Visual Attention Dynamics in Children with Special Needs During Eye-Tracking-Based Adaptive Learning Game Sessions in Pontianak, Indonesia
Abstract
This study aimed to examine changes in oculomotor indicators associated with visual attention across three repeated sessions of an eye-tracking-based adaptive learning game among children with special needs (CSN), addressing the limited evidence on session-to-session visual-attention dynamics in diagnostically heterogeneous populations. An exploratory one-group uncontrolled repeated-measures design was employed involving 16 children aged 9–15 years with mixed diagnoses, including attention-deficit/hyperactivity disorder, autism spectrum conditions, intellectual disability, hearing impairment, and physical disability, recruited from the Disability Services and Assessment Center of Pontianak City. Participants completed three 5-minute game sessions on separate days. Mean fixation duration, saccade count, mean saccade distance, and gaze transition rate were analyzed using the Friedman test, followed by Wilcoxon signed-rank post hoc comparisons with Bonferroni correction (α = .0167), while Kendall’s W was used to estimate effect size. Saccade count and gaze transition rate differed significantly across sessions (p = .002 and p = .003, respectively), primarily reflecting a temporary increase during the second session followed by partial reversal in the third session; neither variable differed significantly between the first and third sessions. Mean fixation duration and mean saccade distance increased numerically but were not statistically significant (both p = .087). These findings indicate a non-linear oculomotor pattern more consistent with transient exploration or familiarization than sustained improvement in visual attention. The small, heterogeneous, uncontrolled sample limits causal inference and generalizability; future studies should employ larger, diagnostically stratified samples, control conditions, and longer observation periods.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Armstrong, R. A. (2014). When to use the Bonferroni correction. Ophthalmic and Physiological Optics, 34(5), 502–508. https://doi.org/10.1111/opo.12131
Azizah, A. F., Djunaidy, A., Siahaan, D., & Suhariadi, F. (2026). A game-based eye tracking approach to measuring interaction levels in children with autism. International Journal of Advances in Signal and Image Sciences, 12(1), 832–850. https://doi.org/10.29284/2zah5d20
Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Boyle, E. A., Hainey, T., Connolly, T. M., Gray, G., Earp, J., Ott, M., Lim, T., Ninaus, M., Ribeiro, C., & Pereira, J. (2016). An update to the systematic literature review of empirical evidence of the impacts and outcomes of computer games and serious games. Computers & Education, 94, 178–192. https://doi.org/10.1016/j.compedu.2015.11.003
Catalano, G., Abbondio, S., Nicotra, R., Berselli, V., Guarischi, M., Vezzali, V., & Signorini, S. (2026). Eye tracking for rehabilitation and training in paediatric neurodevelopmental disorders: A systematic review. Brain Sciences, 16(3), 337. https://doi.org/10.3390/brainsci16030337
Chan, A., Leung, P., Pang, T. W., & Sze, S. L. (2024). Eye-tracking training improves visuospatial working memory of children with attention-deficit/hyperactivity disorder and autism spectrum disorder. Autism Research, 17(11), 2244–2260. https://doi.org/10.1002/aur.3238
Chen, X., Wang, S., Yang, X., Yu, C., Ni, F., Yang, J., Tian, Y., Ye, J., Liu, H., & Luo, R. (2023). Utilizing artificial intelligence-based eye tracking technology for screening ADHD symptoms in children. Frontiers in Psychiatry, 14, 1260031. https://doi.org/10.3389/fpsyt.2023.1260031
Chita-Tegmark, M. (2016). Social attention patterns in autism spectrum disorder as revealed by eye tracking: A systematic literature review. Research in Developmental Disabilities, 49–50, 79–93. https://doi.org/10.1016/j.ridd.2015.11.006
Conover, W. J. (1999). Practical nonparametric statistics (3rd ed.). John Wiley & Sons.
Di Cara, M., De Domenico, C., Piccolo, A., Alito, A., Costa, L., Quartarone, A., & Cucinotta, F. (2026). The diagnostic potential of eye tracking to detect autism spectrum disorder in children: A systematic review. Medical Sciences, 14(1), 28. https://doi.org/10.3390/medsci14010028
Duchowski, A. T. (2017). Eye tracking methodology: Theory and practice (3rd ed.). Springer. https://doi.org/10.1007/978-3-319-57883-5
Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). SAGE Publications.
García-Baos, A., D’Amelio, T., Oliveira, I., Collins, P., Echevarria, C., Pérez Zapata, L., Liddle, E., & Supèr, H. (2019). Novel interactive eye-tracking game for training attention in children with attention-deficit/hyperactivity disorder. The Primary Care Companion for CNS Disorders, 21(4), 19m02428. https://doi.org/10.4088/PCC.19m02428
Guillon, Q., Hadjikhani, N., Baduel, S., & Rogé, B. (2016). Visual social attention in autism spectrum disorder: Insights from eye tracking studies. Neuroscience & Biobehavioral Reviews, 64, 1–12. https://doi.org/10.1016/j.neubiorev.2016.02.012
Holmqvist, K., Nyström, M., Andersson, R., Dewhurst, R., Jarodzka, H., & Van de Weijer, J. (2011). Eye tracking: A comprehensive guide to methods and measures. Oxford University Press.
Hunicke, R. (2005). The case for dynamic difficulty adjustment in games. In Proceedings of the 2005 ACM SIGCHI International Conference on Advances in Computer Entertainment Technology (pp. 429–433). https://doi.org/10.1145/1178477.1178573
Kendall, M. G., & Babington Smith, B. (1939). The problem of m rankings. The Annals of Mathematical Statistics, 10(3), 275–287. https://doi.org/10.1214/aoms/1177732186
Lee, D. Y., Shin, Y., & Park, R. W. (2023). Use of eye tracking to improve the identification of attention-deficit/hyperactivity disorder in children. Scientific Reports, 13, 14469. https://doi.org/10.1038/s41598-023-41654-9
Lee, T. L., Yeung, M. K., Sze, S. L., & Chan, A. S. (2020). Computerized eye-tracking training improves the saccadic eye movements of children with attention-deficit/hyperactivity disorder. Brain Sciences, 10(12), 1016. https://doi.org/10.3390/brainsci10121016
Lee, T. L., Yeung, M. K., Sze, S. L., & Chan, A. S. (2021). Eye-tracking training improves inhibitory control in children with attention-deficit/hyperactivity disorder. Brain Sciences, 11(3), 314. https://doi.org/10.3390/brainsci11030314
Mayer, R. E. (2021). Multimedia learning (3rd ed.). Cambridge University Press. https://doi.org/10.1017/9781316941355
Orui, M., Ishikuro, M., Obara, T., Noda, A., Shinoda, G., Murakami, K., Metoki, H., Kikuya, M., Nakaya, N., Nishimura, T., Tanaka, K., Miyake, Y., Hozawa, A., Tsuchiya, K. J., & Kuriyama, S. (2025). Longitudinal association between the duration of eye gaze fixation on social information and specific symptoms of neurodevelopmental disorders in children: A large-scale community-based cohort study. PCN Reports, 4(2), e70095. https://doi.org/10.1002/pcn5.70095
Plass, J. L., Homer, B. D., & Kinzer, C. K. (2015). Foundations of game-based learning. Educational Psychologist, 50(4), 258–283. https://doi.org/10.1080/00461520.2015.1122533
Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25–42. https://doi.org/10.1146/annurev.ne.13.030190.000325
Sailer, M., & Homner, L. (2020). The gamification of learning: A meta-analysis. Educational Psychology Review, 32, 77–112. https://doi.org/10.1007/s10648-019-09498-w
Salvucci, D. D., & Goldberg, J. H. (2000). Identifying fixations and saccades in eye-tracking protocols. In Proceedings of the 2000 Symposium on Eye Tracking Research & Applications (pp. 71–78). https://doi.org/10.1145/355017.355028
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Houghton Mifflin.
Shaikh, M. F., Higley, C., Campanile, C., Francis, R., Panja, E., Santacaterina, S., Pratesi, G., & Piaggio, D. (2026). Serious gaming and eye-tracking for the screening, monitoring, and diagnosis of neurodevelopmental disorders in children: A systematic literature review. Frontiers in Bioengineering and Biotechnology, 13, 1672718. https://doi.org/10.3389/fbioe.2025.1672718
Tomczak, M., & Tomczak, E. (2014). The need to report effect size estimates revisited: An overview of some recommended measures of effect size. Trends in Sport Sciences, 21(1), 19–25.
Wass, S. V., Jones, E. J., Gliga, T., Smith, T. J., Charman, T., & Johnson, M. H. (2015). Shorter spontaneous fixation durations in infants with later emerging autism. Scientific Reports, 5, 8284. https://doi.org/10.1038/srep08284
Wouters, P., van Nimwegen, C., van Oostendorp, H., & van der Spek, E. D. (2013). A meta-analysis of the cognitive and motivational effects of serious games. Journal of Educational Psychology, 105(2), 249–265. https://doi.org/10.1037/a0031311
Yoo, J. H., Kang, B. J., Lim, M. H., Wang, S. M., Choi, T. K., Hwang, J. W., Han, D. H., Kim, J. W., Cheon, K. A., & Kim, B. N. (2024). Development of an innovative approach using portable eye tracking to assist ADHD screening: A machine learning study. Frontiers in Psychiatry, 15, 1337595. https://doi.org/10.3389/fpsyt.2024.1337595
Zohaib, M. (2018). Dynamic difficulty adjustment (DDA) in computer games: A review. Advances in Human-Computer Interaction, 2018, 5681652. https://doi.org/10.1155/2018/5681652
Copyright (c) 2026 Rahmah Susanti, Arina Restian; Husamah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with JPI: Jurnal Pustaka Indonesia journal agree to the following terms:
- Authors retain copyright and grant the JPI: Jurnal Pustaka Indonesia journal right of first publication with the work simultaneously licensed under Creative Commons Attribution License (CC BY 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the published version of the work (e.g., post it to an institutional repository or edit it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
1.png)
_(3).png){kind=small}
