stokes JD, Rizzo A, Geng JJ, Schweitzer JB. Measuring Attentional Distraction in Children With ADHD Using Virtual Reality Technology With Eye-Tracking. Front Virtual Real. 2022; 3:855895. DOI: 10.3389/frvir.2022.855895.
13. Chan AS, Leung PY, Pang TW, Sze SL. Eye-tracking training improves visuospatial working memory of children with attention-deficit/hyperactivity disorder and autism spectrum disorder. Autism Res. 2024; 17(11):2244-2260. DOI: 10.1002/aur.3238.
14. Le DD, Nguyen TKC, Le TH, Ngo TD. The use of eye-tracking technology in supporting children and adolescents with attention deficit/hyperactivity disorder: a comprehensive review. Disabil Rehabil Assist Technol. 2025; 20(5):1296-1323. DOI: 10.1080/17483107.2025.2497305.
15. Li L, Wang L, Zhu X, & Wan S.. An Experimental Study of Virtual Space Design for Emotional Intervention in Autistic Children with Eye Movement Technology. Journal of Innovation and Development. 2024; 8(3), 82-86. Doi: 10.54097/th82s372
16. Khademi Kalantari S. The Impact of Architectural Elements In Occupational Therapy Centers On The Sensory Profile of Children With Attention Deficit Hyperactivity Disorder. JRehab. 2025; 26 (3):446-463. DOI: 10.32598/RJ.26.3.4063.1
17. Mohamed I, Almaz A. The role of architectural and interior design in creating an autism-friendly environment to promote sensory-mitigated design as one of the autistic needs.. International Design Journal, 2024; 14(2): 239-255. DOI: 10.21608/idj.2024.340122.
18. Solomon M, Ono M, Timmer S, Goodlin-Jones B. The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. J Autism Dev Disord. 2008 Oct;38(9):1767-76. DOI: 10.1007/s10803-008-0567-5.
19. Mahoney, G., Boyce, G., Fewell, R. R., Spiker, D., & Wheeden, C. A. The Relationship of Parent-Child Interaction to the Effectiveness of Early Intervention Services for at-Risk Children and Children with Disabilities. Topics in Early Childhood Special Education. 1998; 18(1), 5-17. Doi: 10.1177/027112149801800104.
20. Byun J, Joung C, Lee Y, Lee S, Won W. Le Petit Care: A Child-Attuned Design for Personalized ADHD Symptom Management Through AI-powered Extended Reality. In Proceedings of the Extended Abstracts of the CHI Conference on Human Factors in Computing Systems. 2025; 26: 1-7. Doi: 10.1145/3706599.3720300.
21. Khademi Kalantari S, MirzaKhani Araghi N, Khademi Kalantari S. Utilizing Eye-Tracking Software to Identify and Modify Architectural Factors Affecting Treatment Outcomes for Autistic Children in Rehabilitation Treatment Environments: A Research Proposal. The Scientific Journal of Rehabilitation Medicine, 2025; 14(3): 480-491. DOI: 10.32598/SJRM.14.3.3375.
- Abstract Viewed: 133 times
- PDF Downloaded: 71 times