Gaze Following is Related to the Broader Autism Phenotype in a Sex-Specific Way: Building the Case for Distinct Male and Female Autism Phenotypes

Using visual attention estimation on videos for automated prediction of autism spectrum disorder and symptom severity in preschool children

Atypical visual attention in individuals with autism spectrum disorders (ASD) has been utilised as a unique diagnosis criterion in previous research. This paper presents a novel approach to the automatic and quantitative screening of ASD as well as symptom severity prediction in preschool children. We develop a novel computational pipeline that extracts learned features from a dynamic visual stimulus to classify ASD children and predict the level of ASD-related symptoms. Experimental results demonstrate promising performance that is superior to using handcrafted features and machine learning algorithms, in terms of evaluation metrics used in diagnostic tests. Using a leave-one-out cross-validation approach, we obtained an accuracy of 94.59%, a sensitivity of 100%, a specificity of 76.47% and an area under the receiver operating characteristic curve (AUC) of 96% for ASD classification. In addition, we obtained an accuracy of 94.74%, a sensitivity of 87.50%, a specificity of 100% and an AUC of 99% for ASD symptom severity prediction.

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.

Individual differences in gaze-cuing effect are associated with facial emotion recognition and social conformity

Spontaneous gaze following and the concomitant joint attention enable us to share representations of the world with others, which forms a foundation of a broad range of social cognitive processes. Although this form of social orienting has long been suggested as a critical starting point for the development of social and communicative behavior, there is limited evidence directly linking it to higher-level social cognitive processes among healthy adults. Here, using a gaze-cuing paradigm, we examined whether individual differences in gaze following tendency predict higher-order social cognition and behavior among healthy adults. We found that individuals who showed greater gaze-cuing effect performed better in recognizing others' emotion and had greater tendency to conform with group opinion. These findings provide empirical evidence supporting the fundamental role of low-level socio-attentional processes in human sociality.

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.

Time perception of individuals with subthreshold autistic traits: the regulation of interpersonal information associations

BACKGROUND

People with high subthreshold autistic traits usually share behavioral patterns similar to those of individuals on the autism spectrum, but with fewer social and cognitive changes. The effect of autistic traits on time perception and the role of interpersonal information in this effect remain unexplored.

METHODS

This study used a temporal bisection task between 400 and 1600 ms to compare the time perception of individuals with higher and lower autistic traits, and to explore the regulation of interpersonal information on their time perception by establishing associations between identities and geometric shapes. Thirty-two participants with high autistic traits and thirty-one participants with low autistic traits participated in this study.

RESULTS

In the absence of identity information, people with high autistic traits tended to judge short durations as longer. Their subjective bisection point was lower, and the Weber ratio was higher than for those with low autistic traits, suggesting that their overestimation of short duration was due to decreased temporal sensitivity. With the involvement of interpersonal information, the proportion of long responses for no identity was significantly lower than for self, friends, and strangers, which seemed more obvious in individuals with low autistic traits although there was no significant interaction between identity and group. The Weber ratio of no identity was lower than that for other identities.

CONCLUSION

The results suggest that individuals with high autistic traits have more conservative responses that are relatively shorter in duration, and this change is related to a decline in perceptual sensitivity. Compared to individuals with high autistic traits, the time perception of individuals with low autistic traits seemed more susceptible to interpersonal information.

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.

Sex Differences in Autism Spectrum Disorder: Focus on High Functioning Children and Adolescents

Autism Spectrum Disorder (ASD) has historically been studied, known, and diagnosed in males. Females tend to remain unidentified, especially those with average intelligence abilities. This sex/gender difference might be partially explained by biological risk factors, but it is probably also bound to methodological issues. The present study aims to examine phenotypic characteristics (cognitive, emotive, socio-communicative, and academic) of a group of 54 females with ASD matched to a group of 55 males with ASD (3-18 years), all without cognitive impairment. Results suggest that there are subtle, yet potentially meaningful, quantitative, and qualitative phenotypic differences between females and males that common screening tests are not always sensitive enough to recognize. Further studies to improve practice and course for the assessment of females, reducing sex/gender-based inequities in ASD care, are required.

A quantitative meta-analysis of face recognition deficits in autism: 40 years of research

The ability to recognize an individual face is essential to human social interaction. Even subtle errors in this process can have huge implications for the way we relate to social partners. Because autism spectrum disorder (ASD) is characterized by deficits in social interaction, researchers have theorized about the potential role of atypical face identity processing to the symptom profile of ASD for more than 40 years. We conducted an empirical meta-analysis of this large literature to determine whether and to what extent face identity processing is atypical in ASD compared to typically developing (TD) individuals. We also tested the hypotheses that the deficit is selective to face identity recognition, not perception, and that methodological variation across studies moderates the magnitude of the estimated deficit. We identified 112 studies (5,390 participants) that generated 172 effect sizes from both recognition (k = 119) and discrimination (k = 53) paradigms. We used state-of-the-art approaches for assessing the validity and robustness of the analyses. We found comparable and large deficits in ASD for both face identity recognition (Hedge's g = -0.86) and discrimination (Hedge's g = -0.82). This means that the score of an average ASD individual is nearly 1 SD below the average TD individual on tasks assessing both aspects of face identity processing. These deficits generalize across age groups, sex, IQ scores, and task paradigms. These findings suggest that deficits in face identity processing may represent a core deficit in ASD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Mediating Effect of Emotional and Social Competences on Interrelations Between Gender, Age and the Broad Autism Phenotype

The study aimed to identify the mediating role of emotional intelligence and social competences in the relationship between gender and broad autism phenotype (BAP) as well as between age and BAP. It comprised 85 parents of children with ASD. They completed the questionnaires of Autism-Spectrum Quotient, social competences, and emotional intelligence. The results revealed that emotional intelligence in general and its two dimensions: the ability to accept and express emotions and to empathize are important mediators of the relationship between gender and BAP. Also, social competences in general and two of their dimensions: the effectiveness of behavior in intimate situations and in social situations were significant mediators. The relationship between age and BAP could not be confirmed.

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.

Brain Connectivity and Neuroimaging of Social Networks in Autism

Impairments in social communication (SC) predominate among the core diagnostic features of autism spectrum disorders (ASDs). Neuroimaging has revealed numerous findings of atypical activity and connectivity of 'social brain' networks, yet no consensus view on crucial developmental causes of SC deficits has emerged. Aside from methodological challenges, the deeper problem concerns the clinical label of ASD. While genetic studies have not comprehensively explained the causes of nonsyndromic ASDs, they highlight that the clinical label encompasses many etiologically different disorders. The question of how potential causes and etiologies converge onto a comparatively narrow set of SC deficits remains. Only neuroimaging designs searching for subtypes within ASD cohorts (rather than conventional group level designs) can provide translationally informative answers.

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.