Development of a tool to assess visual attention in Rett syndrome: a pilot study

Abstract

This was a two-phase study that aimed to (a) develop a tool for assessing visual attention in individuals with Rett syndrome using AAC with a communication partner during naturalistic interactions in clinical settings; and (b) explore aspects of the tool's reliability, validity, and utility. The Assessment of Visual Attention in Interaction (AVAI) tool was developed to assess visual attention operationalized as focused gazes (1 s or longer) at the communication partner, an object, and a symbol set. For the study, six video-recorded interactions with nine female participants diagnosed with Rett syndrome (range: 15-52-years-old) were used to calculate intra-and inter-rater agreement, and 18 recorded interactions were analyzed to examine sensitivity to change and acceptability. There was a significant difference in the AVAI results between two conditions (with and without aided-language modeling). Inter-rater agreement ranged from moderate and strong. There was a range in scores, indicating that the AVAI could differentiate between participants. The AVAI was found to be reliable, able to detect change, and acceptable to the participants. This tool could potentially be used for evaluating interventions that utilize aided AAC.

Aided language modelling, responsive communication and eye-gaze technology as communication intervention for adults with Rett syndrome: three experimental single case studies

“…Focused gazes are operationalised in AVAI as gaze fixations that last for one second or longer. In a previous study, the tool had acceptable reliability (j ¼ 0.79-0.86) [37,44]. The coding of the videorecorded sessions in the present study was carried out using video editing software (described below).…”

“…Diana had more difficulties with eye motor control than the other participants, partly due to exotropia. In a pilot study including a small group of women diagnosed with Rett syndrome, the rate of focused gazes was higher when the communication partner used aided language modelling [44]. Although the results from these two studies can not be generalised due to small groups, it may be important to assess and evaluate visual attention when introducing aided communication.…”

“…To assess visual attention, the rate of focused gazes was recorded using Assessment of Visual Attention in Interaction (AVAI) [44]. This tool was specifically developed to assess visual attention in individuals with Rett syndrome when using AAC with a communication partner during interactions in clinical settings.…”

Identifying key aspects of the communicative capabilities of children with Rett syndrome

“…The main objective of a communication assessment is to recognise the possibility of any variance in a child's developmental growth chart by attending to the possible cognitive abilities (Ahonniska-Assa et al, 2018), learning skills, and visual-motor capabilities, along with all aspects of communication strengths (Wandin et al, 2020). Furthermore, close attention should be given to a child's medical and developmental history (case history) (Percy, 2014), along with functional assessment and review of assessment outcomes (Byiers et al, 2014), possible diagnosis, and objective settings (Townend et al, 2020).…”

“…The information gained from the consensus-based guidelines for managing the communication of individuals with RTT is generally accepted and evidence-based. However, the matter on hand is the disadvantages of such implementations, such as funds, location, and training (Wandin et al, 2020). This review is proposed to address the following areas explored by Townend et al (2020), eliminating the need to seek knowledge from only a few RTT expert professionals.…”