Eye‐tracking for longitudinal assessment of social cognition in children born preterm – video abstract

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Video abstract from Bethan Dean on the paper ‘Eye‐tracking for longitudinal assessment of social cognition in children born preterm’, in The Journal of Child Psychology and Psychiatry.

Authors; Bethan Dean, Lorna Ginnell, Victoria Ledsham, Athanasios Tsanas, Emma Telford, Sarah Sparrow, Sue Fletcher‐Watson, James P. Boardman

First published: 29 July 2020

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Dr. Bethan Dean
Dr. Bethan Dean

Bethan Dean is a paediatric registrar training to become a neonatologist. She was awarded a bachelors degree in natural sciences, specialising in experimental psychology, from Cambridge University prior to obtaining her medical degree from Oxford University. During her paediatric training, Bethan undertook a clinical research fellowship in the MRC Centre for Reproductive Health at the University of Edinburgh. She worked within the Theirworld Edinburgh Birth Cohort, a longitudinal cohort study of preterm and term-born children. Her research was focussed on the social cognitive skills of children born preterm in the preschool years and she has just submitted her PhD. She has now returned to clinical medicine to complete her sub-speciality training in neonatal medicine.


Hi, my name is Bethan and I’m a PhD student at the University of Edinburgh. Today I am here to give you a brief overview of a paper recently published by my colleagues and I in the Journal of Child Psychology and Psychiatry, entitled Eye-tracking for longitudinal assessment of social cognition in children born preterm. Preterm birth is associated with increased risk of cognitive impairment and social difficulties in childhood. Difficulties with social interaction can cause educational underachievement and affect social and occupational functioning in adulthood. Socio-economic deprivation is also known to impact language and interactional abilities in childhood, including in those born preterm.

One of the challenges to improving long term outcomes for the preterm population is early identification of children that will go on to have social difficulties with the understanding that the preschool years may offer a period of development where interventions may yield the most benefit. In order to do this, we need precise and practical measures of cognition in the early months, coupled with the understanding of how these early measures relate to later outcomes.

Gaze is the control point for the intake of visual information and we can use gaze behaviours in response to visual stimuli in pre verbal children to make inferences about underlying cognitive processes, such as attention and preference. Eye-tracking can provide an objective measure of gaze that is highly resolved in time and space. Gaze studies in preterm infants have shown a consistent pattern of reduced social attentional preference. However, the stability of these differences over time, and whether they contribute to the ontogeny of neurodevelopmental and, or cognitive impairment are unknown.

Therefore, we used eye-tracking in preterm and term-born infants to investigate social attentional preference in infancy and at five years, its relationship with neurodevelopment, and the influence of socioeconomic deprivation. Our cohort was the first phase of the Theirworld Edinburgh Birth Cohort, consisting of 81 preterm children born at or at less than 33 weeks gestation, and 66 healthy term controls. We collected socio economic data at recruitment using a multifactorial measure, the Scottish Index of Multiple Deprivation. We performed eye-tracking assessment in infancy between seven to nine months corrected gestational age, and reassessed a subset at five years chronological age. At five years, we also performed formal neurodevelopmental assessment using the Mullen Scales of Early Learning.


We used three free-viewing eye tasks of increasing stimulus complexity. We calculated a proportional looking score to the predefined areas of social interest for each task, which you can see on the screen there. This was defined as the ratio of the mean looking time to the social areas of interest to the mean looking time to the scene as a whole across all stimuli. We also created an overall social preference score for each individual, calculated from the average PLS for each task.

And here are our findings. Children born preterm demonstrated significantly reduced preference to social information across all three tasks, and consequently for their overall social preference compared to the term-born infants at seven to nine months of age. However, at five years, there were no significant differences with preterm infants showing increases in their social attentional preferences over time. Indeed, there were strong and significant correlations between the baseline scores in infancy, and the difference in scores observed between the two time points, in that lower scores at baseline corresponded to greater increases in the five year scores. In contrast, the term- born infants simply showed a regression towards the mean.

In addition, we found that no gestational age and socioeconomic deprivation were associated with reduced social preference scores at seven to nine months. At five years, the preterm infants have lower scores on the Mullen Scale of Early Learning than the term-born children, driven by deficits in the language domains, but this was not associated with social attentional preference in infancy.

Our study demonstrates that preterm infants have reduced social attentional preferency at seven to nine months compared to term-born controls but equivalent social preference by five years of age. Despite this apparent catch up, preterm infants continue to demonstrate poorer performance in standardised neurocognitive testing at five years, and it is known that a subset of children born preterm go on to have social difficulties. It is possible that the deficit in children’s more complex social abilities, such as language or interactional skills, is secondary to reduced social attention during the sensitive window of development in infancy.

However, in our study, we did not find a relationship between attentional preference in infancy and later neurodevelopmental scores. Therefore, it is possible that other measures of cognitive function, such as language ability, are required to determine the role of atypical infant social cognition in later childhood outcomes. In addition, we found that socioeconomic deprivation significantly influences social attentional preference in addition to gestational age, with maximal effects in infancy. This is particularly interesting as socioeconomic deprivation is known to be associated with impaired language development, including among children born preterm, suggesting that the combination of preterm birth and socioeconomic deprivation may present additive risk for cognitive difficulties.

Further work is required to determine whether and how infant social cognition plays a role in the ontogeny of cognitive impairment and social difficulties, which are all more prevalent among our preterm population. Our data also suggests that socioeconomic disadvantage should be considered in all studies investigating cognitive development of children born preterm.

Thank you very much for watching this video abstract. If you would like to read the full paper, it is now available open access at the Journal of Child Psychology and Psychiatry’s website.

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