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

Abstract

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 SummaryIndividuals 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.

Temporal progression of pupil dilation and gaze behavior to emotion expressions in preschoolers with autism spectrum disorder

“…Temporal progression analyses revealed an initially lower looking time for the eye region in autistic compared to non-autistic children, but a higher looking time for the mouth region. These findings correspond to an established line of research pointing to atypical gaze behavior to eyes 20 , 22 . While previous findings on gaze behavior to the mouth are heterogeneous 21 , our results suggest that sensitive outcome measures are required to quantify atypical mouth attention.…”

“…This corresponds to increased prevalences of intellectual impairment in the ASD population 61 and is unlikely to impact implicit emotion processing. Visual attention has however been linked to language development 24 and culture 20 , which we did not assess in the current sample. Future studies are invited to include additional control groups.…”

“…Gaze behavior constitutes another determinant of emotion processing. Atypical gaze behavior in ASD has been described as a reduced number of fixations and fixation duration to eyes, which is already observable during early childhood and persists with increasing age 20 – 22 . In contrast, a meta-analysis reported heterogeneous, but non-significant group differences in gaze behavior to the mouth 21 , which might be dependent on participants’ speech abilities and the involvement of speech cues in the stimulus material 21 , 23 , 24 .…”

Structure, Function, and Genetics of the Cerebellum in Autism

“…Many other aberrant connections have also been identified in ASD, including additional connections of classically considered nonmotor areas of the cerebellum to sensorimotor cerebral cortices: particularly, regions of the occipital lobe, premotor and primary motor cortices, and primary somatosensory cortex [ 63 ]. Atypical eye gaze [ 67 ], delayed orienting [ 68 ], impairments in smooth pursuit [ 69 ], altered movement perception, and deficits in facial perception [ 70 ] demonstrated by individuals with ASD (details reviewed by [ 71 , 72 ]) are likely mediated by these abnormal sensorimotor connections, other alterations in olivofloccular circuitry [ 73 ], and altered PC activity and number. In rodents, some PC projections bypass the DCN and synapse directly within the vestibular nuclei, suggesting that PC alterations in ASD could directly exacerbate vestibuloocular reflex abnormalities [ 74 , 75 ].…”

I see you, you see me: the impact of social presence on social interaction processes in autistic and non-autistic people

“…A huge volume of research has been conducted on this issue (see [2][3][4][5] for recent reviews) including a focus on whether social attention patterns can be used as a biomarker for autism diagnosis [6][7][8]. Indeed, differences between autistic and non-autistic people's attention to direct gaze have been found to exist across cultures, with a recent meta-analysis including over 2000 autistic participants demonstrating gaze atypicalities for individuals from both Eastern and Western cultures [9]. However, while many of the difficulties experienced by autistic individuals are social in nature, much previous research in this area has been conducted in laboratory environments lacking the presence of a social partner.…”