Please use this identifier to cite or link to this item: https://hdl.handle.net/10316/107627
Title: A Feasibility Clinical Trial to Improve Social Attention in Autistic Spectrum Disorder (ASD) Using a Brain Computer Interface
Authors: Amaral, Carlos 
Mouga, Susana 
Simões, Marco 
Pereira, Helena C. 
Bernardino, Inês 
Quental, Hugo 
Playle, Rebecca
McNamara, Rachel
Oliveira, Guiomar 
Castelo-Branco, Miguel 
Keywords: autism; clinical trial; brain-computer interface; EEG; virtual reality; social attention
Issue Date: 2018
Publisher: Frontiers Media S.A.
Project: This work was supported by FTC—Portuguese national funding agency for science, research, and technology [Grants PAC— MEDPERSYST, POCI-01-0145-FEDER-016428, COMPETE 2020, POCI 030852, BIGDATIMAGE, CENTRO-01-0145 -FEDER-000016 financed by Centro 2020 FEDER, COMPETE, FCT-UID/4539/2013—COMPETE, POCI-01-0145-FEDER -007440, and Fellowships SFRH/BD/78982/2011;SFRH/BD/ 77044/2011; SFRH/BD/102779/2014 and SFRH/BPD/ 101641/2014]; FLAD Life Sciences 2016, and the BRAINTRAIN Project—Taking imaging into the therapeutic domain: Selfregulation of brain systems for mental disorders [FP7-HEALTH- 2013-INNOVATION-1–602186 20, 2013]. 
Serial title, monograph or event: Frontiers in Neuroscience
Volume: 12
Abstract: Deficits in the interpretation of others' intentions from gaze-direction or other social attention cues are well-recognized in ASD. Here we investigated whether an EEG brain computer interface (BCI) can be used to train social cognition skills in ASD patients. We performed a single-arm feasibility clinical trial and enrolled 15 participants (mean age 22y 2m) with high-functioning ASD (mean full-scale IQ 103). Participants were submitted to a BCI training paradigm using a virtual reality interface over seven sessions spread over 4 months. The first four sessions occurred weekly, and the remainder monthly. In each session, the subject was asked to identify objects of interest based on the gaze direction of an avatar. Attentional responses were extracted from the EEG P300 component. A final follow-up assessment was performed 6-months after the last session. To analyze responses to joint attention cues participants were assessed pre and post intervention and in the follow-up, using an ecologic "Joint-attention task." We used eye-tracking to identify the number of social attention items that a patient could accurately identify from an avatar's action cues (e.g., looking, pointing at). As secondary outcome measures we used the Autism Treatment Evaluation Checklist (ATEC) and the Vineland Adaptive Behavior Scale (VABS). Neuropsychological measures related to mood and depression were also assessed. In sum, we observed a decrease in total ATEC and rated autism symptoms (Sociability; Sensory/Cognitive Awareness; Health/Physical/Behavior); an evident improvement in Adapted Behavior Composite and in the DLS subarea from VABS; a decrease in Depression (from POMS) and in mood disturbance/depression (BDI). BCI online performance and tolerance were stable along the intervention. Average P300 amplitude and alpha power were also preserved across sessions. We have demonstrated the feasibility of BCI in this kind of intervention in ASD. Participants engage successfully and consistently in the task. Although the primary outcome (rate of automatic responses to joint attention cues) did not show changes, most secondary neuropsychological outcome measures showed improvement, yielding promise for a future efficacy trial. (clinical-trial ID: NCT02445625-clinicaltrials.gov).
URI: https://hdl.handle.net/10316/107627
ISSN: 1662-4548
DOI: 10.3389/fnins.2018.00477
Rights: openAccess
Appears in Collections:FMUC Medicina - Artigos em Revistas Internacionais
I&D CISUC - Artigos em Revistas Internacionais
I&D CNC - Artigos em Revistas Internacionais

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