What Can Eye Movements Tell Us about Subtle Cognitive Processing Differences in Autism?

Gaze Following as an Early Diagnostic Marker of Autism in a New Word Learning Task in Toddlers

The aim was to test the use of eye-tracking methodology for the early detection of ASD in a task of association between unfamiliar objects and pseudowords. Significant differences were found between ASD (n = 57) and TD (n = 57) Spanish speaking toddlers in the number and time of fixation. The TD children showed more and longer fixations on eyes and mouth while the ASD children attended almost exclusively to objects, making it difficult to integrate lexical and phonological information. Moreover, the TD toddlers looked at the mouth when the pseudoword was produced while the ASD toddlers did not. Gaze fixation on eyes and mouth during word learning recorded by eye-tracking may be used as a biomarker for the early diagnosis of ASD.

Evaluating the validity of eye-tracking tasks and stimuli in detecting high-risk infants later diagnosed with autism: A meta-analysis

Gaze abnormalities are well documented in infants at elevated risk for autism spectrum disorder (ASD). However, variations in experimental design and stimuli across studies have led to mixed results. The current meta-analysis aimed to identify which type of eye tracking task and stimulus are most effective at differentiating high-risk infants (siblings of children with ASD) who later meet diagnosis criteria from low-risk infants without familial autism. We synthesized 35 studies that used eye tracking to investigate gaze behavior in infants at high genetic risk for autism before 2 years of age. We found that stimulus features, regions of interest (ROIs) and study quality moderated effect sizes across studies. Overall, dynamic stimuli and socially-relevant regions in the social stimuli (i.e. the target and activity of characters' shared focus) reliably detected high-risk infants who later develop ASD. Attention disengagement task and stimuli depicting interactions between human and nonhuman characters could identify high-risk infants who later develop ASD and those who have autism-related symptoms but do not meet the diagnostic criteria as well. These findings provide sensitive and reliable early markers of ASD, which is helpful to develop objective and quantitative early autism screening and intervention tools.

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.

Pathways for Naturalistic Looking Behavior in Primate I: Behavioral Characteristics and Brainstem Circuits

Organisms control their visual worlds by moving their eyes, heads, and bodies. This control of "gaze" or "looking" is key to survival and intelligence, but our investigation of the underlying neural mechanisms in natural conditions is hindered by technical limitations. Recent advances have enabled measurement of both brain and behavior in freely moving animals in complex environments, expanding on historical head-fixed laboratory investigations. We juxtapose looking behavior as traditionally measured in the laboratory against looking behavior in naturalistic conditions, finding that behavior changes when animals are free to move or when stimuli have depth or sound. We specifically focus on the brainstem circuits driving gaze shifts and gaze stabilization. The overarching goal of this review is to reconcile historical understanding of the differential neural circuits for different "classes" of gaze shift with two inconvenient truths. (1) "classes" of gaze behavior are artificial. (2) The neural circuits historically identified to control each "class" of behavior do not operate in isolation during natural behavior. Instead, multiple pathways combine adaptively and non-linearly depending on individual experience. While the neural circuits for reflexive and voluntary gaze behaviors traverse somewhat independent brainstem and spinal cord circuits, both can be modulated by feedback, meaning that most gaze behaviors are learned rather than hardcoded. Despite this flexibility, there are broadly enumerable neural pathways commonly adopted among primate gaze systems. Parallel pathways which carry simultaneous evolutionary and homeostatic drives converge in superior colliculus, a layered midbrain structure which integrates and relays these volitional signals to brainstem gaze-control circuits.

Rendimiento de los estímulos visuales en el diagnóstico del TEA por Eye Tracking: Revisión Sistemática

El eye-tracking es una herramienta diagnóstica que tiene como   fin el estudio del comportamiento de la mirada a través del escaneo de ojos para observar el seguimiento ocular, cómo se distribuye la mirada y la precisión de los movimientos oculares. Este sistema se ha utilizado con niños/as del Trastorno del Espectro Autista. El objetivo de esta revisión sistemática ha sido analizar el rendimiento de los estímulos visuales en el diagnóstico del TEA por método eye tracking. Para ello, se siguió la metodología PRISMA, realizando una búsqueda en las bases de datos PubMed, Science Direct y Scopus, así como, Reseach Gate. Se seleccionaron 22 artículos que cumplían los criterios de inclusión con experimentos unifactoriales, experimentales factoriales y cuasiexperimentales. Todos los experimentos han tenido un grupo control compuesto de muestra con participantes con desarrollo normotípico y de un grupo de caso compuesto de muestra con participantes TEA. Esta revisión sintetiza en tres categorías en base a las características del estímulo usado en el diagnóstico (estímulos sociales, no sociales y por confrontación), el análisis del rendimiento de los estímulos visuales, de manera que los estímulos sociales y los estímulos por confrontación van a ser eficaces para establecer un diagnóstico preciso de TEA puesto que permiten realizar un cribado de ambos grupos y establecer un riesgo temprano del trastorno.

Low-level factors increase gaze-guidance under cognitive load: A comparison of image-salience and semantic-salience models

Growing evidence links eye movements and cognitive functioning, however there is debate concerning what image content is fixated in natural scenes. Competing approaches have argued that low-level/feedforward and high-level/feedback factors contribute to gaze-guidance. We used one low-level model (Graph Based Visual Salience, GBVS) and a novel language-based high-level model (Global Vectors for Word Representation, GloVe) to predict gaze locations in a natural image search task, and we examined how fixated locations during this task vary under increasing levels of cognitive load. Participants (N = 30) freely viewed a series of 100 natural scenes for 10 seconds each. Between scenes, subjects identified a target object from the scene a specified number of trials (N) back among three distracter objects of the same type but from alternate scenes. The N-back was adaptive: N-back increased following two correct trials and decreased following one incorrect trial. Receiver operating characteristic (ROC) analysis of gaze locations showed that as cognitive load increased, there was a significant increase in prediction power for GBVS, but not for GloVe. Similarly, there was no significant difference in the area under the ROC between the minimum and maximum N-back achieved across subjects for GloVe (t(29) = -1.062, p = 0.297), while there was a cohesive upwards trend for GBVS (t(29) = -1.975, p = .058), although not significant. A permutation analysis showed that gaze locations were correlated with GBVS indicating that salient features were more likely to be fixated. However, gaze locations were anti-correlated with GloVe, indicating that objects with low semantic consistency with the scene were more likely to be fixated. These results suggest that fixations are drawn towards salient low-level image features and this bias increases with cognitive load. Additionally, there is a bias towards fixating improbable objects that does not vary under increasing levels of cognitive load.

Orexin/Hypocretin System Dysfunction in ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations)

Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is an umbrella term covering a wide range of neurodevelopmental difficulties and disorders. Thus, ESSENCE includes attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental disorders (NDDs) and difficulties, with a variety of symptoms in cognitive, motor, sensory, social, arousal, regulatory, emotional, and behavioral developmental domains, frequently co-occurring and likely having partly common neurobiological substrates. The ESSENCE concept is a clinical paradigm that promotes organizing NDDs in everyday clinical practice according to their coexistence, symptom dimensions overlapping, and treatment possibilities. Despite increased knowledge regarding NDDs, the neurobiological mechanisms that underlie them and other ESSENCE-related problems, are not well understood. With its wide range of neural circuits and interactions with numerous neurotransmitters, the orexin/hypocretin system (Orx-S) is possibly associated with a variety of neurocognitive, psychobiological, neuroendocrine, and physiological functions and behaviors. Dysfunction of Orx-S has been implicated in various psychiatric and neurological disorders. This article provides an overview of Orx-S dysfunctions' possible involvement in the development, presentation, and maintenance of ESSENCE. We provide a focused review of current research evidence linking orexin neuropeptides with specific clinical NDDs symptoms, mostly in ADHD and ASD, within the Research Domain Criteria (RDoC) framework. We propose that Orx-S dysfunction might have an important role in some of these neurodevelopmental symptom domains, such as arousal, wakefulness, sleep, motor and sensory processing, mood and emotional regulation, fear processing, reward, feeding, attention, executive functions, and sociability. Our perspective is presented from a clinical point of view. Further, more thorough systematic reviews are needed as well as planning of extensive new research into the Orx-S's role in ESSENCE, especially considering RDoC elements.

Emotion Facial Processing in Children With Autism Spectrum Disorder: A Pilot Study of the Impact of Service Dogs

Processing and recognizing facial expressions are key factors in human social interaction. Past research suggests that individuals with autism spectrum disorder (ASD) present difficulties to decode facial expressions. Those difficulties are notably attributed to altered strategies in the visual scanning of expressive faces. Numerous studies have demonstrated the multiple benefits of exposure to pet dogs and service dogs on the interaction skills and psychosocial development of children with ASD. However, no study has investigated if those benefits also extend to the processing of facial expressions. The aim of this study was to investigate if having a service dog had an influence on facial expression processing skills of children with ASD. Two groups of 15 children with ASD, with and without a service dog, were compared using a facial expression recognition computer task while their ocular movements were measured using an eye-tracker. While the two groups did not differ in their accuracy and reaction time, results highlighted that children with ASD owning a service dog directed less attention toward areas that were not relevant to facial expression processing. They also displayed a more differentiated scanning of relevant facial features according to the displayed emotion (i.e., they spent more time on the mouth for joy than for anger, and vice versa for the eyes area). Results from the present study suggest that having a service dog and interacting with it on a daily basis may promote the development of specific visual exploration strategies for the processing of human faces.

Application of Eye Tracking Technology in Medicine: A Bibliometric Analysis

Eye tracking provides a quantitative measure of eye movements during different activities. We report the results from a bibliometric analysis to investigate trends in eye tracking research applied to the study of different medical conditions. We conducted a search on the Web of Science Core Collection (WoS) database and analyzed the dataset of 2456 retrieved articles using VOSviewer and the Bibliometrix R package. The most represented area was psychiatry (503, 20.5%) followed by neuroscience (465, 18.9%) and psychology developmental (337, 13.7%). The annual scientific production growth was 11.14% and showed exponential growth with three main peaks in 2011, 2015 and 2017. Extensive collaboration networks were identified between the three countries with the highest scientific production, the USA (35.3%), the UK (9.5%) and Germany (7.3%). Based on term co-occurrence maps and analyses of sources of articles, we identified autism spectrum disorders as the most investigated condition and conducted specific analyses on 638 articles related to this topic which showed an annual scientific production growth of 16.52%. The majority of studies focused on autism used eye tracking to investigate gaze patterns with regards to stimuli related to social interaction. Our analysis highlights the widespread and increasing use of eye tracking in the study of different neurological and psychiatric conditions.

Atypical gaze patterns to facial feature areas in autism spectrum disorders reveal age and culture effects: A meta-analysis of eye-tracking studies

Children and adults with autism spectrum disorder (ASD) often present with atypical gaze patterns to others' faces, a finding substantiated throughout the literature. Yet, a quantification of atypical gaze patterns to different facial regions (e.g., eyes versus mouth) in ASD remains controversial. Also few study has investigated how age and culture impacted the pattern of gaze abnormalities in ASD. This research therefore conducted a meta-analysis of eye-tracking studies to evaluate age and culture effect on atypical gaze patterns of face processing in ASD. A total of 75 articles (91 studies) and 4209 individuals (ASD: 2027; controls: 2182) across all age ranges (i.e., childhood through to adulthood) from both Eastern and Western cultures were included in this meta-analysis. Individuals with ASD yielded shorter fixation durations to the eyes than individuals without ASD. Group differences in the time spent fixating on the eyes were not modulated by age, but affected by culture. Effect size in the eastern culture was larger than that in the western culture. In contrast, group differences on time spent looking at the mouth were not significant, but changed with age and modulated by culture. Relative to the neurotypical controls, Western individuals with ASD spent more time looking at the mouth from school age, whereas Eastern individuals with ASD did not gaze longer on mouth until adulthood. These results add to the body of evidence supporting atypical gaze behaviors to eyes in ASD and provide new insights into a potential mouth compensation strategy that develops with age in ASD. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) often show atypical gaze patterns when looking at others' faces compared to neurotypical individuals. This paper examines the role of age and culture on pattern of gaze abnormalities in individuals with ASD. Results show that reduction of gaze on eyes in ASD is stable across all ages and cultures, while increase of gaze on mouth emerges as individuals with ASD get older. The findings provide a developmental insight to the gaze patterns on the autism spectrum across culture.

Cognitive load influences oculomotor behavior in natural scenes

Cognitive neuroscience researchers have identified relationships between cognitive load and eye movement behavior that are consistent with oculomotor biomarkers for neurological disorders. We develop an adaptive visual search paradigm that manipulates task difficulty and examine the effect of cognitive load on oculomotor behavior in healthy young adults. Participants (N = 30) free-viewed a sequence of 100 natural scenes for 10 s each, while their eye movements were recorded. After each image, participants completed a 4 alternative forced choice task in which they selected a target object from one of the previously viewed scenes, among 3 distracters of the same object type but from alternate scenes. Following two correct responses, the target object was selected from an image increasingly farther back (N-back) in the image stream; following an incorrect response, N decreased by 1. N-back thus quantifies and individualizes cognitive load. The results show that response latencies increased as N-back increased, and pupil diameter increased with N-back, before decreasing at very high N-back. These findings are consistent with previous studies and confirm that this paradigm was successful in actively engaging working memory, and successfully adapts task difficulty to individual subject's skill levels. We hypothesized that oculomotor behavior would covary with cognitive load. We found that as cognitive load increased, there was a significant decrease in the number of fixations and saccades. Furthermore, the total duration of saccades decreased with the number of events, while the total duration of fixations remained constant, suggesting that as cognitive load increased, subjects made fewer, longer fixations. These results suggest that cognitive load can be tracked with an adaptive visual search task, and that oculomotor strategies are affected as a result of greater cognitive demand in healthy adults.

The effect of autism on information sampling during decision-making: An eye-tracking study

Recent research has highlighted a tendency for more rational and deliberative decision-making in individuals with autism. We tested this hypothesis by using eye-tracking to investigate the information processing strategies that underpin multi-attribute choice in a sample of adults diagnosed with autism spectrum condition. We found that, as the number of attributes defining each option increased, autistic decision-makers were speedier, examined less of the available information, and spent a greater proportion of their time examining the option they eventually chose. Rather than indicating a more deliberative style, our results are consistent with a tendency for individuals with autism to narrow down the decision-space more quickly than does the neurotypical population.

Gaze Following and Pupil Dilation as Early Diagnostic Markers of Autism in Toddlers

Background: Children with autism spectrum disorder (ASD) show certain characteristics in visual attention. These may generate differences with non-autistic children in the integration of relevant social information to set the basis of communication. Reliable and objective measurement of these characteristics in a language learning context could contribute to a more accurate early diagnosis of ASD. Gaze following and pupil dilation are being studied as possible reliable measures of visual attention for the early detection of ASD. The eye-tracking methodology allows objective measurement of these biomarkers. The aim of this study is to determine whether measurements of gaze following and pupillary dilation in a linguistic interaction task are potential objective biomarkers for the early diagnosis of ASD. Method: A group of 20 children between 17 and 24 months of age, made up of 10 neurotypical children (NT) and 10 children with an increased likelihood of developing ASD were paired together according to chronological age. A human face on a monitor pronounced pseudowords associated with pseudo-objects. Gaze following and pupil dilation were registered during the task These measurements were captured using eye-tracking methodology. Results: Significant statistical differences were found in the time of gaze fixation on the human face and on the object, as well as in the number of gazes. Children with an increased possibility of developing ASD showed a slightly higher pupil dilation than NT children. However, this difference was not statistically significant. Nevertheless, their pupil dilation was uniform throughout the different periods of the task while NT participants showed greater dilation on hearing the pseudoword. Conclusions: The fixing and the duration of gaze, objectively measured by a Tobii eye-tracking system, could be considered as potential biomarkers for early detection of ASD. Additionally, pupil dilation measurement could reflect differential activation patterns during word processing in possible ASD toddlers and NT toddlers.

It takes all kinds (of information) to learn a language: Investigating the language comprehension of typical children and children with autism

What factors influence children's understanding of language, in both typical and atypical development? In this article, I summarize findings from the Longitudinal Study of Early Language (LSEL), which has been following the talk, understanding, and interactions of typically developing (TD) children and children with Autism Spectrum Disorder (ASD). The LSEL has found group similarities in syntactic understanding and word learning strategies, but also within-group variability that correlates with other aspects of the children's behavior. In particular, early linguistic knowledge and social abilities are both shown to play independent roles in later talk and understanding. Thus, theoretical perspectives that highlight social vs. linguistic underpinnings to language development should be viewed as complementary rather than competing.

Reading Goals and Executive Function in Autism: An Eye-Tracking Study

The sources of reading comprehension difficulties in people with autism spectrum disorder (ASD) are still open to discussion. We explored their ability to adapt reading strategies to different reading goals using eye-tracking technology. A group of participants with ASD, and intelligence-, receptive oral language- and reading skills-matched control peers, read three stories under three different reading goals conditions: read for entertainment; read for study; and read fast and search information for a previously presented question. Each text required participants to answer comprehension questions. The ASD group was less accurate in question answering. The control group was faster in reading questions, displayed more fixations on the text, and reported to be more confident in question answering during reading for study compared to reading for entertainment. These differences between reading goals were not observed in the ASD group. The control group adopted and was aware of using different reading strategies according to different reading goals. In contrast, the ASD group did not change their reading behavior and strategies between entertainment and study reading goal condition, showing less of a tendency to adopt deep-level processing strategies when necessary. Planning, as measured by Tower of Hanoi, was the only executive task that predicted individual differences in text reading time across conditions. Participants with better planning ability were also able to adapt their reading behavior to different reading instructions. Difficulties in adjusting the reading behavior according to the task, evaluating own performance and planning may be partly involved in reading comprehension problems in ASD. LAY ABSTRACT: The control group read questions faster, reported to be more confident in question answering during reading for study compared to reading for entertainment, and were aware of using different reading strategies according to different reading goals. In contrast, the autistic group did not change their reading behavior and strategies according to the reading goal. Difficulties in adjusting the reading behavior according to the task, in evaluating own performance and in planning may be partly involved in reading comprehension problems in autism. Autism Res 2021, 14: 1007-1024. © 2020 International Society for Autism Research, Wiley Periodicals, LLC.

To covet what we see: Autistic traits modulate the relationship between looking and choosing

Behavioral studies indicate that autistic traits predict reduced gaze toward social stimuli. Moreover, experiments that require participants to make an explicit choice between stimuli indicate reduced preferences for social stimuli in individuals with high autistic traits. These observations, in combination, fit with the idea that gaze is actively involved in the formation of choices-gaze toward a stimulus increases the likelihood of its subsequent selection. Although these aspects of gaze and choice behavior have been well characterized separately, it remains unclear how autistic traits affect the relationship between gaze and socially relevant choices. In a choice-based eye-tracking paradigm, we observed that autistic traits predict less frequent and delayed selection of social stimuli. Critically, eye tracking revealed novel phenomena underlying these choice behaviors: first, the relationship between gaze and choice behavior was weaker in individuals with high autistic traits-an increase in gaze to a stimulus was associated with a smaller increase in choice probability. Second, time-series analyses revealed that gaze became predictive of choice behaviors at longer latencies in observers with high autistic traits. This dissociation between gaze and choice in individuals with high autistic traits may reflect wider atypicalities in value coding. Such atypicalities may predict the development of atypical social behaviors associated with the autism phenotype. LAY SUMMARY: When presented with multiple stimuli to choose from, we tend to look more toward the stimuli we later choose. Here, we found that this relationship between looking and choosing was reduced in individuals with high autistic traits. These data indicate that autistic traits may be associated with atypical processing of value, which may contribute to the reduced preferences for social stimuli exhibited by individuals with autism.