Date Presented 03/28/20
This study examined attentional inflexibility for children at elevated likelihood (EL) for autism spectrum disorder (ASD) through use of eye tracking. The results indicate that the EL-ASD group had significantly fewer attention shifts from an area of interest to the rest of the screen. While we only assessed a static activity, we believe attentional inflexibilities are also present during occupational engagement, which has implications for OT practice. OT strategies to address this will also be discussed.
Primary Author and Speaker: Stephanie Bristol
Additional Authors and Speakers: Susan Agostine
Contributing Authors: Aaron Dallman, Clare Harrop, Elizabeth Crais, Grace Baranek, Linda Watson
INTRO: Autism Spectrum Disorder (ASD) is characterized by a complex and vacillating behavioral and clinical profile making diagnosis difficult at earlier ages; however, some have successfully identified symptoms of ASD as early as 9-12 months, often using prospective samples (Lee et al., 2019; Ozonoff et al., 2010). Earlier identification of ASD and markers of ASD-risk is vital as it allows for earlier access to early intervention during critical developmental periods, to optimize developmental and participation outcomes. A key diagnostic marker of ASD is social deficits, therefore it is particularly advantageous to identify early markers related to social attention in infants who may be at elevated likelihood of ASD (EL-ASD). This will enable these infants and their caregivers to receive occupational therapy services specifically targeted to their social participation needs earlier in life. We believe that social attentional biases may have a significant impact on optimal functioning. In this paper, we address the following aims: (1) Evaluate the role of attentional biases (social versus nonsocial) in differentiating EL-ASD from those with lower likelihood (LL-ASD) (2) identify possible strategies occupational therapists can use to promote improved occupational engagement and social participation.
METHODS: Infants (11 to 16 months) were recruited into one of two groups: EL-ASD based on the dual cut-off criteria of the First Years Inventory Lite (FYI-LITE V3.1b), (Baranek, Watson, Crais, Turner-Brown, & Reznick, 2014; n=21) and LL-ASD (n=20). Eye gaze patterns were collected via a Gazepoint GP3 HD eye tracker while infants passively viewed a CDS paradigm that consisted of a baseline video (classical music and minimal visual stimuli), three CDS videos (a puppet narrative, a book story-telling, and an adult playing with a toy using non-sensical speech), and a second baseline. Areas of interest (AOIs) were mapped for each scene. We examined differences in social and non-social attention, overall attention and number of discrete fixations by AOI using t-tests. To evaluate dyadic attention, switching attention between two stimuli, longitudinal patterns of fixation were examined by identifying the frequency of patterns of interest (e.g., fixating on the book, then face; fixating on the face then other portions of the screen; fixating on a toy then face).
RESULTS: There were no differences in overall attention to the screen (across all scenes) between groups. Interestingly, during the book reading scene, infants in the EL-ASD group spent significantly more time attending to faces (p = .02), but spent significantly less time attending to the book (p = .02). We failed to identify differences in dyadic attention (shifting attention from book to face) across groups (p= 0.2). However, across all three scenes, the HL-ASD group had significantly fewer attention shifts from a relevant AOI (i.e., face) to the rest of the screen (book-reading scene and non-sensical speech p<0.05 and approaching significance, p=0.08 for the puppet scene).
IMPLICATIONS: This study has implications for OT practice as the results indicate infants in the EL-ASD group demonstrate decreased flexibility as demonstrated by significantly fewer shifts to the whole screen compared to the LL-ASD group. While we only assessed attentional patterns in a passive activity (watching a TV), we believe attentional inflexibilities may also be present during more active occupational engagement. This suggests that participation may be hindered by the increased difficulty exploring, examining and understanding one’s environment. Occupational therapy strategies to address this gap will be presented.
References
Baranek, G. T., Watson, L. R., Crais, E. R., Turner-Brown, L., & Reznick, J. S. (2014). First Years Inventory version 3.1b. University of North Carolina at Chapel Hill.
Lee, H. Y., Vigen, C., Zwaigenbaum, L., Bryson, S., Smith, I., Brian, J., . . . Baranek, G. T. (2019). The performance of the first year inventory (FYI) screening on a sample of high-risk 12-month-olds diagnosed with autism spectrum disorder (ASD) at 36 Months. Journal of Autism and Developmental Disorders, 49(12), 4957-4973. doi:10.1007/s10803-019-04208-5
Ozonoff, S., Iosif, A., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., . . . Young, G. S. (2010) A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 256-266.e2. doi:10.1016/j.jaac.2009.11.009
