The use of eye-tracking to find objective outcome measures of early intervention strategies for children with autism: A systematic review.

Researchers looked at whether eye-tracking technology could help measure if early autism interventions are working. They found 9 studies that used special cameras to track where children looked during activities. Six of these studies showed that interventions improved how children paid visual attention to things. Eye-tracking seems promising for measuring progress, but some methods worked better than others.

This technology might help doctors and therapists better understand if treatments are helping children with autism.

This systematic review examined whether eye-tracking technology can serve as an objective outcome measure for early autism interventions. Researchers analyzed nine randomized controlled trials that used eye-tracking to evaluate direct, parent-mediated, and pharmacological interventions for children with autism. Six of the nine intervention approaches showed improvements in visual attention measures captured through eye-tracking. The studies demonstrated low-to-moderate risk of bias overall.

Eye-tracking proved sensitive to intervention-related changes across various contexts, suggesting clinical relevance. However, not all eye-tracking paradigms reliably measured change over time, affecting result interpretation. The review identified 24 additional registered trials using eye-tracking outcomes that have not yet published results, indicating growing interest in this technology.

Eye-tracking shows promise as an objective measure for autism intervention outcomes but requires further standardization. Clinicians should consider this technology's potential while awaiting more robust protocols. The approach may eventually provide more precise measurement of intervention effects than traditional behavioral assessments alone.

Only nine unique RCTs met inclusion criteria despite comprehensive search. Variable reliability across different eye-tracking paradigms compromised interpretability of some results. Many registered trials have not yet published results, limiting available evidence.

Early intervention strategies are recommended for children with autism to improve cognitive and social communication skills. However, there is a persistent challenge to identify objective outcome measures of intervention efficacy. Eye-tracking (ET) is a safe and well-tolerated technology able to detect differences in visual attention through gaze behavior. This systematic review aims to identify, appraise and summarize the existing literature using ET to track response to early intervention in autism clinical trials.

A comprehensive literature search was conducted in December 2024 in several bibliographic databases, including Medline ALL Ovid, Embase.com, APA PsycInfo Ovid, the Cochrane Library Wiley and PubMed Central. Additionally, we searched trial registries and we performed citation tracking strategies. We retained randomized controlled trials (RCTs) incorporating an ET outcome measure to evaluate the effect of direct, parent-mediated and pharmacological early interventions. Quality was assessed using Risk of Bias 2 and GRADE.

Out of 1'726 reports screened, eleven articles from nine unique RCTs met inclusion criteria, with overall low-to-moderate risk of bias. Six out of the nine intervention approaches showed improvements in several indices of visual attention measured with different ET paradigms. We also identified 24 RCTs registered with an ET outcome measure yet without published results. ET proved to be a clinically relevant measure sensitive to change in several interventional contexts.

However, not all ET paradigms measured change over time reliably, compromising interpretability. Further research is needed to ensure that ET potentially becomes an accessible and accurate tool for widespread adoption in clinical practice.