Using head-mounted eye tracking to examine visual and manual exploration during naturalistic toy play in children with and without autism spectrum disorder

E-coaching for parents of children with autism spectrum disorder: Protocol for a randomized controlled trial

Autism spectrum disorder (ASD) is a neurodevelopmental condition that significantly affects children's development, posing a significant challenge in pediatric healthcare. Early parent-mediated interventions (PMIs) aim to improve a child's social communication skills through joint engagement in daily activities. However, widespread access to this type of intervention is heavily limited due to implementation barriers and logistical challenges. The use of technology may offer promising alternatives to reach more families. This randomized controlled trial will assess the efficacy of an innovative e-coaching program designed to provide parents of young children with ASD with effective strategies via an online learning platform combined with personalized debriefings. It will compare e-coaching to standard Pediatric Autism Communication Therapy and to the absence of a PMI, with all three arms combined with community assistance as usual, in a cohort of 99 families with preschool children with ASD. The primary outcome will be the quality of parent-child interaction, measured through behavioral assessments and simultaneous dual gaze recording with head-mounted eye-tracking during semi-structured standardized play sessions. Secondary outcomes will include the child's developmental level and parental well-being. If validated, e-coaching could be disseminated to reach more families and have a positive impact on their quality of life.

Implementing mobile eye tracking in psychological research: A practical guide

Eye tracking provides direct, temporally and spatially sensitive measures of eye gaze. It can capture visual attention patterns from infancy through adulthood. However, commonly used screen-based eye tracking (SET) paradigms are limited in their depiction of how individuals process information as they interact with the environment in "real life". Mobile eye tracking (MET) records participant-perspective gaze in the context of active behavior. Recent technological developments in MET hardware enable researchers to capture egocentric vision as early as infancy and across the lifespan. However, challenges remain in MET data collection, processing, and analysis. The present paper aims to provide an introduction and practical guide to starting researchers in the field to facilitate the use of MET in psychological research with a wide range of age groups. First, we provide a general introduction to MET. Next, we briefly review MET studies in adults and children that provide new insights into attention and its roles in cognitive and socioemotional functioning. We then discuss technical issues relating to MET data collection and provide guidelines for data quality inspection, gaze annotations, data visualization, and statistical analyses. Lastly, we conclude by discussing the future directions of MET implementation. Open-source programs for MET data quality inspection, data visualization, and analysis are shared publicly.

Consistency and variability in multimodal parent-child social interaction: An at-home study using head-mounted eye trackers

Real-time attention coordination in parent-toddler dyads is often studied in tightly controlled laboratory settings. These studies have demonstrated the importance of joint attention in scaffolding the development of attention and the types of dyadic behaviors that support early language learning. Little is known about how often these behaviors occur in toddlers' everyday lives. We brought wireless head-mounted eye trackers to families' homes to study the moment-to-moment patterns of toddlers' and parents' visual attention and manual activity in daily routines. Our sample consisted of English- and Spanish-speaking families who all reported being middle- or upper middle-class. Toddlers were 2 to 3 years old. Consistent with the findings from previous laboratory studies, we found variability in how frequently toddlers attended to named objects in two everyday activities-Object Play and Mealtime. We then tested whether parent-toddler joint attention in the seconds before a naming utterance increased toddler's attention on the named object. We found that joint attention accompanied by the attended object being held increased the child's attention to the labeled object during naming. We posit that in the rich, noisy world of toddlers' everyday lives, embodied attention plays a critical role in coordinating dyadic behaviors and creating informative naming moments. Our findings highlight the importance of studying toddlers' natural behavior in the real world. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stop trying to carve Nature at its joints! The importance of a process-based developmental science for understanding neurodiversity

Nature is dynamic and interdependent. Yet we typically study and understand it as a hierarchy of independent static things (objects, factors, capacities, traits, attributes) with well-defined boundaries. Hence, since Plato, the dominant research practice has been to 'carve Nature at its joints' (Phaedrus 265e), rooted in the view that the world comes to us pre-divided - into static forms or essences - and that the goal of science is to simply discover (identify and classify) them. This things-based approach dominates developmental science, and especially the study of neurodevelopmental conditions. The goal of this paper is to amplify the marginalised process-based approach: that Nature has no joints. It is a hierarchy of interacting processes from which emerging functions (with fuzzy boundaries) softly assemble, become actively maintained, and dissipate over various timescales. We further argue (with a specific focus on children with Down syndrome) that the prevailing focus on identifying, isolating, and analysing things rather than understanding dynamic interdependent processes is obstructing progress in developmental science and particularly our understanding of neurodiversity. We explain how re-examining the very foundation of traditional Western thought is necessary to progress our research on neurodiversity, and we provide specific recommendations on how to steer developmental science towards the process-based approach.

Computer Vision Analysis of Caregiver-Child Interactions in Children with Neurodevelopmental Disorders: A Preliminary Report

We report preliminary results of computer vision analysis of caregiver-child interactions during free play with children diagnosed with autism (N = 29, 41-91 months), attention-deficit/hyperactivity disorder (ADHD, N = 22, 48-100 months), or combined autism + ADHD (N = 20, 56-98 months), and neurotypical children (NT, N = 7, 55-95 months). We conducted micro-analytic analysis of 'reaching to a toy,' as a proxy for initiating or responding to a toy play bout. Dyadic analysis revealed two clusters of interaction patterns, which differed in frequency of 'reaching to a toy' and caregivers' contingent responding to the child's reach for a toy by also reaching for a toy. Children in dyads with higher caregiver responsiveness had less developed language, communication, and socialization skills. Clusters were not associated with diagnostic groups. These results hold promise for automated methods of characterizing caregiver responsiveness in dyadic interactions for assessment and outcome monitoring in clinical trials.

Natural behavior in everyday settings

Infant behaviors-walking, vocalizing, playing, interacting with others, and so on-offer an unparalleled window into learning and development. The study of infants requires strategic choices about what to observe, where, when, and how. We argue that loosening study constraints-by allowing infants and caregivers to do whatever they choose, wherever they choose, and with whatever materials they choose-promises to reveal a deep understanding of the everyday data on which learning builds. We show that observations of infants' natural behavior yield unique insights into the nature of visual exploration, object play, posture and locomotion, proximity to caregiver, and communication. Furthermore, we show that by situating the study of behavior in ecologically-valid settings, researchers can gain purchase on the contextual regularities that frame learning. We close by underscoring the value of studies at every point on the research continuum-from cleverly controlled lab-based tasks to fully natural observations in everyday environments. Acceleration in the science of behavior rests on leveraging expertise across disciplines, theoretical positions, and methodological approaches.

Conducting head-mounted eye-tracking research with young children with autism and children with increased likelihood of later autism diagnosis

BACKGROUND

Over the past years, researchers have been using head-mounted eye-tracking systems to study young children's gaze behaviors in everyday activities through which children learn about the world. This method has great potential to further our understanding of how millisecond-level gaze behaviors create multisensory experiences and fluctuate around social environments. While this line of work can yield insight into early perceptual experiences and potential learning mechanisms, the majority of the work is exclusively conducted with typically-developing children. Sensory sensitivities, social-communication difficulties, and challenging behaviors (e.g., disruption, elopement) are common among children with developmental disorders, and they may represent potential methodological challenges for collecting high-quality data.

RESULTS

In this paper, we describe our research practices of using head-mounted eye trackers with 41 autistic children and 17 children with increased likelihood of later autism diagnosis without auditory or visual impairments, including those who are minimally or nonspeaking and/or have intellectual disabilities. The success rate in gathering data among children with autism was 92.68%. 3 of 41 children failed to complete the play-session, resulting in an 86.36% success rate among 1-4-year-olds and a 100.00% success rate among 5-8-year-olds. 1 of 17 children with increased likelihood of later autism diagnosis failed to complete the play-session, resulting in a success rate of 94.11%. There were numerous "challenging" behaviors relevant to the method. The most common challenging behaviors included taking the eye-tracking device off, elopement, and becoming distressed. Overall, among children with autism, 88.8% of 1-4-year-olds and 29.4% of 5-8-year-olds exhibited at least one challenging behavior.

CONCLUSIONS

Research capitalizing on this methodology has the potential to reveal early, socially-mediated gaze behaviors that are relevant for autism screening, diagnosis, and intervention purposes. We hope that our efforts in documenting our study methodology will help researchers and clinicians effectively study early naturally-occuring gaze behaviors of children during non-experimental contexts across the spectrum and other developmental disabilities using head-mounted eye-tracking. Ultimately, such applications may increase the generalizability of results, better reflect the diversity of individual characteristics, and offer new ways in which this method can contribute to the field.

Using head-mounted eye trackers to explore children's color preferences and perceptions of toys with different color gradients

This study investigated how color gradients affect the attraction and visual comfort of children aged 4 to 7 years. We analyzed 108 eye-tracking datasets, including the color attraction index (COI), visual comfort index (PUI), and saccade rate (SR). The findings revealed that children are more attracted to colors as saturation decreases and brightness increases within a specific range. Beyond this range, reduced saturation diminishes color appeal. Moderate brightness and contrast enhance visual comfort during play, while extremely low contrast hinders concentration. Warm colors (red, orange, and yellow) slightly dominate preferences; however, the roles of hue, saturation, and brightness in children's color preferences remain inconclusive. These insights have practical implications for age-appropriate toy design and marketing. Future research should explore age-specific color preferences for more targeted design strategies.

Multimodal pathways to joint attention in infants with a familial history of autism

Joint attention (JA) is an early-developing behavior that allows caregivers and infants to share focus on an object. Deficits in JA, as measured through face-following pathways, are a defining feature of autism spectrum disorder (ASD) and are observable as early as 12 months of age in infants later diagnosed with ASD. However, recent evidence suggests that JA may be achieved through hand-following pathways by children with and without ASD. Development of JA through multimodal pathways has yet to be studied in infants with an increased likelihood of developing ASD. The current study investigated how 6-, 9- and 12-month-old infants with (FH+) and without (FH-) a family history of ASD engaged in JA. Parent-infant dyads played at home while we recorded the interaction over Zoom and later offline coded for hand movements and gaze. FH+ and FH- infants spent similar amounts of time in JA with their parents, but the cues available before JA were different. Parents of FH+ infants did more work to establish JA and used more face-following than hand-following pathways compared to parents of FH- infants, likely reflecting differences in infant motor or social behavior. These results suggest that early motor differences between FH+ and FH- infants may cascade into differences in social coordination.

Infant embodied attention in context: Feasibility of home-based head-mounted eye tracking in early infancy

Social communication emerges from dynamic, embodied social interactions during which infants coordinate attention to caregivers and objects. Yet many studies of infant attention are constrained to a laboratory setting, neglecting how attention is nested within social contexts where caregivers dynamically scaffold infant behavior in real time. This study evaluates the feasibility and acceptability of the novel use of head-mounted eye tracking (HMET) in the home with N = 40 infants aged 4 and 8 months who are typically developing and at an elevated genetic liability for autism spectrum disorder (ASD). Results suggest that HMET with young infants with limited independent motor abilities and at an elevated likelihood for atypical development is highly feasible and deemed acceptable by caregivers. Feasibility and acceptability did not differ by age or ASD likelihood. Data quality was also acceptable, albeit with younger infants showing slightly lower accuracy, allowing for preliminary analysis of developmental trends in infant gaze behavior. This study provides new evidence for the feasibility of using in-home HMET with young infants during a critical developmental period when more complex interactions with the environment and social partners are emerging. Future research can apply this technology to illuminate atypical developmental trajectories of embodied social attention in infancy.

Towards imaging the infant brain at play

Infants' first-person experiences are crucial to early cognitive and neural development. To a vast extent, these early experiences involve play, which in infancy takes the form of object exploration. While at the behavioral level infant play has been studied both using specific tasks and in naturalistic scenarios, the neural correlates of object exploration have largely been studied in highly controlled task settings. These neuroimaging studies did not tap into the complexities of everyday play and what makes object exploration so important for development. Here, we review selected infant neuroimaging studies, spanning from typical, highly controlled screen-based studies on object perception to more naturalistic designs and argue for the importance of studying the neural correlates of key behaviors such as object exploration and language comprehension in naturalistic settings. We suggest that the advances in technology and analytic approaches allow measuring the infant brain at play with the use of functional near-infrared spectroscopy (fNIRS). Naturalistic fNIRS studies offer a new and exciting avenue to studying infant neurocognitive development in a way that will draw us away from our laboratory constructs and into an infant's everyday experiences that support their development.

Using functional near-infrared spectroscopy to study the early developing brain: future directions and new challenges

Significance

Functional near-infrared spectroscopy (fNIRS) is a frequently used neuroimaging tool to explore the developing brain, particularly in infancy, with studies spanning from birth to toddlerhood (0 to 2 years). We provide an overview of the challenges and opportunities that the developmental fNIRS field faces, after almost 25 years of research.

Aim

We discuss the most recent advances in fNIRS brain imaging with infants and outlines the trends and perspectives that will likely influence progress in the field in the near future.

Approach

We discuss recent progress and future challenges in various areas and applications of developmental fNIRS from methodological and technological innovations to data processing and statistical approaches.

Results and Conclusions

The major trends identified include uses of fNIRS "in the wild," such as global health contexts, home and community testing, and hyperscanning; advances in hardware, such as wearable technology; assessment of individual variation and developmental trajectories particularly while embedded in studies examining other environmental, health, and context specific factors and longitudinal designs; statistical advances including resting-state network and connectivity, machine learning and reproducibility, and collaborative studies. Standardization and larger studies have been, and will likely continue to be, a major goal in the field, and new data analysis techniques, statistical methods, and collaborative cross-site projects are emerging.

Effects of early exposure to phthalates on cognitive development and visual behavior at 24 months

BACKGROUND AND OBJECTIVES

Studies focusing on the neurodevelopmental effects of phthalates seldom consider exposure during infancy, a critical period for brain development. Most rely on parent-completed questionnaires to assess child neurodevelopment, which may be subject to reporting error. We studied the associations between prenatal and infancy exposure to phthalates and objective measures of neurodevelopment at the age of two.

METHODS

We relied on 151 mother-child pairs from the SEPAGES mother-child cohort. Women were asked to collect three spot urine samples per day over seven consecutive days during the second (median: 18.0 gestational weeks) and third (median: 34.2 gestational weeks) trimesters of pregnancy. They then collected one urine sample per day over seven consecutive days from their infants around the age of 12 months. Metabolites of phthalates and non-phthalate plasticizers were measured in within-subject and within-period pools of repeated urine samples. Eye tracking tasks were performed at two years allowing to compute four indicators linked with cognitive development and visual behavior: mean fixation duration, novelty preference, percent time spent looking at the eyes and mean reaction time.

RESULTS

Pre-natal exposure to monobenzyl phthalate at the second and third trimesters was associated with shorter fixation durations. In models allowing for interaction with child sex, these associations were only observed among girls. Exposure to di(2-ethylhexyl) phthalate at the third but not the second trimester was associated with increased time spent looking at a novel face and eyes. We observed faster reaction times and decreased time spent looking at the eyes in a face recognition task, with increased post-natal exposure to monoethyl, mono-iso-butyl and mono-n-butyl phthalates.

DISCUSSION

Relying on improved exposure assessment, we highlighted associations of pre- and post-natal exposure to phthalates with indicators derived from eye tracking tasks, mainly in girls. Some of these indicators have been affected in individuals with neurodevelopmental disorders.

Rendimiento de los estímulos visuales en el diagnóstico del TEA por Eye Tracking: Revisión Sistemática

El eye-tracking es una herramienta diagnóstica que tiene como   fin el estudio del comportamiento de la mirada a través del escaneo de ojos para observar el seguimiento ocular, cómo se distribuye la mirada y la precisión de los movimientos oculares. Este sistema se ha utilizado con niños/as del Trastorno del Espectro Autista. El objetivo de esta revisión sistemática ha sido analizar el rendimiento de los estímulos visuales en el diagnóstico del TEA por método eye tracking. Para ello, se siguió la metodología PRISMA, realizando una búsqueda en las bases de datos PubMed, Science Direct y Scopus, así como, Reseach Gate. Se seleccionaron 22 artículos que cumplían los criterios de inclusión con experimentos unifactoriales, experimentales factoriales y cuasiexperimentales. Todos los experimentos han tenido un grupo control compuesto de muestra con participantes con desarrollo normotípico y de un grupo de caso compuesto de muestra con participantes TEA. Esta revisión sintetiza en tres categorías en base a las características del estímulo usado en el diagnóstico (estímulos sociales, no sociales y por confrontación), el análisis del rendimiento de los estímulos visuales, de manera que los estímulos sociales y los estímulos por confrontación van a ser eficaces para establecer un diagnóstico preciso de TEA puesto que permiten realizar un cribado de ambos grupos y establecer un riesgo temprano del trastorno.

Bidding on the go: Links between walking, social actions, and caregiver responses in infant siblings of children with autism spectrum disorder

The development of walking is associated with a shift in how neurotypical infants initiate social interactions. Walking infants are more likely to locate objects in distant places, carry them, and then share those objects by approaching caregivers and using gestures to show or offer their discoveries (i.e., moving bids). The simultaneous organization of the behaviors necessary to generate moving bids requires the coordination of multiple skills-walking, fine motor skills, and gesturing. Infants with an elevated likelihood (EL) for autism spectrum disorder (ASD) exhibit differences and delays in each of these behaviors. This study investigated interconnections between infant walking, social actions, and caregiver responses in 18-month-old EL infants with diverse developmental outcomes (ASD, non-ASD language delay, no diagnosis). We observed 85 infant-caregiver dyads at home during everyday activities for 45 minutes and identified all times when infants walked, instances of walking paired with social action (i.e., approaching the caregiver, approaching while carrying an object, producing a moving bid), and whether caregivers responded to their infants' social actions. There were no group differences in infants' production of social actions. Caregiver responses, however, were more clearly modulated by outcome group. While all caregivers were similarly and highly likely to respond to moving bids, caregivers of EL-ASD infants were substantially more likely to respond when their infants simply approached them (with or without an object in hand). Taken together, this research underscores the complexity of EL infant-caregiver interactions and highlights the role that each partner plays in shaping how they unfold.

Reduced social attention in autism is magnified by perceptual load in naturalistic environments

Individuals with autism spectrum conditions (ASC) describe differences in both social cognition and sensory processing, but little is known about the causal relationship between these disparate functional domains. In the present study, we sought to understand how a core characteristic of autism-reduced social attention-is impacted by the complex multisensory signals present in real-world environments. We tested the hypothesis that reductions in social attention associated with autism would be magnified by increasing perceptual load (e.g., motion, multisensory cues). Adult participants (N = 40; 19 ASC) explored a diverse set of 360° real-world scenes in a naturalistic, active viewing paradigm (immersive virtual reality + eyetracking). Across three conditions, we systematically varied perceptual load while holding the social and semantic information present in each scene constant. We demonstrate that reduced social attention is not a static signature of the autistic phenotype. Rather, group differences in social attention emerged with increasing perceptual load in naturalistic environments, and the susceptibility of social attention to perceptual load predicted continuous measures of autistic traits across groups. Crucially, this pattern was specific to the social domain: we did not observe differential impacts of perceptual load on attention directed toward nonsocial semantic (i.e., object, place) information or low-level fixation behavior (i.e., overall fixation frequency or duration). This study provides a direct link between social and sensory processing in autism. Moreover, reduced social attention may be an inaccurate characterization of autism. Instead, our results suggest that social attention in autism is better explained by "social vulnerability," particularly to the perceptual load of real-world environments.

Autism: The face value of eye contact

Inattention to faces in clinical assessments is a robust marker for autism. However, a new study distinguishes diagnostic marker from behavioral mechanism, showing that face looking in everyday activity is equally rare in autistic and neurotypical children and not required for joint attention in either group.

Computational approaches to understanding interaction and development

Audio-visual recording and location tracking produce enormous quantities of digital data with which researchers can document children's everyday interactions in naturalistic settings and assessment contexts. Machine learning and other computational approaches can produce replicable, automated measurements of these big behavioral data. The economies of scale afforded by repeated automated measurements offer a potent approach to investigating linkages between real-time behavior and developmental change. In our work, automated measurement of audio from child-worn recorders-which quantify the frequency of child and adult speech and index its phonemic complexity-are paired with ultrawide radio tracking of children's location and interpersonal orientation. Applications of objective measurement indicate the influence of adult behavior in both expert ratings of attachment behavior and ratings of autism severity, suggesting the role of dyadic factors in these "child" assessments. In the preschool classroom, location/orientation measures provide data-driven measures of children's social contact, fertile ground for vocal interactions. Both the velocity of children's movement toward one another and their social contact with one another evidence homophily: children with autism spectrum disorder, other developmental disabilities, and typically developing children were more likely to interact with children in the same group even in inclusive preschool classrooms designed to promote interchange between all children. In the vocal domain, the frequency of peer speech and the phonemic complexity of teacher speech predict the frequency and phonemic complexity of children's own speech over multiple timescales. Moreover, children's own speech predicts their assessed language abilities across disability groups, suggesting how everyday interactions facilitate development.

Beyond screen time: Using head-mounted eye tracking to study natural behavior

Head-mounted eye tracking is a new method that allows researchers to catch a glimpse of what infants and children see during naturalistic activities. In this chapter, we review how mobile, wearable eye trackers improve the construct validity of important developmental constructs, such as visual object experiences and social attention, in ways that would be impossible using screen-based eye tracking. Head-mounted eye tracking improves ecological validity by allowing researchers to present more realistic and complex visual scenes, create more interactive experimental situations, and examine how the body influences what infants and children see. As with any new method, there are difficulties to overcome. Accordingly, we identify what aspects of head-mounted eye-tracking study design affect the measurement quality, interpretability of the results, and efficiency of gathering data. Moreover, we provide a summary of best practices aimed at allowing researchers to make well-informed decisions about whether and how to apply head-mounted eye tracking to their own research questions.

What children with and without ASD see: Similar visual experiences with different pathways through parental attention strategies

Background and aims

Although young children's gaze behaviors in experimental task contexts have been shown to be potential biobehavioral markers relevant to autism spectrum disorder (ASD), we know little about their everyday gaze behaviors. The present study aims (1) to document early gaze behaviors that occur within a live, social interactive context among children with and without ASD and their parents, and (2) to examine how children's and parents' gaze behaviors are related for ASD and typically developing (TD) groups. A head-mounted eye-tracking system was used to record the frequency and duration of a set of gaze behaviors (such as sustained attention [SA] and joint attention [JA]) that are relevant to early cognitive and language development.

Methods

Twenty-six parent-child dyads (ASD group = 13, TD group = 13) participated. Children were between the ages of 3 and 8 years old. We placed head-mounted eye trackers on parents and children to record their parent- and child-centered views, and we also recorded their interactive parent-child object play scene from both a wall- and ceiling-mounted camera. We then annotated the frequency and duration of gaze behaviors (saccades, fixation, SA, and JA) for different regions of interest (object, face, and hands), and attention shifting. Independent group t-tests and ANOVAs were used to observe group comparisons, and linear regression was used to test the predictiveness of parent gaze behaviors for JA.

Results

The present study found no differences in visual experiences between children with and without ASD. Interestingly, however, significant group differences were found for parent gaze behaviors. Compared to parents of ASD children, parents of TD children focused on objects and shifted their attention between objects and their children's faces more. In contrast, parents of ASD children were more likely to shift their attention between their own hands and their children. JA experiences were also predicted differently, depending on the group: among parents of TD children, attention to objects predicted JA, but among parents of ASD children, attention to their children predicted JA.

Conclusion

Although no differences were found between gaze behaviors of autistic and TD children in this study, there were significant group differences in parents' looking behaviors. This suggests potentially differential pathways for the scaffolding effect of parental gaze for ASD children compared with TD children.

Implications

The present study revealed the impact of everyday life, social interactive context on early visual experiences, and point to potentially different pathways by which parental looking behaviors guide the looking behaviors of children with and without ASD. Identifying parental social input relevant to early attention development (e.g., JA) among autistic children has implications for mechanisms that could support socially mediated attention behaviors that have been documented to facilitate early cognitive and language development and implications for the development of parent-mediated interventions for young children with or at risk for ASD.Note: This paper uses a combination of person-first and identity-first language, an intentional decision aligning with comments put forth by Vivanti (Vivanti, 2020), recognizing the complexities of known and unknown preferences of those in the larger autism community.