The Eyes Have It?
July 8, 2008 by Kristina Chew, PhD
Filed under Health
Today’s Wall Street Journal discusses some new tools for diagnosing autism in young children by studying their eye movements and eye tracking. Researchers at Yale University’s Toddler Developmental Disabilities Clinic are using gaze-tracking technology to study patterns in “gaze behavior” in children aged 3 months to 3 years for autism. At the Massachusetts Institute of Technology’s Media Lab, an in-home recording device and special software are be developed, to study infants at home. And back in May, researchers at McMaster University announced that they have developed a computer test detect signs of autism in babies as young as 9 months old. From the Wall Street Journal:
“Children with autism in general have difficulty extracting affective information from faces, and also difficulty in recognizing faces,” says Katarzyna Chawarska, director of the Yale clinic. By tracking eye movements, “we can begin to understand what interests them, how they examine objects they select for processing, and what motivates them intrinsically,” she says.
The Yale clinic has been monitoring 17-month-old Caleb Scott from birth. The fact that Caleb’s older brother is autistic raises the odds that Caleb could also develop the disorder. After conducting more standard autism evaluations, Dr. Chawarska’s team tracks Caleb’s eyes as he looks at clips from “Sesame Street” and images of different faces. The perceptual patterns are encouraging, says Caleb’s mother, Katie Scott, of Naugatuck, Conn. “I see him watching the eyes and the mouth, I see him looking at the right-side-up face instead of the upside-down one. All of that gave me hope right away.”
But eye-tracking won’t pick out all children with autism. That’s because the disorder can manifest itself in a variety of ways at different ages, such as a child not responding when called or failing to exhibit normal body gestures. Some children also won’t cooperate with the eye-tracking equipment.
Human observation is still very much necessary in diagnosing a child with autism, note Catherine E. Lord, director of the University of Michigan Autism and Communication Disorders Center and a member of the team that developed the Autism Diagnostic Observation Schedule. The Wall Street Journal notes that “most autistic children currently aren’t diagnosed until they are about 4 years old, using conventional detection methods of observing behavior”; we knew Charlie had “something” in the months leading up to his second birthday—based very much on, indeed, observation.
I’m not at all sure if it would have been possible to administer an eye-tracking test to Charlie (a squirmy infant and toddler). And autism was the last thing that we were thinking Charlie might have back in 1998 when he was turning 18 months old (though we might well have thought it a possibility, were Charlie born in the past few years). Charlie has always looked out of the corners of his eyes since he was an infant, and—while he could focus on something and even for a long time—I suspect that it wasn’t their eyes and mouths. Indeed, we had to teach Charlie to look at our mouths and lips and tongues when he was learning to talk. And, he’s long had trouble tracking moving objects and focusing his eyes more generally.
We don’t always request that he make eye contact and, more and more, Charlie does this spontaneously—-even tries to catch my eye, sometimes.
This type of evaluation, while it may have some value, should also involve evaluation by an opthamologist, not only developmental or psychiatric doctors. One of the issues that clouded my recognizing Nicholas’ Asperger’s is that he was diagnosed as severely farsighted when he was 4. His distance vision is better than his close vision but both are pretty bad. At the time I was trying to figure out what was going on with Nicholas (socially). I asked the opthamologist if this may explain why he doesn’t really respond to my facial expressions and, while she could not answer me for certain, she said that his vision was poor enough that it was unlikely that he could make out facial expessions and that she was suprised that he could navigate the house without tripping over his toys all of the time.
While I realize that having a child with AS and vision problems is probably fairly rare, vision problems in young children are fairly under-diagnosed and this may result in some “false positives” for autism diagnoses if vision problems are not ruled out definitively in advance.
M has always had difficulty tracking. When we were trying to teach her to read the tutor realized she had no idea how to track. So, we had to being teaching her how to track dots on paper and then moved to symbols. It took weeks of practice and she would often cry because it was so difficult for her to learn.
Her eyes still seem very “shaky” to me and we have taken her to the eye doctor many times. They see glasses in her future but not just yet.
I never had any doctors take much time studying this issue with her. Most assumed since she made eye contact she was surely not Autistic. There are so many professionals out there who need education about Autism, at least that has been our finding since we had to search through so many to get one who understood Autism and even chromosome disorders.
Beth, vision problems and AS together are not all that uncommon; my own Nikolas has both. His visual impairment is the result of retinopathy of prematurity which was surgically corrected when he was roughly 4 months old but he has scarring on his right retina. Oddly enough, he compensates really well and many people cannot tell he’s impaired except when they look at how his eyes track (don’t) together.
All that said, I do think that Nik’s VI was blamed for so many communication deficits that were/are really autism-related.
And now, we face the opposite situation— like Marla describes above; Nik makes great eye contact **sometimes** and initiates play **sometimes** but nowhere near what a typical child does and nowhere near age apporpriate playing either.