Visual attention to faces in children with autism spectrum disorder: are there sex differences?

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TitleVisual attention to faces in children with autism spectrum disorder: are there sex differences?
Publication TypeJournal Article
Year of Publication2019
AuthorsHarrop, C, Jones, D, Zheng, S, Nowell, S, Schultz, R, Parish-Morris, J
JournalMolecular autism

Reduced social attention is a core characteristic of autism spectrum disorder (ASD) that has been well characterized using infrared eye tracking [1]. Differences in social attention are evident by the second year of life and predict eventual ASD diagnosis [2, 3] as well as later social competence [4]. Studies using a variety of stimulus types have revealed social attention deficits in ASD [4-8], but there is evidence to suggest that some types of stimuli elicit larger group differences than others.

Eye tracking stimuli can be characterized on continuum of social complexity and ecological validity, ranging from faces presented in isolation or with competing non-social stimuli (e.g., [8, 9]), to faces embedded within static scenes or scrambled [10], to naturalistic social scenes depicting individuals interacting with one another [11, 12]. When faces are presented with competing non-social stimuli, children, and adolescents with ASD attend less to faces than matched peers [8, 9, 13]. This effect is particularly evident when the non-social stimuli overlap with common interests in ASD [8, 9, 13, 14].

Recognizing that faces are not presented in isolation in real-world situations, a handful of recent eye-tracking studies demonstrated that utilizing dynamic, ecologically valid scenes depicting complex social interactions elicits greater diagnostic group differences in social attention. Chawarska et al. [15] reported reduced attention to dyadic social stimuli (gaze and child-directed speech) by toddlers with ASD. This effect was not observed in the absence of these cues, suggesting a context-driven social attention deficit that was most pronounced during rich social scenes. Similarly, Speer et al. [12] reported the largest group effects when children with ASD viewed social-dynamic stimuli, with reduced attention to eye regions and increased attention to body areas relative to controls. Chevallier et al. [11] manipulated the nature of social stimuli, comparing static and dynamic stimuli that varied from socially lean (pictures of faces and objects) to socially rich (videos of children using a variety of nonverbal cues to interact together). Naturalistic social scenes elicited larger attentional differences than non-interactive static stimuli in children with and without ASD. Taken together, these studies suggest that social attention deficits are sensitive to contextual factors, particularly the social richness of a scene.

Sex differences in social attention: typical development and ASD

While social orienting is assumed to reflect a core social challenge in ASD, several eye-tracking studies have failed to replicate the finding that individuals with autism always look less at faces than typical individuals [6, 16]. Two possible explanations could account for this discrepancy; first, stimuli may fail to capture the complexity of real-world social orienting and attention, and thus groups perform similarly. Second, researchers often fail to consider potential moderating effects of biological sex on attention to faces.

Males are four times more likely to be diagnosed with ASD than females [17], which is now understood to underestimate the true prevalence of...