Using Serious Game Technology to Improve Sensitivity to Eye Gaze in Autism

项目摘要 社交行为障碍是自闭症的主要表现。两个最受影响的行为 包括对面孔的视觉注意力和理解眼睛注视如何提供重要信息的能力 别人的行为和意图。一种理论认为，处理面部信息的神经系统 从根本上妥协。然而，我们最近的脑成像研究结果表明， 这些神经系统对动物面孔的反应正常，表明它们没有受到损害， 可能在自闭症中的调节方式不同。因此，我们假设在学习过程中存在早期中断， 环境导致了这种调整模式的改变，这种破坏反映在注意力的减少上。 更多地关注非社会性刺激。长期的结果是自闭症患者 可能从来没有了解过来自面部的社交信号的功能意义，比如眼睛凝视线索。 我们假设，有可能重新调整面部处理系统和社会期待行为， 自闭症通过采用有效的方法鼓励个人集中视觉注意力在脸上， 发现眼睛凝视线索的功能意义。反过来，这可能开始治疗自闭症的症状， 改善社会功能。我们建议开发和测试一种针对自闭症青少年的干预措施， 采用基于证据的“严肃游戏”原则（例如，故事情节，长期目标，缩放难度）。 “严肃游戏”是一种独特的干预工具，可以促进学习困难的技能， 现实世界的结果。我们的干预游戏旨在帮助学习将注意力集中在面孔上， 在叙事故事情节的背景下解释来自动画人物的眼睛注视线索。参与者 必须发现眼睛注视线索对于引导他们自己的目标导向行为来解决问题是有用的 在游戏中这模拟了社会信息线索在真实的世界中被发现和使用的方式， 因此，更有可能推广到现实世界的行为。 我们提出了一个两阶段的探索性研究来测试这种干预。在R61阶段，我们将利用行为 和眼动追踪方法来检查测试前后我们目标机制的变化（对面部的注意力 和对眼睛注视线索的敏感性）。在R33阶段， 进行一项小规模随机对照试验，将干预游戏与主动控制游戏进行比较， 多个时间点（术前、术后、6个月随访），并评估各种 行为，从受控的实验室任务到不受控制的现实社会互动。我们的目标是 评估1）目标机制的变化，2）改善的面部处理行为和现实世界的社会 沟通行为; 3）目标机制的参与与症状之间的关系 结果。这些目标代表了基于计算机的随机对照试验设计的重大创新。 自闭症的干预措施，并拥有广泛和廉价传播的巨大希望。

Project Summary Impairments in social communicative behaviors are primary in autism. Two of the most affected behaviors include visual attention to faces and the ability to understand how eye gaze provides important information about the actions and intentions of others. One theory is that the neural systems for face processing are fundamentally compromised. However, our recent brain imaging findings suggest that there are contexts in which these neural systems respond normally to animal faces, indicating that they are not compromised, but likely tuned differently in autism. As a result, we hypothesize that there is an early disruption in the learning environment that leads to this altered pattern of tuning and that this disruption is reflected by reduced attention to faces and more attention to non-social stimuli. The long-term consequence is that individuals with autism may never have learned about the functional significance of social signals from the face, like eye gaze cues. We hypothesize that it may be possible to re-tune the face processing system and social looking behaviors in autism by employing effective methods for encouraging individuals to focus visual attention on faces and discover the functional significance of eye gaze cues. In turn, this may begin to treat symptoms of autism and improve social functioning. We propose to develop and test an intervention for adolescents with autism that employs evidence-based “serious game” principles (e.g., storylines, long-term goals, scaling difficulty). “Serious games” are unique intervention tools that foster learning of difficult skills, with the goal of improving real-world outcomes. Our intervention game is designed to scaffold learning to focus attention on faces while interpreting eye gaze cues from animated human characters in the context of a narrative storyline. Participants have to discover that eye gaze cues are useful for guiding their own goal-directed behavior to solve problems in the game. This simulates the way social information cues are discovered and used in the real world and, therefore, is more likely to generalize to real-world behavior. We propose a two-stage exploratory study to test this intervention. In the R61 phase, we will utilize behavioral and eye-tracking methods to examine pre- to post-test changes on our target mechanisms (attention to faces and sensitivity to eye gaze cues) in adolescents who play the intervention game. In the R33 phase, we will conduct a small-scale RCT comparing the intervention game to an active control game to assess outcomes at multiple time points (pre-, post-, 6-month follow-up), and to evaluate improvements in a wide range of behaviors, from controlled lab-based tasks to uncontrolled, real-world social interactions. Our aims are evaluating 1) changes in the target mechanisms, 2) improved face-processing behaviors and real-world social communication behaviors, and 3) the relation between engagement of the target mechanisms and symptom outcomes. These goals represent significant innovation in the design of RCTs for computer-based interventions for autism, and hold tremendous promise for widespread and inexpensive dissemination.