Looking but not seeing: atypical visual scanning and recognition of faces in 2 and 4-year-old children with autism spectrum disorder

Preliminary findings on the different gaze patterns on animal-based and human-based picture books in autistic children

Picture books are commonly used as teaching materials for young children. There is a lack of understanding about how autistic children view picture books, raising the question of the type of picture books suitable for children on the autism spectrum. The current study aimed to investigate gaze characteristics of autistic children compared to non-autistic children when viewing animal- and human-based picture books using eye-tracking technology. Twelve pictures were selected from existing picture books (six animal-based, six human-based). Each picture was presented to participants (29 autistic children, Mage = 52.32 months, male: female = 25:4; 40 non-autistic children, Mage = 49.56 months, male: female = 24:16; age range = 42-62 months) in a random sequence. Participants' gaze data were recorded. Autistic children showed longer time to first fixation, shorter total fixation time, and less fixation points to characters in picture books compared to non-autistic children. Animal versus human characters shortened the time to first fixation in autistic but not non-autistic children. Both groups showed greater attention to socially relevant areas, hands and faces, in animal compared to human picture books. Autistic children showed reduced visual attention during picture book viewing compared to non-autistic children. Animal-based picture books were more effective at attracting and maintaining visual attention to socially relevant areas, suggesting their potential as educational tools for autistic children.

Alterations in looking at face-pareidolia images in autism

Face tuning is vital for adaptive and effective social cognition and interaction. This capability is impaired in a wide range of mental conditions including autism spectrum disorder (ASD). Yet the origins of this deficit are largely unknown. Here, an eye-tracking methodology had been implemented in adolescents with high-functioning ASD and in typically developing (TD) matched controls while administering a face-pareidolia task. The spatial distributions of eye fixation in five regions of interest [face, eyes, mouth, CFA (complementary face area, a face area beyond eyes and mouth) and non-face area (a screen area outside a face)] were recorded during spontaneous recognition of a set of Arcimboldo-like Face-n-Food images presented in a predetermined order from the least to most resembling a face. Individuals with ASD gave significantly fewer face responses and looked more often at the mouth, CFA, and non-face areas. By contrast, TD controls mostly fixated the face and eyes areas. The atypical visual scanning strategies could, at least partly, account for the lower face tuning in ASD, supporting the eye avoidance hypothesis, according to which ASD individuals concentrate less on the eyes because the eyes represent a source of emotional information that may make them feel uncomfortable.

A new psychometric tool for evaluating nonverbal social cue-following: regression-based normative data for children 6 to 10 years old

The ability to follow nonverbal social cues is impaired in several disorders. Our aim was to collect normative data for the first psychometric test (TooN) that assesses this skill in children. The normative sample consisted of 339 typically developing children aged 6 to 10. TooN is a computerized tool that includes 120 trials in which children must press a button as soon as possible when an object appears on the right or left side of the screen. Each object is preceded by a video of a model gazing and/or pointing to the side where the object appears (i.e. congruent condition) or the opposite side (i.e. incongruent condition). Linear regression analyses were conducted for reaction times (RTs) and for gaze and pointing cuing effects (i.e. the difference between RTs in incongruent and congruent conditions). Regression analyses showed that age, sex and parental education significantly predicted RTs. Age and sex, but not parental education, were significant predictors of gaze cuing effects. However, age was the only significant predictor of pointing cuing effects. Based on these analyses, we provided the equations to calculate the z-scores for RTs and cuing effects. Accuracy scores, stratified by age and/or sex, are reported as percentiles. Based on the performances of typically developing children, we present the normative data of a new psychometric tool designed to assess nonverbal social cue-following. This tool can be valuable for evaluating children with neurodevelopmental disorders. To support this claim, its validity should be tested across various clinical populations.

Visual Attention in Joint Attention Bids: A Comparison Between Toddlers with Autism Spectrum Disorder and Typically Developing Toddlers

Impairments in joint attention are considered core symptoms of autism spectrum disorder (ASD) and are crucial for early assessment and intervention. However, existing information about visual attention during joint attention and its relation to developmental functioning is limited. The current study investigated the visual attention differences between toddlers with ASD and typically developing (TD) toddlers during single and multiple joint attention cue conditions. This study further examined whether visual attention in joint attention Area of Interests (AOIs) is related to cognitive, language, and motor development in participants. Participants included 56 toddlers with ASD and 56 TD toddlers, aged 18-36 months. A passive viewing paradigm was used to assess participants' visual attention across four different joint attention conditions. Study results showed that toddlers with ASD displayed limited visual attention towards joint attention AOIs, Target, Face, and Target and Face AOIs, in all conditions. As the joint attention cues increased from Condition 1 to Condition 4, toddlers with ASD showed increased visual attention directed towards the Target AOI over the Face AOI. Moreover, increased visual attention on the joint attention AOIs was associated with improved cognitive and language development in toddlers with ASD. This research broadens our understanding of the positive relationships between visual attention to joint attention AOIs and cognitive as well as language development in toddlers with ASD, suggesting that early interventions targeting joint attention may offer promising pathways for treatment.

Face-to-face live eye-tracking in toddlers with autism: Feasibility and impact of familiarity and face covering

Studies utilizing eye-tracking methods have potential to promptly capture real-world dynamics of one of the core areas of vulnerability in autism spectrum disorders (ASD), selective social attention. So far, no studies have successfully reported utilizing the method to examine social attention in toddlers with neurodevelopmental vulnerabilities in real world and challenging settings such as an interactive face-to-face. This study examined the feasibility and validity of live eye-tracking method in response to live interaction occurring in several contexts in toddlers with and without ASD. Forty-seven toddlers with ASD, with atypical development (ATYP), or typically developing (TD), underwent a 30-s live eye-tracking procedure during a face-to-face interaction with a masked stranger using child-directed-speech (16 ASD, 14 ATYP, 17 TD; Mage = 23.44 months, SD = 6.02). Out of this group of toddlers, 29 (10 ASD, 8 ATYP, 11 TD, Mage = 21.97 months, SD = 5.76) underwent the same procedure with one of their maskless parent. Task completion rate, calibration accuracy, and affective response (feasibility measures) as well as attention to the task and the social partner (validity measures) were examined. Task completion rate and calibration accuracy were excellent. Despite the challenging context of face-to-face interaction, the toddlers exhibited a neutral affect, and high attention to the task and the speaker. As anticipated, toddlers with ASD looked less at the social partner compared with control groups. However, attention was comparable between the Stranger and Parent conditions, indicating that the effect was consistent regardless of presence of face covering or the familiarity of the interactive partner. The study demonstrates the high feasibility and validity of a live eye-tracking task involving face-to-face interaction in neurodiverse toddlers with social vulnerabilities. The effect of diminished attention to social partners in toddlers with autism is robust and present when interacting with an unfamiliar person and parent. The results suggest that a brief live eye-tracking method constitutes a promising ecologically valid candidate biomarker and potential intervention outcome in autism.

Salience network connectivity is altered in 6-week-old infants at heightened likelihood for developing autism

Converging evidence implicates disrupted brain connectivity in autism spectrum disorder (ASD); however, the mechanisms linking altered connectivity early in development to the emergence of ASD symptomatology remain poorly understood. Here we examined whether atypicalities in the Salience Network - an early-emerging neural network involved in orienting attention to the most salient aspects of one's internal and external environment - may predict the development of ASD symptoms such as reduced social attention and atypical sensory processing. Six-week-old infants at high likelihood of developing ASD based on family history exhibited stronger Salience Network connectivity with sensorimotor regions; infants at typical likelihood of developing ASD demonstrated stronger Salience Network connectivity with prefrontal regions involved in social attention. Infants with higher connectivity with sensorimotor regions had lower connectivity with prefrontal regions, suggesting a direct tradeoff between attention to basic sensory versus socially-relevant information. Early alterations in Salience Network connectivity predicted subsequent ASD symptomatology, providing a plausible mechanistic account for the unfolding of atypical developmental trajectories associated with vulnerability to ASD.

Autistic Individuals Do Not Alter Visual Processing Strategy During Encoding Versus Recognition of Faces: A Hidden Markov Modeling Approach

PURPOSE

Visual face recognition-the ability to encode, discriminate, and recognize the faces of others-is fundamentally supported by eye movements and is a common source of difficulty for autistic individuals. We aimed to evaluate how visual processing strategies (i.e., eye movement patterns) directly support encoding and recognition of faces in autistic and neurotypical (NT) individuals.

METHODS

We used a hidden Markov modeling approach to evaluate the spatiotemporal dynamics of eye movements in autistic (n = 15) and neurotypical (NT) adolescents (n = 17) during a face identity recognition task.

RESULTS

We discovered distinct eye movement patterns among all participants, which included a focused and exploratory strategy. When evaluating change in visual processing strategy across encoding and recognition phases, autistic individuals did not shift their eye movement patterns like their NT peers, who shifted to a more exploratory visual processing strategy during recognition.

CONCLUSION

These findings suggest that autistic individuals do not modulate their visual processing strategy across encoding and recognition of faces, which may be an indicator of less efficient face processing.

Unraveling the developmental dynamic of visual exploration of social interactions in autism

Atypical deployment of social gaze is present early on in toddlers with autism spectrum disorders (ASDs). Yet, studies characterizing the developmental dynamic behind it are scarce. Here, we used a data-driven method to delineate the developmental change in visual exploration of social interaction over childhood years in autism. Longitudinal eye-tracking data were acquired as children with ASD and their typically developing (TD) peers freely explored a short cartoon movie. We found divergent moment-to-moment gaze patterns in children with ASD compared to their TD peers. This divergence was particularly evident in sequences that displayed social interactions between characters and even more so in children with lower developmental and functional levels. The basic visual properties of the animated scene did not account for the enhanced divergence. Over childhood years, these differences dramatically increased to become more idiosyncratic. These findings suggest that social attention should be targeted early in clinical treatments.

Individual Differences in Multisensory Attention Skills in Children with Autism Spectrum Disorder Predict Language and Symptom Severity: Evidence from the Multisensory Attention Assessment Protocol (MAAP)

Children with autism spectrum disorders (ASD) show atypical attention, particularly for social events. The new Multisensory Attention Assessment Protocol (MAAP) assesses fine-grained individual differences in attention disengagement, maintenance, and audiovisual matching for social and nonsocial events. We investigated the role of competing stimulation on attention, and relations with language and symptomatology in children with ASD and typical controls. Findings revealed: (1) the MAAP differentiated children with ASD from controls, (2) greater attention to social events predicted better language for both groups and lower symptom severity in children with ASD, (3) different pathways from attention to language were evident in children with ASD versus controls. The MAAP provides an ideal attention assessment for revealing diagnostic group differences and relations with outcomes.

Privacy-preserving datasets of eye-tracking samples with applications in XR

Virtual and mixed-reality (XR) technology has advanced significantly in the last few years and will enable the future of work, education, socialization, and entertainment. Eye-tracking data is required for supporting novel modes of interaction, animating virtual avatars, and implementing rendering or streaming optimizations. While eye tracking enables many beneficial applications in XR, it also introduces a risk to privacy by enabling re-identification of users. We applied privacy definitions of k-anonymity and plausible deniability (PD) to datasets of eye-tracking samples and evaluated them against the state-of-the-art differential privacy (DP) approach. Two VR datasets were processed to reduce identification rates while minimizing the impact on the performance of trained machine-learning models. Our results suggest that both PD and DP mechanisms produced practical privacy-utility trade-offs with respect to re-identification and activity classification accuracy, while k-anonymity performed best at retaining utility for gaze prediction.

Virtual Reality Based Gaze-Sensitive Aiming Task Platform: Role of Attention Allocation in Task Performance for Individuals With Autism and Typically Developing Individuals

Individuals with Autism Spectrum Disorder (ASD) often exhibit difficulty in movement preparation and allocating attention towards different Regions of Interest (ROIs) of a visual stimulus. Though research has alluded to differences in movement preparation for aiming tasks between individuals with ASD and typically developing (TD) individuals, there is limited evidence (true for near-aiming tasks) on the contribution of the window (i.e., time duration) of movement preparation (i.e., the planning window preceding movement initiation) on one's aiming performance. However, investigation of the contribution of this planning window on one's performance in far-aiming task remains as majorly unexplored. Again, often one's eye movement leads the initiation of hand movement (for task execution) indicating the importance of monitoring one's eye movement in the planning stage, critical for far-aiming task. Most of the studies (in conventional settings) examining the role of gaze behavior on aiming performance have involved TD individuals and only a few involving individuals with ASD. Here, we have designed Virtual Reality (VR)-based Gaze-sensitive far-aiming (dart throw) task and monitored the looking pattern of participants while they interacted with the task environment. We carried out a study with 40 participants (20 in each of ASD and TD groups) to understand how the participant groups differed in task performance and gaze fixation within the movement planning window. We observed difference in the scan path and last fixation within the movement planning window before triggering the release of the dart with relevance to task performance.

Active Viewing Facilitates Gaze to the Eye Region in Young Children with Autism Spectrum Disorder

Previous studies have shown reduced attention to the eyes in individuals with autism spectrum disorder (ASD). However, most eye-tracking evidence regarding this impairment has been derived from passive viewing tasks. Here, we compared the passive viewing of faces with an active task involving face identification with morphing faces. While typical controls prioritized the eyes over other facial features regardless of viewing condition, autistic children exhibited reduced eye-looking in passive viewing, but displayed increased attention allocation to the eyes when instructed to identify faces. The proportional eye-looking in ASD during facial recognition was negatively related to the autism symptoms severity. These findings provide evidence regarding the specific situations in which diminished eye-looking may rise in young ASD children.

Attention to audiovisual speech does not facilitate language acquisition in infants with familial history of autism

BACKGROUND

Due to familial liability, siblings of children with ASD exhibit elevated risk for language delays. The processes contributing to language delays in this population remain unclear.

METHODS

Considering well-established links between attention to dynamic audiovisual cues inherent in a speaker's face and speech processing, we investigated if attention to a speaker's face and mouth differs in 12-month-old infants at high familial risk for ASD but without ASD diagnosis (hr-sib; n = 91) and in infants at low familial risk (lr-sib; n = 62) for ASD and whether attention at 12 months predicts language outcomes at 18 months.

RESULTS

At 12 months, hr-sib and lr-sib infants did not differ in attention to face (p = .14), mouth preference (p = .30), or in receptive and expressive language scores (p = .36, p = .33). At 18 months, the hr-sib infants had lower receptive (p = .01) but not expressive (p = .84) language scores than the lr-sib infants. In the lr-sib infants, greater attention to the face (p = .022) and a mouth preference (p = .025) contributed to better language outcomes at 18 months. In the hr-sib infants, neither attention to the face nor a mouth preference was associated with language outcomes at 18 months.

CONCLUSIONS

Unlike low-risk infants, high-risk infants do not appear to benefit from audiovisual prosodic and speech cues in the service of language acquisition despite intact attention to these cues. We propose that impaired processing of audiovisual cues may constitute the link between genetic risk factors and poor language outcomes observed across the autism risk spectrum and may represent a promising endophenotype in autism.

Examining Phenotypic Differences in Gaze Avoidance Between Autism Spectrum Disorder and Fragile X Syndrome

We examined potential phenotypic differences in eye gaze avoidance exhibited by boys with autism spectrum disorder (ASD) and boys with fragile X syndrome (FXS). In Study 1, the Eye Contact Avoidance Scale (ECAS) was administered to caregivers of boys aged 7-18 years with FXS (n = 148), ASD (n = 168), and mixed developmental disabilities (MDD; n = 128). In Study 2, subsets of boys with FXS (n = 31) and boys with ASD (n = 25) received a brief behavioral treatment probe to improve eye contact. Results showed that boys with FXS obtained significantly higher scores on the ECAS compared to boys with ASD and MDD. Exposure to the brief behavioral treatment probe resulted in significant decreases in scores for boys with FXS, but not for boys with ASD.

Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis

Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low‐level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta‐analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics.

A constellation of eye-tracking measures reveals social attention differences in ASD and the broad autism phenotype

Background

Social attention differences, expressed through gaze patterns, have been documented in autism spectrum disorder (ASD), with subtle differences also reported among first-degree relatives, suggesting a shared genetic link. Findings have mostly been derived from standard eye-tracking methods (total fixation count or total fixation duration). Given the dynamics of visual attention, these standard methods may obscure subtle, yet core, differences in visual attention mechanisms, particularly those presenting sub-clinically. This study applied a constellation of eye-tracking analyses to gaze data from individuals with ASD and their parents.

Methods

This study included n = 156 participants across groups, including ASD (n = 24) and control (n = 32) groups, and parents of individuals with ASD (n = 61) and control parents (n = 39). A complex scene with social/non-social elements was displayed and gaze tracked via an eye tracker. Eleven analytic methods from the following categories were analyzed: (1) standard variables, (2) temporal dynamics (e.g., gaze over time), (3) fixation patterns (e.g., perseverative or regressive fixations), (4) first fixations, and (5) distribution patterns. MANOVAs, growth curve analyses, and Chi-squared tests were applied to examine group differences. Finally, group differences were examined on component scores derived from a principal component analysis (PCA) that reduced variables to distinct dimensions.

Results

No group differences emerged among standard, first fixation, and distribution pattern variables. Both the ASD and ASD parent groups demonstrated on average reduced social attention over time and atypical perseverative fixations. Lower social attention factor scores derived from PCA strongly differentiated the ASD and ASD parent groups from controls, with parent findings driven by the subset of parents demonstrating the broad autism phenotype.

Limitations

To generalize these findings, larger sample sizes, extended viewing contexts (e.g., dynamic stimuli), and even more eye-tracking analytical methods are needed.

Conclusions

Fixations over time and perseverative fixations differentiated ASD and the ASD parent groups from controls, with the PCA most robustly capturing social attention differences. Findings highlight their methodological utility in studies of the (broad) autism spectrum to capture nuanced visual attention differences that may relate to clinical symptoms in ASD, and reflect genetic liability in clinically unaffected relatives. This proof-of-concept study may inform future studies using eye tracking across populations where social attention is impacted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-022-00490-w.

Gaze-cued shifts of attention and microsaccades are sustained for whole bodies but are transient for body parts

Gaze direction is an evolutionarily important mechanism in daily social interactions. It reflects a person’s internal cognitive state, spatial locus of interest, and predicts future actions. Studies have used static head images presented foveally and simple synthetic tasks to find that gaze orients attention and facilitates target detection at the cued location in a sustained manner. Little is known about how people’s natural gaze behavior, including eyes, head, and body movements, jointly orient covert attention, microsaccades, and facilitate performance in more ecological dynamic scenes. Participants completed a target person detection task with videos of real scenes. The videos showed people looking toward (valid cue) or away from a target (invalid cue) location. We digitally manipulated the individuals in the videos directing gaze to create three conditions: whole-intact (head and body movements), floating heads (only head movements), and headless bodies (only body movements). We assessed their impact on participants’ behavioral performance and microsaccades during the task. We show that, in isolation, an individual’s head or body orienting toward the target-person direction led to facilitation in detection that is transient in time (200 ms). In contrast, only the whole-intact condition led to sustained facilitation (500 ms). Furthermore, observers executed microsaccades more frequently towards the cued direction for valid trials, but this bias was sustained in time only with the joint presence of head and body parts. Together, the results differ from previous findings with foveally presented static heads. In more real-world scenarios and tasks, sustained attention requires the presence of the whole-intact body of the individuals dynamically directing their gaze.

Identification of Social Engagement Indicators Associated With Autism Spectrum Disorder Using a Game-Based Mobile App: Comparative Study of Gaze Fixation and Visual Scanning Methods

BACKGROUND

Autism spectrum disorder (ASD) is a widespread neurodevelopmental condition with a range of potential causes and symptoms. Standard diagnostic mechanisms for ASD, which involve lengthy parent questionnaires and clinical observation, often result in long waiting times for results. Recent advances in computer vision and mobile technology hold potential for speeding up the diagnostic process by enabling computational analysis of behavioral and social impairments from home videos. Such techniques can improve objectivity and contribute quantitatively to the diagnostic process.

OBJECTIVE

In this work, we evaluate whether home videos collected from a game-based mobile app can be used to provide diagnostic insights into ASD. To the best of our knowledge, this is the first study attempting to identify potential social indicators of ASD from mobile phone videos without the use of eye-tracking hardware, manual annotations, and structured scenarios or clinical environments.

METHODS

Here, we used a mobile health app to collect over 11 hours of video footage depicting 95 children engaged in gameplay in a natural home environment. We used automated data set annotations to analyze two social indicators that have previously been shown to differ between children with ASD and their neurotypical (NT) peers: (1) gaze fixation patterns, which represent regions of an individual's visual focus and (2) visual scanning methods, which refer to the ways in which individuals scan their surrounding environment. We compared the gaze fixation and visual scanning methods used by children during a 90-second gameplay video to identify statistically significant differences between the 2 cohorts; we then trained a long short-term memory (LSTM) neural network to determine if gaze indicators could be predictive of ASD.

RESULTS

Our results show that gaze fixation patterns differ between the 2 cohorts; specifically, we could identify 1 statistically significant region of fixation (P<.001). In addition, we also demonstrate that there are unique visual scanning patterns that exist for individuals with ASD when compared to NT children (P<.001). A deep learning model trained on coarse gaze fixation annotations demonstrates mild predictive power in identifying ASD.

CONCLUSIONS

Ultimately, our study demonstrates that heterogeneous video data sets collected from mobile devices hold potential for quantifying visual patterns and providing insights into ASD. We show the importance of automated labeling techniques in generating large-scale data sets while simultaneously preserving the privacy of participants, and we demonstrate that specific social engagement indicators associated with ASD can be identified and characterized using such data.

Characteristics of emotional gaze on threatening faces in children with autism spectrum disorders

Most evidence suggested that individuals with autism spectrum disorder (ASD) experienced gaze avoidance when looking at the eyes compared to typically developing (TD) individuals. Children with ASD magnified their fears when received threatening stimuli, resulting in a reduced duration of eye contact. Few studies have explored the gaze characteristics of children with ASD by dividing emotional faces into threatening and non-threatening pairs. In addition, although dynamic videos are more helpful in understanding the gaze characteristics of children with ASD, the experimental stimuli for some of the previous studies were still emotional pictures. We explored the viewing of dynamic threatening and non-threatening faces by children with ASD in different areas of interest (AOIs). In this study, 6-10 years old children with and without ASD viewed faces with threatening (fearful and angry) and non-threatening (sad and happy) expressions, respectively, with their eyes movements recorded. The results showed that when confronted with threatening faces, children with ASD, rather than TD, showed substantial eye avoidances, particularly non-specific avoidances in the fixation time on the mouths and significantly less time gazing at the mouths in any emotions, which was not observed for non-threatening faces. No correlations were found between the severity of symptoms and characteristics of gaze at the eyes and mouths in children with ASD. These results further enhance the understanding of the gaze characteristics of children with ASD on threatening and non-threatening faces and possibly provide additional evidence for their social interaction improvements.

Different Eye Tracking Patterns in Autism Spectrum Disorder in Toddler and Preschool Children

BACKGROUND

Children with autism spectrum disorder (ASD) have been observed to be associated with fixation abnormality as measured eye tracking, but the dynamics behind fixation patterns across age remain unclear.

MATERIALS AND METHODS

In this study, we investigated gaze patterns between toddlers and preschoolers with and without ASD while they viewed video clips and still images (i.e., mouth-moving face, biological motion, mouthing face vs. moving object, still face picture vs. objects, and moving toys).

RESULTS

We found that the fixation time percentage of children with ASD showed significant decrease compared with that of TD children in almost all areas of interest (AOI) except for moving toy (helicopter). We also observed a diagnostic group (ASD vs. TD) and chronological age (Toddlers vs. preschooler) interaction for the eye AOI during the mouth-moving video clip. Support vector machine analysis showed that the classifier could discriminate ASD from TD in toddlers with an accuracy of 80% and could discriminate ASD from TD in preschoolers with an accuracy of 71%.

CONCLUSION

Our results suggest that toddlers and preschoolers may be associated with both common and distinct fixation patterns. A combination of eye tracking and machine learning methods has the potential to shed light on the development of new early screening/diagnosis methods for ASD.

Visual attention to their own paralytic limbs in children with spina bifida: Measurement of gaze direction using eye tracking

BACKGROUND

Patients with spina bifida experience sensory and motor paralysis and complications in the form of deformation and skin problems of the lower limbs. Enhancing their awareness of the paralysed lesions could be helpful for these patients to prevent secondary disorders. This study sought to investigate to what extent children with spina bifida are visually aware of their body parts and, in particular, to their paralysed lesions.

METHODS

Participants included children with spina bifida (n = 10) and typically developing control children (n = 10) between the ages of 5 and 11 years. All participants were shown still images of themselves on a monitor after which their gaze direction was measured using an eye tracker, with or without providing an instruction to direct their attention to their limbs. The gaze direction data were analyzed and compared between children with spina bifida and the control children.

RESULTS

Children with spina bifida paid visual attention to their bodies in a manner similar to that of control children. Prompts to direct their attention to their limbs were effective in both groups; however, the degree of efficacy in children with spina bifida was inferior to that in control children.

CONCLUSIONS

Promotion of visual awareness to their paralytic parts could be a reasonable and effective method for children with spina bifida to improve their understanding and recognition of their body and prevent associated skin problems.

Investigating intra-individual variability of face scanning in autistic children

LAY ABSTRACT

Atypical face scanning is suggested to be related to social interactions and communicative deficits in autistic children. We systematically examined whether autistic and non-autistic children used consistent scanning patterns when performing different tasks and scanning different types of faces. We found that autistic children scanned faces more variably than non-autistic children: While non-autistic children used more consistent scanning patterns, autistic children's scanning patterns changed frequently when watching different faces. Autistic children's variable face scanning patterns might delay and impair face processing, resulting in a social interaction deficit. What's more, variable scanning patterns may create an unstable and unpredictable perception of the environment for autistic children. Developing in such an unstable environment might motivate autistic children to retract from the environment, avoid social interaction, and focus instead on the performance of repetitive behavior. Therefore, studying face scanning variability might represent a new avenue for understanding core symptoms in autistic people.

Data-driven analysis of gaze patterns in face perception: Methodological and clinical contributions

Gaze patterns during face perception have been shown to relate to psychiatric symptoms. Standard analysis of gaze behavior includes calculating fixations within arbitrarily predetermined areas of interest. In contrast to this approach, we present an objective, data-driven method for the analysis of gaze patterns and their relation to diagnostic test scores. This method was applied to data acquired in an adult sample (N = 111) of psychiatry outpatients while they freely looked at images of human faces. Dimensional symptom scores of autism, attention deficit, and depression were collected. A linear regression model based on Principal Component Analysis coefficients computed for each participant was used to model symptom scores. We found that specific components of gaze patterns predicted autistic traits as well as depression symptoms. Gaze patterns shifted away from the eyes with increasing autism traits, a well-known effect. Additionally, the model revealed a lateralization component, with a reduction of the left visual field bias increasing with both autistic traits and depression symptoms independently. Taken together, our model provides a data-driven alternative for gaze data analysis, which can be applied to dimensionally-, rather than categorically-defined clinical subgroups within a variety of contexts. Methodological and clinical contribution of this approach are discussed.

Emotional content influences eye-movements under natural but not under instructed conditions

ABSTRACTIn everyday life, people can freely decide if and where they would like to move their attention and gaze, often influenced by physical and emotional salience of stimuli. However, many laboratory paradigms explicitly instruct participants when and how to move their eyes, leading to unnatural instructed eye-movements. The current preregistered study compared eye-movements to peripherally appearing faces with happy, angry and neutral expressions under natural and instructed conditions. Participants reliably moved their eyes towards peripheral faces, even when they were not instructed to do so; however, eye-movements were significantly slower under natural than under instructed conditions. Competing central stimuli decelerated eye-movements independently of instructions. Unexpectedly, the emotional salience only affected eye-movements under natural conditions, with faster saccades towards emotional than towards neutral faces. No effects of emotional expression occurred when participants were instructed to move their eyes. The study shows that natural eye-movements significantly differ from instructed eye-movements and emotion-driven attention effects are reduced when participants are artificially instructed to move their eyes, suggesting that research should investigate eye-movements under natural conditions.

Social visual attentional engagement and memory in Phelan-McDermid syndrome and autism spectrum disorder: a pilot eye tracking study

BACKGROUND

The current study used eye tracking to investigate attention and recognition memory in Phelan-McDermid syndrome (PMS), a rare genetic disorder characterized by intellectual disability, motor delays, and a high likelihood of comorbid autism spectrum disorder (ASD). Social deficits represent a core feature of ASD, including decreased propensity to orient to or show preference for social stimuli.

METHODS

We used a visual paired-comparison task with both social and non-social images, assessing looking behavior to a novel image versus a previously viewed familiar image to characterize social attention and recognition memory in PMS (n = 22), idiopathic ASD (iASD, n = 38), and typically developing (TD) controls (n = 26). The idiopathic ASD cohort was divided into subgroups with intellectual disabilities (ID; developmental quotient < 70) and without (developmental quotient > 70) and the PMS group into those with and without a co-morbid ASD diagnosis.

RESULTS

On measures of attention, the PMS group with a comorbid ASD diagnosis spent less time viewing the social images compared to non-social images; the rate of looking back and forth between images was lowest in the iASD with ID group. Furthermore, while all groups demonstrated intact recognition memory when novel non-social stimuli were initially presented (pre-switch), participants with PMS showed no preference during the post-switch memory presentation. In iASD, the group without ID, but not the group with ID, showed a novelty preference for social stimuli. Across indices, individuals with PMS and ASD performed more similarly to PMS without ASD and less similarly to the iASD group.

CONCLUSION

These findings demonstrate further evidence of differences in attention and memory for social stimuli in ASD and provide contrasts between iASD and PMS.

Application of Eye Tracking Technology in Medicine: A Bibliometric Analysis

Eye tracking provides a quantitative measure of eye movements during different activities. We report the results from a bibliometric analysis to investigate trends in eye tracking research applied to the study of different medical conditions. We conducted a search on the Web of Science Core Collection (WoS) database and analyzed the dataset of 2456 retrieved articles using VOSviewer and the Bibliometrix R package. The most represented area was psychiatry (503, 20.5%) followed by neuroscience (465, 18.9%) and psychology developmental (337, 13.7%). The annual scientific production growth was 11.14% and showed exponential growth with three main peaks in 2011, 2015 and 2017. Extensive collaboration networks were identified between the three countries with the highest scientific production, the USA (35.3%), the UK (9.5%) and Germany (7.3%). Based on term co-occurrence maps and analyses of sources of articles, we identified autism spectrum disorders as the most investigated condition and conducted specific analyses on 638 articles related to this topic which showed an annual scientific production growth of 16.52%. The majority of studies focused on autism used eye tracking to investigate gaze patterns with regards to stimuli related to social interaction. Our analysis highlights the widespread and increasing use of eye tracking in the study of different neurological and psychiatric conditions.

How Children with Congenital Limb Deficiencies Visually Attend to Their Limbs and Prostheses: Eye Tracking of Displayed Still Images and Visuospatial Body Knowledge

Purpose: This study aimed to clarify how children with congenital limb deficiencies visually attend to their bodies, particularly their limbs and prostheses.Methods: Participants included children with and without congenital limb deficiencies. They were shown photographs of themselves and their visual attention was measured using an eye tracker.Results: Six children with lower limb deficiencies (age [mean ± SD]: 8.8 ± 2.9; 2 girls and 4 boys), six children with upper limb deficiencies (age: 7.0 ± 2.3; 2 girls and 4 boys), and ten control children (age: 7.7 ± 1.9; 5 girls and 5 boys) were included. Children with congenital upper/lower limb deficiencies looked at their upper/lower limbs as often or more than the control children. Prompts to direct their visual attention to their limbs had limited efficacy.Conclusions: To improve the body knowledge of limbs, approaches other than visual recognition prompting, such as improving linguistic understanding, might be considered.

Puppets facilitate attention to social cues in children with ASD

Diminished visual attention to faces of social partners represents one of the early characteristics of autism spectrum disorder (ASD). Here we examine if the introduction of puppets as social partners alters attention to speakers' faces in young children with ASD and typically developing (TD) controls. Children with ASD (N = 37; Mage  = 49.44 months) and TD (N = 27; Mage  = 40.66 months) viewed a video depicting a puppet and a human engaged in a conversation. Dwell time on these faces was analyzed as a function of group and speaker's identity. Unlike TD controls, the ASD group exhibited limited visual attention to and chance-level visual preference for the human speaker. However, attention to and preference for the puppet speaker's face was greater than chance and comparable across the two groups. While there was a strong association between low human speaker preference and high autism severity, no association with autism severity was found for puppet speaker preference. Unlike humans, expressive and verbal puppets attracted the attention of children with ASD at levels comparable to that of TD controls. Considering that puppets can engage in reciprocal interactions and deliver simplified, salient social-communicative cues, they may facilitate therapeutic efforts in children with ASD. LAY SUMMARY: While studies have shown support for therapeutic uses of robots with children with autism, other similar agents such as puppets remain to be explored. When shown a video of a conversation between a puppet and a person, young children with ASD paid as much attention to the puppet's face as typically-developing (TD) children. Since puppets can engage in back-and-forth interactions and model social interactions and communication, they may play a promising role in therapeutic efforts for young children with ASD.

Atypical Facial Emotion Recognition in Children with Autism Spectrum Disorders: Exploratory Analysis on the Role of Task Demands

People with autism spectrum disorders (ASDs) have difficulty with socio-emotional functioning; however, research on facial emotion recognition (FER) remains inconclusive. Individuals with ASD might be using atypical compensatory mechanisms that are exhausted in more complex tasks. This study compared response accuracy and speed on a forced-choice FER task using neutral, happy, sad, disgust, anger, fear and surprise expressions under both timed and non-timed conditions in children with and without ASD (n = 18). The results showed that emotion recognition accuracy was comparable in the two groups in the non-timed condition. However, in the timed condition, children with ASD were less accurate in identifying anger and surprise compared to children without ASD. This suggests that people with ASD have atypical processing of anger and surprise that might become challenged under time pressure. Understanding these atypical processes, and the environmental factors that challenge them, could be beneficial in supporting socio-emotional functioning in people ASD.

Face-viewing patterns predict audiovisual speech integration in autistic children

Autistic children show audiovisual speech integration deficits, though the underlying mechanisms remain unclear. The present study examined how audiovisual speech integration deficits in autistic children could be affected by their looking patterns. We measured audiovisual speech integration in 26 autistic children and 26 typically developing (TD) children (4- to 7-year-old) employing the McGurk task (a videotaped speaker uttering phonemes with her eyes open or closed) and tracked their eye movements. We found that, compared with TD children, autistic children showed weaker audiovisual speech integration (i.e., the McGurk effect) in the open-eyes condition and similar audiovisual speech integration in the closed-eyes condition. Autistic children viewed the speaker's mouth less in non-McGurk trials than in McGurk trials in both conditions. Importantly, autistic children's weaker audiovisual speech integration could be predicted by their reduced mouth-looking time. The present study indicated that atypical face-viewing patterns could serve as one of the cognitive mechanisms of audiovisual speech integration deficits in autistic children. LAY SUMMARY: McGurk effect occurs when the visual part of a phoneme (e.g., "ga") and the auditory part of another phoneme (e.g., "ba") uttered by a speaker were integrated into a fused perception (e.g., "da"). The present study examined how McGurk effect in autistic children could be affected by their looking patterns for the speaker's face. We found that less looking time for the speaker's mouth in autistic children could predict weaker McGurk effect. As McGurk effect manifests audiovisual speech integration, our findings imply that we could improve audiovisual speech integration in autistic children by directing them to look at the speaker's mouth in future intervention.

Visual Traces of Language Acquisition in Toddlers with Autism Spectrum Disorder During the Second Year of Life

Infants show shifting patterns of visual engagement to faces over the first years of life. To explore the adaptive implications of this engagement, we collected eye-tracking measures on cross-sectional samples of 10-25-month-old typically developing toddlers (TD;N = 28) and those with autism spectrum disorder (ASD;N = 54). Concurrent language assessments were conducted and relationships between visual engagement and expressive and receptive language were analyzed between groups, and within ASD subgroups. TD and ASD toddlers exhibited greater mouth- than eye-looking, with TD exhibiting higher levels of mouth-looking than ASD. Mouth-looking was positively associated with expressive language in TD toddlers, and in ASD toddlers who had acquired first words. Mouth-looking was unrelated to expressive language in ASD toddlers who had not yet acquired first words.

Impaired social attention detected through eye movements in children with early-onset epilepsy

OBJECTIVES

Children with early-onset epilepsy (CWEOE; epilepsy onset before 5 years) exhibit impaired social functioning, but social attention has not yet been examined. In this study we sought to explore visual attention via eye tracking as a component of social attention and examine its relationship with social functioning and Autism Spectrum Disorder (ASD) risk scores.

METHODS

Forty-seven CWEOE (3-63 months) and 41 controls (3-61 months) completed two eye-tracking tasks: (1) preference for social versus nonsocial naturalistic scenes, and (2) face region preference task. ASD risk was measured via the Modified Checklist for Autism in Toddlers or Conners Early Childhood Total Score. Social functioning was assessed via the Greenspan Social-Emotional Growth Chart, or Infant-Toddler Social & Emotional Assessment Competence Scale, or Conners Early Childhood Social Functioning Scale, depending on age. Fixation preferences for social scenes and eyes were compared between groups and evaluated by age and social functioning scores.

RESULTS

Regression analysis revealed that CWEOE viewed the social scene to a significantly less degree than controls. The greatest difference was found between the youngest CWEOE and controls. Fixation duration was independently and significantly related to social functioning scores. There were no significant differences between CWEOE and controls in the face scanning task, and there was no significant relationship between either task and ASD risk scores.

SIGNIFICANCE

CWEOE exhibit task-specific atypical social attention early in the course of the disease. This may be an early marker of impaired social development, and it suggests abnormal social brain development.

Attention to intentional versus incidental pointing gestures in young autistic children: An eye-tracking study

Whereas a reduced tendency to follow pointing gestures is described as an early sign of autism, the literature on response to joint attention indicates that autistic children perform better when a point is added to other social cues such as eye gaze. The purpose of this study was to explore pointing processing in autism when it is the only available cue and to investigate whether autistic children discriminate intentional pointing gestures from incidental pointing gestures. Eye movements of 58 autistic children (48 male) and 61 typically developing children (36 male) aged 3-5 years were recorded as the children were watching videos of a person uttering a pseudoword and pointing intentionally with one hand and incidentally with the other hand. After 3 s, two different potential referents for the pseudoword gradually emerged in both pointed-at corners. In comparison with typically developing children, autistic children's fixations were significantly farther away from both pointed-at zones. Upon hearing a novel word, typically developing children shifted their visual attention toward the zone pointed intentionally. This trend did not emerge in the group of autistic children regardless of their level of vocabulary. Autistic children, independently of their level of language, pay little attention to pointing when no other social cues are available and fail to discriminate intentional pointing gestures from incidental ones. They seem to grasp neither the spatial nor the social value of pointing.

Attentional shift within and between faces: Evidence from children with and without a diagnosis of autism spectrum disorder

Evidence of attentional atypicalities for faces in Autism Spectrum Disorders (ASD) are far from being confirmed. Using eye-tracking technology we compared space-based and object-based attention in children with, and without, a diagnosis of ASD. By capitalizing on Egly's paradigm, we presented two objects (2 faces and their phase-scrambled equivalent) and cued a location in one of the two objects. Then, a target appeared at the same location as the cue (Valid condition), or at a different location within the same object (Same Object condition), or at a different location in another object (Different Object condition). The attentional benefit/cost in terms of time for target detection in each of the three conditions was computed. The findings revealed that target detection was always faster in the valid condition than in the invalid condition, regardless of the type of stimulus and the group of children. Thus, no difference emerged between the two groups in terms of space-based attention. Conversely the two groups differed in object-based attention. Children without a diagnosis of ASD showed attentional shift cost with phase-scrambled stimuli, but not with faces. Instead, children with a diagnosis of ASD deployed similar attentional strategies to focus on faces and their phase-scrambled version.

A privacy-preserving approach to streaming eye-tracking data

Eye-tracking technology is being increasingly integrated into mixed reality devices. Although critical applications are being enabled, there are significant possibilities for violating user privacy expectations. We show that there is an appreciable risk of unique user identification even under natural viewing conditions in virtual reality. This identification would allow an app to connect a user's personal ID with their work ID without needing their consent, for example. To mitigate such risks we propose a framework that incorporates gatekeeping via the design of the application programming interface and via software-implemented privacy mechanisms. Our results indicate that these mechanisms can reduce the rate of identification from as much as 85% to as low as 30%. The impact of introducing these mechanisms is less than 1.5° error in gaze position for gaze prediction. Gaze data streams can thus be made private while still allowing for gaze prediction, for example, during foveated rendering. Our approach is the first to support privacy-by-design in the flow of eye-tracking data within mixed reality use cases.

A study on visual preference for social stimuli in typical Ecuadorian preschoolers as a contribution to the identification of autism risk factors

The goal of this study was to examine the visual preference towards socially salient stimuli, using a low-cost eye-tracking device in a group of typically developing (TD) Ecuadorian preschoolers aged 11 to 60 months, from rural and urban areas, and from families with low to high socioeconomic status (SES). Series of original stimuli inspired by those used in Western experiments on the early detection of Autism Spectrum Disorder (ASD) were proposed in two eye-tracking tasks. Two types of movements (human vs. object) were presented in task 1, and dynamic speaking faces in task 2. Parental perceptions of the adaptability of the low-cost eye-tracking device used here were also investigated through a questionnaire. The analyses of mean fixation times showed a visual preference for human movements compared to moving objects whatever age, residency location or SES. In task 2, visual preference for the mouth's area compared to the eyes' area was observed in specific conditions, modulated by residency location and SES but not by age. The analyses of the parental perception indicated that the eye-tracking technique is well accepted. The findings suggest that these stimuli, along with the experimental procedure and low-cost eye-tracking device used in the present study may be a relevant tool that can be used in clinical settings as a contribution to the early identification of at-risk factors of ASD in low- and middle-income contexts.

Eye-tracking glasses in face-to-face interactions: Manual versus automated assessment of areas-of-interest

The assessment of gaze behaviour is essential for understanding the psychology of communication. Mobile eye-tracking glasses are useful to measure gaze behaviour during dynamic interactions. Eye-tracking data can be analysed by using manually annotated areas-of-interest. Computer vision algorithms may alternatively be used to reduce the amount of manual effort, but also the subjectivity and complexity of these analyses. Using additional re-identification (Re-ID) algorithms, different participants in the interaction can be distinguished. The aim of this study was to compare the results of manual annotation of mobile eye-tracking data with the results of a computer vision algorithm. We selected the first minute of seven randomly selected eye-tracking videos of consultations between physicians and patients in a Dutch Internal Medicine out-patient clinic. Three human annotators and a computer vision algorithm annotated mobile eye-tracking data, after which interrater reliability was assessed between the areas-of-interest annotated by the annotators and the computer vision algorithm. Additionally, we explored interrater reliability when using lengthy videos and different area-of-interest shapes. In total, we analysed more than 65 min of eye-tracking videos manually and with the algorithm. Overall, the absolute normalized difference between the manual and the algorithm annotations of face-gaze was less than 2%. Our results show high interrater agreements between human annotators and the algorithm with Cohen’s kappa ranging from 0.85 to 0.98. We conclude that computer vision algorithms produce comparable results to those of human annotators. Analyses by the algorithm are not subject to annotator fatigue or subjectivity and can therefore advance eye-tracking analyses.

Investigating Gaze Behaviour of Children Diagnosed with Autism Spectrum Disorders in a Classroom Setting

A defining feature of ASD is atypical gaze behaviour, however, eye-tracking studies in ‘real-world’ settings are limited, and the possibility of improving gaze behaviour for ASD children is largely unexplored. This study investigated gaze behaviour of ASD and typically developing (TD) children in their classroom setting. Eye-tracking technology was used to develop and pilot an operant training tool to positively reinforce typical gaze behaviour towards faces. Visual and statistical analyses of eye-tracking data revealed different gaze behaviour patterns during live interactions for ASD and TD children depending on the interaction type. All children responded to operant training with longer looking times observed on face stimuli post training. The promising application of operant gaze training in ecologically valid settings is discussed.

Read my lips! Perception of speech in noise by preschool children with autism and the impact of watching the speaker's face

Background

Adults and adolescents with autism spectrum disorders show greater difficulties comprehending speech in the presence of noise. Moreover, while neurotypical adults use visual cues on the mouth to help them understand speech in background noise, differences in attention to human faces in autism may affect use of these visual cues. No work has yet examined these skills in toddlers with ASD, despite the fact that they are frequently faced with noisy, multitalker environments.

Methods

Children aged 2-5 years, both with and without autism spectrum disorder (ASD), saw pairs of images in a preferential looking study and were instructed to look at one of the two objects. Sentences were presented in the presence of quiet or another background talker (noise). On half of the trials, the face of the target person speaking was presented, while half had no face present. Growth-curve modeling was used to examine the time course of children’s looking to the appropriate vs. opposite image.

Results

Noise impaired performance for both children with ASD and their age- and language-matched peers. When there was no face present on the screen, the effect of noise was generally similar across groups with and without ASD. But when the face was present, the noise had a more detrimental effect on children with ASD than their language-matched peers, suggesting neurotypical children were better able to use visual cues on the speaker’s face to aid performance. Moreover, those children with ASD who attended more to the speaker’s face showed better listening performance in the presence of noise.

Conclusions

Young children both with and without ASD show poorer performance comprehending speech in the presence of another talker than in quiet. However, results suggest that neurotypical children may be better able to make use of face cues to partially counteract the effects of noise. Children with ASD varied in their use of face cues, but those children who spent more time attending to the face of the target speaker appeared less disadvantaged by the presence of background noise, indicating a potential path for future interventions.

Combined frequency-tagging EEG and eye-tracking measures provide no support for the "excess mouth/diminished eye attention" hypothesis in autism

BACKGROUND

Scanning faces is important for social interactions. Difficulty with the social use of eye contact constitutes one of the clinical symptoms of autism spectrum disorder (ASD). It has been suggested that individuals with ASD look less at the eyes and more at the mouth than typically developing (TD) individuals, possibly due to gaze aversion or gaze indifference. However, eye-tracking evidence for this hypothesis is mixed. While gaze patterns convey information about overt orienting processes, it is unclear how this is manifested at the neural level and how relative covert attention to the eyes and mouth of faces might be affected in ASD.

METHODS

We used frequency-tagging EEG in combination with eye tracking, while participants watched fast flickering faces for 1-min stimulation sequences. The upper and lower halves of the faces were presented at 6 Hz and 7.5 Hz or vice versa in different stimulation sequences, allowing to objectively disentangle the neural saliency of the eyes versus mouth region of a perceived face. We tested 21 boys with ASD (8-12 years old) and 21 TD control boys, matched for age and IQ.

RESULTS

Both groups looked longer at the eyes than the mouth, without any group difference in relative fixation duration to these features. TD boys looked significantly more to the nose, while the ASD boys looked more outside the face. EEG neural saliency data partly followed this pattern: neural responses to the upper or lower face half were not different between groups, but in the TD group, neural responses to the lower face halves were larger than responses to the upper part. Face exploration dynamics showed that TD individuals mostly maintained fixations within the same facial region, whereas individuals with ASD switched more often between the face parts.

LIMITATIONS

Replication in large and independent samples may be needed to validate exploratory results.

CONCLUSIONS

Combined eye-tracking and frequency-tagged neural responses show no support for the excess mouth/diminished eye gaze hypothesis in ASD. The more exploratory face scanning style observed in ASD might be related to their increased feature-based face processing style.

Eye-tracking in dentistry: what do children notice in the dental operatory?

OBJECTIVES

To determine, using eye-tracking technology, (i) what children notice the most when they look at images of dental operatories and (ii) the effect of distractors on gaze pattern.

MATERIALS AND METHODS

Forty-one children aged 4-12 years (21 girls, 19 boys) viewed 13 images of dental operatories taken from different perspectives on a computer screen. One child was excluded due to calibration issues with the eye-tracking equipment. Areas of interest (AOI's) were pre-defined on each image, then a Tobii X2-60 eye-tracking camera was used to track the location of participant's gaze. Count of participants to fixate and mean length of fixation (LOF) for each AOI were measured.

RESULTS

Significant differences in the mean LOF was noticed for bracket tables, handpieces, and the dental chair. Significantly differences in mean LOF between different areas of the images were noted where distractors (cartoons) were added.

CONCLUSIONS

When viewing images of dental operatories on a computer screen, children fixated most on the bracket tables, handpieces, and dental chairs. The addition of distractors was able to change where they looked. Eye-tracking was able to effectively assess where the children looked.

CLINICAL RELEVANCE

The findings demonstrate that children have inherent preferences for where they fixate when viewing images of a dental operatory. This has not previously been known and will allow customization of dental operatories where children will be treated.

Face individual identity recognition: a potential endophenotype in autism

BACKGROUND

Face individual identity recognition skill is heritable and independent of intellectual ability. Difficulties in face individual identity recognition are present in autistic individuals and their family members and are possibly linked to oxytocin polymorphisms in families with an autistic child. While it is reported that developmental prosopagnosia (i.e., impaired face identity recognition) occurs in 2-3% of the general population, no prosopagnosia prevalence estimate is available for autism. Furthermore, an autism within-group approach has not been reported towards characterizing impaired face memory and to investigate its possible links to social and communication difficulties.

METHODS

The present study estimated the prevalence of prosopagnosia in 80 autistic adults with no intellectual disability, investigated its cognitive characteristics and links to autism symptoms' severity, personality traits, and mental state understanding from the eye region by using standardized tests and questionnaires.

RESULTS

More than one third of autistic participants showed prosopagnosia. Their face memory skill was not associated with their symptom's severity, empathy, alexithymia, or general intelligence. Face identity recognition was instead linked to mental state recognition from the eye region only in autistic individuals who had prosopagnosia, and this relationship did not depend on participants' basic face perception skills. Importantly, we found that autistic participants were not aware of their face memory skills.

LIMITATIONS

We did not test an epidemiological sample, and additional work is necessary to establish whether these results generalize to the entire autism spectrum.

CONCLUSIONS

Impaired face individual identity recognition meets the criteria to be a potential endophenotype in autism. In the future, testing for face memory could be used to stratify autistic individuals into genetically meaningful subgroups and be translatable to autism animal models.

The role of early social motivation in explaining variability in functional language in toddlers with autism spectrum disorder

LAY ABSTRACT

About one-third of children with autism spectrum disorder never develop the language that they need in different day-to-day situations. Identifying potential factors that can predict later language development is crucial to understanding why some children with autism spectrum disorder successfully develop language while others do not. This study sought to investigate one of the understudied predictors of language development, social motivation, and to test theories for why this association may occur. Testing the theories requires that we measure children's ability to deliberately and directly communicate with others (i.e. intentional communication) and children's language understanding between the measures of social motivation and later expressive language. We tested 87 children with autism spectrum disorder, aged 14-31 months, at four times over 24 months. We found that children with relatively stronger social motivation had relatively better language use 2 years later. This positive link was partly due to a child's ability to produce intentional communication and to understand language. Although we did not measure parents' talking to their children, a theory that inspired this study suggests that children who use frequent intentional communication probably motivate others to talk with them frequently, which facilitates children's language understanding which leads to the development of expressive language. This theory, if confirmed to be true, can provide guidance for parents who want to help their children learn to talk. Parents could look for intentional communication from their children and respond by talking to their children. Effective intervention on both parent and child targets will likely enhance treatment efficacy. Future work is needed to test these ideas.

Attentional bias to fearful faces in infants at high risk for autism spectrum disorder

Individuals with autism spectrum disorder (ASD) and their first-degree relatives show differences from neurotypical individuals in emotional face processing. Prospective studies of infant siblings of children with ASD, a group at high risk for autism (HRA), allow researchers to examine the early emergence of these differences. This study used eye tracking to examine disengagement of attention from emotional faces (fearful, happy, neutral) at 6, 9, and 12 months in low-risk control infants (LRC) and HRA infants who received a subsequent clinical judgment of ASD (HRA+) or non-ASD (HRA-). Infants saw centrally presented faces followed by a peripheral distractor (with face remaining present). For each emotion, latency to shift to the distractor and percentage of trials with no shift were calculated. Results showed increased saccadic latency and a greater percentage of no-shift trials for fearful faces. No between-group differences were present for emotion; however, there was an interaction between age and group for disengagement latency, with HRA+ infants slower to shift at 12 months compared with the other 2 groups. Exploratory correlational analyses looking at shift biases to fearful faces alongside measures of social behavior at 12 and 18 months (from the Communication and Symbolic Behavior Scales) revealed that for HRA+ infants, 9- and 12-month fear biases were significantly related to 12- and 18-month social abilities, respectively. This work suggests that both low- and high-risk infants show biases to threat-relevant faces, and that for HRA+, differences in attention shifting emerge with age, and a stronger fear bias could potentially relate to less social difficulty. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do Animals Engage Greater Social Attention in Autism? An Eye Tracking Analysis

BACKGROUND

Visual atypicalities in autism spectrum disorder (ASD) are a well documented phenomenon, beginning as early as 2-6 months of age and manifesting in a significantly decreased attention to the eyes, direct gaze and socially salient information. Early emerging neurobiological deficits in perceiving social stimuli as rewarding or its active avoidance due to the anxiety it entails have been widely purported as potential reasons for this atypicality. Parallel research evidence also points to the significant benefits of animal presence for reducing social anxiety and enhancing social interaction in children with autism. While atypicality in social attention in ASD has been widely substantiated, whether this atypicality persists equally across species types or is confined to humans has not been a key focus of research insofar.

METHODS

We attempted a comprehensive examination of the differences in visual attention to static images of human and animal faces (40 images; 20 human faces and 20 animal faces) among children with ASD using an eye tracking paradigm. 44 children (ASD n = 21; TD n = 23) participated in the study (10,362 valid observations) across five regions of interest (left eye, right eye, eye region, face and screen).

RESULTS

Results obtained revealed significantly greater social attention across human and animal stimuli in typical controls when compared to children with ASD. However in children with ASD, a significantly greater attention allocation was seen to animal faces and eye region and lesser attention to the animal mouth when compared to human faces, indicative of a clear attentional preference to socially salient regions of animal stimuli. The positive attentional bias toward animals was also seen in terms of a significantly greater visual attention to direct gaze in animal images.

CONCLUSION

Our results suggest the possibility that atypicalities in social attention in ASD may not be uniform across species. It adds to the current neural and biomarker evidence base of the potentially greater social reward processing and lesser social anxiety underlying animal stimuli as compared to human stimuli in children with ASD.