Automatic Detection of Attention Shifts in Infancy: Eye Tracking in the Fixation Shift Paradigm

A Cross-Cultural Analysis of Infants' Spatial Attention on the Infant Orienting With Attention (IOWA) Task

Research with Western samples has uncovered the rapid development of infants' visual attention. This study evaluated spatial attention in 6- to 9-month-old infants living in rural Malawi (N = 511;n Boys  = 255,n Yao  = 427) or suburban California, United States (N = 57,n Boys  = 29,n White  = 37) in 2018-2019. Using the Infant Orienting With Attention (IOWA) task, results showed that infants were faster and more accurate to fixate a target when a cue validly predicted the target location and were slower and less accurate when the cue was invalid. However, compared to US infants, Malawian infants took longer to fixate the target and were more accurate. These results both provide information about the development of spatial attention in an underrepresented population and demonstrate differences in spatial attention in infants with different lived experiences.

Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

OBJECTIVE

To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.

STUDY DESIGN

Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation. Associations between log2-transformed biomarker concentrations and anthropometric (height-for-age z-score [HAZ], weight-for-height z-score, and weight-for-age z-score) and developmental (Global Scales of Early Development development for age z-score and saccadic reaction time [SRT]) outcomes were assessed using linear regression analyses adjusted for background characteristics.

RESULTS

Mean ± SD HAZ was -1.94 ± 1.10. Higher sCD14 and I-FABP concentrations were significantly associated with lower HAZ (β: -0.21, 95% CI: -0.41, -0.01 and β: -0.20, 95% CI: -0.32, -0.08, respectively). Higher I-FABP concentrations were significantly associated with lower development-for-age z-score (β: -0.22, 95% CI: -0.40, -0.03) and slower SRT (β: 7.37 ms, 95% CI: 2.02, 12.72) as were higher alpha-1-acid glycoprotein concentrations (HAZ β: -0.38, 95% CI: -0.72, -0.03; SRT β: 11.14 ms, 95% CI: 0.94, 21.72).

CONCLUSIONS

In children in Lusaka, biomarkers of EED were associated with poor anthropometric and developmental outcomes, underscoring the need for interventions to address EED to improve child health globally.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov identifier for parent trial: NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.

Coregistration of EEG and eye-tracking in infants and developing populations

Infants cannot be instructed where to look; therefore, infant researchers rely on observation of their participant's gaze to make inferences about their cognitive processes. They therefore started studying infant attention in the real world from early on. Developmental researchers were early adopters of methods combining observations of gaze and behaviour with electroencephalography (EEG) to study attention and other cognitive functions. However, the direct combination of eye-tracking methods and EEG to test infants is still rare, as it includes specific challenges. The current article reviews the development of co-registration research in infancy. It points out specific challenges of co-registration in infant research and suggests ways to overcome them. It ends with recommendations for implementing the co-registration of EEG and eye-tracking in infant research to maximise the benefits of the two measures and their combination and to orient on Open Science principles while doing so. In summary, this work shows that the co-registration of EEG and eye-tracking in infant research can be beneficial to studying natural and real-world behaviour despite its challenges.

Differences between overt, covert and natural attention shifts to emotional faces

In daily life, individuals pay attention to emotional facial expressions and dynamically choose how to shift their attention, i.e. either overtly (with eye-movements) or covertly (without eye-movements). However, research on attention to emotional faces has mostly been conducted in controlled laboratory settings, in which people were instructed where to look. The current preregistered study co-registered EEG and eye-tracking to investigate differences in emotion-driven attention between instructed and uninstructed natural attention shifts in 48 adults. While a central stimulus was presented to the participant, a face appeared in the periphery, showing either a happy, neutral or an angry expression. In three counterbalanced blocks participants were instructed to either move their eyes overtly to the peripheral face, keep fixating the center and therefore covertly shift their attention, or freely look wherever they would like to look. We found that emotional content had stronger effects on the amplitude of the Early Posterior Negativity when participants shifted attention naturally, and that natural shifts of attention differed from instructed shifts in both saccade behavior and neural mechanisms. In summary, our results emphasize the importance of investigating modulation of attention using paradigms that allow participants to allocate their attention naturally.

Uncomfortable staring? Gaze to other people in social situations is inhibited in both infants and adults

People attract infants' and adults' gaze when presented on a computer screen. However, in live social situations, adults inhibit their gaze at strangers to avoid sending inappropriate social signals. Such inhibition of gaze has never been directly investigated in infants. The current preregistered study measured gaze and neural responses (EEG alpha power) to a confederate in a live social situation compared to a video of this confederate. Adults looked less at the live confederate than at the video of the confederate, although their neural responses suggest that they were overall equally attentive in both situations. Infants also looked less at the live confederate than at the video of the confederate, with similar neural response patterns. The gaze difference between live social and video situations increased with age. The study shows that young infants are already sensitive to social context and show decreased gaze to strangers in social situations. RESEARCH HIGHLIGHTS: This study shows that infants and adults look more at a video of a stranger than at a stranger that is present live in a social situation. Neural responses suggest that adults are equally attentive in both live and video situations but inhibit their gaze at the stranger in live social situations. Infants show a similar pattern of shorter gaze at a stranger who is present in person than at a video of this stranger. The study shows that gaze in infants and adults may diverge from cognitive processes measured through EEG, highlighting the importance of combining behavioural and neural measures in natural interactions.

Controlling the input: How one-year-old infants sustain visual attention

Traditionally, the exogenous control of gaze by external saliencies and the endogenous control of gaze by knowledge and context have been viewed as competing systems, with late infancy seen as a period of strengthening top-down control over the vagaries of the input. Here we found that one-year-old infants control sustained attention through head movements that increase the visibility of the attended object. Freely moving one-year-old infants (n = 45) wore head-mounted eye trackers and head motion sensors while exploring sets of toys of the same physical size. The visual size of the objects, a well-documented salience, varied naturally with the infant's moment-to-moment posture and head movements. Sustained attention to an object was characterized by the tight control of head movements that created and then stabilized a visual size advantage for the attended object for sustained attention. The findings show collaboration between exogenous and endogenous attentional systems and suggest new hypotheses about the development of sustained visual attention.

Maximizing valid eye-tracking data in human and macaque infants by optimizing calibration and adjusting areas of interest

Remote eye tracking with automated corneal reflection provides insights into the emergence and development of cognitive, social, and emotional functions in human infants and non-human primates. However, because most eye-tracking systems were designed for use in human adults, the accuracy of eye-tracking data collected in other populations is unclear, as are potential approaches to minimize measurement error. For instance, data quality may differ across species or ages, which are necessary considerations for comparative and developmental studies. Here we examined how the calibration method and adjustments to areas of interest (AOIs) of the Tobii TX300 changed the mapping of fixations to AOIs in a cross-species longitudinal study. We tested humans (N = 119) at 2, 4, 6, 8, and 14 months of age and macaques (Macaca mulatta; N = 21) at 2 weeks, 3 weeks, and 6 months of age. In all groups, we found improvement in the proportion of AOI hits detected as the number of successful calibration points increased, suggesting calibration approaches with more points may be advantageous. Spatially enlarging and temporally prolonging AOIs increased the number of fixation-AOI mappings, suggesting improvements in capturing infants' gaze behaviors; however, these benefits varied across age groups and species, suggesting different parameters may be ideal, depending on the population studied. In sum, to maximize usable sessions and minimize measurement error, eye-tracking data collection and extraction approaches may need adjustments for the age groups and species studied. Doing so may make it easier to standardize and replicate eye-tracking research findings.

Analysis and novel methods for capture of normative eye-tracking data in 2.5-month old infants

Development of attention systems is essential for both cognitive and social behavior maturation. Visual behavior has been used to assess development of these attention systems. Yet, given its importance, there is a notable lack of literature detailing successful methods and procedures for using eye-tracking in early infancy to assess oculomotor and attention dynamics. Here we show that eye-tracking technology can be used to automatically record and assess visual behavior in infants as young as 2.5 months, and present normative data describing fixation and saccade behavior at this age. Features of oculomotor dynamics were analyzed from 2.5-month old infants who viewed videos depicting live action, cartoons, geometric shapes, social and non-social scenes. Of the 54 infants enrolled, 50 infants successfully completed the eye-tracking task and high-quality data was collected for 32 of those infants. We demonstrate that modifications specifically tailored for the infant population allowed for consistent tracking of pupil and corneal reflection and minimal data loss. Additionally, we found consistent fixation and saccade behaviors across the entire six-minute duration of the videos, indicating that this is a feasible task for 2.5-month old infants. Moreover, normative oculomotor metrics for a free-viewing task in 2.5-month old infants are documented for the first time as a result of this high-quality data collection.

Visual competition attenuates emotion effects during overt attention shifts

Numerous different objects are simultaneously visible in a person's visual field, competing for attention. This competition has been shown to affect eye-movements and early neural responses toward stimuli, while the role of a stimulus' emotional meaning for mechanisms of overt attention shifts under competition is unclear. The current study combined EEG and eye-tracking to investigate effects of competition and emotional content on overt shifts of attention to human face stimuli. Competition prolonged the latency of the P1 component and of saccades, while faces showing emotional expressions elicited an early posterior negativity (EPN). Remarkably, the emotion-related modulation of the EPN was attenuated when two stimuli were competing for attention compared to non-competition. In contrast, no interaction effects of emotional expression and competition were observed on other event-related potentials. This finding indicates that competition can decelerate attention shifts in general and also diminish the emotion-driven attention capture, measured through the smaller effects of emotional expression on EPN amplitude. Reduction of the brain's responsiveness to emotional content in the presence of distractors contradicts models that postulate fully automatic processing of emotions.

Testing predictions of a neural process model of visual attention in infancy across competitive and non-competitive contexts

A key question in early development is how changes in neural systems give rise to changes in infants' behavior. We examine this question by testing predictions of a dynamic field (DF) model of infant spatial attention. We tested 5‐, 7‐, and 10‐month‐old infants in the Infant Orienting With Attention (IOWA) task containing the original non‐competitive cue conditions (when a central stimulus disappeared before a cue onset) and new competitive cue conditions (when a central stimulus remained visible throughout the trial). This allowed testing of five model predictions: (1) that orienting accuracy would be higher and (2) reaction times would be slower for all competitive conditions; (3) that all infants would be slower to orient in the competitive conditions, though (4) older infants would show the strongest competition costs; and (5) that reaction times would be particularly slow for un‐cued competitive conditions. Four of these five predictions were supported, and the remaining prediction was supported in part. We next examined fits of the model to the expanded task. New simulation results reveal close fits to the present findings after parameter modification. Critically, developmental parameters of the model were not altered, providing support for the DF model's account of neuro‐developmental change.

Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone

OBJECTIVES

To investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone.

DESIGN

Prospective dual cohort study nested in a cluster-randomised trial.

SETTING

8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM).

PARTICIPANTS

For the MAM cohort, all infants aged 7-11 months at the eight sites were enrolled, 138 altogether. For controls, a convenience sample of all non-malnourished infants aged 7-11 months at the same sites were eligible, 60 altogether. A sample of 30 adults at the sites also underwent eye-tracking tests as a further control.

INTERVENTIONS

Infants with MAM were provided with supplementary feeding.

OUTCOME MEASURES

The primary outcomes were feasibility and reliability of eye-tracking-based testing of saccadic reaction time (SRT). Feasibility was assessed by the percent of successful tests in the infants. Reliability was measured with intraclass correlation coefficients (ICCs). Secondary outcomes were mean SRT based on nutritional state as well as and changes in mean SRT after supplementary feeding of MAM children.

RESULTS

Infants exhibited consistent orienting to targets on a computer screen (>95% of valid trials). Mean SRTs had moderate stability within visits (ICCs 0.60-0.69) and across the 4-week test-retest interval (0.53) in infants; the adult control group had greater SRT stability (within visit ICC=0.92). MAM infants had a trend toward higher adjusted SRT at baseline (difference=12.4 ms, 95% CI -2 to 26.9, p=0.09) and improvement in SRT 4 weeks thereafter (difference=-14 ms, 95% CI -26.2 to -1.7, p=0.025) compared with age-matched controls.

CONCLUSIONS

The results demonstrate the feasibility of eye-tracking-based testing in a resource-poor field setting and suggest eye-tracking measures have utility in the detection of group level effects of supplementary feeding.

Eye Movement Alterations in Post-COVID-19 Condition: A Proof-of-Concept Study

There is much evidence pointing out eye movement alterations in several neurological diseases. To the best of our knowledge, this is the first video-oculography study describing potential alterations of eye movements in the post-COVID-19 condition. Visually guided saccades, memory-guided saccades, and antisaccades in horizontal axis were measured. In all visual tests, the stimulus was deployed with a gap condition. The duration of the test was between 5 and 7 min per participant. A group of n=9 patients with the post-COVID-19 condition was included in this study. Values were compared with a group (n=9) of healthy volunteers whom the SARS-CoV-2 virus had not infected. Features such as centripetal and centrifugal latencies, success rates in memory saccades, antisaccades, and blinks were computed. We found that patients with the post-COVID-19 condition had eye movement alterations mainly in centripetal latency in visually guided saccades, the success rate in memory-guided saccade test, latency in antisaccades, and its standard deviation, which suggests the involvement of frontoparietal networks. Further work is required to understand these eye movements' alterations and their functional consequences.

Emotional content influences eye-movements under natural but not under instructed conditions

ABSTRACTIn everyday life, people can freely decide if and where they would like to move their attention and gaze, often influenced by physical and emotional salience of stimuli. However, many laboratory paradigms explicitly instruct participants when and how to move their eyes, leading to unnatural instructed eye-movements. The current preregistered study compared eye-movements to peripherally appearing faces with happy, angry and neutral expressions under natural and instructed conditions. Participants reliably moved their eyes towards peripheral faces, even when they were not instructed to do so; however, eye-movements were significantly slower under natural than under instructed conditions. Competing central stimuli decelerated eye-movements independently of instructions. Unexpectedly, the emotional salience only affected eye-movements under natural conditions, with faster saccades towards emotional than towards neutral faces. No effects of emotional expression occurred when participants were instructed to move their eyes. The study shows that natural eye-movements significantly differ from instructed eye-movements and emotion-driven attention effects are reduced when participants are artificially instructed to move their eyes, suggesting that research should investigate eye-movements under natural conditions.

Quantification of gaze reaction time in infants with Pediatric Perimeter

Purpose

We quantified the eye/head (gaze) reaction time in infants to establish a normative database for the Pediatric Perimeter device. Additionally, we tested the hypothesis that gaze reaction time will reduce with age.

Methods

A cross-sectional study was conducted. Healthy infants between 3 to 10 months of age were recruited. Peripheral visual field stimuli (hemifield and quadrant stimuli) were presented in the Pediatric Perimeter device. Infant’s gaze to these stimuli was observed, documented in real time, and video recorded for offline analysis.

Results

A total of 121 infants were tested in three age group bins [3–5 months, n = 44; >5–7 months, n = 30 and >7–10 months, n = 47]. Overall, 3–5 months old had longer reaction time when compared to the older infants particularly for stimuli presented in the quadrants (Kruskal-Wallis, p<0.038). A significantly asymmetric difference (p = 0.025) in reaction time was observed between the upper (median = 820ms, IQR = 659-1093ms) and lower quadrants (median = 601ms, IQR = 540-1052ms) only for the 3–5 months old infants.

Conclusion

This study provides the normative gaze reaction time of healthy infants. With increase in age, there is reduction in reaction time and disappearance of reaction time asymmetry in quadrant stimuli. The longer reaction time for upward gaze could be due to delayed maturation of neural mechanisms and/or decreased visual attention.

Overt and covert attention shifts to emotional faces: Combining EEG, eye tracking, and a go/no-go paradigm

In everyday life, faces with emotional expressions quickly attract attention and eye movements. To study the neural mechanisms of such emotion-driven attention by means of event-related brain potentials (ERPs), tasks that employ covert shifts of attention are commonly used, in which participants need to inhibit natural eye movements towards stimuli. It remains, however, unclear how shifts of attention to emotional faces with and without eye movements differ from each other. The current preregistered study aimed to investigate neural differences between covert and overt emotion-driven attention. We combined eye tracking with measurements of ERPs to compare shifts of attention to faces with happy, angry, or neutral expressions when eye movements were either executed (go conditions) or withheld (no-go conditions). Happy and angry faces led to larger EPN amplitudes, shorter latencies of the P1 component, and faster saccades, suggesting that emotional expressions significantly affected shifts of attention. Several ERPs (N170, EPN, LPC) were augmented in amplitude when attention was shifted with an eye movement, indicating an enhanced neural processing of faces if eye movements had to be executed together with a reallocation of attention. However, the modulation of ERPs by facial expressions did not differ between the go and no-go conditions, suggesting that emotional content enhances both covert and overt shifts of attention. In summary, our results indicate that overt and covert attention shifts differ but are comparably affected by emotional content.

Oculomotor deficits in children adopted from Eastern Europe

AIM

We aim to assess oculomotor behaviour in children adopted from Eastern Europe, who are at high risk of maternal alcohol consumption.

METHODS

This cross-sectional study included 29 adoptees and 29 age-matched controls. All of them underwent a complete ophthalmological examination. Oculomotor control, including fixation and saccadic performance, was assessed using a DIVE device, with eye tracking technology. Anthropometric and facial measurements were obtained from all the adopted children, to identify features of foetal alcohol spectrum disorders (FASD). Fixational and saccadic outcomes were compared between groups, and the effect of adoption and FASD features quantified.

RESULTS

Oculomotor performance was poorer in adopted children. They presented shorter (0.53 vs 1.43 milliseconds in the long task and 0.43 vs 0.82 in the short task) and more unstable fixations (with a bivariate contour ellipse area of 27.9 vs 11.6 degree² during the long task and 6.9 vs 1.3 degree² during the short task) and slower saccadic reactions (278 vs 197 milliseconds). Children with sentinel finding for FASD showed the worst oculomotor outcomes.

CONCLUSION

Children adopted from Eastern Europe present oculomotor deficits, affecting both fixation and saccadic skills. We highlight prenatal exposure to alcohol as the main cause for these deficits.

Relation Between Event-Related Potential Latency and Saccade Latency in Overt Shifts of Attention

Controlled shifts of attention between competing stimuli are crucial for effective everyday visual behaviour. While these typically involve overt shifts of fixation, many past studies used covert attention shifts in which fixation is unchanged, meaning that some response components may result from the inhibition of eye movements. In this study, the neural events in the human brain when making overt shifts of attention are studied through the combination of event-related potential recording with simultaneous eye tracking. Fixation shifts under competition (central target remains visible when a peripheral target appears) were compared with noncompetition (central target disappears). A longer latency for competition compared with noncompetition, which is found in the saccadic response, is already present in the early occipital positivity when a single target is presented for the fixation shift. These results indicate that the requirement to disengage from a current target affects the time course of neural processing at an early level. However, the relation is more complex when the participant is required to choose which of two targets to fixate.

Visual development

The developing visual brain is an integrated system, linking analysis of the visual input to visuomotor control, visual cognition, and attention. Major points in human visual development are the presence of rudimentary pathways present at birth which can control fixation behavior, with subsequent development of specific functions. These functions include the emergence of cortical selectivity; the integration of local signals to provide global representations of motion, shape, and space; the development of visuomotor modules for eye movements, manual reaching, and locomotion; and the development of distinct attentional systems. Measures of these processes in infancy and early childhood can provide indicators of broader brain development in the at-risk child. A key system in development is the dorsal cortical stream. Measures of global motion processing, visuomotor actions, and attention suggest that this system is particularly vulnerable in children with a wide range of neurodevelopmental disorders. Early disorders of the eye (strabismus, cataract) reveal the level of plasticity in the developing visual system and the ways in which early experience can affect the course of functional development.

Cross-cultural analysis of attention disengagement times supports the dissociation of faces and patterns in the infant brain

Infants are slower to disengage from faces than non-face patterns when distracted by novel competing stimuli. While this perceptual predilection for faces is well documented, its universality and mechanisms in relation to other aspects of attention are poorly understood. We analysed attention disengagement times for faces and non-face patterns in a large sample of 6-to 9-month-old infants (N = 637), pooled from eye tracking studies in socioculturally diverse settings (Finland, Malawi, South Africa). Disengagement times were classified into distinct groups of quick and delayed/censored responses by unsupervised clustering. Delayed disengagement was frequent for faces (52.1% of trials), but almost negligible for patterns (3.9% of trials) in all populations. The magnitude of this attentional bias varied by individuals, whereas the impact of situational factors and facial expression was small. Individual variations in disengagement from faces were moderately stable within testing sessions and independent from variations in disengagement times for patterns. These results point to a fundamental dissociation of face and pattern processing in infants and demonstrate that the bias for faces can be robust against distractors and habituation. The results raise the possibility that attention to faces varies as an independent, early-emerging social trait in populations.

The Effects of Calibration Target, Screen Location, and Movement Type on Infant Eye-Tracking Data Quality

During infant eye-tracking, fussiness caused by the repetition of calibration stimuli and body movements during testing are frequent constraints on measurement quality. Here, we systematically investigated these constraints with infants and adults using EyeLink 1000 Plus. We compared looking time and dispersion of gaze points elicited by stimuli resembling commonly used calibration animations. The adult group additionally performed body movements during gaze recording that were equivalent to movements infants spontaneously produce during testing. In our results, infants' preference for a particular calibration target did not predict data quality elicited by that stimulus, but targets exhibiting the strongest contrasts in their center or targets with globally distributed complexity resulted in the highest accuracy. Our gaze measures from the adult movement tasks were differentially affected by the type of movement as well as the location where the target appeared on the screen. These heterogeneous effects of movement on measures should be taken into account when planning infant eye-tracking experiments. Additionally, to improve data quality, infants' tolerance for repeated calibrations can be facilitated by alternating between precise calibration targets.

Early development of visual attention in infants in rural Malawi

Eye tracking research has shown that infants develop a repertoire of attentional capacities during the first year. The majority of studies examining the early development of attention comes from Western, high-resource countries. We examined visual attention in a heterogeneous sample of infants in rural Malawi (N = 312-376, depending on analysis). Infants were assessed with eye-tracking-based tests that targeted visual orienting, anticipatory looking, and attention to faces at 7 and 9 months. Consistent with prior research, infants exhibited active visual search for salient visual targets, anticipatory saccades to predictable events, and a robust attentional bias for happy and fearful faces. Individual variations in these processes had low to moderate odd-even split-half and test-retest reliability. There were no consistent associations between attention measures and gestational age, nutritional status, or characteristics of the rearing environment (i.e., maternal cognition, psychosocial well-being, socioeconomic status, and care practices). The results replicate infants' early attentional biases in a large, unique sample, and suggest that some of these biases (e.g., bias for faces) are pronounced in low-resource settings. The results provided no evidence that the initial manifestation of infants' attentional capacities is associated with risk factors that are common in low-resource environments.

Classical Short-Delay Eyeblink Conditioning in One-Year-Old Children

Classical eyeblink conditioning (EBC) refers to the learned association between a conditioned stimulus (an auditory tone) and an unconditioned stimulus (a puff of air to the cornea). Eyeblink conditioning is often used experimentally to detect abnormalities in cerebellar-dependent learning and memory that underlies this type of associative learning. While experiments in adults and older children are relatively simple to administer using commercial equipment, eyeblink conditioning in infants is more challenging due to their poor compliance, which makes correct positioning of the equipment difficult. To achieve conditioning in one-year-old infants, a custom-made or an adapted commercial system can be used to deliver the air puff to the infant's cornea. The main challenge lies in successfully detecting and classifying the behavioral responses. We report that automated blink detection methods are unreliable in this population, and that conditioning experiments should be analyzed using frame-by-frame analysis of supplementary video camera recordings. This method can be applied to study developmental changes in eyeblink conditioning and to examine whether this paradigm can detect children with neurological disorders.

Early development of attention to threat-related facial expressions

Infants from an early age have a bias to attend more to faces than non-faces and after 5 months are particularly attentive to fearful faces. We examined the specificity of this "fear bias" in 5-, 7-, and 12-month-old infants (N = 269) and 36-month-old children (N = 191) and whether its development is associated with features of the early rearing environment, specifically maternal anxiety and depression symptoms. Attention dwell times were assessed by measuring the latencies of gaze shifts from a stimulus at fixation to a new stimulus in the visual periphery. In infancy, dwell times were shorter for non-face control stimuli vs. happy faces at all ages, and happy vs. fearful, but not angry, faces at 7 and 12 months. At 36 months, dwell times were shorter for non-faces and happy faces compared to fearful and angry faces. Individual variations in attention dwell times were not associated with mothers' self-reported depression or anxiety symptoms at either age. The results suggest that sensitivity to fearful faces precedes a more general bias for threat-alerting stimuli in early development. We did not find evidence that the initial manifestation of these biases is related to moderate variations in maternal depression or anxiety symptoms.

The Effect of Stimulus Size and Eccentricity on Attention Shift Latencies

The ability to shift attention between relevant stimuli is crucial in everyday life and allows us to focus on relevant events. It develops during early childhood and is often impaired in clinical populations, as can be investigated in the fixation shift paradigm and the gap-overlap paradigm. Different tests use stimuli of different sizes presented at different eccentricities, making it difficult to compare them. This study systematically investigates the effect of eccentricity and target size on refixation latencies towards target stimuli. Eccentricity and target size affected attention shift latencies with greatest latencies to big targets that were presented at a small eccentricity. Slowed responses to large parafoveal targets are in line with the idea that specific areas in the superior colliculus can lead to inhibition of eye movements. Findings suggest that the two different paradigms are generally comparable, as long as the target is scaled in proportion to the eccentricity.

Eye-tracking-based assessment of cognitive function in low-resource settings

BACKGROUND

Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings.

OBJECTIVE AND DESIGN

The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40).

RESULTS

Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks.

CONCLUSIONS

High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings.

The Davida Teller Award Lecture, 2016: Visual Brain Development: A review of "Dorsal Stream Vulnerability"-motion, mathematics, amblyopia, actions, and attention

Research in the Visual Development Unit on "dorsal stream vulnerability' (DSV) arose from research in two somewhat different areas. In the first, using cortical milestones for local and global processing from our neurobiological model, we identified cerebral visual impairment in infants in the first year of life. In the second, using photo/videorefraction in population refractive screening programs, we showed that infant spectacle wear could reduce the incidence of strabismus and amblyopia, but many preschool children, who had been significantly hyperopic earlier, showed visuo-motor and attentional deficits. This led us to compare developing dorsal and ventral streams, using sensitivity to global motion and form as signatures, finding deficits in motion sensitivity relative to form in children with Williams syndrome, or perinatal brain injury in hemiplegia or preterm birth. Later research showed that this "DSV" was common across many disorders, both genetic and acquired, from autism to amblyopia. Here, we extend DSV to be a cluster of problems, common to many disorders, including poor motion sensitivity, visuo-motor spatial integration for planning actions, attention, and number skills. In current research, we find that individual differences in motion coherence sensitivity in typically developing children are correlated with MRI measures of area variations in parietal lobe, fractional anisotropy (from TBSS) of the superior longitudinal fasciculus, and performance on tasks of mathematics and visuo-motor integration. These findings suggest that individual differences in motion sensitivity reflect decision making and attentional control rather than integration in MT/V5 or V3A. Its neural underpinnings may be related to Duncan's "multiple-demand" (MD) system.

Infants' Looking to Surprising Events: When Eye-Tracking Reveals More than Looking Time

Research on infants' reasoning abilities often rely on looking times, which are longer to surprising and unexpected visual scenes compared to unsurprising and expected ones. Few researchers have examined more precise visual scanning patterns in these scenes, and so, here, we recorded 8- to 11-month-olds' gaze with an eye tracker as we presented a sampling event whose outcome was either surprising, neutral, or unsurprising: A red (or yellow) ball was drawn from one of three visible containers populated 0%, 50%, or 100% with identically colored balls. When measuring looking time to the whole scene, infants were insensitive to the likelihood of the sampling event, replicating failures in similar paradigms. Nevertheless, a new analysis of visual scanning showed that infants did spend more time fixating specific areas-of-interest as a function of the event likelihood. The drawn ball and its associated container attracted more looking than the other containers in the 0% condition, but this pattern was weaker in the 50% condition, and even less strong in the 100% condition. Results suggest that measuring where infants look may be more sensitive than simply how much looking there is to the whole scene. The advantages of eye tracking measures over traditional looking measures are discussed.

Neural Differences between Covert and Overt Attention Studied using EEG with Simultaneous Remote Eye Tracking

Research on neural mechanisms of attention has generally instructed subjects to direct attention covertly while maintaining a fixed gaze. This study combined simultaneous eye tracking and electroencephalogram (EEG) to measure neural attention responses during exogenous cueing in overt attention shifts (with saccadic eye movements to a target) and compared these with covert attention shifts (responding manually while maintaining central fixation). EEG analysis of the period preceding the saccade latency showed similar occipital response amplitudes for overt and covert shifts, although response latencies differed. However, a frontal positivity was greater during covert attention shifts, possibly reflecting saccade inhibition to maintain fixation. The results show that combined EEG and eye tracking can be successfully used to study natural overt shifts of attention (applicable to non-verbal infants) and that requiring inhibition of saccades can lead to additional frontal responses. Such data can be used to refine current neural models of attention that have been mainly based on covert shifts.

Evidence for spared attention to faces in 7-month-old infants after prenatal exposure to antiepileptic drugs

INTRODUCTION

Prenatal antiepileptic drug (AED) exposure is associated with an increased risk of cognitive impairment and autism spectrum disorders detected mainly at the age of two to six years. We examined whether the developmental aberrations associated with prenatal AED exposure could be detected already in infancy and whether effects on visual attention can be observed at this early age.

MATERIAL AND METHODS

We compared a prospective cohort of infants with in utero exposure to AED (n=56) with infants without drug exposures (n=62). The assessments performed at the age of seven months included standardized neurodevelopmental scores (Griffiths Mental Developmental Scale and Hammersmith Infant Neurological Examination) as well as a novel eye-tracking-based test for visual attention and orienting to faces. Background information included prospective collection of AED exposure data, pregnancy outcome, neuropsychological evaluation of the mothers, and information on maternal epilepsy type.

RESULTS

Carbamazepine, oxcarbazepine, and valproate, but not lamotrigine or levetiracetam, were associated with impaired early language abilities at the age of seven months. The general speed of visuospatial orienting or attentional bias for faces measured by eye-tracker-based tests did not differ between AED-exposed and control infants.

DISCUSSION

Our findings support the idea that prenatal AED exposure may impair verbal abilities, and this effect may be detected already in infancy. In contrast, the early development of attention to faces was spared after in utero AED exposure.