This preliminary study aimed to examine improvement in eye contact among children with autism spectrum disorder (ASD) following an innovative technological intervention integrated with meta-cognitive guidance. Eighteen ASD participants, ages 5–9 years, were divided into two equal intervention groups—one received metacognitive guidance, and one did not. An eye-contact assessment was conducted pre-intervention and post-intervention by tracing the children’s head and eye movements using a built-in laptop camera. The intervention included six 30-min sessions in which the participants played a computer game (C-Me) that required them to make eye contact with cartoon characters who needed assistance in solving a problem or completing a task. The results indicate that the technological intervention effectively promoted eye contact among all participants, especially those in the metacognitive intervention group.
Albein-UriosN.YoussefG.KlasA.EnticottP. G. (2020). Inner speech moderates the relationship between autism spectrum traits and emotion regulation. Journal of Autism and Developmental Disorders, 51, 3322–3330. https://doi.org/10.1007/s10803-020-04750-7
2.
American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Author.
3.
BaioJ.WigginsL.ChristensenD. L.MaennerM. J.DanielsJ.WarrenZ.Kurzius-SpencerM.ZahorodnyW.RosenbergC. R.WhiteT.DurkinM. S.ImmP.NikolaouL.Yeargin-AllsoppM.LeeL.HarringtonR.LopezM.FitzgeraldR. T.HewittA. . . . DurkinM. S. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1–23. https://doi.org/10.15585/mmwr.ss6706a1
4.
BednarzH. M.TrapaniJ. A.KanaR. K. (2020). Metacognition and behavioral regulation predict distinct aspects of social functioning in autism spectrum disorder. Child Neuropsychology, 26(7), 953–981. https://doi.org/10.1080/09297049.2020.1745166
5.
CañigueralR.HamiltonA. F. D. C. (2019). The role of eye gaze during natural social interactions in typical and autistic people. Frontiers in Psychology, 10, 560. https://doi.org/10.3389/fpsyg.2019.00560
6.
CharltonC. T.KellemsR. O.BlackB.BusseyH. C.FergusonR.GoncalvesB.JensenM.VallejoS. (2020). Effectiveness of avatar-delivered instruction on social initiations by children with Autism Spectrum Disorder. Research in Autism Spectrum Disorders, 71, 101494. https://doi.org/10.1016/j.rasd.2019.101494
7.
ChungE. Y. H. (2019). Robotic intervention program for enhancement of social engagement among children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 31(4), 419–434. https://doi.org/10.1007/s10882-018-9651-8
8.
CookJ. L.RappJ. T.MannK. R.McHughC.BurjiC.NutaR. (2017). A practitioner model for increasing eye contact in children with autism. Behavior Modification, 41(3), 382–404. https://doi.org/10.1177%2F0145445516689323
9.
DavisM.DautenhahnK.PowellS.NehanivC. (2010). Guidelines for researchers and practitioners designing software and software trials for children with autism. Journal of Assistive Technologies, 4(1), 38–48. https://doi.org/10.5042/jat.2010.0043
10.
EdenS.OrenA. (2021). Computer-mediated intervention to foster prosocial ability among children with autism. Journal of Computer Assisted Learning, 37(1), 275–286. https://doi.org/10.1111/jcal.12490
11.
EllisA. K.DentonD. W.BondJ. B. (2014). An analysis of research on metacognitive teaching strategies. Procedia-Social and Behavioral Sciences, 116, 4015–4024. https://doi.org/10.1016/j.sbspro.2014.01.883
12.
EscobedoL.NguyenD. H.BoydL.HiranoS.RangelA.Garcia-RosasD.TentoriM.HayesG. (2012). MOSOCO: A mobile assistive tool to support children with autism practicing social skills in real-life situations. In CHI ‘12: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (pp. 2589–2598) Austin Texas, USA. https://doi.org/10.1145/2207676.2208649
13.
FajaS.ClarksonT.GilbertR.VaidyanathanA.GrecoG.RuedaM. R.CombitaL. M.DriscollK. (2022). A preliminary randomized, controlled trial of executive function training for children with autism spectrum disorder. Autism, 26(2), 346–360. https://doi.org/10.1177/13623613211014990
14.
FengH.GutierrezA.ZhangJ.MahoorM. H. (2013, September). Can NAO robot improve eye-gaze attention of children with high functioning autism?. In J. E. Guerrero (Ed.), 2013 IEEE International Conference on Healthcare Informatics (pp. 484–484). IEEE. https://doi.org/10.1109/ICHI.2013.72
15.
FlavellJ. H. (1976). Metacognitive aspects of problem solving. In L.B.Resnick (Ed.), The nature of intelligence (pp. 231–235). Lawrence Erlbaum.
16.
GriceS. J.HalitH.FarroniT.Baron-CohenS.BoltonP.JohnsonM. H. (2005). Neural correlates of eye-gaze detection in young children with autism. Cortex, 41(3), 342–353. https://doi.org/10.1016/S0010-9452(08)70271-5
17.
GuoL. (2022). Using metacognitive prompts to enhance self-regulated learning and learning outcomes: A meta-analysis of experimental studies in computer-based learning environments. Journal of Computer Assisted Learning, 38(3), 811–832. https://doi.org/10.1111/jcal.12650
18.
IshizakiY.HiguchiT.YanagimotoY.KobayashiH.NoritakeA.NakamuraK.KanekoK. (2021). Eye gaze differences in school scenes between preschool children and adolescents with high-functioning autism spectrum disorder and those with typical development. BioPsychoSocial Medicine, 15(1), 1–7. https://doi.org/10.1186/s13030-020-00203-w
19.
JonesW.CarrK.KlinA. (2008). Absence of preferential looking to the eyes of approaching adults predicts level of social disability in 2-year-old toddlers with autism spectrum disorder. Archives of General Psychiatry, 65(8), 946–954. https://doi.org/10.1001/archpsyc.65.8.946
20.
LamashL.JosmanN. (2021). A metacognitive intervention model to promote independence among individuals with autism spectrum disorder: Implementation on a shopping task in the community. Neuropsychological Rehabilitation, 31(2), 189–210. https://doi.org/10.1080/09602011.2019.1682621
21.
LeungR. C.VoganV. M.PowellT. L.AnagnostouE.TaylorM. J. (2016). The role of executive functions in social impairment in Autism Spectrum Disorder. Child Neuropsychology, 22(3), 336–344. https://doi.org/10.1080/09297049.2015.1005066
22.
MacounS. J.SchneiderI.BedirB.SheehanJ.SungA. (2020). Pilot study of an attention and executive function cognitive intervention in children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 51, 2600–2610. https://doi.org/10.1007/s10803-020-04723-w
23.
MadipakkamA. R.RothkirchM.DziobekI.SterzerP. (2017). Unconscious avoidance of eye contact in autism spectrum disorder. Scientific Reports, 7(1), 1–6. https://doi.org/10.1038/s41598-017-13945-5
24.
McMahonC. M.HendersonH. A.NewellL.JaimeM.MundyP. (2016). Metacognitive awareness of facial affect in higher-functioning children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(3), 882–898. https://doi.org/10.1007/s10803-015-2630-3
25.
MevarechZ. R.IddiniV. (2021). Developing young children’s mathematics knowledge and reasoning through mathematics e-book activities supported by metacognitive scaffolding. Journal of Cognitive Education and Psychology, 20(2), 179–189. https://doi.org/10.1891/JCEP-2021-0016
26.
MillerN.WyattJ.CaseyL. B.SmithJ. B. (2018). Using computer-assisted instruction to increase the eye gaze of children with autism. Behavioral Interventions, 33(1), 3–12. https://doi.org/10.1002/bin.1507
27.
MuisK. R.RanellucciJ.TrevorsG.DuffyM. C. (2015). The effects of technology-mediated immediate feedback on kindergarten students’ attitudes, emotions, engagement and learning outcomes during literacy skills development. Learning and Instruction, 38, 1–13. https://doi.org/10.1016/j.learninstruc.2015.02.001
28.
MulvihillA.CarrollA.DuxP. E.MatthewsN. (2020). Self-directed speech and self-regulation in childhood neurodevelopmental disorders: Current findings and future directions. Development and Psychopathology, 32(1), 205–217. https://doi.org/10.1017/S0954579418001670
29.
MurrayD. S.CreagheadN. A.Manning-CourtneyP.ShearP. K.BeanJ.PrendevilleJ.-A. (2008). The relationship between joint attention and language in children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 23(1), 5–14. https://doi.org/10.1177/1088357607311443
30.
NinciJ.LangR.DavenportK.LeeA.GarnerJ.MooreM.BoutotA.RispoliM.LancioniG. (2013). An analysis of the generalization and maintenance of eye contact taught during play. Developmental Neurorehabilitation, 16(5), 301–307. https://doi.org/10.3109/17518423.2012.730557
31.
NorburyC. F.BrockJ.CraggL.EinavS.GriffithsH.NationK. (2009). Eye-movement patterns are associated with communicative competence in autistic spectrum disorders. Journal of Child Psychology and Psychiatry, 50(7), 834–842. https://doi.org/10.1111/j.1469-7610.2009.02073.x
32.
RappJ. T.CookJ. L.NutaR.BalagotC.CrouchmanK.JenkinsC.KarimS.Watters-WybrowC. (2019). Further evaluation of a practitioner model for increasing eye contact in children with autism. Behavior Modification, 43(3), 389–412. https://doi.org/10.1177%2F0145445518758595
33.
RossetD. B.RondanC.Da FonsecaD.SantosA.AssoulineB.DeruelleC. (2008). Typical emotion processing for cartoon but not for real faces in children with autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 919–925. https://doi.org/10.1007/s10803-007-0465-2
34.
ShamirA.DushnitzkyG. (2019). Metacognitive intervention with e-books to promote vocabulary and story comprehension among children at risk for learning disabilities. In J.E.KimB.Hassinger-Das (Eds.), Reading in the digital age: Young children’s experiences with e-books (pp. 237–257). Springer.
35.
SilvaC.Da FonsecaD.EstevesF.DeruelleC. (2015). Motivational approach and avoidance in autism spectrum disorder: A comparison between real photographs and cartoons. Research in Autism Spectrum Disorders, 17, 13–24. https://doi.org/10.1016/j.rasd.2015.05.004
36.
TangJ. S.FalkmerM.ChenN. T.BӧlteS.GirdlerS. (2019). Designing a serious game for youth with ASD: Perspectives from end-users and professionals. Journal of Autism and Developmental Disorders, 49(3), 978–995. https://doi.org/10.1007/s10803-018-3801-9
37.
TorskeT.NærlandT.ØieM. G.StenbergN.AndreassenO. A. (2018). Metacognitive aspects of executive function are highly associated with social functioning on parent-rated measures in children with autism spectrum disorder. Frontiers in Behavioral Neuroscience, 11, 258. https://doi.org/10.3389/fnbeh.2017.00258
38.
TrevisanD. A.RobertsN.LinC.BirminghamE. (2017). How do adults and teens with self-declared autism spectrum disorder experience eye contact? A qualitative analysis of first-hand accounts. PLOS ONE, 12(11), Article e0188446. https://doi.org/10.1371/journal.pone.0188446
39.
ValenciaK.RusuC.QuiñonesD.JametE. (2019). The impact of technology on people with autism spectrum disorder: A systematic literature review. Sensors, 19(20), 4485. https://doi.org/10.3390/s19204485
40.
WechslerD. (1974). Manual for the Wechsler intelligence scale for children. Psychological Corporation.
YunS. S.ChoiJ.ParkS.-K.BongG.-Y.YooH. (2017). Social skills training for children with autism spectrum disorder using a robotic behavioral intervention system. Autism Research, 10(7), 1306–1323. https://doi.org/10.1002/aur.1778
