Creating new technologies for understanding and helping children with neurodevelopmental conditions
Dr. Michal Hochhauser
Department of Occupational Therapy
Theory of Mind (ToM) is a concept that describes one’s ability to interpret others’ beliefs, intentions and emotions. People with ASD discern the world differently with regards to what other people may think, feel or want. Dr. Michal Hochhauser seeks to better understand the nature of ToM, and to harness new and innovative eye tracking technology for examining visual attention in children with ASD.
One of her collaborative research projects with Prof. Ouriel Grynszpan of Paris-Sud University uses infra-red eye tracking technology to observe what people are looking at during social interaction. People with ASD tend to focus on background objects rather than looking at people and their facial expressions. A scenario presented to the subjects shows two people speaking with one another. One speaker becomes angry at the other. A normal reaction would be to look at the person speaking, and then shift focus to the second speaker to see what the second person’s response will be. In autistic subjects, there is less face gazing and a delay in looking at the next speaker. As a result, they are missing out on facial expressions, so on top of their difficulty in understanding what people are thinking or feeling, they are also not picking up relevant information in order to understand non-verbal expressions.
The team found that it takes people with ASD longer to perform visual attention tasks. This may be due to difficulties in speed processing what they see using their working memory (an executive function). Non-ASD people see the big picture, whereas people with ASD see pieces of the whole picture. This may be compared to seeing a picture of forest as a whole or merely seeing individual trees. Dr. Hochhauser explains, “With the help of new eye-tracking technology, we learn that people with ASD generally look less at peoples’ faces, eyes, eyebrows and foreheads, and focus more at their mouths. People with neurotypical development first notice faces and facial expressions, and then look at the background of what they’re seeing. People with ASD look at each object as a separate thing. It therefore takes them longer to put it all together and understand what they’re seeing and what is important in a picture. In this study, we started with adolescents (12-18), and then ran the same study on young adults (20-29). The results were similar, with a mild improvement in the adults. Both ASD groups performed less effectively than the non-ASD groups.” Dr. Hochhauser is now supervising a PhD student in an international study of autism utilizing eye tracking technologies to further understand attentional behavior in everyday life.
Dr. Hochhauser is conducting a similar study on subjects with Attention Deficit Hyperactivity Disorder (ADHD). “The results were not what we expected. The ADHD group performed almost exactly as norm-typicals. People with ADHD are often able to sharpen their attention on computer-based tasks they are given. However, there are differences in their scan paths as opposed to norm-typicals, with a somewhat higher degree of error, indicating that they still look at things a bit differently, with eye gaze being more scattered than in those with normal development. Their achievements may be attributed to their ability to compensate and find ways to manage.” The technology used in these studies is limited to using a computer or tablet. Michal hopes that the next stage will involve a wearable eye-tracking device, allowing more freedom of movement.
Another collaborative project helps children with developmental coordination disorder (DCD) (handwriting). A device worn on the wrist like a bracelet developed with the help of Dr. Michael Wagner and Prof. Nir Schwalb from Ariel University’s Department of Engineering provides a visual display of the pressure activated on a writing surface. By measuring nerve impulses, it indicates how much pressure is being put on the pen which is synchronized with the tablet on which the children are writing. When the pressure is excessive, the writing is displayed in red, in blue if too weak, and in grey if the pressure is normal. It also indicates the level of writing organization, spacing between letters and words, and the azimuth and tilt of the pen. This technology provides immediate biofeedback to the child. Children who perform less well than neuro-typical children are then included in an interventional study in which the therapist can track improvement. This motor learning involves not only the tiny muscles in the hand, but also shoulders and arms, etc. “With younger children, we work to strengthen the general muscles, but as they grow older, work needs to be concentrated on a particular function, like handwriting,” adds Michal. She is currently jointly supervising a PhD student in this area together with Dr. Michael Wagner.
Dr. Michal Hochhauser grew up in Boston and Cleveland and came on Aliya with her parents in 1979. After high school, she did her National Service in a remedial classroom in Sderot primarily with socially deprived children. Although she applied to and was accepted to study Communications, Law and Linguistics at Hebrew University of Jerusalem, she decided to follow her instincts and study Occupational Therapy (OT) at Hebrew University’s joint program with Hadassah Medical Center. She attributes her decision to a very positive experience working among children and a wonderful team of therapists at the remedial preschool.
She began her career in a child development center and at the Elwyn Jerusalem preschool for children with neurological disabilities, such as cerebral palsy. “The kids ranged from infancy through age 6-7. You work with them and their families through the hardest times and the greatest times, and you’re a part of it. Those were exciting years and I was happy to go to work every day.”
After being approached by Haifa University to teach a few courses in a new OT program for the Haredi population, her interest in furthering her academic career grew, so she completed a master’s degree. “I continued for my PhD under the excellent mentorship of Prof. Tamar Weiss and Prof. Eynat Gal at Haifa University. Working with them made me realize what it means to be a mentor for a doctoral student. More than having knowledge, a good mentor requires you to be able to help students ask the right questions, learn how to independently seek resolutions to the questions, understand research methodology, and develop very good writing skills in order to translate all of this into quality research publications.”
“I started my PhD in 2009, at a time that many of the technologies we are accustomed to today, like WhatsApp or cloud data storage weren’t fully developed. We began working on a basic program, which eventually developed into an application for training adolescents with autism. Why adolescents? Until then, there was more emphasis placed on working with toddlers and young children, but as these children grew older, less was being done for them, and their ‘impairment’ became more prominent. As they grow up, they have additional needs which need to be addressed.” Occupational therapists are helping to improve the lives of people with ASD and other disabilities, such as Intellectual Disability (ID). OTs are now beginning to work with social services and professional training centers to help them develop the skills to hold down jobs in different forms of employment.
“During my doctorate I began to realize I really like this academic business, although the demands are great, especially as the mother of 5.” Immediately after completing her PhD at Haifa University she received an Erasmus Mundus scholarship grant for a post-doctorate in Paris at Pierre and Marie Curie University (a branch of the Sorbonne) in the Intelligence and Robotic Systems Lab, affiliated with the Children’s Development and Rehabilitation Department at the Pitié-Salpêtrière University Hospital. She worked with Prof. Ouriel Grynszpan, with whom she continues to collaborate, together with other researchers from Oxford and Bath Universities.
Just before leaving for Paris she received a late-night phone call from Yigal Cohen-Orgad, the late Chancellor of Ariel University, to discuss the possibility of opening an Occupational Therapy department at AU. “It sounded very interesting, so I gave him a qualified yes. I am very satisfied with my decision to come to Ariel. There’s something very special about AU. It’s young and exciting, and it enables me to do interdisciplinary research with other departments, especially the Department of Engineering, which is working with us to develop new technologies. Ariel University has the advantage of having departments of Engineering, Communication Disorders and Physiotherapy with which my department can collaborate. The department is now in its second year. It is exciting to be creating something new. Difficulty promotes creativity.”