Gaze cueing of attention in schizophrenia: individual differences in neuropsychological functioning and symptoms

Automatic attentional orienting to other people's gaze in schizophrenia

Explicit tests of social cognition have revealed pervasive deficits in schizophrenia. Less is known of automatic social cognition in schizophrenia. We used a spatial orienting task to investigate automatic shifts of attention cued by another person's eye gaze in 29 patients and 28 controls. Central photographic images of a face with eyes shifted left or right, or looking straight ahead, preceded targets that appeared left or right of the cue. To examine automatic effects, cue direction was non-predictive of target location. Cue-target intervals were 100, 300, and 800 ms. In non-social control trials, arrows replaced eye-gaze cues. Both groups showed automatic attentional orienting indexed by faster reaction times (RTs) when arrows were congruent with target location across all cue-target intervals. Similar congruency effects were seen for eye-shift cues at 300 and 800 ms intervals, but patients showed significantly larger congruency effects at 800 ms, which were driven by delayed responses to incongruent target locations. At short 100-ms cue-target intervals, neither group showed faster RTs for congruent than for incongruent eye-shift cues, but patients were significantly slower to detect targets after direct-gaze cues. These findings conflict with previous studies using schematic line drawings of eye-shifts that have found automatic attentional orienting to be reduced in schizophrenia. Instead, our data indicate that patients display abnormalities in responding to gaze direction at various stages of gaze processing-reflected by a stronger preferential capture of attention by another person's direct eye contact at initial stages of gaze processing and difficulties disengaging from a gazed-at location once shared attention is established.

Conceptualizing Social Attention in Developmental Research

The term social attention has become widely used during the last decade, appearing within behavioral neuroscience and developmental neurocognitive literatures to characterize a variety of activities and cognitive processes that emerge in the presence of conspecifics. We provide here an overview of the current status of social attention as a construct, as reflected in its appearance in research studies, and we offer a framework for characterizing the extant literature based on the functions of social attention processes: as behavior for social communication, as motivation to engage in social communication, and as a form of basic visual attention in the context of other social agents. We then provide two overarching questions to guide future research efforts directed toward establishing the utility of social attention as an independent and/or unified construct. We then consider implications and recommendations for future research efforts.

Peripheral cues and gaze direction jointly focus attention and inhibition of return

Centrally presented gaze cues typically elicit a delayed inhibition of return (IOR) effect compared to peripheral exogenous cues. We investigated whether gaze cues elicit early onset IOR when presented peripherally. Faces were presented in the left or right peripheral hemifields, which then gazed upward or downward. A target appeared in one of four oblique spatial locations giving the cue and target horizontal or vertical congruency, both, or neither. After establishing that peripheral movement and gaze direction jointly facilitate target processing at short durations (200 ms: Experiment 1), IOR was evident for peripheral motion at longer time courses (800 and 2400 ms: Experiment 2). Only after 2400 ms did gaze direction additionally contribute to IOR for the specific gazed at location, showing the inverse pattern of response times to Experiment 1. The onset of IOR for gaze cues is independent from peripheral exogenous cueing but nevertheless contributes to the allocation of attention.

Space-based and object-centered gaze cuing of attention in right hemisphere-damaged patients

Gaze cuing of attention is a well established phenomenon consisting of the tendency to shift attention to the location signaled by the averted gaze of other individuals. Evidence suggests that such phenomenon might follow intrinsic object-centered features of the head containing the gaze cue. In the present exploratory study, we aimed to investigate whether such object-centered component is present in neuropsychological patients with a lesion involving the right hemisphere, which is known to play a critical role both in orienting of attention and in face processing. To this purpose, we used a modified gaze-cuing paradigm in which a centrally placed head with averted gaze was presented either in the standard upright position or rotated 90° clockwise or anti-clockwise. Afterward, a to-be-detected target was presented either in the right or in the left hemifield. The results showed that gaze cuing of attention was present only when the target appeared in the left visual hemifield and was not modulated by head orientation. This suggests that gaze cuing of attention in right hemisphere-damaged patients can operate within different frames of reference.

Neural correlates of the preserved inhibition of return in schizophrenia

Inhibition of return (IOR) is an attentional mechanism that previously has been reported to be either intact or blunted in subjects with schizophrenia (SCZ). In the present study, we explored the neural mechanism of IOR in SCZ by comparing the target-locked N1 and P1 activity evoked by valid-cued trials with that evoked by invalid-cued trials. Twenty-seven schizophrenia patients and nineteen healthy controls participated in a task involving covert orienting of attention with two stimulus onset asynchronies (SOAs: 700 ms and 1200 ms) during which 64-channel EEG data were recorded. Behavioral reaction times (RTs) were longer in response to valid-cued trials than to invalid-cued ones, suggesting an intact IOR in SCZ. However, reduced N1 amplitude elicited by valid-cued trials suggested a stronger inhibition of attention from being oriented to a previously cued location, and therefore a relative inhibition of perceptual processing at that location in SCZ. These results indicate that altered N1 activity is associated with the preservation of IOR in SCZ and could be a sensitive marker to track the IOR effect.

Impairment of gaze-directed spatial coding in recent-onset schizophrenia

Patients with schizophrenia show deficits in core cognitive functions as well as in social cognition. The aim of the present study was to test whether deficits in social cognition influence nonsocial, “cold”, cognition. Thirty-five patients with recent-onset schizophrenia (SC) and 30 healthy controls (HC) performed a Simon task with social and simple geometric stimuli. We investigated whether the Simon effect, the slowing of reaction times produced by stimulus incongruities in the task-irrelevant spatial domain, differs between patients and healthy participants as a function of the social nature of the cues. The Simon effect was generated by a schematic drawing of human eyes (social cues) or rectangles (nonsocial cues). Overall, patients had longer reaction times than HC. In the eye-like condition, the Simon effect was significantly stronger for HC than for SC. In HC the Simon effect was significantly stronger in the eye-like than in the rectangle condition. In patients, the Simon effect did not differ significantly between both conditions. Thus, the influence of social cues was greatly reduced in the patient group. Current psychopathology or antipsychotic treatment did not influence results. The present study supports earlier findings of altered processing of schematic social cues in patients with schizophrenia, especially when gaze is task-irrelevant.

Auditory orienting and inhibition of return in schizophrenia: a functional magnetic resonance imaging study

Patients with schizophrenia (SP) exhibit deficits in both attentional reorienting and inhibition of return (IOR) during visual tasks. However, it is currently unknown whether these deficits are supramodal in nature and how these deficits relate to other domains of cognitive dysfunction. In addition, the neuronal correlates of this pathological orienting response have not been investigated in either the visual or auditory modality. Therefore, 30 SP and 30 healthy controls (HC) were evaluated with an extensive clinical protocol and functional magnetic resonance imaging (fMRI) during an auditory cuing paradigm. SP exhibited both increased costs and delayed IOR during auditory orienting, suggesting a prolonged interval for attentional disengagement from cued locations. Moreover, a delay in the development of IOR was associated with cognitive deficits on formal neuropsychological testing in the domains of attention/inhibition and working memory. Event-related fMRI showed the characteristic activation of a frontoparietal network (invalid trials>valid trials), but there were no differences in functional activation between patients and HC during either attentional reorienting or IOR. Current results suggest that orienting deficits are supramodal in nature in SP, and are related to higher-order cognitive deficits that directly interfere with day-to-day functioning.

Inhibition of return and schizophrenia: a meta-analysis

Inhibition of return (IOR) is a phenomenon that involves inhibited or delayed orienting to previously cued locations in favor of attending to novel locations. To date, research on IOR in patients with schizophrenia has generated mixed, and seemingly conflicting, results. Some researchers report patients with schizophrenia exhibit blunted or delayed IOR, while other researchers report normal IOR, in terms of time course and magnitude. This meta-analysis summarizes the literature that has employed an IOR task in patients with schizophrenia and with controls while focusing upon a procedural feature, the use of a cue back to fixation, between the cue and target that is known to be important when executive control has been hampered in non-clinical populations. Fifteen experiments were located yielding a total sample of 362 patients with schizophrenia or schizoaffective disorder and 285 controls. Using a meta-analytic approach, results of the present analyses show that patients with schizophrenia demonstrate delayed IOR in the single cue procedure. In the cue back to fixation procedure, the time course of IOR among patients is more consistent with that of controls. Differences in measured IOR between patients with schizophrenia and controls are largely related to a deficit in endogenous disengagement of attention.