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

Abstract

Background: The male bias in autism spectrum disorder (ASD) diagnoses is well documented. As a result, less is known about the female ASD phenotype. Recent research suggests that conclusions drawn from predominantly male samples may not accurately capture female behavior. In this study, we explore potential sex differences in attention to social stimuli, which is generally reported to be diminished in ASD. Population-based sex differences in attention to faces have been reported, such that typically developing (TD) females attend more to social stimuli (including faces) from infancy through adulthood than TD males. It is yet unknown whether population-based sex differences in the face domain are preserved in ASD. Methods: A dynamic, naturalistic infrared eye-tracking paradigm measured attention to social stimuli (faces) in 74 school-aged males and females with ASD (male N = 23; female N = 19) and without ASD (male N = 16; female N = 16). Two kinds of video stimuli were presented that varied in social content: rich social scenes (dyadic play between two children) and lean social scenes (parallel play by two children). Results: Results revealed a significant 3-way interaction between sex, diagnosis, and condition after controlling for chronological and mental age. ASD females attended more to faces than ASD males in the socially lean condition. This effect was not found in the typically developing (TD) group. ASD males attended less to faces regardless of social context; however, ASD females only attended significantly less to faces compared to TD females in the socially rich condition. TD males and ASD females did not differ in their attention to faces in either condition. Conclusions: This study has implications for how the field understands core social deficits in children with ASD, which should ideally be benchmarked against same-sex peers (male and female). Social attention in ASD females fell on a continuum-greater than their ASD male peers, but not as great as TD females. Overall, their social attention mirrored that of TD males. Improved understanding of the female social phenotype in ASD will enhance early screening and diagnostic efforts and will guide the development of sex-sensitive experimental paradigms and social interventions.

Social attention to activities in children and adults with autism spectrum disorder: effects of context and age

“…First, unlike age, sex did not significantly contribute to any of the linear mixed-effects models, suggesting that while it may be important to account for this variable as a covariate [ 53 ], there is little evidence within the current study to suggest that patterns of social attention are influenced by sex. This finding is consistent with several studies that have not identified sex differences in behavioral features of ASD [ 54 ], but is in contrast to one study that identified sex differences in visual attention to dynamic social scenes for children with ASD [ 55 ]. Methodological differences between our study and Harrop et al [ 55 ] could reconcile this discrepancy as the study included a younger, more restricted age range of participants between 6 and 10 years.…”

“…This finding is consistent with several studies that have not identified sex differences in behavioral features of ASD [ 54 ], but is in contrast to one study that identified sex differences in visual attention to dynamic social scenes for children with ASD [ 55 ]. Methodological differences between our study and Harrop et al [ 55 ] could reconcile this discrepancy as the study included a younger, more restricted age range of participants between 6 and 10 years. It is possible that sex differences in social attention are developmentally sensitive, and that combining children, adolescents, and adults together may mask some developmental trends, and our sample size of 29 females compared to a larger proportion of males was not sufficient to detect any differences.…”

Sex differences in the first impressions made by girls and boys with autism

“…ADOS-2 calibrated severity scores of 1-2 indicate minimal-to-no evidence of autism symptoms, scores of 3-4 indicate a low level of autism symptoms, 5-7 a moderate level, and 8-10 a high level. The Social Communication Questionnaire (SCQ) [67] "Lifetime" version [73] was filled out by parents to assess the presence of ASD symptoms. To assess cognition, clinicians administered one of four cognitive tests; scores were standardized by J. Pandey and reduced to a single cognitive estimate, along with verbal and nonverbal subscores (see S2 for further details).…”

Social Motivation Across Multiple Measures: Caregiver‐Report of Children with Autism Spectrum Disorder

“…A primary limitation of the current study is the absence of girls with ASD among our participants, as girls and women with ASD are underrepresented in the literature [Lai, Baron‐Cohen, & Buxbaum, 2015], may be incompletely characterized by current diagnostic practices [e.g., Boorse et al, 2019; Dworzynski, Ronald, Bolton, & Happé, 2012], may demonstrate distinct patterns of social information processing [Harrop et al, 2018; Harrop et al, 2019], and may have different social experiences and trajectories in comparison to males with ASD [Lai & Szatmari, 2020]. These differences may be especially prominent in a sample such as this one, in which participants had strong verbal and nonverbal cognitive skills [Dworzynski et al, 2012].…”