Sex differences in social attention in autism spectrum disorder

Abstract

Although reduced social attention and increased nonsocial attention have been reported in individuals with autism spectrum disorder (ASD), the studies have relied on predominantly male samples and have been underpowered to examine sex differences. These processes may differ for females with ASD, who have been shown to be dissimilar to males in social motivation and nonsocial features, including circumscribed interests (CI). The goal of this study was to compare social and nonsocial visual attention between males and females with ASD on a validated eye-tracking paradigm. Eighty-five school-aged (6-10 years) males and females with and without ASD completed a paired preference task of face and object stimuli (half of which related to common CI). After covarying for chronological and mental age, the presence of concurrently presented CI images reduced prioritization and attention to faces for males more than females, replicating previous findings. ASD females maintained comparable attention patterns to typically developing females, suggesting that previous findings of reduced social attention and increased attention to CI-related objects in autism may be specific to males. These findings are also inconsistent with the "extreme male brain" theory of autism. The more normative orienting and attention to social stimuli for females with ASD may indicate distinct phenotypic characteristics relative to males and possibly serve as a protective effect.Lay Summary: As autism is more commonly diagnosed in males, less is known about females with autism. Two areas of interest include the interests held by individuals with autism and how socially motivated they are. We used eye tracking as a way to understand these two areas. Our data reveal that elementary school-aged females (6-10 years) with autism attended to faces comparatively to females without autism, suggesting that (1) they were more socially motivated than males with autism and (2) the images of common interests were less motivating to them.

No preference for direct versus averted gaze in autistic adults: a reinforced preferential looking paradigm

“…Contrary to our predictions, we found no correlation between gender and any aspect of visual exploration of our stimuli. The few previous studies that found an effect of gender on social processing in autism mainly focused on infants and children [ 38 , 44 – 49 ]. The absence of gender effect in our sample thus calls for a developmental perspective on the interaction between gender and social attention in autism.…”

“…While there is a growing interest in gender differences in autism, only a few eye-tracking studies controlled for the effects of gender on social processing in autism [ 38 , 44 – 49 ]. Most of these studies (mainly based on child samples) suggest a potentially higher social attention in autistic females compared to autistic males.…”

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

“…Chawarska et al [30] reported enhanced attention to social stimuli—including faces—in female infants at high risk for ASD. Harrop and colleagues [31] reported more normative patterns of social attention in ASD females when faces were paired with images of common circumscribed interests, suggesting that compared to ASD males, they were less influenced by non-social stimuli.…”

Visual Search for Circumscribed Interests in Autism Is Similar to That of Neurotypical Individuals

“…Although it does not seem that there was a ceiling effect, since there were significant differences in slope across categories, as well as noticeable decreases in accuracy and increases in reaction time across array sizes, future studies may wish to compare category task performance with a scrambled-distractor paradigm to performance with an othercategory paradigm. Finally, the number of female participants was too small to assess sex effects in the analyses, which may be informative given the sex imbalance in ASD and the possibility that there is a difference in the effects of interests on behavior across sex (Harrop et al, 2018).…”