Facetime vs. Screentime: Gaze Patterns to Live and Video Social Stimuli in Adolescents with ASD

Does gaze anxiety predict actual gaze avoidance and is it more informative than social anxiety?

BACKGROUND AND OBJECTIVES

In recent years eye-tracking studies have provided converging evidence that socially anxious individuals avoid looking at other people's faces in social situations. In addition to these objective measures, the Gaze Anxiety Rating Scale (GARS) has increasingly been used as a self-report measure of gaze avoidance. However, extant results concerning its predictive validity were inconsistent. Moreover, no study has considered social anxiety and gaze anxiety together to examine their relative contributions to actual gaze behavior.

METHODS

To address these two questions, eye-tracking data collected from 81 female students during the initial 6 min of a face-to-face conversation with a female confederate were analyzed. Gaze anxiety and social anxiety were measured via the GARS and the Leibowitz Social Anxiety Scale.

RESULTS

The results revealed that gaze anxiety was associated with reduced face gaze while speaking. Social anxiety was not only associated with decreased face gaze during speaking, but also across the initial conversation. Moreover, there was no evidence that gaze anxiety made an additional contribution to social anxiety in predicting face gaze behavior.

LIMITATIONS

This study examined face gaze instead of eye gaze. Additionally, the self-report data were not collected on the same day as the eye-tracking data.

CONCLUSIONS

The findings indicate that, in a community sample, gaze anxiety does predict actual gaze behavior during a face-to-face initial encounter, but social anxiety is a stronger predictor.

Social attention patterns of autistic and non-autistic adults when viewing real versus reel people

LAY ABSTRACT

Early research shows that autistic adults do not attend to faces as much as non-autistic adults. However, some recent studies where autistic people are placed in scenarios with real people reveal that they attend to faces as much as non-autistic people. This study compares attention to faces in two situations. In one, autistic and non-autistic adults watched a pre-recorded video. In the other, they watched what they thought were two people in a room in the same building, via a life webcam, when in fact exactly the same video in two situations. We report the results of 32 autistic adults and 33 non-autistic adults. The results showed that autistic adults do not differ in any way from non-autistic adults when they watched what they believed was people interacting in real time. However, when they thought they were watching a video, non-autistic participants showed higher levels of attention to faces than non-autistic participants. We conclude that attention to social stimuli is the result of a combination of two processes. One innate, which seems to be different in autism, and one that is influenced by social norms, which works in the same way in autistic adults without learning disabilities. The results suggest that social attention is not as different in autism as first thought. Specifically, the study contributes to dispel long-standing deficit models regarding social attention in autism as it points to subtle differences in the use of social norms rather than impairments.

Neurotypical, but not autistic, adults might experience distress when looking at someone avoiding eye contact: A live face-to-face paradigm

LAY ABSTRACT

What is already known about the topic?Autistics are usually reported to share less eye contact than neurotypicals with their interlocutors. However, the reason why autistics might pay less attention to eyes looking at them is still unknown: some autistics express being hyper-aroused by this eye contact, while some eye-tracking studies suggest that eye contact is associated with hypo-arousal in autism.What this paper adds?This study is based on a highly controlled live face-to-face paradigm, combining a wearable eye-tracker (to study eye behaviours) with electrodermal activity sensors (to assess potential stress). We draw a nuanced picture of social attention in autism, as our autistic participants did not differ from our neurotypical group in their eye behaviours nor their skin conductance responses. However, we found that neurotypicals, compared to autistics, seemed to be much more distressed when their interlocutor did not gaze at them during the experiment.Implications for practice, research or policy:Our study encourages to consider social interaction difficulties in autism as a relational issue, instead as an individual deficit. This step might be first taken in research, by implementing paradigms sensitive to the experimenter's role and attitude.

I see you, you see me: the impact of social presence on social interaction processes in autistic and non-autistic people

Environments that require social interaction are complex, challenging and sometimes experienced as overwhelming by autistic people. However, all too often theories relating to social interaction processes are created, and interventions are proposed, on the basis of data collected from studies that do not involve genuine social encounters nor do they consider the perception of social presence to be a potentially influential factor. In this review, we begin by considering why face-to-face interaction research is important in this field. We then discuss how the perception of social agency and social presence can influence conclusions about social interaction processes. We then outline some insights gained from face-to-face interaction research conducted with both autistic and non-autistic people. We finish by considering the impact of social presence on cognitive processes more broadly, including theory of mind. Overall, we demonstrate that choice of stimuli in studies assessing social interaction processes has the potential to substantially alter conclusions drawn. Ecological validity matters and social presence, in particular, is a critical factor that fundamentally impacts social interaction processes in both autistic and non-autistic people. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

Identifying phenotypic and physiological subgroups of preschoolers with autism spectrum disorder

BACKGROUND

To understand the emergence of symptoms in autism spectrum disorder (ASD), we need to identify the mechanisms that underpin the development of core social skills. Mounting evidence indicates that young children with later ASD attend less to other people, which could compromise learning opportunities with cascading effects. Passive looking behaviour does not tell us about engagement with visual information, but measures of physiological arousal can provide information on the depth of engagement. In the current study, we use heart rate (HR) and heart rate variability (HRV) to measure engagement with social dynamic stimuli in ASD.

METHODS

Sixty-seven preschoolers with ASD and 65 typical developing preschoolers between 2 and 4 years of age participated in a study where HR was measured during viewing of social and non-social videos. Using latent profile analyses, more homogeneous subgroups of children were created based on phenotype and physiology.

RESULTS

Preschool-aged children with ASD, regardless of their non-verbal, verbal and social competencies, do not differ in overall HR or HRV compared to TD children. However, the ASD group showed a larger increase in HR (more disengagement) than the TD group to later-presented social stimuli. Phenotypic and physiological profiles showed this was primarily the case for children with below average verbal and non-verbal skills, but not necessarily those with more ASD symptoms.

CONCLUSION

Children with ASD, especially a subgroup showing moderate cognitive delays, show an increase in HR to social stimuli over time; this may reflect difficulties re-engaging with social information when attention is waning.

People's dispositional cooperative tendencies towards robots are unaffected by robots' negative emotional displays in prisoner's dilemma games

The study explores the impact of robots' emotional displays on people's tendency to cooperate with a robot opponent in prisoner's dilemma games. Participants played iterated prisoner's dilemma games with a non-expressive robot (as a measure of cooperative baseline), followed by an angry, and a sad robot, in turn. Based on the Emotion as Social Information model, we expected participants with higher cooperative predispositions to cooperate less when a robot displayed anger, and cooperate more when the robot displayed sadness. Contrarily, according to this model, participants with lower cooperative predispositions should cooperate more with an angry robot and less with a sad robot. The results of 60 participants failed to support the predictions. Only the participants' cooperative predispositions significantly predicted their cooperative tendencies during gameplay. Participants who cooperated more in the baseline measure also cooperated more with the robots displaying sadness and anger. In exploratory analyses, we found that participants who accurately recognised the robots' sad and angry displays tended to cooperate less with them overall. The study highlights the impact of personal factors in human-robot cooperation, and how these factors might surpass the influence of bottom-up emotional displays by the robots in the present experimental scenario.

How to choose the size of facial areas of interest in interactive eye tracking

Advances in eye tracking technology have enabled the development of interactive experimental setups to study social attention. Since these setups differ substantially from the eye tracker manufacturer's test conditions, validation is essential with regard to the quality of gaze data and other factors potentially threatening the validity of this signal. In this study, we evaluated the impact of accuracy and areas of interest (AOIs) size on the classification of simulated gaze (fixation) data. We defined AOIs of different sizes using the Limited-Radius Voronoi-Tessellation (LRVT) method, and simulated gaze data for facial target points with varying accuracy. As hypothesized, we found that accuracy and AOI size had strong effects on gaze classification. In addition, these effects were not independent and differed in falsely classified gaze inside AOIs (Type I errors; false alarms) and falsely classified gaze outside the predefined AOIs (Type II errors; misses). Our results indicate that smaller AOIs generally minimize false classifications as long as accuracy is good enough. For studies with lower accuracy, Type II errors can still be compensated to some extent by using larger AOIs, but at the cost of more probable Type I errors. Proper estimation of accuracy is therefore essential for making informed decisions regarding the size of AOIs in eye tracking research.

Mechanisms by which Early Eye Gaze to the Mouth During Multisensory Speech Influences Expressive Communication Development in Infant Siblings of Children with and without Autism

Looking to the mouth of a talker early in life predicts expressive communication. We hypothesized that looking at a talker's mouth may signal that infants are ready for increased supported joint engagement and that it subsequently facilitates prelinguistic vocal development and translates to broader gains in expressive communication. We tested this hypothesis in 50 infants aged 6-18 months with heightened and general population-level likelihood of autism diagnosis (Sibs-autism and Sibs-NA; respectively). We measured infants' gaze to a speaker's face using an eye tracking task, supported joint engagement during parent-child free play sessions, vocal complexity during a communication sample, and broader expressive communication. Looking at the mouth was indirectly associated with expressive communication via increased higher-order supported joint engagement and vocal complexity. This indirect effect did not vary according to sibling status. This study provides preliminary insights into the mechanisms by which looking at the mouth may influence expressive communication development.

Attention to live eye contact in adolescents with autism spectrum disorder

A number of studies have reported diminished attention to the eyes in individuals with autism spectrum disorder (ASD). These studies predominantly used static images of faces as stimuli. Recent studies, however, have shown enhanced response to eye contact in typically developing (TD) individuals when they observe a person in a live interaction. We investigated physiological orienting to perceived eye contact in adolescents with ASD and TD adolescents when they observed a person in live interaction or viewed a photograph of the same person's face. We measured heart rate (HR) deceleration as an index of attentional orienting. Adolescents with ASD, as well as TD adolescents, showed significant HR deceleration for the direct gaze compared to an averted gaze in the live condition, but not in the photographic condition. The results suggest an intact response to perceived eye contact in individuals with ASD during a live face-to-face interaction. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) have a different eye gaze pattern when observing photographic faces. However, little is known about how individuals with ASD process a real person's face. We measured heart rate (HR) and found that adolescents with ASD showed the typical decline in HR when they made eye contact with a real person, which suggests that both groups of individuals directed their attention to eye contact in a live face-to-face interaction.

Mobile Eye Tracking Captures Changes in Attention Over Time During a Naturalistic Threat Paradigm in Behaviorally Inhibited Children

Attentional biases to and away from threat are considered hallmarks of temperamental Behavioral Inhibition (BI), which is a documented risk factor for social anxiety disorder. However, most research on affective attentional biases has traditionally been constrained to computer screens, where stimuli often lack ecological validity. Moreover, prior research predominantly focuses on momentary presentations of stimuli, rather than examining how attention may change over the course of prolonged exposure to salient people and objects. Here, in a sample of children oversampled for BI, we used mobile eye-tracking to examine attention to an experimenter wearing a "scary" or novel gorilla mask, as well as attention to the experimenter after mask removal as a recovery from exposure. Conditional growth curve modeling was used to examine how level of BI related to attentional trajectories over the course of the exposure. We found a main effect of BI in the initial exposure to the mask, with a positive association between level of BI and proportion of gaze allocated to the stranger's masked face over time. Additionally, there was a main effect of BI on proportion of gaze allocated to the stranger's face plus their mask during the recovery period when the mask was removed.

Profiles of Naturalistic Attentional Trajectories Associated with Internalizing Behaviors in School-Age Children: A Mobile Eye Tracking Study

The temperament profile Behavioral Inhibition (BI) is a strong predictor of internalizing behaviors in childhood. Patterns of attention towards or away from threat are a commonality of both BI and internalizing behaviors. Attention biases are traditionally measured with computer tasks presenting affective stimuli, which can lack ecological validity. Recent studies suggest that naturalistic visual attention need not mirror findings from computer tasks, and, more specifically, children high in BI may attend less to threats in naturalistic tasks. Here, we characterized latent trajectories of naturalistic visual attention over time to a female stranger, measured with mobile eye tracking, among kindergarteners oversampled for BI. Group-based trajectory modeling (GBTM) revealed two latent trajectories: 1) high initial orienting to the stranger, gradual decay, and recovery, and 2) low initial orienting and continued avoidance. Higher probability of membership to the "avoidant" group was linked to greater report of internalizing behaviors. We demonstrate the efficacy of mobile eye tracking in quantifying naturalistic patterns of visual attention to social novelty, as well as the importance of naturalistic measures of attention in characterizing socioemotional risk factors.

Context Modulates Attention to Faces in Dynamic Social Scenes in Children and Adults with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) have been found to view social scenes differently compared to typically developing (TD) peers, but results can vary depending on context and age. We used eye-tracking in children and adults (age 6-63) to assess allocation of visual attention in a dynamic social orientation paradigm previously used only in younger children. The ASD group (n = 94) looked less at the actor's face compared to TD (n = 38) when they were engaged in activity (mean percentage of looking time, ASD = 30.7% vs TD = 34.9%; Cohen's d = 0.56; p value < 0.03) or looking at a moving toy (24.5% vs 33.2%; d = 0.65; p value < 0.001). Findings indicate that there are qualitative differences in allocation of visual attention to social stimuli across ages in ASD.ClinicalTrials.gov identifier: NCT02668991.

Cracking the Code of Live Human Social Interactions in Autism: A Review of the Eye-Tracking Literature

Human social interaction involves a complex, dynamic exchange of verbal and non-verbal information. Over the last decade, eye-tracking technology has afforded unique insight into the way eye gaze information, including both holding gaze and shifting gaze, organizes live human interactions. For example, while playing a social game together, speakers end their turn by directing gaze at the listener, who begins to speak with averted gaze (Ho et al., 2015). These findings reflect how eye gaze can be used to signal important turn-taking transitions in social interactions. Deficits in conversational turn-taking is a core feature of autism spectrum disorders. Individuals on the autism spectrum also have notable difficulties processing eye gaze information (Griffin & Scherf, 2020). A central hypothesis in the literature is that the difficulties in processing eye gaze information are foundational to the social communication deficits that make social interactions so challenging for individuals on the autism spectrum. Although eye-tracking technology has been used extensively to assess the way individuals on the spectrum attend to stimuli presented on computer screens (for review see Papagiannopoulou et al., 2014), it has rarely been used to evaluate the critical question regarding whether and how autistic individuals process non-verbal social cues from their partners during live social interactions. Here, we review this emerging literature with a focus on characterizing the experimental paradigms and eye-tracking procedures to understand the scope (and limitations) of research questions and findings. We discuss the theoretical implications of the findings from this review and provide recommendations for future work that will be essential to understand whether and how fundamental difficulties in perceiving and processing information about eye gaze cues interfere with social communication skills in autism.

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 Effects of Storytelling With or Without Social Contextual Information Regarding Eye Gaze and Visual Attention in Children with Autistic Spectrum Disorder and Typical Development: A Randomized, Controlled Eye-Tracking Study

This study examined the effects of storytelling with or without contextual information on children with autism spectrum disorder (ASD) and typical development (TD) using eye-tracker. They were randomized into two groups-the stories included and did not include social contextual information respectively. Training was delivered in groups, with eight sessions across four weeks, 30 min/session. Participants' fixation duration, visit duration, and fixation count on human faces from 20 photos and a video were recorded. Our findings revealed that storytelling with social contextual information enhanced participants' eye gazes on eyes/ faces in static information (photos) for both children with ASD and TD, but the same advantage could not be seen for children with ASD in regard to dynamic information (videos).Clinical Trial Registration Number (URL: http://www.clinicaltrials.gov ): NCT04587557.

Alexithymia explains atypical spatiotemporal dynamics of eye gaze in autism

Recognition of emotional facial expressions is considered to be atypical in autism. This difficulty is thought to be due to the way that facial expressions are visually explored. Evidence for atypical visual exploration of emotional faces in autism is, however, equivocal. We propose that, where observed, atypical visual exploration of emotional facial expressions is due to alexithymia, a distinct but frequently co-occurring condition. In this eye-tracking study we tested the alexithymia hypothesis using a number of recent methodological advances to study eye gaze during several emotion processing tasks (emotion recognition, intensity judgements, free gaze), in 25 adults with, and 45 without, autism. A multilevel polynomial modelling strategy was used to describe the spatiotemporal dynamics of eye gaze to emotional facial expressions. Converging evidence from traditional and novel analysis methods revealed that atypical gaze to the eyes is best predicted by alexithymia in both autistic and non-autistic individuals. Information theoretic analyses also revealed differential effects of task on gaze patterns as a function of alexithymia, but not autism. These findings highlight factors underlying atypical emotion processing in autistic individuals, with wide-ranging implications for emotion research.

Comparing Frequency of Listener Responses Between Adolescents with and Without ASD During Conversation

In conversation, the listener plays an active role in conversation success, specifically by providing listener feedback which signals comprehension and interest. Previous work has shown that frequency of feedback positively correlates with conversation success. Because individuals with ASD are known to struggle with various conversational skills, e.g., turn-taking and commenting, this study examines their use of listener feedback by comparing the frequency of feedback produced by 20 adolescents with ASD and 23 neurotypical (NT) adolescents. We coded verbal and nonverbal listener feedback during the time when participants were listening in a semi-structured interview with a research assistant. Results show that ASD participants produced significantly fewer instances of listener feedback than NT adolescents, which likely contributes to difficulties with social interactions.

Social attention: What is it, how can we measure it, and what can it tell us about autism and ADHD?

Neurodevelopmental disorders like autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) affect 2-10% of children worldwide but are still poorly understood. Prospective studies of infants with an elevated familial likelihood of ASD or ADHD can provide insight into early mechanisms that canalize development down a typical or atypical course. Such work holds potential for earlier identification and intervention to support optimal outcomes in individuals with neurodevelopmental disorders. Disrupted attention may be involved in developmental trajectories to ASD and ADHD. Specifically, altered attention to social stimuli has been suggested as a possible endophenotype of ASD, lying between genetic factors impacting brain development and later symptoms. Similarly, changes in domain-general aspects of attention are commonly seen in ADHD and emerging evidence suggests these may begin in infancy. Could these patterns point to a common risk factor for both disorders? Or does social attention reflect the activity of a particular network of brain systems that is distinct to those underpinning general attention skills? One challenge to addressing such questions is our lack of understanding of the relation between social and general attention. In this chapter we review evidence from infants with later ASD and ADHD that illuminates this question.

Comorbidity Matters: Social Visual Attention in a Comparative Study of Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Their Comorbidity

Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) represent two common neurodevelopmental disorders with considerable co-occurrence. Their comorbidity (ASD + ADHD) has been included in the latest diagnostic guidelines (DSM-V, 2013). The present study focuses on social visual attention that i) is a main aspect of social attention reflecting social cognition and ii) its atypicalities have been suggested as a potential biomarker for ASD. Considering the possible shared background of both disorders and their comorbidity, it is important to compare such traits directly. Here, 73 children and adolescents paired for age and IQ diagnosed with ASD (N = 12), ADHD (N = 21), comorbid ASD + ADHD (N = 15), and "typically developing" (TD) controls (N = 25), were shown static real-life social scenes while their gaze movements were recorded with eye-tracking. Scenes with two levels of social complexity were presented: low complexity (one person depicted) and high (four interacting individuals). Gaze fixation variables were investigated. Fixation duration on faces was significantly reduced only in ASD + ADHD which also required longer time to fixate all faces at least once. Fixation duration on faces in ASD was reduced, compared to TD, only when looking at scenes with high versus low social complexity. ADHD individuals did not differ from TD. Concluding, the observed alterations of social visual attention support the existence of possible dysfunctional particularities differentiating ASD, ADHD, and ASD + ADHD, which can be revealed with the new method of eye-tracking technique. The objective gaze measurements provided contribute to the development of biomarkers enabling early diagnosis, amelioration of care and further interventions specified for each group.

Social and Object Attention Is Influenced by Biological Sex and Toy Gender-Congruence in Children With and Without Autism

Emerging research suggests social attention in autism spectrum disorder (ASD) girls is enhanced relative to ASD boys but may also be affected by the type of social and nonsocial content presented. This study examined how biological sex and gender norms interact to influence visual attention in 79 school-aged children observing scenes that included gender-associated toys and actors of both sexes. Attention to social (faces) and object activity (hands with toys) stimuli was measured. Previously described distinctions between social attention in ASD boys and girls were replicated, with ASD girls looking more at faces than ASD boys. Irrespective of diagnosis, males and females attended more to actors that shared their same sex, and attended more to toys with gender-associations that were consistent with their own sex, suggesting that social and object salience increases for children under sex-consistent conditions. Importantly, ASD and typically developing (TD) children increased their gaze to faces when male actors were shown playing with female-associated toys, suggesting that both groups of children are sensitive to societal messages about the acceptability of males playing with female-associated toys. Our findings provide further evidence of heightened attention to faces in ASD girls relative to ASD boys, and indicate that social attention in ASD and TD children is influenced by who (male or female actor) and what (male- or female-associated toy) is being observed. Collectively, these results present a nuanced profile of attention in ASD that adds to a growing body of research indicating subtle phenotypic differences in ASD girls that may impact identification, assessment, and intervention. Autism Res 2020, 13: 763-776.. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Sex differences observed in typical development may also be present in individuals with autism. In this study, we developed an eye-tracking paradigm featuring videos of boys and girls playing with toys that varied in their gender associations. Attention to faces differed between autistic and non-autistic children but was also influenced by the sex of the actor and gender-association of toys. Autistic females demonstrated subtle attention differences that distinguished them from autistic males and may influence referral, diagnosis, and intervention.