Individual Differences in Newborn Visual Attention Associate with Temperament and Behavioral Difficulties in Later Childhood

Sustained looking at faces at 5 months of age is associated with socio-communicative skills in the second year of life

Efficiently processing information from faces in infancy is foundational for nonverbal communication. We studied individual differences in 5-month-old infants' (N = 517) sustained attention to faces and preference for emotional faces. We assessed the contribution of genetic and environmental influences to individual differences in these gaze behaviors, and the association between these traits and other concurrent and later phenotypes. We found an association between the mean duration of looking at a face (before looking away from it) at 5 months and socio-communicative abilities at 14 months (β = 0.17, 95% CI: 0.08; 0.26, p < 0.001). Sustained attention to faces predicted socio-communicative abilities over and above variance captured by mean fixation duration. We also found a statistically significant but weak tendency to prefer looking at smiling faces (relative to neutral faces), but no indication that variability in this behavior was explained by genetic effects. Moderate heritability was found for sustained attention to faces (A = 0.23, CI: 0.06; 0.38), while shared environmental influences were non-significant for both phenotypes. These findings suggest that sustained looking at individual faces before looking away is a developmentally significant 'social attention' phenotype in infancy, characterized by moderate heritability and a specific relation to later socio-communicative abilities.

Infant visual preference for the mother's face and longitudinal associations with emotional reactivity in the first year of life

Past research has focused on infants' visual preference for the mother's face, however it is still unknown how these responses change over time and what factors associate with such changes. A longitudinal study (N ~ 60) was conducted to investigate the trajectories of infant visual preference for the mother's face and how these are related to the development of emotional reactivity in the first year of life. Two face stimuli (i.e., the infant's mother and a consistent stranger face) were used in a visual preference task at 2 weeks, 4, 6, and 9 months of age. At each time point, mothers were asked to complete a measure of infant temperament via standardised questionnaires. Our results show that while at 2 weeks, 4 months and 9 months of age infants looked equally at both faces, infants at 6 months looked significantly longer at their mother's face. We also observed prospective associations with emotional reactivity variables so that infants who looked longer at the mother's face at 6 months showed higher falling reactivity, i.e. a better ability to recover from distress, at 9 months. We discuss these findings in light of the roles that both infant development and the caregiver play in emerging emotion regulation capacities during the first year of life.

Predicting Effortful Control at 3 Years of Age from Measures of Attention and Home Environment in Infancy: A Machine Learning Approach

Effortful control (EC) is a dimension of temperament that encompass individual differences in self-regulation and the control of reactivity. Much research suggests that EC has a strong foundation on the development of executive attention, but increasing evidence also shows a significant contribution of the rearing environment to individual differences in EC. The aim of the current study was to predict the development of EC at 36 months of age from early attentional and environmental measures taken in infancy using a machine learning approach. A sample of 78 infants participated in a longitudinal study running three waves of data collection at 6, 9, and 36 months of age. Attentional tasks were administered at 6 months of age, with two additional measures (i.e., one attentional measure and another self-restraint measure) being collected at 9 months of age. Parents reported household environment variables during wave 1, and their child's EC at 36 months. A machine-learning algorithm was implemented to identify children with low EC scores at 36 months of age. An "attention only" model showed greater predictive sensitivity than the "environmental only" model. However, a model including both attentional and environmental variables was able to classify the groups (Low-EC vs. Average-to-High EC) with 100% accuracy. Sensitivity analyses indicate that socio-economic variables together with attention control processes at 6 months, and self-restraint capacity at 9 months, are the most important predictors of EC. Results suggest a foundational role of executive attention processes in the development of EC in complex interactions with household environments and provide a new tool to identify early markers of socio-emotional regulation development.

Development of visual attention control in early childhood: Associations with temperament and home environment

Endogenous visual attention orienting is early available from infancy. It shows a steady development during the preschool period towards monitoring and managing executive attention to optimize the interplay between environmental contingencies and internal goals. The current study aims at understanding this transition from basic forms of endogenous control of visual orienting towards the engagement of executive attention, as well as their association with individual differences in temperament and home environment. A total of 150 children between 2 and 4 years of age were evaluated in a Visual Sequence Learning task, measuring visual anticipations in easy (context-free) and complex (context-dependent) stimuli transitions. Results showed age to be a predictor of a reduction in exogenous attention, as well as increased abilities to attempt to anticipate and to correctly anticipate in complex transitions. Home chaos predicted more complex correct anticipations, suggesting that the exposure to more unpredictable environments could benefit learning in context-dependent settings. Finally, temperamental surgency was found to be positively related to sustained attention in the task. Results are informative of age differences in visual attention control during toddlerhood and early childhood, and their association with temperament and home environment.

The role of infant attention and parental sensitivity in infant cognitive development in the Netherlands and China

Infant attention and parental sensitivity are important predictors of later child executive function (EF). However, most studies have investigated infant and parent factors in relation to child EF separately and included only mothers from Western samples. The current study examined whether both infant attention at 4 months and parental sensitivity at 4 and 14 months were related to infant EF (i.e., inhibition, working memory, and cognitive flexibility) at 14 months among 124 Dutch and 63 Chinese first-time mothers and fathers and their infants. Findings revealed that parental sensitivity at 4 months was not correlated with infant EF abilities at 14 months. However, infant attention at 4 months was significantly related to 14-month working memory, but not to inhibition and cognitive flexibility. Maternal sensitivity at 14 months was significantly related to 14-month inhibition, but not to working memory and cognitive flexibility). No country differences were found in the relation among 4-month infant attention, parental sensitivity, and EF outcomes. Results show that both infant and parent factors are associated with early EF development and that these correlates of early EF skills may be similar in Western and non-Western samples.

Infant Attentional behaviors Are Associated With ADHD Symptomatology and Executive Function in Early Childhood

Objective: We explored associations between infant attentional behaviors as measured by the First Year Inventory (FYIv2.0) and dimensional ratings of ADHD symptomatology and executive function (EF) in early childhood. Methods: This study included parents (N = 229) who filled out the FYIv2.0 when their children were 12 months of age. When children were approximately 54 months (4.5 years) of age, parents completed reports of children's ADHD symptomatology and EF abilities. Correlation and regression analyses were conducted among measures. Results: We found significant associations among the variables of interest, both cross-sectionally and longitudinally, as well as gender differences. Notably, non-social sensory attention (NSA) was significantly related to 54-month ADHD symptom severity. All three 12-month attention variables were significantly related to 54-month EF. Conclusion: Results suggest that infant attentional behaviors predict later ADHD-related behaviors in early childhood. Future research should explore associations using laboratory-based measures and could inform early intervention efforts.

Competing Perceptual Salience in a Visual Word Recognition Task Differentially Affects Children With and Without Autism Spectrum Disorder

Differences in visual attention have long been recognized as a central characteristic of autism spectrum disorder (ASD). Regardless of social content, children with ASD show a strong preference for perceptual salience-how interesting (i.e., striking) certain stimuli are, based on their visual properties (e.g., color, geometric patterning). However, we do not know the extent to which attentional allocation preferences for perceptual salience persist when they compete with top-down, linguistic information. This study examined the impact of competing perceptual salience on visual word recognition in 17 children with ASD (mean age 31 months) and 17 children with typical development (mean age 20 months) matched on receptive language skills. A word recognition task presented two images on a screen, one of which was named (e.g., Find the bowl!). On Neutral trials, both images had high salience (i.e., were colorful and had geometric patterning). On Competing trials, the distracter image had high salience but the target image had low salience, creating competition between bottom-up (i.e., salience-driven) and top-down (i.e., language-driven) processes. Though both groups of children showed word recognition in an absolute sense, competing perceptual salience significantly decreased attention to the target only in the children with ASD. These findings indicate that perceptual properties of objects can disrupt attention to relevant information in children with ASD, which has implications for supporting their language development. Findings also demonstrate that perceptual salience affects attentional allocation preferences in children with ASD, even in the absence of social stimuli. LAY SUMMARY: This study found that visually striking objects distract young children with autism spectrum disorder (ASD) from looking at relevant (but less striking) objects named by an adult. Language-matched, younger children with typical development were not significantly affected by this visual distraction. Though visual distraction could have cascading negative effects on language development in children with ASD, learning opportunities that build on children's focus of attention are likely to support positive outcomes.

Visual disengagement in young infants in relation to age, sex, SES, developmental level and adaptive functioning

Visual attention plays a key role in infants' interaction with the environment, and shapes their behavioral and brain development. As such, early problems with flexibly switching gaze from one stimulus to another (visual disengagement) have been hypothesized to lead to developmental difficulties (e.g. joint attention and social skills) over time. This study aimed to identify cross-sectional associations between performance in the Gap task (gaze shift latencies and visual attention disengagement) and measures of development and adaptive behavior in conjunction to any sex or socioeconomic status effects in infancy. We measured visual attention disengagement in 436 5-month-old infants and calculated its association with cognitive developmental level, adaptive behaviours, socioeconomic status (SES) and biological sex. In the Gap task, participants must redirect their gaze from a central stimulus to an appearing peripheral stimulus. The three experimental conditions of the task (Gap, Baseline and Overlap) differ on the timepoint when the central stimuli disappears in relation to the appearance of the peripheral stimulus: 200 ms before the peripheral stimulus appears (Gap), simultaneously to its appearance (Baseline), or with peripheral stimulus offset (Overlap). The data from the experimental conditions showed the expected pattern, with average latencies being the shortest in the Gap and longest in the Overlap condition. Females were faster (p = .004) than males in the Gap condition, which could indicate that arousal-related effects differ as a function of biological sex. Infants from higher SES were slower (p = .031) in the Overlap condition compared to lower SES infants. This suggests that basic visual attention may differ by socio-cultural background, and should be considered when studying visual attention and its developmental correlates. We observed no significant association to concurrent developmental level or adaptive function. Given its large sample size, this study provides a useful reference for future studies of visual disengagement in early infancy.

Reper intraocular lens with artificial iris: implantation techniques and outcomes

The authors describe the surgical techniques to implant a novel intraocular lens with artificial iris (Reper) in patients affected by traumatic aphakia and aniridia. Two surgical approaches are proposed: implantation by suture-loaded cartridge and "open sky" implantation combined with penetrating keratoplasty. The method of establishing the exact position of the scleral fixation points and the pre-assembly of the suture of Reper before its implantation are the main novel proposed surgical procedures. The rationale is to minimize surgical procedures in the anterior chamber and to prevent knot loosening and lens tilting. The simultaneous treatment of aphakia and aniridia with a single prosthesis, the stability of the Reper and the functional, anatomical and aesthetic outcomes obtained are the highlighted advantages in this study.

Infants' gaze exhibits a fractal structure that varies by age and stimulus salience

The development of selective visual attention is critical for effectively engaging with an ever-changing world. Its optimal deployment depends upon interactions between neural, motor, and sensory systems across multiple timescales and neurocognitive loci. Previous work illustrates the spatio-temporal dynamics of these processes in adults, but less is known about this emergent phenomenon early in life. Using data (n = 190; 421 visits) collected between 3 and 35 months of age, we examined the spatio-temporal complexity of young children's gaze patterns as they viewed stimuli varying in semantic salience. Specifically, we used detrended fluctuation analysis (DFA) to quantify the extent to which infants' gaze patterns exhibited scale invariant patterns of nested variability, an organizational feature thought to reflect self-organized and optimally flexible system dynamics that are not overly rigid or random. Results indicated that gaze patterns of even the youngest infants exhibited fractal organization that increased with age. Further, fractal organization was greater when children (a) viewed social stimuli compared to stimuli with degraded social information and (b) when they spontaneously gazed at faces. These findings suggest that selective attention is well-organized in infancy, particularly toward social information, and indicate noteworthy growth in these processes across the first years of life.

Look duration at the face as a developmental endophenotype: elucidating pathways to autism and ADHD

Identifying developmental endophenotypes on the pathway between genetics and behavior is critical to uncovering the mechanisms underlying neurodevelopmental conditions. In this proof-of-principle study, we explored whether early disruptions in visual attention are a unique or shared candidate endophenotype of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). We calculated the duration of the longest look (i.e., peak look) to faces in an array-based eye-tracking task for 335 14-month-old infants with and without first-degree relatives with ASD and/or ADHD. We leveraged parent-report and genotype data available for a proportion of these infants to evaluate the relation of looking behavior to familial (n = 285) and genetic liability (using polygenic scores, n = 185) as well as ASD and ADHD-relevant temperament traits at 2 years of age (shyness and inhibitory control, respectively, n = 272) and ASD and ADHD clinical traits at 6 years of age (n = 94).

Results showed that longer peak looks at the face were associated with elevated polygenic scores for ADHD (β = 0.078, p = .023), but not ASD (β = 0.002, p = .944), and with elevated ADHD traits in mid-childhood (F(1,88) = 6.401, p = .013, $\eta _p^2$=0.068; ASD: F (1,88) = 3.218, p = .076), but not in toddlerhood (ps > 0.2). This pattern of results did not emerge when considering mean peak look duration across face and nonface stimuli. Thus, alterations in attention to faces during spontaneous visual exploration may be more consistent with a developmental endophenotype of ADHD than ASD. Our work shows that dissecting paths to neurodevelopmental conditions requires longitudinal data incorporating polygenic contribution, early neurocognitive function, and clinical phenotypic variation.

The emergence of a functionally flexible brain during early infancy

While adult brains are known to be functionally flexible, the emergence of a functionally flexible brain during early infancy is largely uncharted due the lack of approaches to assess neural flexibility in infants. Using recent advances of multilayer network approaches and a cohort of typically developing children who underwent longitudinal MRI during the first 2 y of life, we investigated the developmental characteristics of brain neural flexibility. The temporal and spatial emergence of a functionally flexible brain was revealed. Brain regions with high neural flexibility appear consistent with the core regions supporting cognitive flexibility processing in adults, whereas brain regions governing basic brain functions exhibit lower neural flexibility, demonstrating the emergence of functionally flexible brain during early infancy.

Adult brains are functionally flexible, a unique characteristic that is thought to contribute to cognitive flexibility. While tools to assess cognitive flexibility during early infancy are lacking, we aimed to assess the spatiotemporal developmental features of “neural flexibility” during the first 2 y of life. Fifty-two typically developing children 0 to 2 y old were longitudinally imaged up to seven times during natural sleep using resting-state functional MRI. Using a sliding window approach, MR-derived neural flexibility, a quantitative measure of the frequency at which brain regions change their allegiance from one functional module to another during a given time period, was used to evaluate the temporal emergence of neural flexibility during early infancy. Results showed that neural flexibility of whole brain, motor, and high-order brain functional networks/regions increased significantly with age, while visual regions exhibited a temporally stable pattern, suggesting spatially and temporally nonuniform developmental features of neural flexibility. Additionally, the neural flexibility of the primary visual network at 3 mo of age was significantly and negatively associated with cognitive ability evaluated at 5/6 y of age. The “flexible club,” comprising brain regions with neural flexibility significantly higher than whole-brain neural flexibility, were consistent with brain regions known to govern cognitive flexibility in adults and exhibited unique characteristics when compared to the functional hub and diverse club regions. Thus, MR-derived neural flexibility has the potential to reveal the underlying neural substrates for developing a cognitively flexible brain during early infancy.

Aesthetics of iris reconstruction with a custom-made artificial iris prosthesis

Patients with large iris defects not only suffer from functional disadvantages but also from aesthetic limitations. The aim of this study was to evaluate the aesthetic outcome of iris reconstruction using an artificial iris (AI). In this study, 82 eyes of 79 consecutive patients with mostly traumatic partial or total aniridia that underwent iris reconstruction surgery using a custom-made silicone AI (HumanOptics, Erlangen, Germany). Pre- and postoperative photographs of 66 patients were analysed subjectively and objectively. Subjective evaluation was based questionnaires. Objective evaluation included measurement of pupil centration and iris colour analysis. Averaged hues from iris areas were transferred to numerical values using the LAB-colour-system. Single parameters and overall difference value (ΔE) were compared between AI and remaining iris (RI), as well as AI and fellow eye iris (FI). Patients, eye doctors and laymen rated the overall aesthetic outcome with 8.9 ±1.4, 7.7 ±1.1 and 7.3 ±1.1 out of 10 points, respectively. Mean AI decentration was 0.35 ±0.24 mm. Better pupil centration correlated with a higher overall score for aesthetic outcome (p<0.05). The AI was on average 4.65 ±10 points brighter than RI and FI. Aniridia treatment using a custom-made artificial iris prosthesis offers a good aesthetic outcome. Pupil centration was a key factor that correlated with the amount of aesthetic satisfaction. The AI was on average slightly brighter than the RI and FI.

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.

Individual differences in visual attention and self-regulation: A multimethod longitudinal study from infancy to toddlerhood

Given the importance of self-regulation for a broad range of developmental outcomes, identifying reliable precursors of self-regulation early in development is important for early prevention of developmental problems. The aim of this study was to examine whether three visual attention measures (fixation duration, variation in fixation duration, and disengagement) in infancy (9.10-11.43 months of age) predicted effortful control and compliance in toddlerhood (26.71-31.80 months). The sample consisted of 74 children (50% boys). In infancy, two eye-tracking tasks were conducted: a visual search task to assess fixation duration and variation in fixation duration (n = 58) and the gap-overlap task to assess disengagement (n = 49). In toddlerhood, children's effortful control (n = 65) and compliance (n = 65) were assessed by parent reports and observed during a delay of gratification task and a cleanup session together with the parents, respectively. Using full information maximum likelihood to account for missing data, multiple regression analyses revealed that, when all three measures of visual attention were taken into account, longer fixations and less variation in fixation duration in infancy predicted better effortful control. Disengagement did not predict effortful control. Compliance in toddlerhood was not predicted by any of the visual attention measures. These findings may indicate that visual attentional measures in infancy predict relatively independent forms of self-regulation in toddlerhood. Future studies are necessary to elucidate the mechanisms that underlie the association between (variation in) fixation duration in infancy and effortful control in toddlerhood.

Disentangling the mechanisms underlying infant fixation durations in scene perception: A computational account

The goal of this article is to investigate the unexplored mechanisms underlying the development of saccadic control in infancy by determining the generalizability and potential limitations of extending the CRISP theoretical framework and computational model of fixation durations (FDs) in adult scene-viewing to infants. The CRISP model was used to investigate the underlying mechanisms modulating FDs in 6-month-olds by applying the model to empirical eye-movement data gathered from groups of infants and adults during free-viewing of naturalistic and semi-naturalistic videos. Participants also performed a gap-overlap task to measure their disengagement abilities. Results confirmed the CRISP model's applicability to infant data. Specifically, model simulations support the view that infant saccade programming is completed in two stages: an initial labile stage, followed by a non-labile stage. Moreover, results from the empirical data and simulation studies highlighted the influence of the material viewed on the FD distributions in infants and adults, as well as the impact that the developmental state of the oculomotor system can have on saccade programming and execution at 6months. The present work suggests that infant FDs reflect on-line perceptual and cognitive activity in a similar way to adults, but that the individual developmental state of the oculomotor system affects this relationship at 6months. Furthermore, computational modeling filled the gaps of psychophysical studies and allowed the effects of these two factors on FDs to be simulated in infant data providing greater insights into the development of oculomotor and attentional control than can be gained from behavioral results alone.