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Improving sensitivity to eye gaze cues in autism using serious game technology: study protocol for a phase I randomised controlled trial
  1. K. Suzanne Scherf1,
  2. Jason W Griffin1,
  3. Brian Judy1,
  4. Elisabeth M Whyte1,
  5. Charles F Geier2,
  6. Daniel Elbich1,
  7. Joshua M Smyth3
  1. 1 Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA
  2. 2 Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
  3. 3 Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
  1. Correspondence to Dr K. Suzanne Scherf; suzyscherf{at}


Introduction Autism spectrum disorder (ASD) is characterised by impairments in social communication. Core symptoms are deficits in social looking behaviours, including limited visual attention to faces and sensitivity to eye gaze cues. We designed an intervention game using serious game mechanics for adolescents with ASD. It is designed to train individuals with ASD to discover that the eyes, and shifts in gaze specifically, provide information about the external world. We predict that the game will increase understanding of gaze cues and attention to faces.

Methods and analysis The Social Games for Adolescents with Autism (SAGA) trial is a preliminary, randomised controlled trial comparing the intervention game with a waitlist control condition. 34 adolescents (10–18 years) with ASD with a Full-Scale IQ between 70 and 130 and a minimum second grade reading level, and their parents, will be randomly assigned (equally to intervention or the control condition) following baseline assessments. Intervention participants will be instructed to play the computer game at home on a computer for ~30 min, three times a week. All families are tested in the lab at baseline and approximately 2 months following randomisation in all measures. Primary outcomes are assessed with eye tracking to measure sensitivity to eye gaze cues and social visual attention to faces; secondary outcomes are assessed with questionnaires to measure social skills and autism-like behaviours. The analyses will focus on evaluating the feasibility, safety and preliminary effectiveness of the intervention.

Ethics and dissemination SAGA is approved by the Institutional Review Board at Pennsylvania State University (00005097). Findings will be disseminated via scientific conferences and peer-reviewed journals and to participants via newsletter. The intervention game will be available to families in the control condition after the full data are collected and if analyses indicate that it is effective.

Trial registration number NCT02968225.

  • mental health

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  • Contributors KSS, EMW, JMS and CFG secured funding to support this project. KSS, EMW and JMS conceived and designed the study. KSS, EMW, JMS and BJ designed the intervention game. JWG will be responsible for testing participants. DE, JMS, CFG and KSS are responsible for designing the procedures to manage the fidelity of the intervention. JWG and DE will be responsible for managing the data generated during the project. JWG and KSS will conduct the statistical analyses of the data. KSS and JWG drafted the manuscript and all authors reviewed the manuscript for intellectual content and approved the final version.

  • Funding This work is supported by National Institutes of Mental Health (R61-MH110624; PI KSS).

  • Competing interests EMW was at the Department of Psychology at Pennsylvania State University when she contributed to this work. She is currently working for Daybreak Games in San Diego, California.

  • Patient consent Next of kin consent obtained.

  • Ethics approval Pennsylvania State University Institutional Review Board (IRB# 00005097).

  • Provenance and peer review Not commissioned; externally peer reviewed.