Evaluación integrada del conjunto de los indicadores

relevant discourse between adults and TD pre-schoolers when learning via paper-books compared to e-books, extending this finding to high-functioning children with ASC. It is possible that the self-contained nature of iPad learning (Allen et al., 2016) combined with the increased cognitive load provided by interactive touchscreen features (Kirkorian, 2018; Richter & Courage, 2017) may diminish the need to share salient information with the adult, fostering a more solitary learning style than paper-based mediums (Radesky et al., 2015; Schugar et al., 2013). This may hinder the facilitation of social interaction in individuals with ASC, who often experience wide-ranging social and communicative impairments (Kjelgaard & Tager-Flusberg, 2001; Pelphrey et al., 2011). Moreover, some children with ASC often become fixated on a topic/item of interest at the expense of other stimuli (Bryson et al., 2004; Liss et al., 2006; Zwaigenbaum et al., 2005). Consequently, children with ASC may be preoccupied with interactive and multimedia features, leading to less communication and adult orientation.

6.3. Question 3: Is there a relationship between engagement and task performance in children with ASC?

A relationship between visual attention and task performance was found in Study 1 (iconicity and symbol learning) and Study 4 (narrative comprehension), however this was not the case in Study 3 (label learning). A different pattern of results emerged between children with ASC and TD children in Studies 1 and 4. Study 2 (labelling and symbol learning) did not examine the relationship between engagement and task performance and so will not be

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discussed in this section. In Study 1 (iconicity and symbol learning), children with ASC who exhibited greater visual attention towards the task (regardless of condition) demonstrated more robust symbolic responding in the test phase. Despite also exhibiting a high level of visual attention throughout the training phase, visual attention was not related to robust symbolic responding for TD children. In Study 4 (narrative comprehension), TD children who exhibited greater visual attention during the storybook reading (regardless of condition) demonstrated higher scores on both measures of narrative comprehension - multiple choice questions (measuring fact-based knowledge of the story) and a picture ordering task

(measuring temporal sequencing of the narrative). This suggests that visual attention predicts the performance of TD children on tasks tapping different aspects of narrative comprehension. Although children with ASC were also highly visually engaged throughout the storybook reading, visual attention was not related to narrative comprehension for this group. No relationship between engagement and performance was found in Study 3 (label learning). As previously mentioned, this may be due to the short length of the task resulting in a failure to capture variability in visual attention between conditions.

The findings of Study 1 (iconicity and symbol learning) and Study 4 (narrative comprehension) suggest that, for children with ASC, the relationship between visual attention and performance may be dependent on the design of the task. When information was presented via a specially designed, single-purpose iPad application (Study 1), visual attention towards the task was beneficial for learning in this population. Symbols were presented one at a time on a blank white background, eliminating the potential influence of extraneous on-screen information. Visually engaging and relevant stimuli may increase the child’s attention away from environmental distractors (Oakes et al. 2004), particularly aiding the learning of children with poorer executive functioning (Richter & Courage, 2017), such as those with ASC (Finnegan & Mazin 2016; Richard & Lajiness-O’Neill, 2015; Rinehart et al., 2001). In contrast, when information was presented via an e-book compared to a paper-book (Study 4), visual attention only benefitted the learning of TD children. Both relevant and irrelevant information was presented through interactive and multimedia features in the e-

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book. Despite children with ASC demonstrating a high level of visual attention while listening to the story, with 92% of time spent orienting their gaze towards the page/screen, visual attention was not related to narrative comprehension for this group. As children with ASC often demonstrate weak central coherence (Frith, 1989; Omar & Bidin, 2015), this population may be more easily distracted by irrelevant information presented within a task compared to TD children (Renner et al., 2006; Townsend et al., 1996; Werner et al., 2000).

Despite demonstrating less distractibility in the e-book conditions in Study 4 (narrative comprehension) (El Zein et al., 2016; Fletcher-Watson et al., 2015; Lee et al., 2015; Oakes et al., 2004), it cannot be determined whether children were visually attending to information that was relevant to the central plot of the story or miscellaneous background illustrations and animations. Eye-tracking could be used in future research to examine which features on the screen/page children are visually attending to during storybook reading (Caruana et al., 2017). This could then be used to compare those who are attending to central or peripheral information to test the theory that engagement (visual attention) influences narrative comprehension. If children visually attend to central information that is relevant to the plot, it is expected that they would exhibit greater narrative comprehension than those who visually attend to peripheral/extraneous information during storybook reading, especially for children with ASC (Frith, 1989; Renner et al., 2006; Townsend et al., 1996; Werner et al., 2000).

It is also noteworthy that no relationship between visual attention and task

performance was found in Study 1 (iconicity and symbol learning) for TD children. A potential explanation is that this population may already possess robust symbolic understanding and consequently demonstrate no variability in performance (Ganea et al., 2009). This study included a TD group with an average age of 3 years and 5 months. As 2-year-old TD children have been found to demonstrate reliable referential responding (Preissler & Carey, 2004; Samuelson & Smith, 1999), this skill may already be well-established for the TD children. This contrasts with children with ASC, who can often experience difficulties with symbolic understanding into later childhood (Hartley & Allen, 2015a; Hartley & Allen, 2015b).

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Consequently, the TD children may not have needed to be as attentive to the task as the children with ASC to learn new symbols.

In contrast to visual attention, no relationship was found between oral communication and task performance for both children with ASC and TD children. Although measures such as task relevant and irrelevant speech may indicate engagement/disengagement (Moody et al., 2010; Richter & Courage, 2017) such measures are prone to variability due to individual differences in verbal ability (Smith, Mirenda, & Zaidman-Zait, 2007; Speidel, 1989). Despite not including any entirely non-verbal children in the studies, the level of verbal ability was not measured. Therefore, future research investigating the relationship between communication and task performance should include a measure of verbal ability to control for individual differences in expressive language for both populations.

In terms of gestural communication, gesture was negatively related to narrative comprehension in Study 4 for TD children only. Gesture was also negatively related to chronological age and receptive vocabulary score for this population. Therefore, children who produced more gestures were also younger and thus may have had a poorer capacity for sustained attention and inhibition control (Betts, Mckay, Maruff, & Anderson, 2006; Reck & Hund, 2011). This may explain the relationship between gesture and poorer learning outcomes in TD children.

Overall, the current studies suggest that the relationship between visual attention and performance is dependent on the design of the task for some children with ASC. Task- oriented visual attention benefitted the symbol learning of children with ASC from a single purpose iPad application (Study 1), presenting symbols one at a time against a blank

background. However, when both relevant and irrelevant multimedia and interactive features were included, task-oriented visual attention was not related to narrative comprehension for children with ASC (Study 4). This research suggests that perceived attentiveness towards a task may not translate into learning outcomes for this population. Finally, expressive

language ability should be measured and controlled for within future studies, to allow for the use of oral communication as a measure of task engagement.

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6.4. Does adult/experimenter involvement benefit the task performance of children