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Atypical Face Gaze in Autism

CHERYL TREPAGNIER, Ph.D., MARC M. SEBRECHTS, Ph.D., andREBECCA PETERSON, M.A.

ABSTRACT

An eye-tracking study of face and object recognition was conducted to clarify the character oface gaze in autistic spectrum disorders. Experimental participants were a group of individu

als diagnosed with Aspergers disorder or high-functioning autistic disorder according ttheir medical records and confirmed by the Autism Diagnostic InterviewRevised (ADI-R)Controls were selected on the basis of age, gender, and educational level to be comparable tthe experimental group. In order to maintain attentional focus, stereoscopic images were presented in a virtual reality (VR) headset in which the eye-tracking system was installed. Preliminary analyses show impairment in face recognition, in contrast with equivalent and evensuperior performance in object recognition among participants with autism-related diagnoses, relative to controls. Experimental participants displayed less fixation on the centraface than did control-group participants. The findings, within the limitations of the smalnumber of subjects and technical difficulties encountered in utilizing the helmet-mounted

display, suggest an impairment in face processing on the part of the individuals in the experimental group. This is consistent with the hypothesis of disruption in the first months of lifea period that may be critical to typical social and cognitive development, and has importanimplications for selection of appropriate targets of intervention.

CYBERPSYCHOLOGY & BEHAVIORVolume 5, Number 3, 2002 Mary Ann Liebert, Inc.

INTRODUCTION

AUTISTIC DISORDER is a behaviorally definedcondition, diagnosed by severe impair-ments in social and communicative domains,and the presence of repetitive behaviors and/orrestrictive, narrow interests.1 Aspergers disor-der, considered a less severe variant of autisticdisorder, is similar to high-functioning autisticdisorder, such that there remain unresolvedquestions about whether they should be treatedas distinct diagnostic categories. For conve-nience, autistic disorder and Aspergers disor-der will be referred to here as autistic spectrumdisorder, or simply, autism.

Accounts of the core psychobiological deficitin autism have included impairment in the ca-

pacity for social connection,2 impaired ability tshift attention,3 inability to represent and manipulate complex information,4 inability to conceive of others mental states,5 an impairment ocentral coherence, the ability to extract organizing principles,6 and more multifaceted cognitive deficits.7 Research has increasingly pointedto reductions in the connectivity among brainregions that typically work as integrated systems.810 It is important to note, however, thafunctional and structural brain differences canreflect as well as cause atypical behavior.11

Gaze-disruption hypothesis

A hypothesis proposed by the first author1

suggests that disruption of social attention dur

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ing the early months of life due to underlyingneuropsychiatric disorder may be sufficient tobring about autistic development. There is in-creasing evidence of elevated incidence ofneuropsychiatric disorder of the anxiety disor-ders/depressive disorders type among indi-

viduals with autism and their first-degreerelatives (prior to the birth of the disabled indi-vidual). Very early onset or precursor symp-toms may disrupt infant social interaction byimpairing the infants ability to tolerate theoverwhelming excitement of social stimuli.13

Individuals born blind because of cataracts,whose vision is restored by surgery even asearly as age 2 months, have a persistent impair-ment in configurational face processing.14 In

the presence of intact vision, impaired configu-rational face processing may be the marker fora failure to engage in very early social interac-tion, experience that is critical to normal social,cognitive, and emotional development.

Face attention and interpretation

By 1 year of age, typically developing in-fants routinely monitor their adults facial ex-

pressions, and modify their own actions andresponses accordingly. In contrast, childrenand many adolescents and adults with autismdo not.1517 Children with autistic disorder didnot look at faces to discern intention,16 andadults with Aspergers were more likely tolook at someones face when they themselveswere talking to that person, rather than look-ing at someone who was speaking to them.18 Arecent study of children with autism seen at

the Yale Child Study Center over a period ofseveral years found that all were impaired inface recognition relative to controls.19 In func-tional imaging studies, the fusiform gyrus ofcontrols was activated during performance offace-recognition tasks; this was not the case forindividuals with autism carrying out the sametasks.20 In a pilot study using eye-tracking dur-ing a face recognition task, a high-functioningyoung adult with autism spent much less timethan controls looking at eyes and the centralface.21

This study of face and object recognition ex-

spectrum disorders would be impaired in facrecognition, but not in object recognition orecognition of inverted faces (in which configurational information is not preserved), relative to controls; and that persons with autistispectrum disorder would spend less of thei

time than controls fixating on the central facregion (from the eyebrows down to and including the mouth, with width determined bythe outer corners of the eyes).

MATERIALS AND METHODS

Participants were individuals with autismspectrum diagnoses according to their medica

records and confirmed by the Autism Diagnostic InterviewRevised (ADI-R),22 carriedout by the first author, and a group of controlof similar age. Verbal intelligence and nonverbal intelligence were not controlled for; however, all experimental participants were veryhigh-functioning, including one individuawith a graduate degree and a successful professional career, and successful students andcollege-bound adolescents.

Participants were asked to look at and remember a series of images of faces and objectpresented stereoscopically in a virtual reality(VR) head-mounted display equipped with anISCAN eye-tracking system, and then to viewsubsequently a longer series of images and indicate which they had already seen. Foublocks of trials were presented sequentiallyeach with eight acquisition trials (images tolearn) followed by 16 recognition trials (im

ages to evaluate as already seen or not). Ineach acquisition set, participants were shownfour faces and four objects. The acquisition images of the third and fourth blocks includedinverted as well as upright images. Eachimage was presented for 4 sec, with a 4-sec interstimulus interval. Each recognition set included eight previously presented images andeight foils. Participants were asked to indicatby saying yes or no whether or not theyhad seen the image before. Recognition stimulremained present until the participanresponded.

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approximately 30 frames/sec, showing a cur-sor representing the PORs superimposed on atwo-dimensional image of the stimulus. Tem-poral and spatial thresholds were set to definefixation as a gaze of at least 100 msec in length,within approximately 1 degree of visual angle

of the mean location of the points. Further con-straints were introduced into the fixation-detection algorithm to reduce the effects ofspurious points and dropped tracking. Fixa-tion locations were examined with respect topredefined regions of the face stimuli. Data arereported here from five individuals with au-tism spectrum disorder (one female, mean age18.4 years), and six controls (two females,mean age 19.5 years). These were individuals

who responded to a call for subjects disturbedvia the Autism Society of America chapternewsletters and local physicians treating indi-viduals with autism. Individuals with severedisorder self-excluded when they or their par-ents were informed that the study involvedwearing a headset that covered much of thefront of the face. Other candidates and somesubsets of the data from the participants wereexcluded for the following reasons: failure to

meet criterion for autism on the social subscaleof the ADI-R (one participant); technical prob-lems in the data-acquisition program (some ofthe data from two participants); error (some ofthe data from one participant); familiarity withone or more of the people whose images wereused (exclusion of three individuals; exclusionof half the data from one participant); and age(one participant).

RESULTS

Participants initial fixations occurred in thegeneral area at which they had been looking asthe image appeared. Since difficulty in shiftingattention is expected to the autism popu-lation,3 data visualizations for all files (up to96 per participant) were reviewed to deter-mine start time of the first fixation after shift.Examination revealed cases of artifact ap-pended to the beginning of several files, result-ing from technical difficulties in managing the

tism participants were slower overall thancontrols to make the shift from their startinpoint to active examination of the image (p Aa n.s.Block 3 C > Aa A > Ca

Block 4 n.s. A > Ca

All upright C > Ab n.s.All inverted n.s. A > Cb

ap < 0.05, one-tailed.bp < 0.1.n.s., not significant; C, control group; A, autistic group

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Because of difficulties in achieving calibra-tion of the VR helmet-mounted eye-trackingdevice, and the additional barrier it represented

to enrollment of individuals with autistic spec-trum disorders, use of the headset-mountedsystem was discontinued. The study is about toresume using a desk-top eye-tracking deviceand stimuli presented on a large monitor. AnIntegraph computer is now being used to ac-quire the data, and the program has beenthoroughly tested to assure that no buffer-management artifacts occur. It remains to beseen whether the nonimmersive, nonthree-

dimensional presentation of images will evokesimilar responses.

CONCLUSION

The results of this study must be regarded asprovisional, in view of the technical problemsthat taint the initial second of some of the files,the calibration difficulties encountered, and

the small number of participants. If these re-sults are borne out, they indicate a relationshipbetween the face-recognition difficulties of au-tism and maladaptive allocation of face gaze.This suggests that intervention directed at in-creasing attention to the informative area ofthe face, and teaching how to interpret face-borne information, may be beneficial, all themore so if provided early in development.These findings are also consistent with the hy-

pothesis of failure to acquire configurationalface-processing skills, pointing to very earlydisruption in the infants availability to social

ACKNOWLEDGMENTS

Partial support for this work was provided

by the Rehabilitation Engineering ResearchCenter on Telerehabilitation, which is fundedby the National Institute on Disability and Rehabilitation Research of the U.S. Departmenof Education under grant no. H133E980025.

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216 TREPAGNIER ET AL

TABLE 2. PERCENT OF FIXATIONS ON CENTRAL FACE REGION

t scores

(p < 0.05,

Blocks Task Autistic Control one-tailed)

1 and 2 Acquisition (16 images) 50% 73% t(7) = 2.141 and 2 Recognition (32) 46% 78% t(6) = 2.16

3 and 4 Acquisitiona

(8) 55% 85% t(9) = 2.603 and 4 Recognition (32) 57% 88% t(8) = 3.01

aUpright images only.

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Address reprint requests toCheryl Trepagnier, Ph.D

Rehabilitation Engineering Servic

National Rehabilitation Hospita102 Irving St. NW

Washington, DC 2001

E-mail: Cheryl.trepagnier@medstar.ne

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