Measuring sensitivity to eye gaze cues in naturalistic scenes: Presenting the eye gaze FoCuS database

Social visual attention as a treatment outcome: evaluating the social games for autistic adolescents (SAGA) intervention

A core feature of autism involves difficulty perceiving and interpreting eye gaze shifts as nonverbal communicative signals. A hypothesis about the origins of this phenotype is that it emerges from developmentally different social visual attention (SVA). We developed Social Games for Autistic Adolescents (SAGA; Scherf et al. BMJ Open 8(9):e023682, 2018) as a serious game intervention for autistic individuals to discover the significance of eye gaze cues. Previously, we demonstrated the effectiveness of SAGA to improve the perception and understanding of eye gaze cues and social skills for autistic adolescents (Griffin et al. JCPP Adv 1(3):e12041, 2021). Here, we determine whether increases in social visual attention to faces and/or target gazed-at objects, as measured via eye tracking during the same Gaze Perception task in the same study sample, moderated this improvement. In contrast to predictions, SVA to faces did not differentially increase for the treatment group. Instead, both groups evinced a small increase in SVA to faces over time. Second, Prior to the SAGA intervention, attention to faces failed to predict performance in the Gaze Perception task for both the treatment and standard care control groups. However, at post-test, autistic adolescents in the treatment group were more likely to identify the object of directed gaze when they attended longer to faces and longer to target objects. Importantly, this is the first study to measure social visual attention via eye tracking as a treatment response in an RCT for autism. NCT02968225.

Improving sensitivity to eye gaze cues in adolescents on the autism spectrum using serious game technology: A randomized controlled trial

Background

Perceiving and interpreting eye gaze cues is foundational for social cognition and social interactions because it involves the ability to use eye gaze direction to predict the actions and intentions of others. Autism is a disability that impacts social interactions. A diagnostic symptom of autism is difficulty understanding eye gaze cues as social signals. This deficit has long-term consequences for understanding goal-directed behavior, language learning, and social communication. We hypothesize that targeted intervention methods designed to improve sensitivity to eye gaze cues may begin to treat core symptoms of autism and potentially alter multiple aspects of social functioning. Social Games for Autistic Adolescents (SAGA) is a serious computer game intervention designed to improve sensitivity to eye gaze cues. Serious games improve targeted skills with the goal of enhancing real life outcomes. In SAGA, participants progress through a narrative storyline and interact with animated characters. In so doing, they implicitly discover that eye gaze cues are useful for guiding their own goal-directed behavior to solve problems in the game.

Methods

We evaluated the feasibility and effectiveness of SAGA in a hybrid phase 1/2, randomized controlled trial. Forty adolescents on the autism spectrum were randomized to either the treatment or standard care control group. Adolescents in the treatment group were asked to play SAGA for 30-minute sessions at home 3 times a week over 10 weeks.

Results

A group × time interaction revealed that the treatment group developed increasing sensitivity to human eye gaze cues, whereas the standard care group did not. Participants who experienced a sufficient dose of gameplay showed larger treatment-related improvements. Critically, increases in sensitivity to human eye gaze cues were associated with improvements in social skills.

Conclusions

This accessible, scalable, and affordable intervention shows promise as an effective tool for improving the ability to interpret and understand eye gaze cues and social skills in adolescents on the autism spectrum.

Measuring sensitivity to eye gaze cues in naturalistic scenes: Presenting the eye gaze FoCuS database

OBJECTIVES

The ability to process information about eye gaze and its use for nonverbal communication is foundational to human social interactions. We developed and validated a database of stimuli that are optimized to investigate the perception and referential understanding of shifts in eye gaze.

METHODS

The 245 Gaze Perception stimuli are digital photographs that test the ability to estimate and interpret eye gaze trajectory. The 82 Gaze Following stimuli are digital videos that measure the ability to follow and interpret eye gaze shifts online. Both stimuli were designed for a 4-alternative forced choice paradigm (4AFC) in which the participant identifies the gazed-at object.

RESULTS

Each stimulus was validated by independent raters and only included if the endorsement of the correct item was ≥75%. Finally, we provided timestamps for 19 40-second video segments from adolescent-oriented entertainment movies that are matched on several factors. These segments involve social interactions with eye gaze shifts and can be used to measure visual social attention.

CONCLUSIONS

This database will be an excellent resource for researchers interested in studying the developmental, behavioral, and/or neural mechanisms supporting the perception and interpretation of eye gaze cues.

Does decreased visual attention to faces underlie difficulties interpreting eye gaze cues in autism?

BACKGROUND

Shifts in eye gaze communicate social information that allows people to respond to another's behavior, interpret motivations driving behavior, and anticipate subsequent behavior. Understanding the social communicative nature of gaze shifts requires the ability to link eye movements and mental state information about objects in the world. Autism spectrum disorder (ASD) is characterized by atypical sensitivity to eye gaze cues, which impacts social communication and relationships. We evaluated whether reduced visual attention to faces explains this difficulty in ASD.

METHODS

We employed eye-tracking technology to measure visual attention to faces and gazed-at objects in a 4-alternative forced choice paradigm in adolescents with ASD and typically developing (TD) adolescents. Participants determined the target object that an actor was looking at in ecologically rich scenes. We controlled for group differences in task engagement and data quality.

RESULTS

In the Gaze Following task, adolescents with ASD were relatively impaired (Cohen's d = 0.63) in the ability to identify the target object. In contrast to predictions, both groups exhibited comparable fixation durations to faces and target objects. Among both groups, individuals who looked longer at the target objects, but not faces, performed better in the task. Finally, among the ASD group, parent SSIS-Social Skills ratings were positively associated with performance on the Gaze Following task. In the Gaze Perception task, there was a similar pattern of results, which provides internal replication of the findings that visual attention to faces is not related to difficulty interpreting eye gaze cues. Together, these findings indicate that adolescents with ASD are capable of following gaze, but have difficulty linking gaze shifts with mental state information.

LIMITATIONS

Additional work is necessary to determine whether these findings generalize to individuals across the full autism spectrum. New paradigms that manipulate component processes of eye gaze processing need to be tested to confirm these interpretations.

CONCLUSIONS

Reduced visual attention to faces does not appear to contribute to atypical processing of eye gaze cues among adolescents with ASD. Instead, the difficulty for individuals with ASD is related to understanding the social communicative aspects of eye gaze information, which may not be extracted from visual cues alone.