Designing AAC Systems for Children with Autism: Evidence from Eye Tracking Research

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

BACKGROUND

Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords.

METHODOLOGY

We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed.

DISCUSSION

Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism.

TRIAL REGISTRATION

ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.

Innovations for Supporting Communication: Opportunities and Challenges for People with Complex Communication Needs

Individuals with complex communication needs have benefited greatly from technological innovations over the past two decades, as well as from social movements that have shifted focus from disability to functioning and participation in society. Three strands of technological innovation are reviewed in this paper: (1) innovations in the tools that have become available, specifically tablet technologies; (2) innovations in access methods (eye gaze technologies and brain-computer interfaces); and (3) innovations in output, specifically speech technologies. The opportunities these innovations offer are explored, as are some of the challenges that they imply, not only for individuals with complex communication needs, but also for families, professionals, and researchers.

Gaze Toward Naturalistic Social Scenes by Individuals With Intellectual and Developmental Disabilities: Implications for Augmentative and Alternative Communication Designs

PURPOSE

A striking characteristic of the social communication deficits in individuals with autism is atypical patterns of eye contact during social interactions. We used eye-tracking technology to evaluate how the number of human figures depicted and the presence of sharing activity between the human figures in still photographs influenced visual attention by individuals with autism, typical development, or Down syndrome. We sought to examine visual attention to the contents of visual scene displays, a growing form of augmentative and alternative communication support.

METHOD

Eye-tracking technology recorded point-of-gaze while participants viewed 32 photographs in which either 2 or 3 human figures were depicted. Sharing activities between these human figures are either present or absent. The sampling rate was 60 Hz; that is, the technology gathered 60 samples of gaze behavior per second, per participant. Gaze behaviors, including latency to fixate and time spent fixating, were quantified.

RESULTS

The overall gaze behaviors were quite similar across groups, regardless of the social content depicted. However, individuals with autism were significantly slower than the other groups in latency to first view the human figures, especially when there were 3 people depicted in the photographs (as compared with 2 people). When participants' own viewing pace was considered, individuals with autism resembled those with Down syndrome.

CONCLUSION

The current study supports the inclusion of social content with various numbers of human figures and sharing activities between human figures into visual scene displays, regardless of the population served. Study design and reporting practices in eye-tracking literature as it relates to autism and Down syndrome are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6066545.

Application of eye tracking in medicine: A survey, research issues and challenges

The performance and quality of medical procedures and treatments are inextricably linked to technological development. The application of more advanced techniques provides the opportunity to gain wider knowledge and deeper understanding of the human body and mind functioning. The eye tracking methods used to register eye movement to find the direction and targets of a person's gaze are well in line with the nature of the topic. By providing methods for capturing and processing images of the eye it has become possible not only to reveal abnormalities in eye functioning but also to conduct cognitive studies focused on learning about peoples' emotions and intentions. The usefulness of the application of eye tracking technology in medicine was proved in many research studies. The aim of this paper is to give an insight into those studies and the way they utilize eye imaging in medical applications. These studies were differentiated taking their purpose and experimental paradigms into account. Additionally, methods for eye movement visualization and metrics for its quantifying were presented. Apart from presenting the state of the art, the aim of the paper was also to point out possible applications of eye tracking in medicine that have not been exhaustively investigated yet, and are going to be a perspective long-term direction of research.

Social Referencing Gaze Behavior During a Videogame Task: Eye Tracking Evidence from Children With and Without ASD

The purpose of this study was to understand the social referencing behaviors of children with and without autism spectrum disorder (ASD) while visually attending to a videogame stimulus depicting both the face of the videogame player and the videogame play action. Videogames appear to offer a uniquely well-suited environment for the emergence of friendships, but it is not known if children with and without ASD attend to and play videogames similarly. Eyetracking technology was used to investigate visual attention of participants matched based on chronological age. Parametric and nonparametric statistical analyses were used and results indicated the groups did not differ on percentage of time spent visually attending to any of the areas of interest, with one possible exception.

Eye tracking research to answer questions about augmentative and alternative communication assessment and intervention

Recently, eye tracking technologies (i.e., technologies that automatically track the point of an individual's gaze while that person views or interacts with a visual image) have become available for research purposes. Based on the sampling of the orientation of the individual's eyes, researchers can quantify which locations within the visual image were fixated (viewed), for how long, and how many times. These automated eye tracking research technologies open up a wealth of avenues for investigating how individuals with developmental or acquired communication disabilities may respond to aided augmentative and alternative communication (AAC) systems. In this paper, we introduce basic terminology and explore some of the special challenges of conducting eye tracking research with populations with disabilities who might use AAC, including challenges of inferring attention from the presence of fixation and challenges related to calibration that may result from participant characteristics, behavioral idiosyncracies, and/or the number of calibration points. We also examine how the technology can be applied to ask well-structured experimental questions that have direct clinical relevance, with a focus on the unique contributions that eye tracking research can provide by (a) allowing evaluation of skills in individuals who are difficult to assess via traditional methods, and (b) facilitating access to information on underlying visual cognitive processes that is not accessible via traditional behavioral measures.