Playing Games with Your Eyes: An at-Home Video Gaming System for Training Attention Orienting in ASD

Background:   In addition to the social, communicative and behavioral triad of symptoms that define Autism Spectrum Disorders (ASD), individuals with ASD have difficulty re-orienting attention quickly and accurately.  Similarly, fast re-orienting saccadic eye movements are also inaccurate and more variable in both endpoint and timing in individuals with ASD. The brain circuitry that guides the redirection of spatial attention is shared with the circuitry used to shift gaze.  This suggests that gaze-contingent training could be a unique way to improve attention orienting skill.  

Objectives:   1) Demonstrate the feasibility of using gaze-contingent video games for low cost in-home training for high functioning adolescents with ASD.  2) Demonstrate improvement of spatial attention orienting and eye movement behavior after 8 weeks of play on these gaze-contingent games in a small group of adolescents with ASD.  

Methods:   We designed and deployed PC-based gaze-contingent video games using the Unity game engine and an EyeTribe eye tracker (see Figure). The games were designed around training principles to train fast and accurate attention orienting behavior as well as stable fixation.   In addition, the game system was designed to be sufficiently robust for long-term at-home use.  Eight adolescents with ASD participated in an 8 week training, flanked by pre- and post-testing of eye movement and attention control. 

Results:   Six of eight adolescents completed the 8 weeks of training and all of those six showed improvement in attention orienting, eye movement control or both.  All of the game systems remained intact for the duration of training. Each participant could use the system independently.

Conclusions:   We delivered a low cost and robust gaze-contingent game system for home use that, in our pilot training sample, improved the attention orienting and eye movement performance of adolescent participants in 8 weeks of training.  The next steps involve a small clinical trial to assess the importance of gaze-contingency and what aspects of training, if any, transfer to real-world tasks.