*4.3. Pros and Cons of Using Eye-Gaze AT in Communicative Interaction*

This study demonstrated that EGAT could provide opportunities for children with complex needs to initiate a conversation with minimal movements and engage in a wider range of communication demands, for instance, providing explicit information to others or making comments where the natural modes of communication could not be achieved. Increasing communication intelligibility could also reduce the burden of guessing for communication partners and make the co-construction of conversation easier. This innovative

technology on the children's interactions with others could enhance a child's control in communication and potentially increase the long-term opportunities in social participation.

Despite the advantages, the severe motor impairments in children/youths with complex needs necessitate assistance from communication partners to set up an eye-gaze controlled computer and adapt AAC content to meet their changing needs in communication [16]. Moreover, these children might take a longer time to operate/navigate computers compared with using gestures or vocalizations, particularly when they are novice users. Insufficient eye control skills at early stages of learning and cognitive demands might cause the children to tire easily which could decrease the efficiency of EGAT use over time [48]. Recent research showed children with complex needs normally used EGAT for up to two hours per day [17], which means they might use other modes of communication in communicative interactions in daily contexts more often. It is important to develop strategies and means for increasing the frequency that children are exposed to EGAT every day, i.e., embed opportunity to use EGAT in everyday activities in natural contexts, according to a newly developed clinical guideline [49]. As of today, the time spent using EGAT is too low to allow children to use the whole communicative potential.

As AAC is certainly multimodal [13], children/youths utilize multiple communication methods, by which they think fast and efficiently to fulfill communication needs depending on the communication contexts and demands. This study supported previous research [5,14,15] by showing these children demonstrated preferences using gestures or vocalizations in communicating social routines such as greetings, responding yes–no answers, or expressing affection, probably because these natural modes might be faster and more accessible for them. Thus, the findings indicated the importance of supporting their functional use of the multimodal approach in everyday contexts [50] and echoed the statement by Light and McNaughton [23] that the central focus of AAC intervention is the communication needs of children/youths with complex needs, rather than the devices.
