BCI Training for Social Cognition and Error Monitoring in ASD

University of Coimbra28 enrolled

Overview

Social cognition seems to develop atypically in autism, particularly in processes such as faces perception, joint attention and social information processing. In this sense, and using an Emotional Paradigm of Facial Expressions (EFP) with a Brain-Computer Interface (BCI) based on Electroencephalography (EEG), the investigators intend to evaluate its effectiveness as a medical device in Autism Spectrum Disorder (ASD), namely: improving 1) social skills and 2) reducing generalized anxiety, 3) improve error monitoring, and consequently verify 4) an increase in motivation. To this end, the investigators will test a gamified intervention (EFP), using personalized feedback in real time. In this gamified interface, there is an artificial agent that learns rules through Reinforcement Learning using the evoked potentials from the participant as they observe the agent's right or wrong actions. The hypothesis is that this approach allows, during the gamified task (EFP), not only the agent/interface to learn, but also the participant through operant conditioning and implicit scrutiny of errors, which makes it particularly interesting for disorders in which error monitoring processes are compromised, as in ASD.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Autism Spectrum Disorder (ASD)

Emotional Facial Expression Paradigm (EFP)DEVICE

The experimental intervention is a social cognition gamified training, through a software that implements communication between a participant and a computer, using a detection and classification algorithm based on EEG signal. The training consists of a visual stimulation model, specifically an emotional facial paradigm, where the subject is asked to observe the movements of a facial expression (referred to as cue image) expressing either happiness or sadness and to adapt the visual gaze according the cue image.

Speller taskDEVICE

The control intervention is a executive function gamified training, through a software that implements communication between a participant and a computer, using a detection and classification algorithm based on the P300 EEG signal. The task consists of a speller, in which the participant is asked to write a word, by sequentially focusing the attention on the necessary letters.

Eligibility

Sex: ALLMin age: 16 YearsMax age: 55 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Participant is able and willing to give written informed consent/assent * Previous diagnosis of Autism Spectrum Disorder by a qualified clinician according to gold-standard instruments * Aged between 16 and 55 years old * Normal or corrected-to-normal vision Exclusion Criteria: * Global Intelligence Quotient \<70 * Dermatological diseases of the scalp * Concurrent neurofeedback therapy * Concomitant medication without a stable dosage for at least 4 weeks * History of seizures and/or epilepsy

Outcomes

Primary Outcomes

Change from baseline to post-intervention in a computerized attention task (Subway Game)

Responses consist on the time spent to complete 3 mazes, using computer mouse navigation. Responses are measured in seconds and the best outcomes correspond to the fastest responses.

Time frame: From baseline to the end of treatment (maximum of 8 weeks)

Change from baseline to post-intervention in the Anxiety Sub-Scale from "The Hospital Anxiety and Depression Scale"

Participants scores ranges from 0 (best outcome) to 21 (worst outcome).

Time frame: From baseline to the end of treatment (maximum of 8 weeks).

Secondary Outcomes

Change in error-monitoring in Emotional Facial Expression Paradigm (EFP) across intervention

Improvement of the amplitude/discrimination of waveform morphology of Event-Related Potentials (ERPs).

Time frame: At each intervention session, from first to last (intervention lasts up to 8 weeks and starts within 2 weeks after baseline)

Change from baseline to post-intervention in the Interest/Enjoyment subscale of "Intrinsic Motivation Inventory (IMI)"

Higher scores indicate greater interest/enjoyment when practicing the task (better outcome). Scores are calculated by averaging the item scores of the subscale.

Time frame: From baseline to the end of treatment (maximum of 8 weeks)

Change from baseline to post-intervention in a computerized attention task (Subway Game - eye gaze)

Responses consist on the time spent to complete 3 mazes, using eye gaze. Responses are measured in seconds and the best outcomes correspond to the fastest responses.