Diminished social attention in pediatric brain tumor survivors: Using eye tracking technology during naturalistic social perception.

Abstract

Objective:The etiology of pediatric brain tumor survivor (PBTSs) social difficulties is not well understood. A model of social competence for youth with brain disorder and evidence from youth with autism spectrum disorder (ASD) suggests that diminished social attention may underlie social deficits in PBTSs. This study used eye tracking technology to compare visual social attention in PBTSs, youth with ASD, and typically developing (TD) youth. Methods: Participants included 90 age-, gender-, and IQ-matched youth (N ϭ 30 per group). PBTSs were at least 5 years from diagnosis and 2 years from the completion of tumor-directed therapy. Participants' eye gaze patterns were recorded while watching an established social play paradigm that presented videos of children engaging in either interactive or parallel play. Group differences in proportional gaze duration toward social versus nonsocial areas of interest were compared. Medical correlates of social attention in PBTSs were evaluated. Results: Groups significantly differed in gaze preference across conditions, with PBTSs looking less at social areas of interest than TD youth and in a manner comparable to youth with ASD. Among PBTSs, multimodal tumor-directed therapy was associated with reduced gaze preference for faces. Conclusions: This study provides the first evidence of disrupted social attention in PBTSs, with parallels to the social attention deficits observed in ASD. Findings offer a new way to conceptualize the social difficulties of PBTSs and could guide interventions aimed at improving PBTS social adjustment by increasing visual attention to socially relevant information during social interactions.

Reduced Fusiform Gyrus Activation During Face Processing in Pediatric Brain Tumor Survivors

“…Additional neuroimaging research, particularly longitudinal studies and those that have sufficient samples to evaluate the effects of specific treatment variables (e.g., radiation field and dose), is needed to determine the neurobiological processes underlying the social difficulties of PBTS. Findings from the current study provide an important perspective for prior research with PBTS showing reduced facial affect recognition accuracy (Bonner et al, 2008;Moxon-Emre et al, 2019) and diminished gaze preference for faces when observing social interactions (Hocking et al, 2020). Hypoactivation in the specialized face processing areas of the fusiform gyrus may underlie these social information processing difficulties in survivors and contribute to a negative feedback loop.…”

“…Another study, showed face processing to be uniquely important to the social functioning of PBTS (Hocking et al, 2021). Further, recent evidence suggests that PBTS gaze less at faces during social situations than TD youth and in a manner consistent with youth with ASD (Hocking et al, 2020) suggesting reduced experience in processing facial information. Two recent studies have evaluated the neurobiological factors associated with the face processing abilities of PBTS (Moxon-Emre et al, 2019;Moxon-Emre et al, 2020), focusing on associations between the processing of facial expressions and structural connectivity (e.g., white matter).…”

Cognitive predictors of social adjustment in pediatric brain tumor survivors treated with photon versus proton radiation therapy

“…Regarding measurement, the present study incorporated only parent report measures for the assessment of social outcomes. Although parent ratings provide meaningful information and are commonly used in clinical settings, other studies have noted the benefits of sociometric approaches, computer‐based measures of social information processing, and interviews for the evaluation of survivor social outcomes 3,4,53,54 . The lack of self‐report measures is another limitation and may lead to under‐ or overestimation of social challenges depending on caregiver awareness of social difficulties experienced by survivors outside of the home.…”

“…Although parent ratings provide meaningful information and are commonly used in clinical settings, other studies have noted the benefits of sociometric approaches, computer-based measures of social information processing, and interviews for the evaluation of survivor social outcomes. 3,4,53,54 The lack of self-report measures is another limitation and may lead to under-or overestimation of social challenges depending on caregiver awareness of social difficulties experienced by survivors outside of the home. Future studies will benefit from carefully selected methods for measuring survivor selfreported social functioning, including an interview format permitting clarification.…”

Social participation of school‐aged survivors of pediatric brain tumors: A daily diary report

“…While the 5‐year survival rates for children with brain tumors has increased dramatically, 1,2 late effects are common and include weaknesses in neurocognition, 3,4 social functioning, 5–7 and delayed psychosocial development 8 . Deficits in social functioning in survivors of pediatric brain tumors (PBTS) have been most frequently assessed via parent, teacher, or self‐report questionnaires, or peer nominations as a means of assessing social acceptance 9–11 .…”