Social attention in children with epilepsy

Abstract

Children with epilepsy may be vulnerable to impaired social attention given the increased risk of neurobehavioural comorbidities. Social attentional orienting and the potential modulatory role of attentional control on the perceptual processing of gaze and emotion cues have not been examined in childhood onset epilepsies. Social attention mechanisms were investigated in patients with epilepsy (n = 25) aged 8-18 years old and performance compared to healthy controls (n = 30). Dynamic gaze and emotion facial stimuli were integrated into an antisaccade eye-tracking paradigm. The time to orient attention and execute a horizontal saccade toward (prosaccade) or away (antisaccade) from a peripheral target measured processing speed of social signals under conditions of low or high attentional control. Patients with epilepsy had impaired processing speed compared to healthy controls under conditions of high attentional control only when gaze and emotions were combined meaningfully to signal motivational intent of approach (happy or anger with a direct gaze) or avoidance (fear or sad with an averted gaze). Group differences were larger in older adolescent patients. Analyses of the discrete gaze emotion combinations found independent effects of epilepsy-related, cognitive and behavioural problems. A delayed disengagement from fearful gaze was also found under low attentional control that was linked to epilepsy developmental factors and was similarly observed in patients with higher reported anxiety problems. Overall, findings indicate increased perceptual processing of developmentally relevant social motivations during increased cognitive control, and the possibility of a persistent fear-related attentional bias. This was not limited to patients with chronic epilepsy, lower IQ or reported behavioural problems and has implications for social and emotional development in individuals with childhood onset epilepsies beyond remission.

Impaired social attention detected through eye movements in children with early‐onset epilepsy

“…CWEOE fixated the social scene longer than the nonsocial scene, indicating they were more drawn toward social stimuli overall, but they did so significantly less than control children, reflecting a weaker attraction to social stimuli than should be expected. This reduction in attentional priority for socially relevant stimuli in the absence of a clear interaction between group and social functioning T scores, suggests that, like in previous reports, 21 epilepsy itself has an independent and adverse impact on the development of the social brain in early life. Fixation duration to the social scene remained stable across age in CWEOE, and thus the clearest disparity in social attention was observed in the youngest CWEOE.…”

“…Eye movement analysis of social attention in childhood epilepsy has been scarce, although atypical visual attention toward faces in adolescents with epilepsy as well as epilepsy‐related Rett syndrome has been reported 21‐23 . In adolescents, Lunn et al 21 found slower gaze processing toward emotional expressions that was independently associated with epilepsy, with the authors suggesting that age at epilepsy onset could be associated with age‐dependent social skill acquisition. Social attention status in CWEOE has not been investigated to our knowledge, despite early childhood being a key period in fundamental neural and social development 24,25 .…”