Autistic symptomatology, face processing abilities, and eye fixation patterns

Eye tracking based clustering using the Korean version of the reading the mind in the eyes test

This study applies eye-tracking paradigms to cluster data based on participants' gaze patterns, while performing the Korean version of the Reading the Mind in Eyes Test, and to investigate whether there were differences in the neurocognitive and other Theory of Mind (ToM) tests among the classified clusters. A total of 89 (50 males) non-clinical youths were recruited. The k-means algorithm was adopted, and the optimised number of clusters was determined using the elbow, silhouette and NbClust methods. Furthermore, multivariate analysis was employed to determine whether there were differences among the clusters in the neurocognitive and other ToM tests. Four clusters were proposed based on the index used to estimate the optimised cluster. The long word fixation time cluster had significantly more total errors and fewer categories completed in the Wisconsin Card Sorting Test, lower backward Digit Span score, and lower sequencing scores in the Theory of Mind Picture Stories Task than in the other clusters. The main findings suggested that even when performing a perceptual-level ToM task that requires the ability to understand mental states, at least in some individuals, gaze patterns are related to neurocognitive strategies, especially executive function, rather than to the specific social cognitive function itself.

First Diagnostic Questionnaire for Assessing Patients' Social Functioning: Comprehensive DDX3X Syndrome Patient Profile

Background/Objectives: DDX3X syndrome is often misdiagnosed as autism spectrum disorder (ASD, Rett Syndrome, and Dandy-Walker Syndrome). Precise phenotyping is needed with reference to neurodevelopmental diagnosis. Observation of behavior and communication in parents with DDX3X syndrome in the USA, France, and Poland; conversations with the parents of patients; and rudimentary information in evidence-based medical articles prompted us to identify differences in communication, play, and social interaction between children with ASD only, those with both ASD and DDX3X, and those with DDX3X only. Methods: As diagnostic tool for DDX3X patients, we created a questionnaire divided into four sections: medical, social, play, and communication. Results: The results showed inconsistent diagnoses in different countries where children could have been diagnosed with DDX3X. In a comparative analysis, individuals with DDX3X exhibited greater social skills than individuals with ASD. Furthermore, those with DDX3X demonstrated higher levels of social functioning compared to children with ASD. Therefore, parents of children recently diagnosed with ASD or similar conditions are encouraged to complete a survey to determine if their child is likely to have features of DDX3X syndrome. Conclusion: Identification of early behavioral markers that differentiate children with ASD and those with DDX3X could lead to the earliest opportunity for identification and intervention, and can significantly impact developmental trajectories, leading to better long-term outcomes.

Variations in the Appearance and Interpretation of Interpersonal Eye Contact in Social Categorizations and Psychiatric Populations Worldwide: A Scoping Review with a Critical Appraisal of the Literature

BACKGROUND

Eye contact is one of the most fundamental forms of interhuman communication. However, to date, there has been no comprehensive research comparing how eye contact is made and interpreted in all possible populations worldwide. This study presents a summary of the existing literature on these modalities stratified to social categorizations and psychiatric disorders.

METHOD

A scoping review with critical appraisal of the literature according to the Joanna Briggs Institute (JBI) methodology. Databases AnthroSource, Medline, CINAHL, the Psychology and Behavioral Sciences Collection (EBSCO) and PsychInfo were searched.

RESULTS

7068 articles were screened for both the grey literature and reference lists, of which 385 were included, 282 for social categorizations and 103 for psychiatric disorders. In total, 603 thematic clustered outcomes of variations were included. Methodological quality was generally moderate to good.

CONCLUSIONS

There is a great degree of variation in the presentation and interpretation of eye contact between and within populations. It remains unclear why specific variations occur in populations. Additionally, no gold standard for how eye contact should be used or interpreted emerged from the studies. Further research into the reason for differences in eye contact between and within populations is recommended.

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.

Recognition of facial expressions in autism: Effects of face masks and alexithymia

It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia-a trait associated with difficulties interpreting interoceptive and emotional states-not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism.

Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction

BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.

Pupillometric measures of altered stimulus-evoked locus coeruleus-norepinephrine activity explain attenuated social attention in preschoolers with autism spectrum disorder

Attenuated social attention has been described as a reduced preference for social compared to geometric motion in preschoolers with autism spectrum disorder (ASD). The locus coeruleus-norpinephrine (LC-NE) system modulates sensory reactivity and is a promising underlying mechanism. LC-NE activity is indexed by a stimulus-evoked pupillary response (SEPR) and partially by a luminance-adaptation pupillary response (LAPR), which were both shown to be aberrant in ASD. We examined whether SEPR and LAPR explain an attenuated social motion preference. We applied pupillometry via video-based eye tracking in young children (18-65 months) with ASD (n = 57) and typically developing (TD) children (n = 39) during a preferential looking paradigm of competing social and geometric motion and a changing light condition paradigm. We found an attenuated social motion preference in the ASD compared to the TD group. This was accompanied by atypical pupillometry showing a smaller SEPR to social motion, a larger SEPR to geometric motion and a reduced LAPR to a dark screen. SEPR but not LAPR explained the group difference in social motion preference. An ASD diagnosis was statistically predicted by the social motion preference, while this effect was mediated by the inclusion of SEPR to geometric and social motion. Our findings suggest a decreased sensory reactivity to social and increased reactivity to non-social motion in ASD, which may concurrently contribute to an attenuated social attention. The LC-NE system is supported as a promising underlying mechanism of altered social attention in young children with ASD, while the specificity of findings remains to be addressed.

A narrative sequencing and mentalizing training for adults with autism: A pilot study

Adults diagnosed with autism experience difficulties with understanding the mental states of others, or themselves (mentalizing) and with adequately sequencing personal stories (narrative coherence). Given that the posterior cerebellum is implicated in both skills, as well as in the etiology of autism, we developed a narrative sequencing and mentalizing training for autistic adults. Participants with an official autism diagnosis were randomly assigned to a Training group (n = 17) or a waiting-list Control group (n = 15). The Training group took part in six weekly sessions in groups of three participants lasting each about 60 min. During training, participants had to (re)tell stories from the perspective of the original storyteller and answer questions that required mentalizing. We found significant improvements in mentalizing about others’ beliefs and in narrative coherence for the Training group compared to the Control group immediately after the training compared to before the training. Almost all participants from the Training group expressed beneficial effects of the training on their mood and half of the participants reported positive effects on their self-confidence in social situations. All participants recommended the current training to others. Results are discussed in light of cerebellar theories on sequencing of social actions during mentalizing. Further improvements to the program are suggested. Our results highlight the potential clinical utility of adopting a neuroscience-informed approach to developing novel therapeutic interventions for autistic populations.

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.

Eye-Tracking Studies in Adults with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Eye-tracking studies have shown potential in effectively discriminating between autism spectrum disorder (ASD) and non-ASD groups. The main objective of the present study was to conduct a systematic review and meta-analysis of eye-tracking studies in adults with ASD. A total of 22 studies were included for meta-analysis. Eyes and Non-Social regions proved better for discriminating between ASD and non-ASD adults, while fixation duration seems to be the outcome to choose. Active engaged tasks seem to reduce differences between ASD and non-ASD adults, regardless of the emotional content of the stimuli/task. Proportional fixation duration on eyes and non-social areas in non-active tasks (e.g. free viewing) seems to be the best eye-tracking design for increasing the sensitivity and specificity in ASD adults.

Integration of Facial Expression and Gaze Direction in Individuals with a High Level of Autistic Traits

BACKGROUND

We investigated whether individuals with high levels of autistic traits integrate relevant communicative signals, such as facial expression, when decoding eye-gaze direction.

METHODS

Students with high vs. low scores on the Autism Spectrum Quotient (AQ) performed a task in which they responded to the eye directions of faces, presented on the left or the right side of a screen, portraying different emotional expressions.

RESULTS

In both groups, the identification of gaze direction was faster when the eyes were directed towards the center of the scene. However, in the low AQ group, this effect was larger for happy faces than for neutral faces or faces showing other emotional expressions, whereas participants from high AQ group were not affected by emotional expressions.

CONCLUSIONS

These results suggest that individuals with more autistic traits may not integrate multiple communicative signals based on their emotional value.

Comparing visual preferences between autism spectrum disorder (ASD) and normal children to explore the characteristics of visual preference of ASD children by improved visual preference paradigm: a case-control study

BACKGROUND

One of features of Visual preference in autism spectrum disorder (ASD) is that they tend to social stimuli to nonsocial stimuli. Though it has been studied widely, until now the results are still not consistent. One of the most important reasons may be that the stimuli of the past visual preference paradigm have different movement patterns. Therefore, the present study aimed to improve the visual preference paradigm to reduce the bias caused by different movement of stimuli and explore the features of visual preference of ASD further.

METHODS

Two hundred and seven children who met DSM-5 criteria for ASD and 125 typically developmental (TD) children were enrolled. They were matched in age and gender. Visual preference was measured by eye tracking technology. The subjects presented simultaneously with dynamic object images (DOI) and dynamic social images (DSI) with the same type and same speed of repetitive movement. Social interaction deficits of ASD were assessed by parents with Aberrant Behavior Checklist (ABC).

RESULTS

Compared with TD children, the following findings were noted: (I) children with ASD paid less attention to social stimuli and more attention to nonsocial stimuli (t=6.417, P<0.001). (II) Increased preference to DSI was positively correlated with age (R=0.23, P=0.001). (III) No association was noted between visual preference and IQ in children with ASD (R=0.081, P=0.435). (IV) Reduced preference to DSI was negatively correlated with the severity of social interaction impairment rated by parents with ABC in children with ASD (R=0.237, P=0.010).

CONCLUSIONS

Children with ASD exhibited abnormal visual preference for social and nonsocial stimuli.

A Scalable Off-the-Shelf Framework for Measuring Patterns of Attention in Young Children and its Application in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is associated with deficits in the processing of social information and difficulties in social interaction, and individuals with ASD exhibit atypical attention and gaze. Traditionally, gaze studies have relied upon precise and constrained means of monitoring attention using expensive equipment in laboratories. In this work we develop a low-cost off-the-shelf alternative for measuring attention that can be used in natural settings. The head and iris positions of 104 16-31 months children, an age range appropriate for ASD screening and diagnosis, 22 of them diagnosed with ASD, were recorded using the front facing camera in an iPad while they watched on the device screen a movie displaying dynamic stimuli, social stimuli on the left and nonsocial stimuli on the right. The head and iris position were then automatically analyzed via computer vision algorithms to detect the direction of attention. Children in the ASD group paid less attention to the movie, showed less attention to the social as compared to the nonsocial stimuli, and often fixated their attention to one side of the screen. The proposed method provides a low-cost means of monitoring attention to properly designed stimuli, demonstrating that the integration of stimuli design and automatic response analysis results in the opportunity to use off-the-shelf cameras to assess behavioral biomarkers.

The influence of emotional face distractors on attentional orienting in Chinese children with autism spectrum disorder

The current study examined how emotional faces impact on attentional control at both involuntary and voluntary levels in children with and without autism spectrum disorder (ASD). A non-face single target was either presented in isolation or synchronously with emotional face distractors namely angry, happy and neutral faces. ASD and typically developing children made more erroneous saccades towards emotional distractors relative to neutral distractors in parafoveal and peripheral conditions. Remote distractor effects were observed on saccade latency in both groups regardless of distractor type, whereby time taken to initiate an eye movement to the target was longest in central distractor conditions, followed by parafoveal and peripheral distractor conditions. The remote distractor effect was greater for angry faces compared to happy faces in the ASD group. Proportions of failed disengagement trials from central distractors, for the first saccade, were higher in the angry distractor condition compared with the other two distractor conditions in ASD, and this effect was absent for the typical group. Eye movement results suggest difficulties in disengaging from fixated angry faces in ASD. Atypical disengagement from angry faces at the voluntary level could have consequences for the development of higher-level socio-communicative skills in ASD.

Social Attention Deficits in Children With Autism Spectrum Disorder: Task Dependence of Objects vs. Faces Observation Bias

Social attention deficits represent a central impairment of patients suffering from autism spectrum disorder (ASD), but the nature of such deficits remains controversial. We compared visual attention regarding social (faces) vs. non-social stimuli (objects), in an ecological diagnostic context, in 46 children and adolescents divided in two groups: ASD (N = 23) and typical neurodevelopment (TD) (N = 23), matched for chronological age and intellectual performance. Eye-tracking measures of visual scanning, while exploring and describing scenes from three different tasks from the Autism Diagnostic Observation Schedule (ADOS), were analyzed: "Description of a Picture," "Cartoons," and "Telling a Story from a Book." Our analyses revealed a three-way interaction between Group, Task, and Social vs. Object Stimuli. We found a striking main effect of group and a task dependence of attentional allocation: while the TD attended first and longer to faces, ASD participants became similar to TD when they were asked to look at pictures while telling a story. Our results suggest that social attention allocation is task dependent, raising the question whether spontaneous attention deficits can be rescued by guiding goal-directed actions.

Prosopagnosia and disorders of face processing

Face recognition is a form of expert visual processing. Acquired prosopagnosia is the loss of familiarity for facial identity and has several functional variants, namely apperceptive, amnestic, and associative forms. Acquired forms are usually caused by either occipitotemporal or anterior temporal lesions, right or bilateral in most cases. In addition, there is a developmental form, whose functional and structural origins are still being elucidated. Despite their difficulties with recognizing faces, some of these subjects still show signs of covert recognition, which may have a number of explanations. Other aspects of face perception can be spared in prosopagnosic subjects. Patients with other types of face processing difficulties have been described, including impaired expression processing, impaired lip-reading, false familiarity for faces, and a people-specific amnesia. Recent rehabilitative studies have shown some modest ability to improve face perception in prosopagnosic subjects through perceptual training protocols.

Distance to the Neutral Face Predicts Arousal Ratings of Dynamic Facial Expressions in Individuals With and Without Autism Spectrum Disorder

Arousal is one of the dimensions of core affect and frequently used to describe experienced or observed emotional states. While arousal ratings of facial expressions are collected in many studies it is not well understood how arousal is displayed in or interpreted from facial expressions. In the context of socioemotional disorders such as Autism Spectrum Disorder, this poses the question of a differential use of facial information for arousal perception. In this study, we demonstrate how automated face-tracking tools can be used to extract predictors of arousal judgments. We find moderate to strong correlations among all measures of static information on one hand and all measures of dynamic information on the other. Based on these results, we tested two measures, average distance to the neutral face and average facial movement speed, within and between neurotypical individuals (N = 401) and individuals with autism (N = 19). Distance to the neutral face was predictive of arousal in both groups. Lower mean arousal ratings were found for the autistic group, but no difference in correlation of the measures and arousal ratings could be found between groups. Results were replicated in an high autistic traits group. The findings suggest a qualitatively similar perception of arousal for individuals with and without autism. No correlations between valence ratings and any of the measures could be found, emphasizing the specificity of our tested measures. Distance and speed predictors share variability and thus speed should not be discarded as a predictor of arousal ratings.

No preference for direct versus averted gaze in autistic adults: a reinforced preferential looking paradigm

Background

With the overarching objective to gain better insights into social attention in autistic adults, the present study addresses three outstanding issues about face processing in autism. First, do autistic adults display a preference for mouths over eyes; second, do they avoid direct gaze; third, is atypical visual exploration of faces in autism mediated by gender, social anxiety or alexithymia?

Methods

We used a novel reinforced preferential looking paradigm with a group of autistic adults (n = 43, 23 women) pairwise matched on age with neurotypical participants (n = 43, 21 women). Participants watched 28 different pairs of 5 s video recordings of a speaking person: the two videos, simultaneously displayed on the screen, were identical except that gaze was directed at the camera in one video and averted in the other. After a 680 ms transition phase, a short reinforcement animation appeared on the side that had displayed the direct gaze.

Results

None of the groups showed a preference for mouths over eyes. However, neurotypical participants fixated significantly more the stimuli with direct gaze, while no such preference emerged in autistic participants. As the experiment progressed, neurotypical participants also increasingly anticipated the appearance of the reinforcement, based on the location of the stimulus with the direct gaze, while no such anticipation emerged in autistic participants.

Limitations

Our autistic participants scored higher on the social anxiety and alexithymia questionnaires than neurotypicals. Future studies should match neurotypical and autistic participants on social anxiety and alexithymia and complement questionnaires with physiological measures of anxiety.

Conclusions

The absence of preference for direct versus averted gaze in the autistic group is probably due to difficulties in distinguishing eye gaze direction, potentially linked to a reduced spontaneous exploration or avoidance of the eye region. Social attention and preference for direct versus averted gaze correlated with alexithymia and social anxiety scores, but not gender.

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.

Increased Accuracy of Emotion Recognition in Individuals with Autism-Like Traits after Five Days of Magnetic Stimulations

Individuals with autism-like traits (ALT) belong to a subclinical group with similar social deficits as autism spectrum disorders (ASD). Their main social deficits include atypical eye contact and difficulty in understanding facial expressions, both of which are associated with an abnormality of the right posterior superior temporal sulcus (rpSTS). It is still undetermined whether it is possible to improve the social function of ALT individuals through noninvasive neural modulation. To this end, we randomly assigned ALT individuals into the real (n = 16) and sham (n = 16) stimulation groups. All subjects received five consecutive days of intermittent theta burst stimulation (iTBS) on the rpSTS. Eye tracking data and functional magnetic resonance imaging (fMRI) data were acquired on the first and sixth days. The real group showed significant improvement in emotion recognition accuracy after iTBS, but the change was not significantly larger than that in the sham group. Resting-state functional connectivity (rsFC) between the rpSTS and the left cerebellum significantly decreased in the real group than the sham group after iTBS. At baseline, rsFC in the left cerebellum was negatively correlated with emotion recognition accuracy. Our findings indicated that iTBS of the rpSTS could improve emotion perception of ALT individuals by modulating associated neural networks. This stimulation protocol could be a vital therapeutic strategy for the treatment of ASD.

Representational similarity analysis reveals atypical age-related changes in brain regions supporting face and car recognition in autism

BACKGROUND

Autism Spectrum Disorder (ASD) is associated with atypical activation in the ventral stream during face processing. The current study further characterizes the development of face processing in ASD using a multivoxel pattern analysis, which assesses the similarity in the representation of exemplars from the same category.

METHODS

Ninety-two children, adolescents and adults - with and without ASD - performed the Cambridge Face Memory Test, the Australian Face Memory Test, and a matched car memory test. Regions of interest during these tasks included Fusiform Face Area (FFA), based on the literature, and additional, structurally-defined regions in the ventral stream. Group differences in the patterns of activity within these ROIs when memorizing exemplars were examined using a representational similarity analysis (RSA).

RESULTS

The RSA revealed significant interactions between age group and diagnostic group in R FFA, with increasing similarity within a category (faces, cars) into adulthood typically but not in those with ASD. This pattern was also evident in structurally defined ventral stream regions, namely L inferior frontal gyrus (IFG), bilateral temporoparietal junction (TPJ), L inferior temporal lobule, and the R fusiform gyrus.

CONCLUSIONS

The specialization of face and object processing from adolescence to adulthood evident in typical development may be impaired in ASD, undermining the ability to reach adult-level visual processing in those with ASD.

Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

Social interaction deficits are evident in many psychiatric conditions and specifically in autism spectrum disorder (ASD), but hard to assess objectively. We present a digital tool to automatically quantify biomarkers of social interaction deficits: the simulated interaction task (SIT), which entails a standardized 7-min simulated dialog via video and the automated analysis of facial expressions, gaze behavior, and voice characteristics. In a study with 37 adults with ASD without intellectual disability and 43 healthy controls, we show the potential of the tool as a diagnostic instrument and for better description of ASD-associated social phenotypes. Using machine-learning tools, we detected individuals with ASD with an accuracy of 73%, sensitivity of 67%, and specificity of 79%, based on their facial expressions and vocal characteristics alone. Especially reduced social smiling and facial mimicry as well as a higher voice fundamental frequency and harmony-to-noise-ratio were characteristic for individuals with ASD. The time-effective and cost-effective computer-based analysis outperformed a majority vote and performed equal to clinical expert ratings.

Differences in the Late Positive Potential and P300 to Emotional Faces in Individuals with Autism Spectrum Disorder

Despite evidence suggesting differences in early event-related potential (ERP) responses to social emotional stimuli, little is known about later stage ERP contributions to social emotional processing in individuals with autism spectrum disorder (ASD). Adults with and without ASD completed a facial emotion recognition task involving stimuli that varied by emotional intensity while electroencephalograms were recorded. Principal components analysis was used to examine P300 and late positive potential (LPP) modulation by emotional intensity. Results indicated that greater ASD symptomatology evinced heightened P300 to high relative to low intensity faces, then heightened LPP to low relative to high intensity faces. Findings suggest that adults with greater ASD symptomatology may demonstrate a lag in engagement in elaborative processing of low intensity faces.

Reading the Mind in the Eyes of Children Test (RME-C-T): Development and Validation of a Complex Emotion Recognition Test

Much research has been devoted to the development of emotion recognition tests that can be used to investigate how individuals identify and discriminate emotional expressions of other individuals. One of the most prominent emotion recognition tests is the Reading the Mind in the Eyes Test (RME-T). The original RME-T has been widely used to investigate how individuals recognize complex emotional expressions from the eye region of adult faces. However, the RME-T can only be used to investigate inter-individual differences in complex emotion recognition during the processing of adult faces. To extend its usefulness, we developed a modified version of the RME-T, the Reading the Mind in the Eyes of Children Test (RME-C-T). The RME-C-T can be used to investigate how individuals recognize complex emotional expressions from the eye region of child faces. However, the validity of the RME-C-T has not been evaluated yet. We, thus, administered the RME-C-T together with the RME-T to a sample of healthy adult participants (n = 119). The Interpersonal Reactivity Index (IRI) and the Toronto Alexithymia Scale (TAS) were also administered. Participants' RME-C-T performance correlated with participants' RME-T performance, implying that the RME-C-T measures similar emotion recognition abilities as the RME-T. Participants' RME-C-T performance also correlated with participants' IRI and TAS scores, indicating that these emotion recognition abilities are affected by empathetic and alexithymic traits. Moreover, participants' RME-C-T performance differed between participants with high and low TAS scores, suggesting that the RME-C-T is sensitive enough to detect impairments in these emotion recognition abilities. The RME-C-T, thus, turned out to be a valid measure of inter-individual differences in complex emotion recognition during the processing of child faces.

What Can Eye Movements Tell Us about Subtle Cognitive Processing Differences in Autism?

Autism spectrum disorder (ASD) is neurodevelopmental condition principally characterised by impairments in social interaction and communication, and repetitive behaviours and interests. This article reviews the eye movement studies designed to investigate the underlying sampling or processing differences that might account for the principal characteristics of autism. Following a brief summary of a previous review chapter by one of the authors of the current paper, a detailed review of eye movement studies investigating various aspects of processing in autism over the last decade will be presented. The literature will be organised into sections covering different cognitive components, including language and social communication and interaction studies. The aim of the review will be to show how eye movement studies provide a very useful on-line processing measure, allowing us to account for observed differences in behavioural data (accuracy and reaction times). The subtle processing differences that eye movement data reveal in both language and social processing have the potential to impact in the everyday communication domain in autism.

A novel machine learning analysis of eye-tracking data reveals suboptimal visual information extraction from facial stimuli in individuals with autism

We propose a new method of quantifying the utility of visual information extracted from facial stimuli for emotion recognition. The stimuli are convolved with a Gaussian fixation distribution estimate, revealing more information in those facial regions the participant fixated on. Feeding this convolution to a machine-learning emotion recognition algorithm yields an error measure (between actual and predicted emotions) reflecting the quality of extracted information. We recorded the eye-movements of 21 participants with autism and 23 age-, sex- and IQ-matched typically developing participants performing three facial analysis tasks: free-viewing, emotion recognition, and brow-mouth width comparison. In the emotion recognition task, fixations of participants with autism were positioned on lower areas of the faces and were less focused on the eyes compared to the typically developing group. Additionally, the utility of information extracted by them in the emotion recognition task was lower. Thus, the emotion recognition deficit typical in autism can be at least partly traced to the earliest stage of face processing, i.e. to the extraction of visual information via eye-fixations.

The "Reading the Mind in the Eyes" Test in Autism-Spectrum Disorders Comparison with Healthy Controls: A Systematic Review and Meta-analysis

We conducted a meta-analysis of 18 studies to establish whether a relation exists between Reading the Mind in the Eye Test (RMET) performance and intelligence quotient (IQ) in individuals diagnosed with autism-spectrum disorders (ASD) and controls, taking into account relevant characteristics such as age, gender, and autism quotient. Our findings indicate that RMET performance was better in controls compared with those diagnosed with ASD. We found that RMET performance is dependent on full and verbal IQ and age in controls. However, RMET performance is negatively correlated with performance IQ in individuals diagnosed with ASD. These results suggest that the methodology applied by ASD when taking the RMET is different from control individuals and might depend less on verbal abilities.

Cognitive and Emotional Empathy in Individuals with Spinal Cord Injury

Background

Empathy has been conceptualized as comprising a cognitive and an emotional component, the latter being further divided into direct and indirect aspects, which refer, respectively, to the explicit evaluation of the observer's feelings while attending someone in an emotional situation and to the physiological response of the observer. Empathy has been previously investigated in several neurological disorders.

Objective

This study is aimed at investigating empathy in patients with spinal cord injury (SCI). We hypothesize that, due to deafferentation following their injury, SCI patients will display difficulty in the processing of emotional stimuli and blunted empathic responses as compared to healthy controls.

Materials and Methods

20 patients with spinal cord injury (SCI) (12 males and 8 females, mean age = 50.9, standard deviation (SD) = 16.1 years; mean education = 10.9, SD = 4.1 years) were included in the study and compared to 20 matched healthy subjects. Participants were investigated using the State-Trait Anxiety Inventory (Form Y) (STAI-Y), the Beck Depression Scale, and the Toronto Alexithymia Scale. Moreover, participants were further evaluated by means of the Interpersonal Reactivity Index (IRI), which explores both cognitive and emotional aspects of empathy, and through an experimental protocol based on the use of a modified version of the computerized Multifaceted Empathy Test (MET) to evaluate emotional (direct and indirect) empathy and the ability to judge the valence of complex emotional scenes.

Results

As compared to healthy controls, SCI patients reported higher scores on the Perspective-Taking subscale of the IRI, while, on the modified MET, they were less accurate in identifying the valence of neutral scenes, notwithstanding their spared direct and indirect emotional empathy ability. Furthermore, we found a significant negative correlation between the time interval since injury and the direct emotional empathy scores on the positive images, as well as a negative correlation with the indirect emotional empathy scores on both positive and neutral images, indicating a blunting of the empathic responses as time elapses.

Conclusion

Results suggest that SCI patients, when analyzing the meaning of emotional stimuli, tend to rely on a cognitive empathy strategy rather than on emotion simulation.

Pictorial Empathy Test (PET)

Abstract. Research on empathy has increased rapidly during the last decades but brief assessment methods are not easily available. The aim was to develop a test for affective empathic reactions which would be simple to translate into different languages, easy to use in a variety of research settings, and which would catch the empathic reactions at the moment they arise. We describe the development and validation of the Pictorial Empathy Test (PET) in three studies (Study 1, N = 91; Study 2, N = 2,789; and Study 3, N = 114). The PET includes seven photographs about distressed individuals and the participants are asked to rate on a 5-point scale how emotionally moving they find the photograph. The results indicated that the PET displayed a unitary factor structure and it had high internal consistency and good seven-month test-retest reliability. In addition, the results supported convergent and discriminant validity of the test. The results suggest that the PET is a useful addition to the prevailing methods for assessing affective empathy.

Face Identity Recognition and the Social Difficulties Component of the Autism-Like Phenotype: Evidence for Phenotypic and Genetic Links

Autism spectrum disorder (ASD) and autism-like traits are associated with deficits in face memory ability, although it is not yet clear whether this deficit reflects a specific aspect of the ASD/autism-like phenotype. We addressed this issue using a neurotypical sample of adolescent twins (Ncomplete pairs = 782) drawn from the Twins Early Development Study who were assessed on face and object memory performance alongside two core aspects of autism-like traits: (i) difficulties with social behavior/interactions, and (ii) attention to detail. We observed a negative association between face memory ability and difficulties with social behavior/interactions. This association reflected an overlapping genetic etiology: heritable influences acting on face memory ability are associated with the social difficulties aspects of autism-like traits.

Safety and Lack of Negative Effects of Wearable Augmented-Reality Social Communication Aid for Children and Adults with Autism

There is a growing interest in the use of augmented reality (AR) to assist children and adults with autism spectrum disorders (ASD); however, little investigation has been conducted into the safety of AR devices, such as smartglasses. The objective of this report was to assess the safety and potential negative effects of the Empowered Brain system, a novel AR smartglasses-based social communication aid for people with ASD. The version of the Empowered Brain in this report utilized Google Glass (Google, Mountain View, CA, USA) as its hardware platform. A sequential series of 18 children and adults, aged 4.4 to 21.5 years (mean 12.2 years), with clinically diagnosed ASD of varying severity used the system. Users and caregivers were interviewed about the perceived negative effects and design concerns. Most users were able to wear and use the Empowered Brain (n = 16/18, 89%), with most of them reporting no negative effects (n = 14/16, 87.5%). Caregivers observed no negative effects in users (n = 16/16, 100%). Most users (77.8%) and caregivers (88.9%) had no design concerns. This report found no major negative effects in using an AR smartglasses-based social communication aid across a wide age and severity range of people with ASD. Further research is needed to explore longer-term effects of using AR smartglasses in this population.

Atypical information-use in children with autism spectrum disorder during judgments of child and adult face identity

Unusual patterns of fixation behavior in individuals with autism spectrum disorder during face tasks hint at atypical processing strategies that could contribute to diminished face expertise in this group. Here, we use the Bubbles reverse correlation technique to directly examine face-processing strategies during identity judgments in children with and without autism, and typical adults. Results support a qualitative atypicality in autistic face processing. We identify clear differences not only in the specific features relied upon for face judgments, but also more generally in the extent to which they demonstrate a flexible and adaptive profile of information use.

Inferior Frontal Gyrus Volume Loss Distinguishes Between Autism and (Comorbid) Attention-Deficit/Hyperactivity Disorder-A FreeSurfer Analysis in Children

Objective: Autism spectrum (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with a high rate of comorbidity. To date, diagnosis is based on clinical presentation and distinct reliable biomarkers have been identified neither for ASD nor ADHD. Most previous neuroimaging studies investigated ASD and ADHD separately. Method: To address the question of structural brain differences between ASD and ADHD, we performed FreeSurfer analysis in a sample of children with ADHD (n = 30), with high-functioning ASD (n = 14), with comorbid high-functioning ASD and ADHD (n = 15), and of typically developed controls (TD; n = 36). With FreeSurfer, an automated brain imaging processing and analyzing suite, we reconstructed the cerebral cortex and calculated gray matter volumes as well as cortical surface parameters in terms of cortical thickness and mean curvature. Results: A significant main effect of the factor ADHD was detected for the left inferior frontal gyrus (Pars orbitalis) volume, with the ADHD group exhibiting smaller Pars orbitalis volumes. Dimensional measures of autism (SRS total raw score) and ADHD (DISYPS-II FBB-ADHD score) had no significant influence on the left Pars orbitalis volume. Both, ASD and ADHD tended to have an effect on cortical thickness or mean curvature, which did not survive correction for multiple comparisons. Conclusion: Our results underline that ADHD rather than ASD is associated with volume loss in the left inferior frontal gyrus (Pars orbitalis). This area might play a relevant role in modulating symptoms of inattention and/or impulsivity in ADHD. The effect of comorbid ADHD in ASD samples and vice versa, on cortical thickness and mean curvature, requires further investigation in larger samples.

The impact of atypical sensory processing on social impairments in autism spectrum disorder

Altered sensory processing has been an important feature of the clinical descriptions of autism spectrum disorder (ASD). There is evidence that sensory dysregulation arises early in the progression of ASD and impacts social functioning. This paper reviews behavioral and neurobiological evidence that describes how sensory deficits across multiple modalities (vision, hearing, touch, olfaction, gustation, and multisensory integration) could impact social functions in ASD. Theoretical models of ASD and their implications for the relationship between sensory and social functioning are discussed. Furthermore, neural differences in anatomy, function, and connectivity of different regions underlying sensory and social processing are also discussed. We conclude that there are multiple mechanisms through which early sensory dysregulation in ASD could cascade into social deficits across development. Future research is needed to clarify these mechanisms, and specific focus should be given to distinguish between deficits in primary sensory processing and altered top-down attentional and cognitive processes.

Validation of eye-tracking measures of social attention as a potential biomarker for autism clinical trials

Social communication impairments are a core feature of autism spectrum disorder (ASD), and this class of symptoms is a target for treatments for the disorder. Measures of social attention, assessed via eye-gaze tracking (EGT), have been proposed as an early efficacy biomarker for clinical trials targeting social communication skills. EGT measures have been shown to differentiate children with ASD from typical children; however, there is less known about their relationships with social communication outcome measures that are typically used in ASD clinical trials. In the present study, an EGT task involving viewing a videotape of an actor making bids for a child's attention was evaluated in 25 children with ASD aged 24-72 months. Children's attention to the actor during the dyadic bid condition measured via EGT was found to be strongly associated with five well-validated caregiver-reported outcome measures that are commonly used to assess social communication in clinical trials. These results highlight the convergent validity of EGT measures of social attention in relation to caregiver-reported clinical measures. EGT holds promise as a non-invasive, quantitative, and objective biomarker that is associated with social communication abilities in children with ASD. Autism Res 2018, 11: 166-174. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Eye-gaze tracking (EGT), an automated tool that tracks eye-gaze patterns, might help measure outcomes in clinical trials investigating interventions to treat autism spectrum disorders. In this study, an EGT task was evaluated in children with ASD, who watched a video with an actor talking directly to them. Patterns of eye-gaze were associated with caregiver-reported measures of social communication that are used in clinical trials. We show EGT may be a promising objective tool measuring outcomes.

Patterns of fixation during face recognition: Differences in autism across age

Difficulties with face recognition increase from adolescence to adulthood in autism, reflecting a lack of typical late development. We examined whether this reflects differences in the development of patterns of fixation to eyes and mouths during face recognition. Children, adolescents, and adults (aged 7-30) with and without autism completed the Cambridge Face Memory Test while gaze was recorded. Average duration and number of fixations were calculated for eyes and mouth regions of interest, defined individually for each face image in the task. All groups and age groups made more and longer fixations to eyes than mouths. However, during face memorization, typically developing children and adults, but not adolescents, made more fixations to eyes than did their peers with autism. During face recognition, typically developing children and adults made shorter fixations on mouths than did their peers with autism; this pattern was reversed in adolescence, with adolescents with autism making more fixations to mouths than typically developing adolescents. Results suggest that group differences in patterns of fixations to faces change with age. Furthermore, different relationships between patterns of fixations and face recognition performance in typical development and autism suggest that these differences contribute, at least in part, to difficulties in autism.

Social attention and autism symptoms in high functioning women with autism spectrum disorders

BACKGROUND

Research has suggested a different, less visible, clinical manifestation of Autism Spectrum Disorders (ASD) in females. There is, however, limited research into possible underlying mechanisms explaining the female phenotype.

AIMS

This study investigates social attention in females with ASD.

METHODS AND PROCEDURES

26 women diagnosed with ASD and 26 typical female controls were shown three video clips containing intense emotions. Social attention was assessed by measuring eye fixation patterns during the video clips. Autism symptoms were assessed using the informant reported Social Responsiveness Scale (SRS).

OUTCOME AND RESULTS

Results show normal time to first fixation to the face, but lower fixation duration to the face in women with ASD. Analyzing the visual patterns further, there were similar impairments in fixation to mouth, eyes and other facial areas. Relating social attention to autism symptoms revealed several significant correlations within the ASD group.

CONCLUSIONS AND IMPLICATIONS

Women with ASD show abnormalities in social attention and these abnormalities are related to level of autism symptoms. In contrast to other studies which investigate male dominated ASD samples, a hyperfocus to the mouth area could not be found.

Repetition Suppression and Memory for Faces is Reduced in Adults with Autism Spectrum Conditions

Autism spectrum conditions (ASC) are associated with a number of atypicalities in face processing, including difficulties in face memory. However, the neural mechanisms underlying this difficulty are unclear. In neurotypical individuals, repeated presentation of the same face is associated with a reduction in activity, known as repetition suppression (RS), in the fusiform face area (FFA). However, to date, no studies have investigated RS to faces in individuals with ASC, or the relationship between RS and face memory. Here, we measured RS to faces and geometric shapes in individuals with a clinical diagnosis of an ASC and in age and IQ matched controls. Relative to controls, the ASC group showed reduced RS to faces in bilateral FFA and reduced performance on a standardized test of face memory. By contrast, RS to shapes in object-selective regions and object memory did not differ between groups. Individual variation in face-memory performance was positively correlated with RS in regions of left parietal and prefrontal cortex. These findings suggest difficulties in face memory in ASC may be a consequence of differences in the way faces are stored and/or maintained across a network of regions involved in both visual perception and short-term/working memory.

Voice identity processing in autism spectrum disorder

People with autism spectrum disorder (ASD) have difficulties in identifying another person by face and voice. This might contribute considerably to the development of social cognition and interaction difficulties. The characteristics of the voice recognition deficit in ASD are unknown. Here, we used a comprehensive behavioral test battery to systematically investigate voice processing in high-functioning ASD (n = 16) and typically developed pair-wise matched controls (n = 16). The ASD group had particular difficulties with discriminating, learning, and recognizing unfamiliar voices, while recognizing famous voices was relatively intact. Tests on acoustic processing abilities showed that the ASD group had a specific deficit in vocal pitch perception that was dissociable from otherwise intact acoustic processing (i.e., musical pitch, musical, and vocal timbre perception). Our results allow a characterization of the voice recognition deficit in ASD: The findings indicate that in high-functioning ASD, the difficulty to recognize voices is particularly pronounced for learning novel voices and the recognition of unfamiliar peoples' voices. This pattern might be indicative of difficulties with integrating the acoustic characteristics of the voice into a coherent percept-a function that has been previously associated with voice-selective regions in the posterior superior temporal sulcus/gyrus of the human brain. Autism Res 2017, 10: 155-168. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Threatening faces fail to guide attention for adults with autistic-like traits

Individuals diagnosed with autistic spectrum conditions often show deficits in processing emotional faces relative to neurotypical peers. However, little is known about whether similar deficits exist in neurotypical individuals who show high-levels of autistic-like traits. To address this question, we compared performance on an attentional blink task in a large sample of adults who showed low- or high-levels of autistic-like traits on the Autism Spectrum Quotient. We found that threatening faces inserted as the second target in a rapid serial visual presentation were identified more accurately among individuals with low- compared to high-levels of autistic-like traits. This is the first study to show that attentional blink abnormalities seen in autism extend to the neurotypical population with autistic-like traits, adding to the growing body of research suggesting that autistic-related patterns of behaviors extend into a subset of the neurotypical population. Autism Res 2017, 10: 311-320. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Facial affect recognition in autism, ADHD and typical development

INTRODUCTION

Autism spectrum disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) have been associated with facial affect recognition (FAR) alterations.

METHODS

This study examined accuracy and response times for general and specific FAR in whole face and eye-region stimuli. FAR was assessed in matched samples of children and adolescents with ASD (n = 35), ADHD (n = 32), and typical development (TD) (n = 32) aged 8.6-15.9 years (M = 11.6; SD = 2.0).

RESULTS

Compared to TD, the ASD group performed less accurate and showed longer response times for general and specific FAR, mostly driven by problems in neutral and happy face identification. The ADHD group responded faster than the ASD group for global FAR. No differences between ADHD and TD were found. Attentional distractibility had a significant effect on FAR performance in ASD and ADHD.

CONCLUSIONS

Findings confirm FAR alterations in ASD, but not ADHD, and endorse effects of attentional distractibility on FAR in ASD and ADHD. FAR and attention function training is clinically meaningful in ASD. Future studies should include control for visual attention and facial configuration skills, use naturalistic FAR material and also investigate implicit FAR.

Visual preference for social stimuli in individuals with autism or neurodevelopmental disorders: an eye-tracking study

BACKGROUND

Recent research has identified differences in relative attention to competing social versus non-social video stimuli in individuals with autism spectrum disorder (ASD). Whether attentional allocation is influenced by the potential threat of stimuli has yet to be investigated. This is manipulated in the current study by the extent to which the stimuli are moving towards or moving past the viewer. Furthermore, little is known about whether such differences exist across other neurodevelopmental disorders. This study aims to determine if adolescents with ASD demonstrate differences in attentional allocation to competing pairs of social and non-social video stimuli, where the actor or object either moves towards or moves past the viewer, in comparison to individuals without ASD, and to determine if individuals with three genetic syndromes associated with differing social phenotypes demonstrate differences in attentional allocation to the same stimuli.

METHODS

In study 1, adolescents with ASD and control participants were presented with social and non-social video stimuli in two formats (moving towards or moving past the viewer) whilst their eye movements were recorded. This paradigm was then employed with groups of individuals with fragile X, Cornelia de Lange, and Rubinstein-Taybi syndromes who were matched with one another on chronological age, global adaptive behaviour, and verbal adaptive behaviour (study 2).

RESULTS

Adolescents with ASD demonstrated reduced looking-time to social versus non-social videos only when stimuli were moving towards them. Individuals in the three genetic syndrome groups showed similar looking-time but differences in fixation latency for social stimuli moving towards them. Across both studies, we observed within- and between-group differences in attention to social stimuli that were moving towards versus moving past the viewer.

CONCLUSIONS

Taken together, these results provide strong evidence to suggest differential visual attention to competing social versus non-social video stimuli in populations with clinically relevant, genetically mediated differences in socio-behavioural phenotypes.

Social attention in ASD: A review and meta-analysis of eye-tracking studies

Determining whether social attention is reduced in Autism Spectrum Disorder (ASD) and what factors influence social attention is important to our theoretical understanding of developmental trajectories of ASD and to designing targeted interventions for ASD. This meta-analysis examines data from 38 articles that used eye-tracking methods to compare individuals with ASD and TD controls. In this paper, the impact of eight factors on the size of the effect for the difference in social attention between these two groups are evaluated: age, non-verbal IQ matching, verbal IQ matching, motion, social content, ecological validity, audio input and attention bids. Results show that individuals with ASD spend less time attending to social stimuli than typically developing (TD) controls, with a mean effect size of 0.55. Social attention in ASD was most impacted when stimuli had a high social content (showed more than one person). This meta-analysis provides an opportunity to survey the eye-tracking research on social attention in ASD and to outline potential future research directions, more specifically research of social attention in the context of stimuli with high social content.

The effect of inversion on face recognition in adults with autism spectrum disorder

Face identity recognition has widely been shown to be impaired in individuals with autism spectrum disorders (ASD). In this study we examined the influence of inversion on face recognition in 26 adults with ASD and 33 age and IQ matched controls. Participants completed a recognition test comprising upright and inverted faces. Participants with ASD performed worse than controls on the recognition task but did not show an advantage for inverted face recognition. Both groups directed more visual attention to the eye than the mouth region and gaze patterns were not found to be associated with recognition performance. These results provide evidence of a normal effect of inversion on face recognition in adults with ASD.