Atypical Biological Motion Perception in Children with Attention Deficit Hyperactivity Disorder: Dissociating the Roles of Local Motion and Global Configuration Processing

Reviewer #1 (Public Review):

Summary:
The paper presents a nice study investigating differences in biological motion perception in participants with ADHD in comparison with controls. Motivated by the idea that there is a relationship between biological motion perception and social capabilities, the authors investigated local and global (holistic) biological motion perception, the group, and several additional behavioral variables that are affected in ADHS (IQ, social responsiveness, and attention/impulsivity). As well as local global biological motion perception is reduced in ADHD participants. In addition, the study demonstrates a significant correlation between local biological motion perception skills and the social responsiveness score in the ADHD group, but not the controls. A path analysis in the ADHD data suggests that general performance in biological motion perception is influenced mainly by global biological motion perception performance and attentional and perceptual reasoning skills.

Strengths:
It is true that there exists not much work on biological motion perception and ADHD. Therefore, the presented study contributes an interesting new result to the biological motion literature and adds potentially also new behavioral markers for this clinical condition. The design of the study is straightforward and technically sound, and the drawn conclusions are supported by the presented results.

Weaknesses:
Some of the claims about the relationship between genetic factors and ADHD and the components of biological motion processing have to remain speculative at this point because genetic influences were not explicitly tested in this paper.

Reviewer #2 (Public Review):

Summary:
Tian et al. aimed to assess differences in biological motion (BM) perception between children with and without ADHD, as well as relationships to indices of social functioning and possible predictors of BM perception (including demographics, reasoning ability and inattention). In their study, children with ADHD showed poorer performance relative to typically developing children in three tasks measuring local, global, and general BM perception. The authors further observed that across the whole sample, performance in all three BM tasks was negatively correlated with scores on the social responsiveness scale (SRS), whereas within groups a significant relationship to SRS scores was only observed in the ADHD group and for the local BM task. Local and global BM perception showed a dissociation in that global BM processing was predicted by age, while local BM perception was not. Finally, general (local & global combined) BM processing was predicted by age and global BM processing, while reasoning ability mediated the effect of inattention on BM processing.

Strengths:
Overall, the manuscript is presented in a relatively clear fashion and methods and materials are presented with sufficient detail so the study could be reproduced by independent researchers. The study uses an innovative, albeit not novel, paradigm to investigate two independent processes underlying BM perception. The results are novel and have the potential to have wide-reaching impact on multiple fields.

Weaknesses:
Except for the main analysis, it is unclear what the authors' specific predictions are regarding the three different tasks they employ. The three BM tasks are used to probe different processes underlying BM perception, but it is difficult to gather from the introduction why these three specific tasks were chosen and what predictions the authors have about the performance of the ADHD group in these tasks. Relatedly, the authors do not report whether (and if so, how) they corrected for multiple comparisons in their analyses. As the number of tests one should control for depends on the theoretical predictions (http://daniellakens.blogspot.com/2016/02/why-you-dont-need-to-adjust-you-alpha.html), both are necessary for the reader to assess the statistical validity of the results and any inferences drawn from them. The same is the case for the secondary analyses exploring relationships between the 3 individual BM tasks and social function measured by the social responsivity scale (SRS).

In relation to my prior point, the authors could provide more clarity on how the conclusions drawn from the results relate to their predictions. For example, it is unclear what specific conclusions the authors draw based on their findings that ADHD show performance differences in all three BM perception tasks, but only local BM is related to social function within this group. Here, the claim is made that their results support a specific hypothesis, but it is unclear to me what hypothesis they are actually referring to (see line 343 & following). This lack of clarity is aggravated by the fact that throughout the rest of the discussion, in particular when discussing other findings to support their own conclusions, the authors often make no distinction between the two processes of interest. Lastly, some of the authors' conclusions related to their findings on local vs global BM processing are not logically following from the evidence: For instance, the authors conclude that their data supports the idea that social atypicalities are likely to reduce with age in ADHD individuals. However, according to their own account, local BM perception - the only measure that was related to social function in their study - is understood to be age invariant (and was indeed not predicted by age in the present study).

Results reported are incomplete, making it hard for the reader to comprehensively interpret the findings and assess whether the conclusions drawn are valid. Whenever the authors report negative results (p-values > 0.05), the relevant statistics are not reported, and the data not plotted. In addition, summary statistics (group means) are missing for the main analysis.

Some of the conclusions/statements in the article are too strong and should be rephrased to indicate hypotheses and speculations rather than facts. For example, in lines 97-99 the authors state that the finding of poor BM performance in TD children in a prior study 'indicated inferior applicability' or 'inapplicable experimental design'. While this is one possibility, a perhaps more plausible interpretation could be that TD children show 'poor' performance due to outstanding maturation of the underlying (global) BM processes (as the authors suggest themselves that BM perception can improve with age). There are several other examples where statements are too strong or misleading, which need attention.

Reviewer #3 (Public Review):

Summary:
The authors presented point light displays of human walkers to children (mean = 9 years) with and without ADHD to compare their biological motion perception abilities and relate them to IQ, social responsiveness scale (SRS) scores and age. They report that children with ADHD were worse at all three biological motion tasks, but that those loading more heavily on local processing related to social interaction skills and global processing to age. The important and solid findings are informative for understanding this complex condition, as well as biological motion processing mechanisms in general. However, I am unsure that these differences between local and global skills are truly supported by the data and suggest some further analyses.

Strengths:
The authors present clear differences between the ADHD and TD children in biological motion processing, and this question has not received as much attention as equivalent processing capabilities in autism. They use a task that appears well controlled. They raise some interesting mechanistic possibilities for differences in local and global motion processing, which are distinctions worth exploring. The group differences will therefore be of interest to those studying ADHD, as well as other developmental conditions, and those examining biological motion processing mechanisms in general.

Weaknesses:
I am unsure that the data are strong enough to support claims about differences between global and local processing wrt social communication skills and age. The mechanistic possibilities for why these abilities may dissociate in such a way are interesting, but do not seem so plausible to me. I am also concerned about gender, and possible autism, confounds when examining the effect of ADHD. Specifics:

Gender confound. There are proportionally more boys in the ADHD than TD group. The authors appear to attempt to overcome this issue by including gender as a covariate. I am unsure if this addresses the problem. The vast majority of participants in the ADHD group are male, and gender is categorically, not continuously, defined. I'm pretty sure this violates the assumptions of ANCOVA.

Autism. Autism and ADHD are highly comorbid. The authors state that the TD children did not have an autism or ADHD diagnosis, but they do not state that the ADHD children did not have an autism diagnosis. Given the nature of the claims, this seems crucial information for the reader.

Conclusions. The authors state frequently that it was the local BM task that related to social communication skills (SRS) and not the global tasks. However, the results section shows a correlation between SRS and all three tasks. The only difference is that when looking specifically within the ADHD group, the correlation is only significant for the local task. I think that if the authors wish to make strong claims here they must show inferential stats supporting (1) a difference between ADHD and TD SRS-Task 1 correlations, and (2) a difference in those differences for Task 2 and 3 relative to Task 1. I think they should also show a scatterplot of this correlation, with separate lines of best fit for the two groups, for Tasks 2 and 3 as well. I.e. Figure 4 should have 3 panels. I would recommend the same type of approach for age. Currently, they have small samples for correlations, and are reading much of theoretical significance between some correlations passing significance threshold and others not. It would be incredibly interesting if the social skills (as measured by SRS) only relate to local BM abilities, and age only to global, but I think the data are not so clear with the current information. I would be surprised if all BM abilities did not improve with age. Even if there is some genetic starter kit (and that this differs according to particular BM component), most abilities improve with learning/experience/age.

Theoretical assumptions. The authors make some sweeping statements about local vs global biological motion processing that need to be toned down. They assume that local processing is specifically genetically whereas global processing is a product of experience. The fact their global, but not local, task performance improves with age would tend to suggest there could be some difference here, but the existing literature does not allow for this certainty. The chick studies showing a neonatal preference are controversial and confounded - I cannot remember the specifics but I think there an upper vs lower visual field complexity difference here.