=Paper=
{{Paper
|id=Vol-3100/paper20
|storemode=property
|title=E-BTT in primary school-aged children: preliminary results
|pdfUrl=https://ceur-ws.org/Vol-3100/paper20.pdf
|volume=Vol-3100
|authors=Federica Somma,Paolo Bartolomeo,Onofrio Gigliotta
|dblpUrl=https://dblp.org/rec/conf/psychobit/SommaBG21
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==E-BTT in primary school-aged children: preliminary results==
https://ceur-ws.org/Vol-3100/paper20.pdf
E-BTT in primary school-aged children: preliminary results
Federica Sommaa, Paolo Bartolomeob and Onofrio Gigliottaa
a
Natural and Artificial Cognition Laboratory, Department of Humanistic Studies, University of Naples Federico
II, Via Porta di Massa, 1, Naples, Italy
b
Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de la Pitié
Salpêtrière, 75013 Paris, France
Abstract
Visuospatial orientation of attention is the cognitive process that allows to orient and focus on
stimuli presented in the visual field. A cognitive-attentional bias towards one side of the visual
field, often the left side, derives from cerebral, evolutionary, and cultural factors. Such a
leftward bias is often referred to as “pseudoneglect”. School-aged children gradually shift
spatial attention to the left, with differences related to manual dominance or to possible
neurodevelopmental disorders. The new Enhanced-Baking Tray Task (E-BTT) is an ecological
task that enriches the spatial exploration evaluation procedure by adding a digital/hardware
platform to automate the data collection.
For the first time we administered the E-BTT to school-aged children with the aim to explore
children's initial orientation of spatial attention and to compare their performances to those of
a sample of young adults who showed a leftward preference. Results showed that children, as
adults, shifted their attention leftward in the E-BTT task, however not prominently as adults.
Our results show that performances on E-BTT support what has been reported in the literature
on leftward spatial bias shown in other tasks: that it emerges during development in relation to
biological, cultural and biomechanical factors.
Keywords 1
Leftward spatial bias, Pseudoneglect, Baking Tray Task, Development
1. Introduction
Spatial cognition concerns the perception, awareness, and processing of spatial information, as well
as the ability to use that information for the representation and resolution of visuospatial problems [1],
therefore it plays a central role in human evolution, adaptation, and daily functioning. Visuospatial
orientation of attention is the cognitive process that allows to orient and focus on stimuli presented in
the visual field.
1.1. Left-ward visuospatial attention
Healthy individuals do not pay equal attention to the left and right side of space, showing the
pseudoneglect phenomenon, a cognitive-attentional bias towards one side of the visual field, often the
left one [2]. This phenomenon reflects the influence of hemispheric functional specialization in
visuospatial attention and, more specifically, the dominance of the right hemisphere in spatial
information processing [3]. The orientation of attention towards a specific visuospatial field, is evident
in many daily life tasks and situations. When people respond to Likert scales, for example,
pseudoneglect can cause a left bias to balance the left and right sides of the scale [4].
1Proccedings of the Third Symposium on Psychology-Based Technologies (PSYCHOBIT2021), October 4–5, 2021, Naples, Italy
EMAIL: federica.somma@unina.it (A. 1); paolo.bartolomeo@icm-institute.org (A. 2); onofrio.gigliotta@unina.it (A. 3)
ORCID: 0000-0003-4341-3393 (A. 1); 0000-0002-2640-6426 (A. 2); 0000-0003-1436-1563 (A. 3)
©️ 2021 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
In the scientific literature, various explanations for pseudoneglect have been proposed, which are
not mutually exclusive: the inter-individual differences, in terms of consistency and direction of the
pseudoneglect, could be explained as a function of cerebral asymmetries [5], of evolutionary
mechanisms [6], of cultural differences deriving from reading experience and exposure to visuomotor
explorations according to preferential reading or writing direction [7].
Visuospatial attention during line bisection or cancellation tasks apparently shifts leftward over the
course of primary school years, in left-to-right reading cultures, as children learn to read. In general,
the literature provides evidence for an overall spatial attention shift to the left even in school-aged
children [8] [9]. Manual dominance can influence performance [8] [10], as can neurodevelopmental
disorders such as Attention-deficit/hyperactivity disorder (ADHD) and Developmental Dyslexia [11].
Handedness differences in pseudoneglect decrease during development, perhaps as a consequence of
the development of the corpus callosum up to the mid-20s. Children with ADHD bisect horizontal lines
more rightward than control children. Children with Developmental Dyslexia display mild inattention
in the left visual field and excessive distraction in the right visual field [11]. Investigating orientation
and spatial directionality patterns during development could improve understanding of the functioning
of cognitive processes and specific brain structures related to these behaviours.
Pseudoneglect manifests in classical experimental contexts during bisection of horizontal lines, as a
small deviation to the left of the real midpoint [2] or as a bias to initiate a visual search from a left-sided
element [12] [13] [14]. Considering the multicomponent nature of this visuospatial attention bias, other
researchers have used different types of stimuli to investigate the phenomenon in developmental age,
considering the origin, but also the directionality: cancellation of target stimuli among irrelevant
distractors [15] [16], drawing or reproduction of objects [17], drawing of circles and filling of points
[18]. In summary, these studies report a strong left-to-right direction preference for right-handed
children which increases with age, while left-handed children show less lateralization; however,
lateralization of left-handed children is still a poorly understood phenomenon.
In a visual search task, spatial attention orientation to the visual environment, can influence the
organization of search behavior. An efficient visual search implies, first of all, determining a position
of the space from which to start the search. Starting the visual search or the cancellation of stimuli at or
near the edge of the considered space increases the probability of a more organized search, compared
to starting in the center of the space [16]. Furthermore, an organized search reduces the likelihood of
intersections in the path and facilitates orthogonal or radial searches. Age-related or individual-related
changes in spatial orientation may play a role in spatial organization performance differences between
children and adults
Many stimuli and tools used by the aforementioned and other scientific studies have not been
digitized and do not permit an objective and sensitive data collection and analysis. Moreover, they
evaluate a limited number of indexes regarding directionality and visual search or design strategies.
Rinaldi and colleagues [15], instead, exploited a digitized cancellation test and collected chronometric
and spatial parameters (measured in x and y coordinates) ranging from the starting point (first mark) of
the visual search to the scanning strategy adopted (directional shifts and smooth index).
Below we will introduce an assessment tool of visuospatial behaviors and processes that combines
the ecological aspect of everyday tasks with a digital and automatic system for collecting spatial data.
1.2. E-BTT
The E-Tan platform, designed to connect tangible environments to digital data collection, has been
used to enhance the Baking Tray Task (E-BTT), an ecological visuospatial task that requires test takers
to uniformly place 16 objects on a rectangular tray (see [19] [20] [21] [22] for details), originally
developed to assess unilateral spatial neglect (USN).
The E-Tan platform supports tangible interfaces and is able to digitally trace performances thanks
to tags and a camera placed perpendicular to the tray. It thus allows the examiner to instantly obtain
data on: total time spent on the task; the time each object is positioned; spatial coordinates (x and y) of
single objects positioned; objects placement order. The information collected through the new E-BTT
enriches the classic evaluation procedure; E-BTT new features allow not only to investigate spatial
orientation and lateralization [23] but also spatial exploration and organization patterns in clinical or
healthy subjects [24], such as the strategies used to plan and organize elements in the peripersonal space.
In a recent study we have investigated the lateral dimension of spatial behaviour, particularly left-
right spatial asymmetry or pseudoneglect in samples of young adults [23], mainly analyzing the starting
point of the disks disposition and the general center of the arrangement of all 16 disks. The results have
shown a statistically significant preference to place the first disk in the left quadrants (mostly in the
upper-left one) and a slight imbalance toward the left of all disks arrangement, thus demonstrating a
leftward bias consistent with pseudoneglect.
This work, for the first time, focuses on the expression of visuospatial bias of school-aged children
in E-BTT performance.
1.3. Aims
The aims of the present study were 1) to explore children's spatial performance and 2) compare their
patterns of performance with those of a sample of young adults [23] who showed signs of leftward
spatial bias.
To this end, prior to administering E-BTT to children, we collected preliminary data in order to adapt
the test instructions. Subsequently, we administered the E-BTT task to typically developing school-age
children.
Based on previous literature on visuospatial attention bias, we expected children to often start spatial
organization on the left-side of the space. This initial bias should increase with age; however, it should
not be as consistent a phenomenon as in adults. Furthermore, if spatial orientation effects reflect changes
related to learning to read, children should also demonstrate a propensity for initially orienting spatial
attention to the upper-left quadrant of the space, consistent with the typical starting location for reading,
rather than simply orienting more leftward. Another possibility is that, due to the size and location of
the frame, especially younger children could be more likely to prefer the lower portion of the test space
than adults.
2. Materials and methods
2.1. Participants
A small sample of school-age children was recruited from a primary school of the Campania region,
in Southern Italy, for the first study on task instruction. Ten children aged 6 to 10 years, with normal or
corrected vision, were involved following inclusion criteria: (1) typical cognitive development,
expressed by a score above the 15th percentile for the Raven Colored Progressive Matrices test (CPM
- Italian standardization) [25]; (2) no clinical diagnosis of neurological, neuropsychiatric, or
neurodevelopmental disorders as reported by the parents.
Afterwards, a second convenience sample of children was recruited from 16 classes of 2 primary
schools of the Campania region, for a total of 157 children from grade 1 to 5. For the recruitment of the
participants, contact was made in advance with the managers of the schools and subsequently interviews
were held to define the objectives and methods of the research, first with the manager himself and then
with the teachers.
Participants were included in the study following inclusion criteria: (1) typical cognitive
development, expressed by a score above the 15th percentile for the Raven CPM test; (2) no clinical
diagnosis of neurological, neuropsychiatric, or neurodevelopmental disorders as reported by the parents.
One hundred and forty-eight children (72 females and 76 males aged 6 to 11 years) met the inclusion
criteria (see Table 1). All participants spoke Italian as their mother tongue, had normal or corrected
vision, were both right-handed (N = 127) and left-handed (N = 21) according to the "Edinburgh
Inventory Questionnaire" (EI) [26].
Table 1
Sample details
Grade Age range Females Males Total
1 6,3;7,2 9 14 22
2 7;8,2 14 13 25
3 8;9,1 8 14 20
4 9,2;10,4 20 19 39
5 10,1;11,2 21 16 37
72 76 148
The study was conducted in accordance with the Declaration of Helsinki and approved by the Local
Ethics Committee - Department of Humanities University of Naples Federico II [protocol number:
12/2020]. Written informed consent was obtained from all participants' parents prior to the test.
2.2. Procedure
Both the instruction study and the task administration took place in a room of each primary school
attended by the children. The rooms were bright and quiet, and there was a table suitable for the children,
on which the material for the administration of the E-BTT was placed. Throughout the procedure, only
one child at time and an experimenter were present in the room. The children were seated on a chair
placed in front of the table on which the frame was. The material on the table was arranged as shown
in Figure 1.
Figure 1: E-BTT tool setting
2.2.1. E-BTT instruction
In the pilot study, children were given 3 different instructions in random order, including the original
instruction and other 2 modified ones. The original instruction was: "Please, arrange all the disks, one
at a time with one hand, on the surface inside the wood frame as evenly as possible, as if they were
biscuits to be placed on a baking tray. Once placed, the disks cannot be moved”. Two modified and
simpler instructions have been proposed since children may have difficulty in understanding the
expression "as evenly as possible"; thus, another instruction was: “Please, arrange all the disks, one at
a time with one hand, on the surface inside the wood frame so that they are placed on as much space as
possible, as if they were biscuits to be placed on a baking tray. Once placed, the disks cannot be moved”;
and the other was: “Please, arrange all the disks, one at a time with one hand, on the surface inside the
wood frame so that they are as far away from each other as possible, as if they were biscuits to be placed
on a baking tray. Once placed, the disks cannot be moved”.
The first two instructions did not produce satisfactory configurations: children often anchored the
disks to the frame, either sideways or on the top and bottom, placing them as a row one behind the other.
The instruction that turned out to be more suitable, that is the one that, for most children, brought out a
final configuration of evenly spaced cubes, was the third one, which was then further modified as
follows: “Here are some disks in front of you: please, on my count, arrange all the disks on the surface
inside the wood frame as far away from each other as possible. Pretend these are cookies to be placed
on a baking tray, one at a time with one hand. Once placed, the disks cannot be moved. By repeating,
arrange all the disks as far away from each other as possible."
The addition of "on my count" is motivated by the fact that very often children acted impulsively
and very quickly began to place the disks without waiting for the instruction to finish. The expression
"arrange them as far away from each other as possible", although different from the original E-BTT
instruction, is the easiest way for most children, especially in the younger age groups, to understand
that the objective is an even distribution of objects on a space; the expression equally implies an
objective to be represented mentally and to be achieved, therefore a visuospatial planning and
organization, albeit a very simple one. An element that is made explicit with this instruction is that of
estimating the distances between one object and another. The instruction is then repeated at the end to
ensure that it is understood and memorized as best as possible by the children.
2.2.2. E-BTT administration
The experimental sessions started immediately after the conclusion of the instruction study. The E-
BTT was part of a visuospatial skills assessment battery administered in two different sessions. In the
first session Raven Colored Progressive Matrices and E-BTT were administered. After performing
Raven’s CPM, the children were instructed with the E-BTT task and asked to do it first with their
dominant hand and then with the other.
Before giving the E-BTT adapted instruction, the procedure also required the children to perform a
short pre-test: particularly, they were asked to 1) place a disk inside the frame 2) place another one near
the first one and 3) place a third one away from the first. This pre-test was conducted to make sure the
children understood the spatial concepts of the proximity or distance of objects from other objects.
2.3. Measures and data analysis
The E-TAN software platform records the spatial coordinates (x and y) of each single disk placed
on the tray, the order of placement and the duration of the performance. The data output consists of an
Excel file with the coordinates in pixels (then normalized in centimeters). The center of the tray has
been set to coordinates 0,0. A negative x indicates a point to the left of the center and a positive x
indicates a point to the right, as well as a negative y indicates a point below the center and a positive y
indicates a point above.
To evaluate the initial spatial orientation, that is, where one begins to arrange objects in the
peripersonal space, the coordinates of the first disk positioned on the surface has been used; moreover,
the average horizontal or vertical position of all placed objects (average of the X and Y of the 16 disks)
has been also considered as a measure of the center of the disposition. The center of the frame has been
marked with (0, 0), we also divided the surface into 4 equal quadrants (top-left, bottom-left, top-right,
bottom-right), to evaluate the quadrant of initial orientation, that is the frequency that the 4 quadrants
were used to arrange the first object.
E-BTT performance was first analyzed by means of the measures described. Data computation was
performed using SPSS [27] and R [28] software.
3. Results
To conduct the following preliminary analyses, 5 children had to be excluded due to E-TAN software
issues. Left-handed participants were also excluded. Therefore, the analyses were carried out on a final
sample of 122 children (63 males).
3.1. Spatial orientation
To evaluate the children’s initial spatial orientation in the E-BTT task, we first divided the space
into four equal quadrants and analyzed the distribution of the first disk (unlike adults, see [23]).
Frequency analysis demonstrated that 37.70% (n = 46/122) of participants began arranging the first disk
in the bottom-left quadrant of the space. The next most frequent quadrant was the top-left one (27.05%;
n = 33/122). The bottom-right quadrant was chosen with a frequency of 25/122 (20.49%) and the top-
right quadrant with a frequency of 18/122 (14.75%). The analysis carried out of Pearson's chi square
among the four positioning alternatives led to the following results: χ2 = 14,197, df= 3, χ2 / dof = 4,732,
p = .003. Hence, the result demonstrates a preference to position the first disk in the bottom-left quadrant
and a lower frequency for that in the upper right portion of the space.
Regarding the comparison between children and a sample of 122 young adults [19] with respect to
the quadrant of the first disk positioned, a statistically significant difference emerges (χ2 = 25,805, df=
3, p< .001). These data show that children tend to place the first disk more at the bottom and that, even
if prevalent, the shift to the left is not as prominent as that of adults, since children still tend to shift to
the right too.
We then conducted a univariate ANOVA, setting as independent variables the x coordinates of the
first positioned disk and the x coordinates average, which revealed a difference for first disk x
coordinate (Figure 2a) between adults (M = -16,013, SE = 1,826) and children (M = -6,813, SE = 1,826):
F(1.242) = 12,694, p <0.001, η2=0.050, with a low- to mid- effect size value, as for first disk y
coordinates average (Figure 2b): F(1.242) = 12,905, p <0.001, η2=0.051 (adults M = 4,129, SE = 1,479;
children M = -3,385, SE = 1,479).
Figure 2: On the left (a) mean of first disks x-coordinate (cm) of adults vs children; on the right (b)
mean of first disks y-coordinate (cm) of adults vs children.
Moreover, the average horizontal position of all the positioned objects turns out to be different
between the two groups (F(1.242) = 9,116, p <0.05, η2=0.036) despite a low effect size value, with the
adults (M = -1,363, SE = 0,264) moved slightly more to the left than the children (M = -0,234, SE =
0,264). On the other hand, the average vertical position of all placed objects did not differ between the
two groups (F(1.242) = ,147, p = 0,702, η2=0.001).
Therefore, consistently with the results of the quadrants analysis, the X-axis coordinates average of
children is shifted towards the left of the space, but much closer to the center as opposed to that of adults
which is clearly more leftwards.
3.2. Preliminary cluster analysis
Our following purpose was to analyze the children initial attention orientation more precisely, and
to highlight possible groupings among the subjects; thus, the participants were clustered according to
the X and Y coordinates of the first disk, which were then compared with the adults’ sample clustering,
also based on the first disks’ X and Y coordinates. Particularly, what we wanted to verify was the
presence of groups of children whose first disk was not extremely lateralized to the left or to the right
and if so, identify the representative spatial localizations of those groups.
A cluster analysis was conducted by using the K-means algorithm, that requires the number of
clusters to be specified. To estimate the optimal number of clusters in our data such we used the
Silhouette Coefficient and performed a silhouette analysis between 2 to 5 numbers of clusters both for
children and adult dataset. The best silhouette score for the children dataset resulted for a number of
clusters equal to 5 (si = 0.8); the best silhouette score for the adult's dataset resulted for a number of
clusters equal to 4 (si = 0.86).
Cluster analysis on children dataset identified the following 5 distinct cluster groups (please, check
Figure 3): of the 122 participants, 31,97% (cluster 5, n = 39) were classified as positioning the first disk
in the bottom-left portion of the space; 22,13% (cluster 2, n = 27) as positioning the first disk at the
center of the space, mainly in the center of the Y-axis, but also above and below the 0 point; 18,03%
(cluster 1, n = 22) as positioning the first disk in the bottom-right portion of the space; 17,21% (cluster
3, n = 21) as positioning the first disk in the top-right portion of the space; 12,30% (cluster 4, n = 13)
as positioning the first disk in the top-left portion of the space. Cluster 2 reveals a group of children
directing the first object in the central area of the space.
K-means cluster analysis on adults dataset identified 4 distinct cluster groups (please, check Figure
4): of the 122 participants, 59,02% (cluster 1, n = 72) were classified as positioning the first disk in the
top-left portion of the space; 25,41% (cluster 4, n = 31) as positioning the first disk in the bottom-left
portion of the space; 10,66% (cluster 2, n = 13) as positioning the first disk in the bottom-right portion
of the space; 4,92% (cluster 3, n = 6) as positioning the first disk in the extreme top-right portion. No
cluster revealed any group of adults who placed the first object in the central area of the space.
Figure 3: Children’s K-means Cluster Analysis results
Figure 4: Adults’ K-means Cluster Analysis results
4. Discussions and conclusions
As expected, the majority of children started spatial organization on the left-side of the space,
particularly the bottom-left portion of space; however, the comparison between adults and children data
revealed a significant difference, since children’s leftward shift was less pronounced than that of adults.
Children also started disks disposition on the right-side of the space and didn’t demonstrate any
propensity to initially orient spatial attention to the upper-left quadrant of the space (the starting location
for reading) as much as adults, rather than simply orienting more leftward. This finding could be
explained by the size of the frame; especially younger children could find it difficult to fully explore
the frame with their arms.
Moreover, we conducted a cluster analysis to understand if, in addition to positioning first disks in
specific quadrants, participants first disks were extremely lateralized to the left or to the right and, if
not, identify the representative spatial localizations of those groups. The results showed that there is a
group of children that is more oriented to the center of the space, positioning the first disks centrally, at
the bottom or at the top of the Y-axis. This tendency toward the center was not present in the adult’s
sample.
Again, we expected children to be less shifted towards the left side of the space than adults, on one
hand because left-sided bias gradually increases during primary school years in Western cultures. On
the other hand, it is possible that children's tendency to start the task centrally reflects a preference for
using specific spatial reference points of an empty space (such as corners or central points), which could
sustain the orientation on the peripersonal space, as well as it happens in the landmark-based
extrapersonal spatial orientation [29]. It seems that children focused on those points rather than the
directional path of disposition and the final configuration of disks. However, these hypotheses will be
subsequently analysed, e.g. investigating the disposition pattern followed by the children, in order to
understand the disposition strategy implemented and how it develops based on the starting point.
Our results show that performances on E-BTT (so far only in terms of the positions of the first placed
object) support what has been reported in the literature on pseudoneglect regarding other tasks: that it
emerges during development in relation to biological, cultural and biomechanical factors. Children, as
adults, show a leftward orientation shift in the E-BTT task however not marked as that of adults:
children orient the first object disposition to the left side of the space but also to the right, and especially
to the center.
The reported results are preliminary; we plan to implement the following analyses in the future.
First, the orientation of the spatial attention in the E-BTT task will be compared with that shown in
other tasks of the spatial battery, to explore if the pseudoneglect phenomenon manifests itself differently
in different tasks, as demonstrated in the literature for adults [30], even in childhood. We also collected
data on left-handed participants; we shall assess whether left-handers show different spatial bias, as
reported in the literature [8] [10].
In the near future we also plan to assess whether the starting point of the object’s organization
influences the subsequent arrangement pattern and compare the organization of spatial arrangement
between children and adults. We shall also use the E-BTT to assess whether starting at the extreme side
of a space in a visual search task provides a foundation for more organized search than starting in the
middle of the page, perhaps because it decreases the likelihood of path intersections [16].
The E-BTT task was originally developed to assess and quantify asymmetries in spatial cognition
resulting from unilateral spatial neglect (USN) following brain injury. Studies have been carried out
with adult patients, however the literature on children who have suffered a perinatal brain injury is
scarce. Some reviews on the topic [31] [32] point out that it may be necessary to use different types of
assessment tools to test children with perinatal brain damage in order to develop a complete profile of
specific attentional and perceptual deficits. In this way, therapies could be tailored to target specific
deficits. In addition, specific considerations may be envisaged in school settings to better accommodate
these children. To adequately assess cognitive functioning in this population, the authors recommend a
combination of measures, including the use of pencil and paper neuropsychological tests, which remain
fundamental as well as tasks sensitive to deficits in daily functioning. The E-BTT could represent a
useful ecological tool to assess USN in developmental age.
5. Acknowledgements
For their outstanding contribution and support given to the research and to the NAC laboratory, the
authors sincerely thank Antonio Cerrato and Orazio Miglino.
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