Development of an Objective Autism Risk Index Using Remote Eye Tracking

Abstract

Objective Abnormal eye gaze is a hallmark characteristic of autism spectrum disorder (ASD), and numerous studies have identified abnormal attention patterns in ASD. The primary aim of the present study was to create an objective, eye tracking-based autism risk index. Method In initial and replication studies, children were recruited after referral for comprehensive multidisciplinary evaluation of ASD and subsequently grouped by clinical consensus diagnosis (ASD n=25/15, non-ASD n=20/19 for initial/replication samples). Remote eye tracking was blinded to diagnosis and included multiple stimuli. Dwell times were recorded to each a priori-defined region-of-interest (ROI) and averaged across ROIs to create an autism risk index. Receiver operating characteristic curve analyses examined classification accuracy. Correlations with clinical measures evaluated whether the autism risk index was associated with autism symptom severity independent of language ability. Results In both samples, the autism risk index had high diagnostic accuracy (area under the curve [AUC]=.91 and .85, 95%CIs=.81–.98 and .71–.96), was strongly associated with Autism Diagnostic Observation Schedule–Second Edition (ADOS-2) severity scores (r=.58 and .59, p<.001), and not significantly correlated with language ability (r≤|−.28|, p>.095). Conclusion The autism risk index may be a useful quantitative and objective measure of risk for autism in at-risk settings. Future research in larger samples is needed to cross-validate these findings. If a validated scale for clinical use, this measure could inform clinical judgment regarding ASD diagnosis and track symptom improvements.

A Meta-Analysis of Gaze Differences to Social and Nonsocial Information Between Individuals With and Without Autism

“…The finding of larger overall effects for nonsocial stimuli is consistent with our recent study 22 and suggests several nonexclusive possibilities: a) a basic discrimination problem in selecting the most salient stimuli, b) difficulty sustaining attention to the most salient stimuli and filtering extraneous information during visual perceptual experience, and/or c) a top-down attentional preference for stimuli that are not socially or emotionally relevant in most contexts but have acquired reinforcing value via prior experience (e.g. restricted interests and abnormal sensory interests).…”

“…While the present meta-analysis cannot definitively distinguish between these possibilities, consistency of effects across age decreases the likelihood that reinforcement history is playing a major role. Furthermore, the fact that we have found abnormal attention to nonsocial stimuli within the first few seconds of presentation 22 decreases the likelihood of primary sustained attention deficits. The most plausible explanation appears to be a basic discrimination problem that emerges early in life and remains relatively constant.…”

“…Specifically, medium-sized effects for nonsocial, eye, and whole face ROIs within human interaction stimuli, if aggregated, could produce sufficient validity to inform autism identification. 22 …”

“…Based on recent findings across a wide range of stimuli and paradigms, 22 we hypothesized that gaze differences would be significant and medium-sized, with larger effect sizes seen to face regions and nonsocial regions embedded within a social context. The secondary aim was to evaluate whether gaze differences were stronger to stimuli that included social interaction and/or increased complexity (e.g.…”

Fostering Spontaneous Visual Attention in Children on the Autism Spectrum: A Proof‐of‐Concept Study Comparing Singing and Speech

“…Recent eye‐tracking studies measuring gaze toward social target areas in still pictures [Nuske, Vivanti, & Dissanayake, ], videos [Frazier et al, ; Klin, Jones, Schultz, Volkmar, & Cohen, ; Nakano et al, ] or in vivo social interactions via computer application such as Skype [Hutchins & Brien, ] reveal notable differences in individuals with autism across the lifespan. Children as young as 3 years old are more likely to look toward non‐social aspects of video recordings [Frazier et al, ], while both children and adults on the autism spectrum divert their gaze away from an actor in a video earlier than typically developing controls, with adults also displaying a preference for focusing on the mouths of the actors [Nakano et al, ].…”