Sex Differences in Social Attention in Infants at Risk for Autism

Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder

Purpose of Review

Females and males are disproportionately diagnosed with autism, a sex difference that has historically represented this neurodevelopmental condition. The current review examines lifespan developmental trajectories of autism based on sex to elucidate behavioral phenotypic differences that may contribute to differential rates of diagnosis.

Recent Findings

We review sex differences in diagnostic criteria: social communication and restricted interests/repetitive behaviors (RRBs). Results suggest RRBs are more indicative of a diagnosis in males, whereas social differences are more indicative of a diagnosis in females. Factors contributing to a later diagnosis in females include social strengths (camouflaging) and diagnostic overshadowing.

Summary

Sex differences in diagnostic criteria may contribute to differential rates of identification in males and females. Sex differences are most pronounced when assessing naturalistic social communication instead of reliance on standardized measure. Numerous future directions are identified including increasing samples of sub-threshold autistic females and evaluating longitudinal sex differences.

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.

Dynamic emotional messages differentially affect 6-month-old infants' attention to eyes and gaze cues

Infants often experience interactions in which caregivers use dynamic messages to convey their affective and communicative intent. These dynamic emotional messages may shape the development of emotion discrimination skills and shared attention by influencing infants' attention to internal facial features and their responses to eye gaze cues. However, past research examining infants' responses to emotional faces has predominantly focused on classic, stereotyped expressions (e.g., happy, sad, angry) that may not reflect the variability that infants experience in their daily interactions. The present study therefore examined forty-two 6-month-old infants' attention to eyes vs. mouth and gaze cueing responses across multiple dynamic emotional messages that are common to infant-directed interactions. Overall, infants looked more to the eyes during messages with negative affect, but this increased attention to the eyes during these message conditions did not directly facilitate gaze cueing. Infants instead showed reliable gaze cueing only after messages with positive and neutral affect. We additionally observed gender differences in infants' attention to internal face features and subsequent gaze cueing responses. Female infants spent more time looking at the eyes during the dynamic emotional messages and showed increased initial orienting and longer looking to gaze-cued objects following positive messages, whereas male infants showed these gaze cueing effects following neutral messages. These results suggest that variability in caregivers' communication can shape infants' attention to and processing of emotion and gaze information.

Updating Expectations About Unexpected Object Motion in Infants Later Diagnosed with Autism Spectrum Disorder

In typical development, infants form predictions about future events based on incoming sensory information, which is essential for perception and goal-directed action. It has been suggested that individuals with autism spectrum disorder (ASD) make predictions differently compared to neurotypical individuals. We investigated how infants who later received an ASD diagnosis and neurotypical infants react to temporarily occluded moving objects that violate initial expectations about object motion. Our results indicate that infants regardless of clinical outcome react similarly to unexpected object motion patterns, both in terms of gaze shift latencies and pupillary responses. These findings indicate that the ability to update representations about such regularities in light of new information may not differ between typically developing infants and those with later ASD.

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.

Polygenic Risk Scores for Developmental Disorders, Neuromotor Functioning During Infancy, and Autistic Traits in Childhood

BACKGROUND

Impaired neuromotor development is often one of the earliest observations in children with autism spectrum disorder (ASD). We investigated whether a genetic predisposition to developmental disorders was associated with nonoptimal neuromotor development during infancy and examined the genetic correlation between nonoptimal neuromotor development and autistic traits in the general population.

METHODS

In a population-based cohort in The Netherlands (2002-2006), we calculated polygenic risk scores (PRSs) for ASD and attention-deficit/hyperactivity disorder (ADHD) using genome-wide association study summary statistics. In 1921 children with genetic data, parents rated autistic traits at 6 years of age. Among them, 1174 children (61.1%) underwent neuromotor examinations (tone, responses, senses, and other observations) during infancy (9-20 weeks of age). We used linear regressions to examine associations of PRSs with neuromotor scores and autistic traits. We performed a bivariate genome-based restricted maximum likelihood analysis to explore whether genetic susceptibility underlies the association between neuromotor development and autistic traits.

RESULTS

Higher PRSs for ASD were associated with less optimal overall infant neuromotor development, in particular low muscle tone. Higher PRSs for ADHD were associated with less optimal senses. PRSs for ASD and those for ADHD both were associated with autistic traits. The single nucleotide polymorphism-based heritability of overall motor development was 20% (SE = .21) and of autistic traits was 68% (SE = .26). The genetic correlation between overall motor development and autistic traits was .35 (SE = .21, p < .001).

CONCLUSIONS

We found that genetic liabilities for ASD and ADHD covary with neuromotor development during infancy. Shared genetic liability might partly explain the association between nonoptimal neuromotor development during infancy and autistic traits in childhood.

Visual attention to faces in children with autism spectrum disorder: are there sex differences?

Background

The male bias in autism spectrum disorder (ASD) diagnoses is well documented. As a result, less is known about the female ASD phenotype. Recent research suggests that conclusions drawn from predominantly male samples may not accurately capture female behavior. In this study, we explore potential sex differences in attention to social stimuli, which is generally reported to be diminished in ASD. Population-based sex differences in attention to faces have been reported, such that typically developing (TD) females attend more to social stimuli (including faces) from infancy through adulthood than TD males. It is yet unknown whether population-based sex differences in the face domain are preserved in ASD.

Methods

A dynamic, naturalistic infrared eye-tracking paradigm measured attention to social stimuli (faces) in 74 school-aged males and females with ASD (male N = 23; female N = 19) and without ASD (male N = 16; female N = 16). Two kinds of video stimuli were presented that varied in social content: rich social scenes (dyadic play between two children) and lean social scenes (parallel play by two children).

Results

Results revealed a significant 3-way interaction between sex, diagnosis, and condition after controlling for chronological and mental age. ASD females attended more to faces than ASD males in the socially lean condition. This effect was not found in the typically developing (TD) group. ASD males attended less to faces regardless of social context; however, ASD females only attended significantly less to faces compared to TD females in the socially rich condition. TD males and ASD females did not differ in their attention to faces in either condition.

Conclusions

This study has implications for how the field understands core social deficits in children with ASD, which should ideally be benchmarked against same-sex peers (male and female). Social attention in ASD females fell on a continuum—greater than their ASD male peers, but not as great as TD females. Overall, their social attention mirrored that of TD males. Improved understanding of the female social phenotype in ASD will enhance early screening and diagnostic efforts and will guide the development of sex-sensitive experimental paradigms and social interventions.