Field Usability and Validity of Eye-Tracking Instrumentation With the Early Childhood Vigilance Test Among Children Aged 2–4 Years Old in Northern Coastal Ecuador

Objective: There is a need for effective cognitive assessment tools to evaluate the development of very young children in resource-limited low- and middle-income country settings. Our objective was to evaluate the field usability of a computer-based attention test and its concurrent validity with a caregiver-reported screener of neurodevelopment in rural, Ecuadorian children. Method: To assess a computer-based attention test in a resource-limited setting, 41 Ecuadorian children between 2 and 4 years of age were evaluated once with the Early Childhood Vigilance Test (ECVT) of attention adapted to eye-tracking instrumentation. To evaluate the validity of the ECVT, results were compared with the Ages and Stages Questionnaire–3, measured 3–4 times between 21 and 48 months of age. Results: ECVT measures were collected successfully for 97.6% of children (40/41), suggesting good field usability of the test in this resource-limited setting. An increase in 1 SD in child attention, as measured by the ECVT average fixation duration, was associated with a 7.9-point increase in the overall Ages and Stages Questionnaire–3 score (95% CI [1.5, 14.2], p =.015). Conclusions: A computer-based attention assessment in early childhood was usable in a resource-limited setting and predictive of a caregiver-reported screener of child neurodevelopment. The ECVT, therefore, can be used to assess the effects of early risk factors and resilience in brain/behavior development.