Improving social gaze behavior in fragile X syndrome using a behavioral skills training approach: a proof of concept study
Two packed days of BST lifted social gaze in boys with fragile X, and the same recipe has worked for play and peer skills in other studies.
01Research in Context
What this study did
Gannon et al. (2018) tested a two-day Behavioral Skills Training package on boys with fragile X syndrome. The boys got either high-dose or low-dose BST that mixed discrete-trial instruction with short relaxation breaks.
All sessions happened in a quiet lab. Trainers used modeling, practice, and praise to teach longer eye contact during short conversations.
What they found
Sixty percent of the high-dose group improved their social gaze time. Only thirty percent of the low-dose group improved. Heart rate stayed the same, so the gain was behavioral, not just calmer bodies.
How this fits with other research
Spjut Janson et al. (2022) also tracked eye-gaze gains, but in preschoolers with autism. After fifteen months their gaze improved only a little and gesture joint attention did not move. The younger age and longer time frame likely explain the smaller payoff.
Covey et al. (2021) used the same BST steps with typical classmates. They doubled interactive play for students with moderate disabilities. The method travels well across skills and diagnoses.
Christopher et al. (1991) did the first BST social-skills study in a group home. Adults learned without any tangible rewards, showing the core procedure has worked for decades.
Why it matters
You can teach eye contact to boys with fragile X in just two days. Pack the day with more trials and add mini relaxation breaks. No extra toys or tokens are needed. If you run a social-skills group, try this high-density format first and measure gaze with a simple stopwatch. The same BST bones also work for play and peer tutoring, so you can reuse the steps across goals.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Schedule ten brief BST loops tomorrow: model the gaze, let the child practice, give praise, and insert a 30-second breathing break after every three trials.
02At a glance
03Original abstract
Individuals diagnosed with fragile X syndrome (FXS), the most common known inherited form of intellectual disability, commonly exhibit significant impairments in social gaze behavior during interactions with others. Although this behavior can restrict social development and limit educational opportunities, behavioral interventions designed to improve social gaze behavior have not been developed for this population. In this proof of concept (PoC) study, we examined whether administering a behavioral skills training package—discrete trial instruction (DTI) plus relaxation training—could increase social gaze duration in males with FXS. As part of a larger clinical trial, 20 boys with FXS, aged 8 to 18 years, were randomized to receive DTI plus relaxation training administered at one of two prescribed doses over a 2-day period at our research center. Potential improvements in social gaze behavior were evaluated by direct observations conducted across trials during the training, and generalization effects were examined by administering a social challenge before and after the treatment. During the social challenge, social gaze behavior was recorded using an eye tracker and physiological arousal levels were simultaneously recorded by monitoring the child’s heart rate. Levels of social gaze behavior increased significantly across blocks of training trials for six (60%) boys who received the high-dose behavioral treatment and for three (30%) boys who received the low-dose behavioral treatment. Boys who received the high-dose treatment also showed greater improvements in social gaze behavior during the social challenge compared to boys who received the low-dose treatment. There was no effect of the treatment on physiological arousal levels recorded on the heart rate monitor at either dose. These results suggest that appropriate social gaze behavior can be successfully taught to boys with FXS using a standardized behavioral skills training approach. Future studies will need to evaluate whether younger children with FXS might benefit from this treatment, and/or whether more naturalistic forms of behavioral skills training might be beneficial, before social gaze avoidance becomes established in the child’s repertoire. ClinicalTrials.gov, NCT02616796. Registered 30 November 2015.
Journal of Neurodevelopmental Disorders, 2018 · doi:10.1186/s11689-018-9243-z