Absence of Preferential Looking to the Eyes of Approaching Adults Predicts Level of Social Disability in 2-Year-Old Toddlers With Autism Spectrum Disorder

Yale Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT 06520, USA.
Archives of general psychiatry (Impact Factor: 14.48). 08/2008; 65(8):946-54. DOI: 10.1001/archpsyc.65.8.946
Source: PubMed


Within the first week of life, typical human newborns give preferential attention to the eyes of others. Similar findings in other species suggest that attention to the eyes is a highly conserved phylogenetic mechanism of social development. For children with autism, however, diminished and aberrant eye contact is a lifelong hallmark of disability.
To quantify preferential attention to the eyes of others at what is presently the earliest point of diagnosis in autism.
We presented the children with 10 videos. Each video showed an actress looking directly into the camera, playing the role of caregiver, and engaging the viewer (playing pat-a-cake, peek-a-boo, etc). Children's visual fixation patterns were measured by eye tracking.
Fifteen 2-year-old children with autism were compared with 36 typically developing children and with 15 developmentally delayed but nonautistic children.
Preferential attention was measured as percentage of visual fixation time to 4 regions of interest: eyes, mouth, body, and object. Level of social disability was assessed by the Autism Diagnostic Observation Schedule.
Looking at the eyes of others was significantly decreased in 2-year-old children with autism (P < .001), while looking at mouths was increased (P < .01) in comparison with both control groups. The 2 control groups were not distinguishable on the basis of fixation patterns. In addition, fixation on eyes by the children with autism correlated with their level of social disability; less fixation on eyes predicted greater social disability (r = -0.669, P < .01).
Looking at the eyes of others is important in early social development and in social adaptation throughout one's life span. Our results indicate that in 2-year-old children with autism, this behavior is already derailed, suggesting critical consequences for development but also offering a potential biomarker for quantifying syndrome manifestation at this early age.

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Available from: Ami Klin, Dec 09, 2014
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    • "If individuals with ASD experience eye contact as an aversive stimulus, they might avert their gaze when people look at them directly. Consistent with this notion, some eye-tracking studies that have examined visual-scanning patterns of neutral/emotional faces with direct eye contact or naturalistic social scenes have found reduced attention to the eye region in ASD (Jones et al. 2008; Klin et al. 2002; Nuske et al. 2014b; Spezio et al. 2007). However, other eye-tracking studies have found normative visual attention to the eye region in ASD (e.g., Elsabbagh et al. 2009; Van der Geest et al. 2002; Young et al. 2009), with some studies suggesting that individuals with ASD, just like TD individuals , do look for a longer duration to the eye region compared to other face regions (e.g., Hernandez et al. 2009). "
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    ABSTRACT: The ‘gaze aversion hypothesis’, suggests that people with Autism Spectrum Disorder (ASD) avoid mutual gaze because they experience it as hyper-arousing. To test this hypothesis we showed mutual and averted gaze stimuli to 23 mixed-ability preschoolers with ASD (M Mullen DQ = 68) and 21 typically-developing preschoolers, aged 2–5 years, using eye-tracking technology to measure visual attention and emotional arousal (i.e., pupil dilation). There were no group differences in attention to the eye region or pupil dilation. Both groups dilated their pupils more to mutual compared to averted gaze. More internalizing symptoms in the children with ASD related to less emotional arousal to mutual gaze. The pattern of results suggests that preschoolers with ASD are not dysregulated in their responses to mutual gaze.
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    • "Yet, studies reported inconsistent results: Klin et al.'s (2002b) initial report that adolescents and adults tended to focus more on the mouth and less on the eyes than typical controls has only been partly confirmed (Speer et al., 2007; Norbury et al., 2009). Jones et al. (2008) showed that fixation times on the eyes were reduced in toddlers with ASD, but more recent studies failed to reproduce this finding (Nakano et al., 2010; Chawarska et al., 2013). The most consistent discriminating measure between ASD and typical participants appears to be the fixation times on faces (Riby and Hancock, 2009; von Hofsten et al., 2009; Grynszpan et al., 2012a; Rice et al., 2012; Chawarska et al., 2013; Magrelli et al., 2013). "
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    • "Finally, tracking of eye movement using infrared cameras has revealed a range of differences in the way visual attention is deployed in young children with autism (e.g. Chawarska and Shic 2009; Falck-Ytter et al. 2013a, b, c; Jones et al. 2008; Klin et al. 2009; Swanson and Siller 2013). Whilst neuroimaging and psychophysiological techniques have become increasingly child-friendly over time, the unusual sensory behaviours and difficulties in social communication and restricted and stereotyped behavioural patterns of ASD can pose significant challenges to investigators using these techniques . "
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