A comparison of formal and informal methods for assessing language and cognition in children with Rett syndrome.
Kids with Rett syndrome can show 1–3 word expressive language when you embed informal eye-gaze tasks in everyday activities like cake-decorating.
01Research in Context
What this study did
Ward et al. (2021) watched girls with Rett syndrome do two kinds of eye-gaze tasks.
One task was a formal test on a computer. The other was an informal game like decorating a real cake.
The team wanted to see which method better caught the girls’ true language skills.
What they found
The computer test showed big swings in visual and receptive scores.
The cake game uncovered one- to three-word expressive language that the formal test missed.
Mixed results: formal scores varied, informal play revealed hidden words.
How this fits with other research
Clarkson et al. (2017) and Anonymous (2017) already proved that eye-tracking Mullen tests save 44 % time and still give valid receptive data. Callie’s team used that same formal tool as their baseline.
Galuska et al. (2006) first showed that girls with Rett can aim their gaze on purpose. Callie extends that proof into everyday kitchen tasks, not just lab screens.
Kremkow et al. (2022) saw fewer babbles in RTT infants and called it a red flag. Callie finds hidden words in preschoolers. The two papers seem opposite, but age explains the gap: babies lose sounds, yet older kids keep eye-gaze words.
Why it matters
If you test only with computer tasks, you may label a child as “no expressive language.” Build five-minute eye-gaze choices into real activities—snack, art, or play—to capture the words that formal tests miss.
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02At a glance
03Original abstract
BACKGROUND: Opinions about the cognitive and receptive language skills of people with Rett syndrome (RTT) range from severe intellectual impairment to near-normal development. Assessment is challenging because most are non-verbal, with no purposeful hand use. Clarkson et al. (2017) adapted the Mullen Scales of Early Learning for use with eye gaze technology (MSEL-A/ET) for people with RTT. AIMS: To investigate and compare the performance of children with RTT on formal and newly-designed informal assessments of language and cognition using eye gaze/tracking technology. METHODS AND PROCEDURES: Ten children with RTT aged 4:0-6:8 were assessed on the MSEL-A/ET for Visual Reception (VR) and Receptive Language (RL), and standard MSEL for Expressive Language (EL). Informal assessments of the same skills were embedded in activities such as reading and cake-decorating. OUTCOMES AND RESULTS: Standard scores on MSEL-A/ET VR and RL subtests ranged from 'very low' to 'above average'. All children scored 'very low' on standard EL assessment. Informal assessments added information about EL, with children producing 1-3 word utterances and a range of communicative functions through an eye gaze device. CONCLUSIONS AND IMPLICATIONS: Combining low-tech augmentative and alternative communication, eye gaze technology, informal activities and formal assessment, yields greater insight into children's abilities. This is important in informing suitable support and education for the individual.
Research in developmental disabilities, 2021 · doi:10.1016/j.ridd.2021.103961