Gaze Performance in Children with Autism Spectrum Disorder when Observing Communicative Actions

Impaired inhibitory control when processing real but not cartoon emotional faces in autistic children: Evidence from an event-related potential study

Impaired socioemotional functioning characterizes autistic children, but does weak inhibition control underlie their socioemotional difficulty? This study addressed this question by examining whether and, if so, how inhibition control is affected by face realism and emotional valence in school-age autistic and neurotypical children. Fifty-two autistic and 52 age-matched neurotypical controls aged 10-12 years completed real and cartoon emotional face Go/Nogo tasks while event-related potentials (ERPs) were recorded. The analyses of inhibition-emotion components (i.e., N2, P3, and LPP) and a face-specific N170 revealed that autistic children elicited greater N2 while inhibiting Nogo trials and greater P3/LPP and late LPP for real but not cartoon emotional faces. Moreover, autistic children exhibited a reduced N170 to real face emotions only. Furthermore, correlation results showed that better behavioral inhibition and emotion recognition in autistic children were associated with a reduced N170. These findings suggest that neural mechanisms of inhibitory control in autistic children are less efficient and more disrupted during real face processing, which may affect their age-appropriate socio-emotional development.

Objective Measurement of Social Gaze and Smile Behaviors in Children with Suspected Autism Spectrum Disorder During Administration of the Autism Diagnostic Observation Schedule, 2nd Edition

Best practice for the assessment of autism spectrum disorder (ASD) symptom severity relies on clinician ratings of the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), but the association of these ratings with objective measures of children's social gaze and smiling is unknown. Sixty-six preschool-age children (49 boys, M = 39.97 months, SD = 10.58) with suspected ASD (61 confirmed ASD) were administered the ADOS-2 and provided social affect calibrated severity scores (SA CSS). Children's social gaze and smiling during the ADOS-2, captured with a camera contained in eyeglasses worn by the examiner and parent, were obtained via a computer vision processing pipeline. Children who gazed more at their parents (p = .04) and whose gaze at their parents involved more smiling (p = .02) received lower social affect severity scores, indicating fewer social affect symptoms, adjusted R2 = .15, p = .003.

Correlation Between Gaze Behaviors and Social Communication Skills of Young Autistic Children: A Meta-Analysis of Eye-Tracking Studies

This meta-analysis examined correlations between eye-tracking measures of gaze behaviors manifested during dynamic salient social stimuli and behavioral assessment measures of social communication skills of young autistic children. We employed a multilevel model with random effects to perform three separate meta-analyses for correlation between social communication skills and (a) all gaze behaviors, (b) gaze duration, and (c) gaze transition. Subsequently, we performed meta-regression to assess the role of four moderators, including age, continuum of naturalness of stimuli, gaze metric, and area of interest, on correlation effect sizes that were heterogeneous at the population level. A total of 111 correlation coefficients from 17 studies for 1132 young autistic children or children with high-likelihood for autism (Mage range = 6-95 months) were included in this meta-analysis. The correlation effect sizes for all three meta-analyses were significant, supporting the relation between improved gaze behaviors and better social communication skills. In addition, age, gaze metric, and area of interest were significant moderators. This suggests the importance of identifying meaningful gaze behaviors related to social communication skills and the increasingly influential role of gaze behaviors in shaping social communication skills as young autistic children progress through the early childhood stage. The continuum of naturalness of stimuli, however, was revealed to trend towards having a significant moderating effect. Lastly, it is important to note the evidence of potential publication bias. Our findings are discussed in the context of early identification and intervention and unraveling the complex nature of autism.

Social visual attention as a treatment outcome: evaluating the social games for autistic adolescents (SAGA) intervention

A core feature of autism involves difficulty perceiving and interpreting eye gaze shifts as nonverbal communicative signals. A hypothesis about the origins of this phenotype is that it emerges from developmentally different social visual attention (SVA). We developed Social Games for Autistic Adolescents (SAGA; Scherf et al. BMJ Open 8(9):e023682, 2018) as a serious game intervention for autistic individuals to discover the significance of eye gaze cues. Previously, we demonstrated the effectiveness of SAGA to improve the perception and understanding of eye gaze cues and social skills for autistic adolescents (Griffin et al. JCPP Adv 1(3):e12041, 2021). Here, we determine whether increases in social visual attention to faces and/or target gazed-at objects, as measured via eye tracking during the same Gaze Perception task in the same study sample, moderated this improvement. In contrast to predictions, SVA to faces did not differentially increase for the treatment group. Instead, both groups evinced a small increase in SVA to faces over time. Second, Prior to the SAGA intervention, attention to faces failed to predict performance in the Gaze Perception task for both the treatment and standard care control groups. However, at post-test, autistic adolescents in the treatment group were more likely to identify the object of directed gaze when they attended longer to faces and longer to target objects. Importantly, this is the first study to measure social visual attention via eye tracking as a treatment response in an RCT for autism. NCT02968225.

Investigating the borders of autism spectrum disorder: lessons from the former diagnosis of pervasive developmental disorder not otherwise specified

Introduction

Autism Spectrum Disorder (ASD) diagnosis is relatively consensual in typical forms. The margins of the spectrum and their degree of extension, however, are controversial. This has far-reaching implications, which extend beyond theoretical considerations: first, peripheral forms of autism are more prevalent than central forms; second, we do not know how relevant typical-targeted recommendations are for atypical forms. In DSM-IV-TR, these margins of autism were studied within the category of Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS). In spite of its low reliability, this former diagnosis was of particular interest to shed light on the gray area of margins. The aim of this systematic is therefore to investigate the clinical characteristics of PDD-NOS in comparison with Autistic Disorder.

Method

A stepwise systematic PRISMA literature review was conducted by searching PubMed and Web Of Science databases to select corresponding studies.

Results

The systematic review included 81 studies comprising 6,644 children with PDD-NOS. Cross-sectional and longitudinal studies comparing PDD-NOS and AD showed that PDD-NOS corresponds to milder form of autism with less impact and less associated disorder, with the exception of schizophrenia and mood disorder.

Discussion

Our review challenges initial views of PDD-NOS, and shows the clinical relevance of this diagnosis when dealing with the margins of autism, and the de facto diversity included in the spectrum. However, in view of the many limitations of PDD-NOS (low reliability, instability through time, low acceptability), we suggest taxonomic changes in DSM-5: we introduce a new category based on three main dimensions related to socialization impairment, emotional lability and psychotic symptoms.

Conclusion

Our review argues for a distinction between AD and PDD-NOS on clinical characteristics and thus highlights the need to study the margins of autism. While the limitations of the PDD-NOS category made it irrelevant to investigate these margins from a research perspective, we believe that a multidimensional approach for mental health professionals taping socialization, emotion lability and psychotic symptoms would be interesting. Our review therefore encourage future studies to test relevant criteria for a new category and possibly identify developmental trajectories, specific interventions and treatments.

Machine learning for distinguishing saudi children with and without autism via eye-tracking data

BACKGROUND

Despite the prevalence of Autism Spectrum Disorder (ASD) globally, there's a knowledge gap pertaining to autism in Arabic nations. Recognizing the need for validated biomarkers for ASD, our study leverages eye-tracking technology to understand gaze patterns associated with ASD, focusing on joint attention (JA) and atypical gaze patterns during face perception. While previous studies typically evaluate a single eye-tracking metric, our research combines multiple metrics to capture the multidimensional nature of autism, focusing on dwell times on eyes, left facial side, and joint attention.

METHODS

We recorded data from 104 participants (41 neurotypical, mean age: 8.21 ± 4.12 years; 63 with ASD, mean age 8 ± 3.89 years). The data collection consisted of a series of visual stimuli of cartoon faces of humans and animals, presented to the participants in a controlled environment. During each stimulus, the eye movements of the participants were recorded and analyzed, extracting metrics such as time to first fixation and dwell time. We then used these data to train a number of machine learning classification algorithms, to determine if these biomarkers can be used to diagnose ASD.

RESULTS

We found no significant difference in eye-dwell time between autistic and control groups on human or animal eyes. However, autistic individuals focused less on the left side of both human and animal faces, indicating reduced left visual field (LVF) bias. They also showed slower response times and shorter dwell times on congruent objects during joint attention (JA) tasks, indicating diminished reflexive joint attention. No significant difference was found in time spent on incongruent objects during JA tasks. These results suggest potential eye-tracking biomarkers for autism. The best-performing algorithm was the random forest one, which achieved accuracy = 0.76 ± 0.08, precision = 0.78 ± 0.13, recall = 0.84 ± 0.07, and F1 = 0.80 ± 0.09.

CONCLUSIONS

Although the autism group displayed notable differences in reflexive joint attention and left visual field bias, the dwell time on eyes was not significantly different. Nevertheless, the machine algorithm model trained on these data proved effective at diagnosing ASD, showing the potential of these biomarkers. Our study shows promising results and opens up potential for further exploration in this under-researched geographical context.

Nonlinear features of gaze behavior during joint attention in children with autism spectrum disorder

Since children with autism spectrum disorder (ASD) might exhibit a variety of aberrant response to joint attention (RJA) behaviors, there is growing interest in identifying robust, reliable and valid eye-tracking metrics for determining differences in RJA behaviors between typically developing (TD) children and those with ASD. Previous eye-tracking studies have not been deeply investigated nonlinear features of gaze time-series during RJA. As a main motivation, this study aimed to extract three nonlinear features (i.e., complexity, long-range correlation, and local instability) of gaze time-series during RJA in children with ASD, which can be measured by fractal dimension (FD), Hurst exponent (H), and largest Lyapunov exponent (LLE), respectively. To illustrate our idea, this study adopted a publicly accessible database, including eye-tracking data collected during RJA from 19 children with ASD (7.74 ± 2.73) and 30 TD children (8.02 ± 2.89), and conducted a battery of nonparametric analysis of covariance (ANCOVA), where gender was used as covariable. Findings showed that gaze time-series during RJA in autistic children may generally have greater FD but lower H than that in TD controls. This implies that children with ASD possess more complex and unpredictable gaze behaviors during RJA than TD children. Furthermore, nonlinear metrics outperformed traditional eye-tracking metrics in obtaining higher identification performance with an accuracy of 82% and an AUC value of 0.81, distinguishing the differences between successful and failed RJA trails, and predicting the severity of ASD symptoms. Findings might bring some new insights into the understanding of the impairments in RJA behaviors for children with ASD.

Eye-tracking correlates of response to joint attention in preschool children with autism spectrum disorder

BACKGROUND

A number of differences in joint attention behaviour between children with autism spectrum disorder (ASD) and typically developing (TD) individuals have previously been documented.

METHOD

We use eye-tracking technology to assess response to joint attention (RJA) behaviours in 77 children aged 31 to 73 months. We conducted a repeated-measures analysis of variance to identify differences between groups. In addition, we analysed correlations between eye-tracking and clinical measures using Spearman's correlation.

RESULTS

The children diagnosed with ASD were less likely to follow gaze compared to TD children. Children with ASD were less accurate at gaze following when only eye gaze information was available, compared to when eye gaze with head movement was observed. Higher accuracy gaze-following profiles were associated with better early cognition and more adaptive behaviours in children with ASD. Less accurate gaze-following profiles were associated with more severe ASD symptomatology.

CONCLUSION

There are differences in RJA behaviours between ASD and TD preschool children. Several eye-tracking measures of RJA behaviours in preschool children were found to be associated with clinical measures for ASD diagnosis. This study also highlights the construct validity of using eye-tracking measures as potential biomarkers in the assessment and diagnosis of ASD in preschool children.

RJAfinder: An automated tool for quantification of responding to joint attention behaviors in autism spectrum disorder using eye tracking data

Deficits in responding to joint attention (RJA) are early symptoms of autism spectrum disorder (ASD). Currently, no automated tools exist for identifying and quantifying RJA behaviors. A few eye tracking studies have investigated RJA in ASD children but have produced conflicting results. In addition, little is known about the trajectory of RJA development through developmental age. Here, a new video was designed including 12 clips of an actor pointing to or looking at an object. Eye tracking technology was used to monitor RJA in three groups: 143 ASD children assessed with the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) (4-7 years old), 113 age- and gender-matched typically developing children (TDC), and 43 typically developing adults (TDA) (19-32 years old). RJAfinder was developed in R and MATLAB to quantify RJA events from the eye tracking data. RJA events were compared among the three groups. Spearman correlation coefficients between total number of RJA events in ASD and the Social Responsiveness Scale (SRS) scores were calculated. A logistic regression model was built using the average valid sampling rate and the total number of RJA events as two predictive variables to classify ASD and TDC groups. ASD children displayed statistically significantly less RJA events than the TDC and TDA groups with medium-to-large-sized effects. ASD and TDC children both displayed more RJA events in response to pointing stimuli than to looking stimuli. Our logistic regression model predicted ASD tendency with 0.76 accuracy in the testing set. RJA ability improved more slowly between the ages of 4-7 years old in the ASD group than in the TDC group. In ASD children, RJA ability showed negative correlation with SRS total T-score as well as the scores of five subdomains. Our study provides an automated tool for quantifying RJA and insights for the study of RJA in ASD children, which may help improve ASD screening, subtyping, and behavior interventions.

High-Risk Siblings without Autism: Insights from a Clinical and Eye-Tracking Study

Joint attention (JA)-the human ability to coordinate our attention with that of other people-is impaired in the early stage of Autism Spectrum Disorder (ASD). However, little is known about the JA skills in the younger siblings of children with ASD who do not develop ASD at 36 months of age [high-risk (HR)-noASD]. In order to advance our understanding of this topic, a prospective multicenter observational study was conducted with three groups of toddlers (age range: 18-33 months): 17 with ASD, 19 with HR-noASD and 16 with typical development (TD). All subjects underwent a comprehensive clinical assessment and an eye-tracking experiment with pre-recorded stimuli in which the visual patterns during two tasks eliciting initiating joint attention (IJA) were measured. Specifically, fixations, transitions and alternating gaze were analyzed. Clinical evaluation revealed that HR-noASD subjects had lower non-verbal cognitive skills than TD children, while similar levels of restricted and repetitive behaviors and better social communication skills were detected in comparison with ASD children. Eye-tracking paradigms indicated that HR-noASD toddlers had visual patterns resembling TD in terms of target-object-to-face gaze alternations, while their looking behaviors were similar to ASD toddlers regarding not-target-object-to-face gaze alternations. This study indicated that high-risk, unaffected siblings displayed a shared profile of IJA-eye-tracking measures with both ASD patients and TD controls, providing new insights into the characterization of social attention in this group of toddlers.

Motion or sociality? The cueing effect and temporal course of autistic traits on gaze-triggered attention

Gaze-triggered attention changes have been found in individuals with high autistic traits in the nonclinical population. However, gaze cues used in previous studies imply not only sociality of gaze but also the motion of gaze. To exclude the influence of motion, we manipulated the cue sociality by setting dot cues with similar motion characteristics as gaze cues to explore the underlying reasons of gaze-triggered attention changes in individuals with high autistic traits. We used a cueing paradigm within a visual matching task and recorded individuals' eye movements. Both the RT and eye movement of probe interface showed the benefit from gaze of the low autistic trait group was larger than that from dot and was larger than that of the high autistic trait group. While the high autistic trait group show similar benefit between gaze and dot. Eye movement results showed the dynamic changes of validity effect in two groups. The interaction between autistic traits and cue sociality was not significant within the 500 ms of cue presentation, marginally significant within 500-1,000 ms after cue presentation, but significant after 1,000 ms of cue presentation. The results demonstrated that the changes of gaze-triggered attention in individuals with high autistic traits was mainly caused by the sociality of gaze in the relative late stage.

The Impact of Sex Chromosome Trisomies (XXX, XXY, XYY) on Early Social Cognition: Social Orienting, Joint Attention, and Theory of Mind

OBJECTIVE

About 1:650-1,000 children are born with an extra X or Y chromosome (XXX; XXY; XYY), which results in a sex chromosome trisomy (SCT). This study aims to cross-sectionally investigate the impact of SCT on early social cognitive skills. Basic orienting toward social cues, joint attention, and theory of mind (ToM) in young children with SCT were evaluated.

METHOD

About 105 children with SCT (range: 1-7 years old) were included in this study, as well as 96 age-matched nonclinical controls. Eyetracking paradigms were used to investigate the eye gaze patterns indicative of joint attention skills and orienting to social interactions. The ToM abilities were measured using the subtest ToM of the Developmental NEuroPSYchological Assessment, second edition, neuropsychological test battery. Recruitment and assessment took place in the Netherlands and in the United States.

RESULTS

Eyetracking results revealed difficulties in children with SCT in social orienting. These difficulties were more pronounced in children aged 3 years and older, and in boys with 47,XYY. Difficulties in joint attention were found over all age groups and karyotypes. Children with SCT showed impairments in ToM (26.3% in the [well] below expected level), increasing with age. These impairments did not differ between karyotypes.

CONCLUSIONS

An impact of SCT on social cognitive abilities was found already at an early age, indicating the need for early monitoring and support of early social cognition. Future research should explore the longitudinal trajectories of social development in order to evaluate the predictive relationships between social cognition and outcome later in life in terms of social functioning and the risk for psychopathology.

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.

Identifying autism spectrum disorder symptoms using response and gaze behavior during the Go/NoGo game CatChicken

Previous studies have found that Autism Spectrum Disorder (ASD) children scored lower during a Go/No-Go task and faced difficulty focusing their gaze on the speaker's face during a conversation. To date, however, there has not been an adequate study examining children's response and gaze during the Go/No-Go task to distinguish ASD from typical children. We investigated typical and ASD children's gaze modulation when they played a version of the Go/No-Go game. The proposed system represents the Go and the No-Go stimuli as chicken and cat characters, respectively. It tracks children's gaze using an eye tracker mounted on the monitor. Statistically significant between-group differences in spatial and auto-regressive temporal gaze-related features for 21 ASD and 31 typical children suggest that ASD children had more unstable gaze modulation during the test. Using the features that differ significantly as inputs, the AdaBoost meta-learning algorithm attained an accuracy rate of 88.6% in differentiating the ASD subjects from the typical ones.

Improving sensitivity to eye gaze cues in adolescents on the autism spectrum using serious game technology: A randomized controlled trial

Background

Perceiving and interpreting eye gaze cues is foundational for social cognition and social interactions because it involves the ability to use eye gaze direction to predict the actions and intentions of others. Autism is a disability that impacts social interactions. A diagnostic symptom of autism is difficulty understanding eye gaze cues as social signals. This deficit has long-term consequences for understanding goal-directed behavior, language learning, and social communication. We hypothesize that targeted intervention methods designed to improve sensitivity to eye gaze cues may begin to treat core symptoms of autism and potentially alter multiple aspects of social functioning. Social Games for Autistic Adolescents (SAGA) is a serious computer game intervention designed to improve sensitivity to eye gaze cues. Serious games improve targeted skills with the goal of enhancing real life outcomes. In SAGA, participants progress through a narrative storyline and interact with animated characters. In so doing, they implicitly discover that eye gaze cues are useful for guiding their own goal-directed behavior to solve problems in the game.

Methods

We evaluated the feasibility and effectiveness of SAGA in a hybrid phase 1/2, randomized controlled trial. Forty adolescents on the autism spectrum were randomized to either the treatment or standard care control group. Adolescents in the treatment group were asked to play SAGA for 30-minute sessions at home 3 times a week over 10 weeks.

Results

A group × time interaction revealed that the treatment group developed increasing sensitivity to human eye gaze cues, whereas the standard care group did not. Participants who experienced a sufficient dose of gameplay showed larger treatment-related improvements. Critically, increases in sensitivity to human eye gaze cues were associated with improvements in social skills.

Conclusions

This accessible, scalable, and affordable intervention shows promise as an effective tool for improving the ability to interpret and understand eye gaze cues and social skills in adolescents on the autism spectrum.

Design of an Interactive Virtual Reality System, InViRS, for Joint Attention Practice in Autistic Children

Many children with Autism Spectrum Disorder (ASD) exhibit atypical gaze behaviors related to joint attention, a fundamental social-communication skill. Specifically, children with ASD show differences in the skills of gaze sharing and gaze following. In this work we present a novel virtual reality (VR)-based system, called InViRS, in which children with ASD play games allowing them to practice gaze sharing and gaze following. InViRS has three main design contributions: (i) a closed-loop joint attention paradigm with real-time tracking of the participant’s eye gaze and game performance measures, (ii) an assistive feedback mechanism that provides guidance and hints in real time, and (iii) a controller that adaptively changes the avatar’s gaze prompts according to the performance measures. Results from a pilot study to evaluate the feasibility of InViRS with 9 autistic¹ children and 9 typically developing (TD) children offered preliminary support for the feasibility of successful gameplay as well as positive impacts on the targeted skills of gaze sharing and gaze following.

Social synchronization during joint attention in children with autism spectrum disorder

We explored the social synchronization of gaze-shift behaviors when responding to joint attention in children with autism spectrum disorder (ASD). Forty-one children aged 5 to 8 with ASD and 43 typically developing (TD) children watched a video to complete the response to joint attention (RJA) tasks, during which their gaze data were collected. The synchronization of gaze-shift behaviors between children and the female model in the video was measured with the cross-recurrence quantification analysis (CRQA). Ultimately, we discovered that children with ASD had the ability to synchronize their gaze shifts with the female model in the video during RJA tasks. Compared to the TD children, they displayed lower levels of synchronization and longer latency in this synchronized behavior. These findings provide a new avenue to deepen our understanding of the impairments of social interaction in children with ASD. Notably, the analytic method can be further applied to explore the social synchronization of numerous other social interactive behaviors in ASD. LAY SUMMARY: This study explored how autistic children synchronized their gazed shifts with others' gaze cues during joint attention. We found that compared to typical children, autistic children synchronized their gazed shifts less and needed more time to follow others' gaze. These findings provide a new avenue to deepen our understanding of the impairments of social interaction in children with ASD.

Social attention as a cross-cultural transdiagnostic neurodevelopmental risk marker

The primary objectives of this study were to evaluate the structure and age-related stability of social attention in English and Arabic-speaking youth and to compare social attention between children with autism spectrum disorder (ASD), other developmental disabilities (DD), and typically-developing controls. Eye-tracking data were collected from US (N = 270) and Qatari (N = 242) youth ages 1-17, including children evaluated for possible ASD. Participants viewed 44 stimuli from seven social paradigms. Fixation was computed for areas of interest within each stimulus. Latent variable models examined the structure of social attention. Generalized estimating equation models examined the effect of age, sex, culture, and diagnostic group on social attention. The best-fitting model included a general social attention factor and six specific factors. Cultural differences in social attention were minimal and social attention was stable across age (r = 0.03), but females showed significantly greater social attention than males (d = 0.28). Social attention was weaker in DD (d = -0.17) and lowest in ASD (d = -0.38) relative to controls. Differences were of sufficient magnitude across areas-of-interest to reliably differentiate DD from controls (AUC = 0.80) and ASD-only from all other cases (AUC = 0.76). A social attention dimension that represents an early-life preference for socially salient information was identified. This preference was cross-culturally consistent and stable across development but stronger in females and weaker in DD, especially ASD. Given rapid and easy-to-collect remote eye tracking administration, social attention measurement may be useful for developmental monitoring. Acquisition of population norms, analogous to height/weight/head circumference, might enhance early screening and tracking of neurodevelopment. LAY SUMMARY: This research found that social attention is a single dimension of behavior that represents a strong preference for social stimuli, is consistent across cultures, stable across age, and stronger in females. Children with developmental disabilities had lower levels of social attention than neurotypical children and children with autism spectrum disorder had the lowest levels of social attention.

The impact of social complexity on the visual exploration of others' actions in preschoolers with autism spectrum disorder

BACKGROUND

Typical development of socio-communicative skills relies on keen observation of others. It thus follows that decreased social attention negatively impacts the subsequent development of socio-communicative abilities in children with autism spectrum disorders (ASD). In addition, studies indicate that social attention is modulated by context and that greater social difficulties are observed in more socially demanding situations. Our study aims to investigate the effect of social complexity on visual exploration of others' actions in preschoolers.

METHODS

To investigate the impact of social complexity, we used an eye-tracking paradigm with 26 typically developing preschoolers (TD, age = 3.60 ± 1.55) and 37 preschoolers with ASD (age = 3.55 ± 1.21). Participants were shown videos of two children engaging in socially simple play (parallel) versus socially complex play (interactive). We subsequently quantified the time spent and fixation duration on faces, objects, bodies, as well as the background and the number of spontaneous gaze shifts between socially relevant areas of interest.

RESULTS

In the ASD group, we observed decreased time spent on faces. Social complexity (interactive play) elicited changes in visual exploration patterns in both groups. From the parallel to the interactive condition, we observed a shift towards socially relevant parts of the scene, a decrease in fixation duration, as well as an increase in spontaneous gaze shifts between faces and objects though there were fewer in the ASD group.

LIMITATIONS

Our results need to be interpreted cautiously due to relatively small sample sizes and may be relevant to male preschoolers, given our male-only sample and reported phenotypic differences between males and females.

CONCLUSION

Our results suggest that similar to TD children, though to a lesser extent, visual exploration patterns in ASD are modulated by context. Children with ASD that were less sensitive to context modulation showed decreased socio-communicative skills or higher levels of symptoms. Our findings support using naturalistic designs to capture socio-communicative deficits in ASD.

Paving the Way toward Personalized Medicine: Current Advances and Challenges in Multi-OMICS Approach in Autism Spectrum Disorder for Biomarkers Discovery and Patient Stratification

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder characterized by impairments in two main areas: social/communication skills and repetitive behavioral patterns. The prevalence of ASD has increased in the past two decades, however, it is not known whether the evident rise in ASD prevalence is due to changes in diagnostic criteria or an actual increase in ASD cases. Due to the complexity and heterogeneity of ASD, symptoms vary in severity and may be accompanied by comorbidities such as epilepsy, attention deficit hyperactivity disorder (ADHD), and gastrointestinal (GI) disorders. Identifying biomarkers of ASD is not only crucial to understanding the biological characteristics of the disorder, but also as a detection tool for its early screening. Hence, this review gives an insight into the main areas of ASD biomarker research that show promising findings. Finally, it covers success stories that highlight the importance of precision medicine and the current challenges in ASD biomarker discovery studies.

Measuring sensitivity to eye gaze cues in naturalistic scenes: Presenting the eye gaze FoCuS database

OBJECTIVES

The ability to process information about eye gaze and its use for nonverbal communication is foundational to human social interactions. We developed and validated a database of stimuli that are optimized to investigate the perception and referential understanding of shifts in eye gaze.

METHODS

The 245 Gaze Perception stimuli are digital photographs that test the ability to estimate and interpret eye gaze trajectory. The 82 Gaze Following stimuli are digital videos that measure the ability to follow and interpret eye gaze shifts online. Both stimuli were designed for a 4-alternative forced choice paradigm (4AFC) in which the participant identifies the gazed-at object.

RESULTS

Each stimulus was validated by independent raters and only included if the endorsement of the correct item was ≥75%. Finally, we provided timestamps for 19 40-second video segments from adolescent-oriented entertainment movies that are matched on several factors. These segments involve social interactions with eye gaze shifts and can be used to measure visual social attention.

CONCLUSIONS

This database will be an excellent resource for researchers interested in studying the developmental, behavioral, and/or neural mechanisms supporting the perception and interpretation of eye gaze cues.

How accurate are autistic adults and those high in autistic traits at making face-to-face line-of-sight judgements?

LAY ABSTRACT

In order to effectively understand and consider what others are talking about, we sometimes need to follow their line-of-sight to the location at which they are looking, as this can provide important contextual information regarding what they are saying. If we are not able to follow other people's line-of-sight, this could result in social communication difficulties. Here we tested how effectively autistic and neurotypical adults are at following a social partner's line-of-sight during a face-to-face task. In a first study, completed by 14 autistic adult participants of average to above-average verbal ability and 14 neurotypical adult participants, we found that all participants were able to effectively follow the social partner's line-of-sight. We also found that participants tended to be as effective at making these judgements from both a brief, 1s, glance or a long, 5s, stare. However, autistic adults were less accurate, on average, than neurotypical adults overall. In a second study, a separate group of 65 neurotypical adults completed the same line-of-sight judgement task to investigate whether task performance was related to individual variation in self-reported autistic traits. This found that the amount of self-reported autistic traits was not at all related to people's ability to accurately make line-of-sight judgements. This research isolates and furthers our understanding of an important component part of the social communication process and assesses it in a real-world context.

Does decreased visual attention to faces underlie difficulties interpreting eye gaze cues in autism?

BACKGROUND

Shifts in eye gaze communicate social information that allows people to respond to another's behavior, interpret motivations driving behavior, and anticipate subsequent behavior. Understanding the social communicative nature of gaze shifts requires the ability to link eye movements and mental state information about objects in the world. Autism spectrum disorder (ASD) is characterized by atypical sensitivity to eye gaze cues, which impacts social communication and relationships. We evaluated whether reduced visual attention to faces explains this difficulty in ASD.

METHODS

We employed eye-tracking technology to measure visual attention to faces and gazed-at objects in a 4-alternative forced choice paradigm in adolescents with ASD and typically developing (TD) adolescents. Participants determined the target object that an actor was looking at in ecologically rich scenes. We controlled for group differences in task engagement and data quality.

RESULTS

In the Gaze Following task, adolescents with ASD were relatively impaired (Cohen's d = 0.63) in the ability to identify the target object. In contrast to predictions, both groups exhibited comparable fixation durations to faces and target objects. Among both groups, individuals who looked longer at the target objects, but not faces, performed better in the task. Finally, among the ASD group, parent SSIS-Social Skills ratings were positively associated with performance on the Gaze Following task. In the Gaze Perception task, there was a similar pattern of results, which provides internal replication of the findings that visual attention to faces is not related to difficulty interpreting eye gaze cues. Together, these findings indicate that adolescents with ASD are capable of following gaze, but have difficulty linking gaze shifts with mental state information.

LIMITATIONS

Additional work is necessary to determine whether these findings generalize to individuals across the full autism spectrum. New paradigms that manipulate component processes of eye gaze processing need to be tested to confirm these interpretations.

CONCLUSIONS

Reduced visual attention to faces does not appear to contribute to atypical processing of eye gaze cues among adolescents with ASD. Instead, the difficulty for individuals with ASD is related to understanding the social communicative aspects of eye gaze information, which may not be extracted from visual cues alone.

Learning of skilled movements via imitation in ASD

Autism spectrum disorder (ASD) consists of altered performance of a range of skills, including social/communicative and motor skills. It is unclear whether this altered performance results from atypical acquisition or learning of the skills or from atypical "online" performance of the skills. Atypicalities of skilled actions that require both motor and cognitive resources, such as abnormal gesturing, are highly prevalent in ASD and are easier to study in a laboratory context than are social/communicative skills. Imitation has long been known to be impaired in ASD; because learning via imitation is a prime method by which humans acquire skills, we tested the hypothesis that children with ASD show alterations in learning novel gestures via imitation. Eighteen participants with ASD and IQ > 80, ages 8-12.9 years, and 19 typically developing peers performed a task in which they watched a video of a model performing a novel, meaningless arm/hand gesture and copied the gesture. Each gesture video/copy sequence was repeated 4-6 times. Eight gestures were analyzed. Examination of learning trajectories revealed that while children with ASD made nearly as much progress in learning from repetition 1 to repetition 4, the shape of the learning curves differed. Causal modeling demonstrated the shape of the learning curve influenced both the performance of overlearned gestures and autism severity, suggesting that it is in the index of learning mechanisms relevant both to motor skills and to autism core features. Autism Res 2020, 13: 777-784.. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Imitation is a route by which humans learn a wide range of skills, naturally and in therapies. Imitation is known to be altered in autism spectrum disorder (ASD), but learning via imitation has not been rigorously examined. We found that the shape of the learning curve is altered in ASD, in a way that has a significant impact both on measures of autism severity and of other motor skills.

Developmental changes in attention to social information from childhood to adolescence in autism spectrum disorders: a comparative study

BACKGROUND

Elucidating developmental changes in the symptoms of autism spectrum disorder (ASD) is important to support individuals with ASD. However, no report has clarified the developmental changes in attention to social information for a broad age range. The aim of this study was to investigate the developmental changes in attention to social information from early childhood to adolescence in individuals with ASD and typically developed (TD) children.

METHODS

We recruited children with ASD (n = 83) and TD participants (n = 307) between 2 and 18 years of age. Using the all-in-one-eye-tracking system, Gazefinder, we measured the percentage fixation time allocated to areas of interest (AoIs) depicted in movies (the eyes and mouth in movies of a human face with/without mouth motion, upright and inverted biological motion in movies showing these stimuli simultaneously, people and geometry in preference paradigm movies showing these stimuli simultaneously, and objects with/without finger-pointing in a movie showing a woman pointing toward an object). We conducted a three-way analysis of variance, 2 (diagnosis: ASD and TD) by 2 (sex: male and female) by 3 (age group: 0-5, 6-11, and 12-18 years) and locally weighted the scatterplot smoothing (LOESS) regression curve on each AoI.

RESULTS

In the face stimuli, the percentage fixation time to the eye region for the TD group increased with age, whereas the one for the ASD group did not. In the ASD group, the LOESS curves of the gaze ratios at the eye region increased up to approximately 10 years of age and thereafter tended to decrease. For the percentage fixation time to the people region in the preference paradigm, the ASD group gazed more briefly at people than did the TD group.

LIMITATIONS

It is possible that due to the cross-sectional design, the degree of severity and of social interest might have differed according to the subjects' age.

CONCLUSIONS

There may be qualitative differences in abnormal eye contact in ASD between individuals in early childhood and those older than 10 years.

Initiation and response of joint attention bids in autism spectrum disorder children depend on the visibility of the target

BACKGROUND AND AIMS

Response to joint attention (RJA) and initiation of joint attention (IJA) are impaired in pre-schoolers with autism spectrum disorder (ASD). Children's response to joint attention may depend on the presence of the target in the child's field of vision or on the type of deictic index (head and eye orientation, pointing and verbalisations) used by the adult to initiate joint attention.

METHODS

This study deals with 50 ASD children aged from 2 years 8 months to 11 years 7 months, with a communicative level comparable to children under 31 months of age, according to the French version of the Early Social Communication Scales (ECSP, by its French acronym). We compared the aforementioned ASD children with 50 typically developing (TD) children, aged 9 to 30 months who had no communication disorders according to the ECSP. During the ECSP test, we analysed joint attention behaviours on three posters present or absent from the children's visual field.

RESULTS

We did not observe any difference in the number of IJAs between groups, but ASD children were less responsive than TD children were. Our results showed a developmental progression in the responses of children with ASD if several deictic cues were used by an adult simultaneously (looking and pointing, or looking and verbalising to indicate a target), whether the referent was present or absent from the child's visual field. In addition, we observed developmental progression when the referent was behind the child and the adult only used their gaze to refer to it.

CONCLUSION

Thus, we argue that the type of cues used affects ASD children's response behaviours during joint attention towards a referent that may be present or absent from their visual field.Implications: Regarding the social and the sensory difficulties of children with ASD, many therapeutic approaches focus their intervention methods on non-verbal communication skills and joint attention. This fundamental research makes it possible to identify the most appropriate type of deictic index for children with ASD with developmental delay, depending on the presence or absence of the referent in the child's visual field.

Joint Attention in Infancy and the Emergence of Autism

BACKGROUND

In typical infant development, parents and their children jointly contribute to establishing frequent episodes of joint attention that boost language acquisition and shape social cognition. Here we used novel live eye-tracking technology to evaluate the degree to which autism spectrum disorder (ASD) is related to reduced responding to others' joint attention bids in infancy (RJA) and to a reduced tendency to initiate joint attention episodes (IJA). Because young infants use their gaze for both RJA and IJA, this approach allowed us to quantify these elusive processes early in life.

METHODS

The final sample consisted of 112 infants (54 boys and 58 girls), of whom 81 were at familial risk for ASD and 31 were typically developing low-risk infants. At follow-up (36 months of age), 22 children in the high-risk group were diagnosed with ASD.

RESULTS

At 10 months of age, rates of IJA were lower in infants later diagnosed with ASD than in the comparison groups (effect sizes d = 0.78-0.95) and followed an atypical developmental trajectory from 10 to 18 months (p < .002). RJA distinguished infants based on familial ASD risk, albeit not ASD diagnosis. The differences in IJA could not be explained by overall looking time, social preference, eye movement latencies, or number of fixations.

CONCLUSIONS

This live eye-tracking study suggests that during an important period for the development of social cognition (10-18 months of age), infants later diagnosed with ASD show marked atypicalities in IJA but not in RJA. The results indicate that IJA is an important target for future prodromal intervention trials.

Visual Exploration of Dynamic or Static Joint Attention Bids in Children With Autism Syndrome Disorder

Eye-tracking studies have revealed a specific visual exploration style characterizing individuals with autism spectrum disorder (ASD). The aim of this study is to investigate the impact of stimulus type (static vs. dynamic) on visual exploration in children with ASD. Twenty-eight children with ASD, 28 children matched for developmental communication age, and 28 children matched for chronological age watched a video and a series of photos involving the same joint attention scene. For each stimulus, areas of interest (AOI) were determined based on Voronoi diagrams, which were defined around participants' fixation densities, defined by the mean shift algorithm. To analyze the eye-tracking data on visual exploration, we used a method for creating AOI a posteriori, based on participants' actual fixations. The results showed the value of both kinds of stimuli. The photos allowed for the identification of more precise AOI and showed similarities in exploration between ASD and typical children. On the other hand, video revealed that, among ASD children only, there are few differences in the way they look at the target depending on the deictic cue used. This raises questions regarding their understanding of a joint attention bid recorded on a video. Finally, whatever the stimulus, pointing seems to be the most important element for children looking at the target.

Referent selection in children with Autism Spectrum Condition and intellectual disabilities: Do social cues affect word-to-object or word-to-location mappings?

BACKGROUND

There is conflicting evidence regarding whether children with Autism Spectrum Condition (ASC) and intellectual disabilities (ID) follow social pragmatic cues such as a speaker's eye gaze or pointing towards a novel object to assist mapping a new word onto a new object (e.g. fast mapping).

AIMS

We test fast mapping from a speaker's gaze and pointing towards objects in children with ASC and ID with varying chronological and receptive language ages compared with receptive language matched groups of typically developing (TD) children.

METHODS AND PROCEDURE

Across eight trials, a speaker gazed and/or pointed towards one out of two objects while saying a new word. Pointing was either 'referential' (with intention), or 'incidental' (without obvious intention). To investigate whether children formed more robust word-to-object links rather than associative word-to-location ones, we reversed the original location of the objects in half of the test trials.

OUTCOMES AND RESULTS

Children with ASC were as successful as TD children using social cues to form word-to-object mappings. Surprisingly, children with ID did not fast map from referential pointing, or when objects changed location.

CONCLUSIONS AND IMPLICATIONS

Children with ID may use different processes to facilitate word learning compared to TD children and even children with ASC.

Interaction With Social Robots: Improving Gaze Toward Face but Not Necessarily Joint Attention in Children With Autism Spectrum Disorder

It is widely recognized that robot-based interventions for autism spectrum disorders (ASD) hold promise, but the question remains as to whether social humanoid robots could facilitate joint attention performance in children with ASD. In this study, responsive joint attention was measured under two conditions in which different agents, a human and a robot, initiated joint attention via video. The participants were 15 children with ASD (mean age: 4.96 ± 1.10 years) and 15 typically developing (TD) children (mean age: 4.53 ± 0.90 years). In addition to analyses of fixation time and gaze transitions, a longest common subsequence approach (LCS) was employed to compare participants' eye movements to a predefined logical reference sequence. The fixation of TD toward agent's face was earlier and longer than children with ASD. Moreover, TD showed a greater number of gaze transitions between agent's face and target, and higher LCS scores than children with ASD. Both groups showed more interests in the robot's face, but the robot induced a lower proportion of fixation time on the target. Meanwhile participants showed similar gaze transitions and LCS results in both conditions, suggesting that they could follow the logic of the joint attention task induced by the robot as well as human. We have discussed the implications for the effects and applications of social humanoid robots in joint attention interventions.

Applying Eye Tracking to Identify Autism Spectrum Disorder in Children

Eye tracking (ET) holds potential for the early detection of autism spectrum disorder (ASD). To overcome the difficulties of working with young children, developing a short and informative paradigm is crucial for ET. We investigated the fixation times of 37 ASD and 37 typically developing (TD) children ages 4-6 watching a 10-second video of a female speaking. ASD children showed significant reductions in fixation time at six areas of interest. Furthermore, discriminant analysis revealed fixation times at the mouth and body could significantly discriminate ASD from TD with a classification accuracy of 85.1%, sensitivity of 86.5%, and specificity of 83.8%. Our study suggests that a short video clip may provide enough information to distinguish ASD from TD children.

Improving sensitivity to eye gaze cues in autism using serious game technology: study protocol for a phase I randomised controlled trial

INTRODUCTION

Autism spectrum disorder (ASD) is characterised by impairments in social communication. Core symptoms are deficits in social looking behaviours, including limited visual attention to faces and sensitivity to eye gaze cues. We designed an intervention game using serious game mechanics for adolescents with ASD. It is designed to train individuals with ASD to discover that the eyes, and shifts in gaze specifically, provide information about the external world. We predict that the game will increase understanding of gaze cues and attention to faces.

METHODS AND ANALYSIS

The Social Games for Adolescents with Autism (SAGA) trial is a preliminary, randomised controlled trial comparing the intervention game with a waitlist control condition. 34 adolescents (10-18 years) with ASD with a Full-Scale IQ between 70 and 130 and a minimum second grade reading level, and their parents, will be randomly assigned (equally to intervention or the control condition) following baseline assessments. Intervention participants will be instructed to play the computer game at home on a computer for ~30 min, three times a week. All families are tested in the lab at baseline and approximately 2 months following randomisation in all measures. Primary outcomes are assessed with eye tracking to measure sensitivity to eye gaze cues and social visual attention to faces; secondary outcomes are assessed with questionnaires to measure social skills and autism-like behaviours. The analyses will focus on evaluating the feasibility, safety and preliminary effectiveness of the intervention.

ETHICS AND DISSEMINATION

SAGA is approved by the Institutional Review Board at Pennsylvania State University (00005097). Findings will be disseminated via scientific conferences and peer-reviewed journals and to participants via newsletter. The intervention game will be available to families in the control condition after the full data are collected and if analyses indicate that it is effective.

TRIAL REGISTRATION NUMBER

NCT02968225.

The Thorn in the Dyad: A Vision on Parent-Child Relationship in Autism Spectrum Disorder

Parents and children form a family: their characteristics balance personal and family well-being with healthy levels of stress. Research on parents of children with Autism Spectrum Disorder (ASD) demonstrated that higher levels of parental stress are associated with communication impairment, a core symptom of ASD. The aim of this article is to discuss the connection between non-verbal communication impairment and parental psychological distress, in families with children with ASD. The interaction between atypical communication and distress of parents likely determines a cascade effect on the parent-child dyad; in fact, it decreases the quality and frequency of interactions, preventing the establishment of a healthy parent-child relationship and leading to a series of collateral problems. To this perspective, guiding the parents to reframe their children’s atypical communicative behaviour can relieve parental stress and re-program the interactional routine. This observation stresses the importance of interventions centred on the dyad, especially during early development and soon after the diagnosis, when the communicative impairment may be extremely severe.

Heart Rate Variability During a Joint Attention Task in Toddlers With Autism Spectrum Disorders

Background: Autism Spectrum Disorders (ASD) are a heterogeneous group of neurodevelopmental disorders featuring early impairments in social domain, with autonomic nervous system (ANS) unbalance possibly representing a useful marker for such disturbances. Impairments in joint attention (JA) are one of the earliest markers of social deficits in ASD. In this study, we assessed the feasibility of using wearable technologies for characterizing the ANS response in ASD toddlers during the presentation of JA stimuli. Methods: Twenty ASD toddlers and 20 age- and gender-matched typically developed (TD) children were recorded at baseline and during a JA task through an unobtrusive chest strap for electrocardiography (ECG). Specific algorithms for feature extraction, including Heart Rate (HR), Standard Deviation of the Normal-to-Normal Intervals (SDNN), Coefficient of Variation (CV), pNN10 as well as low frequency (LF) and high frequency (HF), were applied to the ECG signal and a statistical comparison between the two groups was performed. Results: As regards the single phases, SDNN (p = 0.04) and CV (p = 0.021) were increased in ASD at baseline together with increased LF absolute power (p = 0.034). Moreover, CV remained higher in ASD during the task (p = 0.03). Considering the phase and group interaction, LF increased from baseline to task in TD group (p = 0.04) while it decreased in the ASD group (p = 0.04). Conclusions: The results of this study indicate the feasibility of characterizing the ANS response in ASD toddlers through a minimally obtrusive tool. Our analysis showed an increased SDNN and CV in toddlers with ASD particularly at baseline compared to TD and lower LF during the task. These findings could suggest the possibility of using the proposed approach for evaluating physiological correlates of JA response in young children with ASD.

Brief Report: Evaluation of an Intelligent Learning Environment for Young Children with Autism Spectrum Disorder

Researchers are increasingly attempting to develop and apply innovative technological platforms for early detection and intervention of autism spectrum disorder (ASD). This pilot study designed and evaluated a novel technologically-mediated intelligent learning environment with relevance to early social orienting skills. The environment was endowed with the capacity to administer social orienting cues and adaptively respond to autonomous real-time measurement of performance (i.e., non-contact gaze measurement). We evaluated the system with both toddlers with ASD (n = 8) as well as typically developing infants (n = 8). Children in both groups were able to ultimately respond accurately to social prompts delivered by the technological system. Results also indicated that the system was capable of attracting and pushing toward correct performance autonomously without user intervention.

An integrated EEG and eye-tracking approach for the study of responding and initiating joint attention in Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) are characterised by impairment in joint attention (JA), which has two components: the response to JA and the initiation of JA. Literature suggests a correlation between JA and neural circuitries, although this link is still largely unexplored in ASD. In this pilot study, we aimed at investigating the neural correlates of responding and initiating JA in high-functioning children with ASD and evaluating the changes in brain function and visual pattern after six months of rehabilitative treatment using an integrated EEG/eye-tracking system. Our results showed that initiating and responding JA subtend both overlapping (i.e. frontal and temporal) and specialized (i.e. parietal for responding JA and occipital for initiating JA) neural circuitries. In addition, in a subgroup of subjects, we observed trends of changes in both brain activity and connectivity after rehabilitative treatment in both the two tasks, which were correlated with modifications in gaze measures. These preliminary results, if confirmed in a larger sample, suggest the feasibility of using the proposed multimodal approach to characterise JA-related brain circuitries and visual pattern in ASD individuals and to monitor longitudinal changes in response to rehabilitative intervention.

Spatiotemporal characteristics of gaze of children with autism spectrum disorders while looking at classroom scenes

Children with autism spectrum disorders (ASD) who have neurodevelopmental impairments in social communication often refuse to go to school because of difficulties in learning in class. The exact cause of maladaptation to school in such children is unknown. We hypothesized that these children have difficulty in paying attention to objects at which teachers are pointing. We performed gaze behavior analysis of children with ASD to understand their difficulties in the classroom. The subjects were 26 children with ASD (19 boys and 7 girls; mean age, 8.6 years) and 27 age-matched children with typical development (TD) (14 boys and 13 girls; mean age, 8.2 years). We measured eye movements of the children while they performed free viewing of two movies depicting actual classes: a Japanese class in which a teacher pointed at cartoon characters and an arithmetic class in which the teacher pointed at geometric figures. In the analysis, we defined the regions of interest (ROIs) as the teacher's face and finger, the cartoon characters and geometric figures at which the teacher pointed, and the classroom wall that contained no objects. We then compared total gaze time for each ROI between the children with ASD and TD by two-way ANOVA. Children with ASD spent less gaze time on the cartoon characters pointed at by the teacher; they spent more gaze time on the wall in both classroom scenes. We could differentiate children with ASD from those with TD almost perfectly by the proportion of total gaze time that children with ASD spent looking at the wall. These results suggest that children with ASD do not follow the teacher's instructions in class and persist in gazing at inappropriate visual areas such as walls. Thus, they may have difficulties in understanding content in class, leading to maladaptation to school.

Looking at reality versus watching screens: Media professionalization effects on the spontaneous eyeblink rate

This article explores whether there are differences in visual perception of narrative between theatrical performances and screens, and whether media professionalization affects visual perception. We created a live theatrical stimulus and three audio-visual stimuli (each one with a different video editing style) having the same narrative, and displayed them randomly to participants (20 media professionals and 20 non-media professionals). For media professionals, watching movies on screens evoked a significantly lower spontaneous blink rate (SBR) than looking at theatrical performances. Media professionals presented a substantially lower SBR than non-media professionals when watching screens, and more surprisingly, also when seeing reality. According to our results, media professionals pay higher attention to both screens and the real world than do non-media professionals.

Sensing Technologies for Autism Spectrum Disorder Screening and Intervention

This paper reviews the state-of-the-art in sensing technologies that are relevant for Autism Spectrum Disorder (ASD) screening and therapy. This disorder is characterized by difficulties in social communication, social interactions, and repetitive behaviors. It is diagnosed during the first three years of life. Early and intensive interventions have been shown to improve the developmental trajectory of the affected children. The earlier the diagnosis, the sooner the intervention therapy can begin, thus, making early diagnosis an important research goal. Technological innovations have tremendous potential to assist with early diagnosis and improve intervention programs. The need for careful and methodological evaluation of such emerging technologies becomes important in order to assist not only the therapists and clinicians in their selection of suitable tools, but to also guide the developers of the technologies in improving hardware and software. In this paper, we survey the literatures on sensing technologies for ASD and we categorize them into eye trackers, movement trackers, electrodermal activity monitors, tactile sensors, vocal prosody and speech detectors, and sleep quality assessment devices. We assess their effectiveness and study their limitations. We also examine the challenges faced by this growing field that need to be addressed before these technologies can perform up to their theoretical potential.

Disentangling the initiation from the response in joint attention: an eye-tracking study in toddlers with autism spectrum disorders

Joint attention (JA), whose deficit is an early risk marker for autism spectrum disorder (ASD), has two dimensions: (1) responding to JA and (2) initiating JA. Eye-tracking technology has largely been used to investigate responding JA, but rarely to study initiating JA especially in young children with ASD. The aim of this study was to describe the differences in the visual patterns of toddlers with ASD and those with typical development (TD) during both responding JA and initiating JA tasks. Eye-tracking technology was used to monitor the gaze of 17 children with ASD and 15 age-matched children with TD during the presentation of short video sequences involving one responding JA and two initiating JA tasks (initiating JA-1 and initiating JA-2). Gaze accuracy, transitions and fixations were analyzed. No differences were found in the responding JA task between children with ASD and those with TD, whereas, in the initiating JA tasks, different patterns of fixation and transitions were shown between the groups. These results suggest that children with ASD and those with TD show different visual patterns when they are expected to initiate joint attention but not when they respond to joint attention. We hypothesized that differences in transitions and fixations are linked to ASD impairments in visual disengagement from face, in global scanning of the scene and in the ability to anticipate object's action.

Brief report: Lack of processing bias for the objects other people attend to in 3-year-olds with autism

Whether gaze following—a key component of joint attention—is impaired in children with autism spectrum disorder (ASD) is currently debated. Functional gaze following involves saccading towards the attended rather than unattended targets (accuracy) as well as a subsequent processing bias for attended objects. Using non-invasive eye tracking technology, we show that gaze following accuracy is intact in intellectually low-functioning 3-year-olds with ASD. However, analyses of the duration of first fixations at the objects in the scene revealed markedly weaker initial processing bias for attended objects in children with ASD compared to children with typical development and non-autistic children with developmental delays. Limited processing bias for the objects other people attend to may negatively affect learning opportunities in ASD.

Intact Reflexive but Deficient Voluntary Social Orienting in Autism Spectrum Disorder

Impairment in social interactions is a primary characteristic of people diagnosed with autism spectrum disorder (ASD). Although these individuals tend to orient less to naturalistic social cues than do typically developing (TD) individuals, laboratory experiments testing social orienting in ASD have been inconclusive, possibly because of a failure to fully isolate reflexive (stimulus-driven) and voluntary (goal-directed) social orienting processes. The purpose of the present study was to separately examine potential reflexive and/or voluntary social orienting differences in individuals with ASD relative to TD controls. Subjects (ages 7–14) with high-functioning ASD and a matched control group completed three gaze cueing tasks on an iPad in which individuals briefly saw a face with averted gaze followed by a target after a variable delay. Two tasks were 100% predictive with either all congruent (target appears in gaze direction) or all incongruent (target appears opposite from gaze direction) trials, respectively. Another task was non-predictive with these same trials (half congruent and half incongruent) intermixed randomly. Response times (RTs) to the target were used to calculate reflexive (incongruent condition RT—congruent condition RT) and voluntary (non-predictive condition RT—predictive condition RT) gaze cueing effects. Subjects also completed two additional non-social orienting tasks (ProPoint and AntiPoint). Subjects with ASD demonstrate intact reflexive but deficient voluntary gaze following. Similar results were found in a separate test of non-social orienting. This suggests problems with using social cues, but only in a goal-directed fashion, in our sample of high-functioning individuals with ASD. Such findings may not only explain inconclusive previous findings but more importantly be critical for understanding social dysfunctions in ASD and for developing future interventions.

Exploring associations between gaze patterns and putative human mirror neuron system activity

The human mirror neuron system (MNS) is hypothesized to be crucial to social cognition. Given that key MNS-input regions such as the superior temporal sulcus are involved in biological motion processing, and mirror neuron activity in monkeys has been shown to vary with visual attention, aberrant MNS function may be partly attributable to atypical visual input. To examine the relationship between gaze pattern and interpersonal motor resonance (IMR; an index of putative MNS activity), healthy right-handed participants aged 18–40 (n = 26) viewed videos of transitive grasping actions or static hands, whilst the left primary motor cortex received transcranial magnetic stimulation. Motor-evoked potentials recorded in contralateral hand muscles were used to determine IMR. Participants also underwent eyetracking analysis to assess gaze patterns whilst viewing the same videos. No relationship was observed between predictive gaze and IMR. However, IMR was positively associated with fixation counts in areas of biological motion in the videos, and negatively associated with object areas. These findings are discussed with reference to visual influences on the MNS, and the possibility that MNS atypicalities might be influenced by visual processes such as aberrant gaze pattern.

"Put Myself Into Your Place": Embodied Simulation and Perspective Taking in Autism Spectrum Disorders

Embodied cognition theories hold that cognitive processes are grounded in bodily states. Embodied processes in autism spectrum disorders (ASD) have classically been investigated in studies on imitation. Several observations suggested that unlike typical individuals who are able of copying the model's actions from the model's position, individuals with ASD tend to reenact the model's actions from their own egocentric perspective. Here, we performed two behavioral experiments to directly test the ability of ASD individuals to adopt another person's point of view. In Experiment 1, participants had to explicitly judge the left/right location of a target object in a scene from their own or the actor's point of view (visual perspective taking task). In Experiment 2, participants had to perform left/right judgments on front-facing or back-facing human body images (own body transformation task). Both tasks can be solved by mentally simulating one's own body motion to imagine oneself transforming into the position of another person (embodied simulation strategy), or by resorting to visual/spatial processes, such as mental object rotation (nonembodied strategy). Results of both experiments showed that individual with ASD solved the tasks mainly relying on a nonembodied strategy, whereas typical controls adopted an embodied strategy. Moreover, in the visual perspective taking task ASD participants had more difficulties than controls in inhibiting other-perspective when directed to keep one's own point of view. These findings suggested that, in social cognitive tasks, individuals with ASD do not resort to embodied simulation and have difficulties in cognitive control over self- and other-perspective.

Visualization and analysis of eye movement data from children with typical and atypical development

Looking at other children’s interactions provides rich learning opportunities for a small child. How children with autism look at other children is largely unknown. Using eye tracking, we studied gaze performance in children with autism and neurotypical comparison children while they were watching videos of semi-naturalistic social interactions between young children. Using a novel, bottom-up approach we identified event-related measures that distinguished between groups with high accuracy. The observed effects remained in a subset of the total sample matched on IQ, and were replicated across several different stimuli. The described method facilitates the detection of meaningful patterns in complex eye tracking data. Also, the approach significantly improves visualization, which will help investigators understand, illustrate, and generate new hypotheses.