Abstract
One challenge to the development of effective interventions to support learning and behavioural change in neurodevelopmental disorders is a lack of suitable outcome measures. Eye-tracking has been used widely to chart cognitive development and clinically-relevant group differences in many populations. This proof-of-concept study investigates whether it also has the potential to act as a marker of treatment effects, by testing its sensitivity to differential change over a short period of exposure to an iPad app in typically developing children. The app targets a key skill in early social communication development, by rewarding attention to people, operationalised via a finger-tap on screen. We measured attention to images taken from the app, and a selection of matched stimuli to test generalisation of effects, at baseline and two weeks later. Children were assigned to either an app-exposure or no-app condition in the intervening period. The app exposure group showed increases in fixation on people for images from the app, and for distant-generalisation photographs, at high levels of complexity. We conclude that, with careful selection of stimuli, eye-tracking has the potential to make a valuable contribution to the range of outcome measures available for psycho-behavioural interventions in neurodevelopmental disorders.
Highlights
The challenges of measuring outcome in intervention studies with populations with neurodevelopmental disorders have been well-documented[1,2,3]
It permits a blinded analysis of data, and provides a degree of objectivity. This is not absolute, due to the need to process raw data into meaningful variables for analysis, but may exceed that permitted by the use of self-report measures, or ratings of video behaviour - both commonly used in measurement of treatment effect for psycho-behavioural intervention
This study asked whether recordings of eye-movement patterns show promise as a sensitive measure of behavioural change over time, whereby a change in eye-movement patterns can be detected as a result of rewarding a manual motor behaviour
Summary
The challenges of measuring outcome in intervention studies with populations with neurodevelopmental disorders have been well-documented[1,2,3]. A good quality outcome measure for psycho-behavioural intervention should meet a series of criteria including: sensitivity to change; objective measurement; clinical relevance; construct validity; feasibility; and capable of being administered by assessors blind to status. Eye-tracking has shown sensitivity to between-group differences, sensitivity to change over longer time spans, and some (albeit limited) clinical and construct validity – all features relevant to the evaluation of psycho-behavioural interventions. It permits a blinded analysis of data, and provides a degree of objectivity. In relation to our original criteria, we can see that eye-tracking offers potential for objective measurement; clinical relevance; construct validity; feasibility; and capacity for blinded administration. It remains to be demonstrated whether a behavioural intervention in a real-world 3-d environment can influence the location of fixations or speed of fixation to those locations
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