نقايص جهت گيري اجتماعي: شاخص شناسايي كودكان با ريسك ابتلا به اتيسم

Social orientation deficit: Index of autism at-risk infants

هدف ناكامي در جهت گيري به سوي محرك هاي اجتماعي، از علائم ابتدايي اتيسم است كه در شناسايي زودهنگام اتيسم حائز اهميت است؛ بنابراين، پژوهش حاضر با هدف مقايسه جهت گيري اجتماعي در كودكان با ريسك بالا و پايين اتيسم انجام شد. روش بررسي اين پژوهش از نوع علي-مقايسه اي بود. جامعه آماري، شامل تمامي كودكان پسر 12-10ماهه ساكن شهر تهران بود. تعداد 53 كودك از طريق نمونه گيري طبقه اي انتخاب شده و براساس ملاك هاي تشخيصي، به يك گروه آزمايش (13 كودك در ريسك) و دو گروه گواه (20 كودك تاخيري و 20 كودك سالم) گماشته شدند. تحول عمومي كودكان با پرسشنامه سنين و مراحل (سوكر و بريكر، 1995) و سطح تحول هيجاني-كاركردي آن ها با پرسشنامه تحول هيجاني-كاركردي (گرينسپن، 2002) بررسي شد. سپس، حركات چشم كودكان در پاسخ به سه آزمون ديداري مرتبط با جهت گيري اجتماعي: جهت گيري به سوي حركت زيستي، تصاوير پوياي اجتماعي و نگاه مستقيم با استفاده از ردياب چشم (Tobii, TX300) ثبت شد. يافته ها با آزمون هاي آماري تحليل واريانس كروسكال واليس، تحليل واريانس يك طرفه (ANOVA)، ويلكاكسون، t وابسته و آزمون بونفروني در سطح معناداري 0٫05 و با استفاده از نسخه 21 نرم افزار SPSS بررسي شد. يافته ها نتايج نشان داد بين سه گروه در متغيرهاي جهت گيري به سوي حركت زيستي (0٫336=p) و نگاه مستقيم (0٫892=p) اختلاف معنادار آماري وجود ندارد اما در متغير جهت گيري به سوي محرك هاي پوياي اجتماعي اختلاف معنادار آماري وجود دارد (0٫003=p). همچنين، توزيع نگاه بين جفت محرك هاي همزمان براي آزمون جهت گيري به سوي حركت زيستي در دو گروه سالم و تاخيري هدفمند (0٫002=p) و در گروه در ريسك (0٫116=p) تصادفي بود. توزيع نگاه بين جفت محرك هاي هم زمان براي آزمون جهت گيري به سوي محرك هاي اجتماعي در گروه سالم (0٫001=p) و تاخيري (0٫005=p) هدفمند و در گروه در ريسك (0٫283=p) تصادفي بود. توزيع نگاه بين جفت محرك هاي هم زمان براي آزمون جهت گيري به سوي نگاه مستقيم در گروه سالم (0٫940=p)، تاخيري (0٫086=p) و در ريسك (0٫600=p) تصادفي بود. نتيجه گيري باتوجه به يافته ها استنباط مي شود جهت گيري اجتماعي از ماه هاي اول در كودكان در ريسك، صدمه ديده است و بررسي آن از طريق ردياب چشم مي تواند در شناسايي زودهنگام اين كودكان مفيد باشد.

Background & Objective: Autism is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, as well as restricted, repetitive patterns of behaviors and interests. Infants who develop autism have early deficits in social motivation, which is expressed by decreased attention to social information. These deficits lead to impaired socio-cognitive development. Base on researches, interventions implemented between 12–48 months is associated with significant gains in cognition, language, and adaptive behavior. To facilitate early diagnosis, screening tools whit suitable sensitivity and specificity are needed. The eye tracker is one of the screening tools that have attracted much attention in recent years. It requires no skills unless eye movement. So, it is suitable for screening at early ages. The goal of the present study was to investigate the social orienting in at-risk infants. It was expected that, in contrast to typically developing (TD) and developmentally delay (DD) infants, at-risk infants would show impaired performance on tasks measuring social orienting. Methods: This study was a causal-comparative. The statistical population included 10-12 months boy infants in Tehran. The research sampling was Stratified sampling. Fifty-three boy infants were selected and divided into three groups based on diagnostic criteria (the experimental group included 13 at-risk infants, and control groups included 20-TD and 20-DD infants). Parents were asked to complete the Age and Stage Questionnaire (ASQ) (Bricker & Squires, 1995) and the Functional Emotional Developmental Questionnaire (FEDQ) (Greenspan, 2002). Then infants regarding ASQ and family history of autism were divided into an at-risk group (developmentally delay and ASD-sib), DD-group (developmentally suspend without autistic history) and TD-group (no history of developmentally delay or ASD). Then, Infants completed three social orienting tasks: orienting to direct gaze, biological motion, and dynamic social images (DSI, children moving) and their eye movements record whit eye-tracker (Tobii, TX300). For each kind of stimuli, we calculated several variables: the total fixation duration, the whole looking time on screen, and the number of saccades between images. Results analyzed by Kruskal–Wallis one-way analysis of variance, one-way ANOVA, Wilcoxson test, paired sample T-test with dependent groups, and Bonferroni method (p value=0.05) Using SPSS version 21 software. Results: The total time spent looking at the screens was not statistically significantly different between the three groups (p>0.05). When viewing point-light displays of biological motion, at-risk infants were random in their looking patterns: 44.72% on the upright figure vs. 55.28% on the inverted (p=0.116). In contrast, both control groups demonstrated significant preferential attention to the upright animations: 61.54% upright for the TD group (p=0.002), and 57.54% upright for the DD group (p=0.002). Comparison across groups was not significantly different (by Kruskal– Wallis one-way analysis of variance, p=0.336). The difference in the fixation duration on dynamic social images (DSI) between the three groups is statistically different (by one-way ANOVA analysis of variance, p=0.003). In pairwise comparisons, looking by the at-risk group differed significantly from that of the TD group (p = 0.002 in comparison with the TD group, and p= 0.065 relatives to the DD group). The percentage of time spent on DSI was 55.4% vs. 44.6% on the dynamic geometric images (DGI, moving geometric shapes or toys) in the at-risk group (p=0.283). In contrast, both control groups demonstrated significant preferential attention to the DSI: 60.91% for the TD group (p=0.001), and 60.69% for the DD group (p=0.005). Comparison in the fixation duration on direct gaze across groups was not significantly different (by Kruskal– Wallis one-way analysis of variance, p=0.892). The percentage of time spent on direct gaze was 50.6% vs. 49.4% on the averted gaze in the atrisk group (p=0.600); 50.54% vs. 49.45% for the TD group (p=0.940) and 53.44% vs. 46.56% for the DD group (p=0.086). Conclusion: This finding highlights that social orientation in the first months of life is damaged in at-risk infants. It appears that social orientation assessment in at-risk infants has the potential to autism screening in early years. Eye-tracking revealed a promising future for autism screening at an early age. Further research is needed to confirm the findings.