Joining in: investigating use of eye gaze
in children with cerebral palsy
Katie Price, Speech and Language Therapist1,2, Dr Michael Clarke, Lecturer2, Dr John Swettenham, Senior Lecturer2
1
Wolfson Neurodisability Team, Great Ormond Street Hospital for Children NHS Trust, London. 2Developmental Science, Division of Psychology and Language Sciences, UCL.
Background
Aims of the Study
The study aims to establish the
occurrence, nature and severity of social
communication deficits in a group of
young children with 4-limb cerebral palsy.
We will also look at how these deficits are
related, or not, to other (motor, language
and cognitive) skills. We will compare
these links to those seen in two other
groups of children: those with a diagnosed
autistic spectrum disorder, and much
younger children developing typically.
Recent amendments to the proposed definition
of cerebral palsy (CP) reflect that the disorder
has co-occurring disabilities, including social
communication deficits (SCD) similar to those
seen in children with autistic spectrum disorder
(Rosenbaum et al., 2007). Research with
children with CP has shown some of these
SCD, which may further hamper children’s
communication development, but may not be
the focus of intervention (Arens et al., 2005),
(Cress, 1999). Joint attention skills appear to
be particularly vulnerable, and assessment
depends on understanding the nature of their
physical eye gaze skills (Cazzagon et al., 2002).
It has been reported that autism can co-occur
with CP (Fombonne, 2003), but the physical
limitations of children with CP mean that
standardised measures of the impairments
associated with autism may be not be reliable
(Nordin and Gillberg, 1996). This study aims to
explore more appropriate measures of social
communication deficits for children with CP,
and to investigate the nature and severity of
the deficits shown.
Methods
Design and participants:
The study will use a cross-sectional group design,
with one target group of 55 children with CP aged
2-7 years. Comparison groups of
„„ 55 children aged 2-7 with autistic spectrum
disorder and
„„ receptive and expressive language, using
Pre-School Language Scales 4th Edition
(Zimmerman et al., 2002) with use of publisher’s
suggested modificarions for children with
physical impairments
„„ speech intelligibility, using
Measures of social communication:
The set of measures we have chosen to use to
identify social communication skills and deficits
have been selected to be accessible to young
children with CP. They include the following:
„„ 55 children aged 2-5 who are typically
developing
• 5 point rating scale of speech production
(Pennington and McConachie, 2001) and
„„ assessment of social orienting (Dawson et
al, 2004)
will allow comparison on language matches, where
normative data is not available for measures used.
• Children’s Speech Intelligibility Measure
(Willcox and Morris, 1999)
„„ responsiveness to emotion, assessment
of joint attention, and symbolic
comprehension
Exclusion criteria will comprise
„„ severe/profound hearing loss
„„ severe uncorrected visual acuity impairments
„„ uncontrolled seizure disorder
„„ language understanding below 18 month level
Participating families will be approached via
collaborators at Great Ormond Street Hospital,
and through Nursery Classes in Special Schools in
London.
Background measures:
Children will attend for assessment of
„„ functional motor ability, using the Gross Motor
Function Classification System (Rosenbaum et
al., 2008), and the Manual Ability Classification
System (Eliasson et al., 2006)
„„ non-verbal cognition, using sub-tests from
the British Ability Scales (Elliot, 1996). There
is no clearly suitable published assessment
for cognitive assessment for children with CP,
and a full range cognitive skills may not be
accessible, but this will offer some information
for this population.
Pre-requisite measures:
As our target measures (see below) involve use of
eye gaze for joint attention, we will first investigate
abilities with physical control and visual attention
to respond to non-social stimuli as follows:
„„ non-social orienting: fixing gaze on an object
as it appears in the field of view
„„ 2-place gaze transfer; following and
anticipating with eye gaze as objects are
related (for example, as a ball goes into a box)
„„ (Chiat and Roy, 2008). This is a three-part
assessment (Very Early Processing Skills)
• developed for use with children with
speech and language impairment, but
with responses possible through eyegaze alone
• using toys to elicit responses in each
category
• deriving numeric scores for each set of
skills, and in total
„„ other social/emotional engagement
available despite physical limitations,
to include engaged facial expression,
enjoyment or interest in task, gaze coordinated with facial expression, gesture or
vocalisation
Analysis
We will conduct inter-rater reliability testing for each
assessment for a sample of the group. As relatively
little is known about the nature or range of the social
communication deficits under scrutiny, an initial
investigation of the descriptive statistics will be
informative. Further group comparisons and regression
models will then be undertaken.
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