Early social attention impairments in autism: social orienting, joint attention, and attention to distress

This study investigated social attention impairments in autism (social orienting, joint attention, and attention to another's distress) and their relations to language ability. Three- to four-year-old children with autism spectrum disorder (ASD; n = 72), 3- to 4-year-old developmentally delayed children (n = 34), and 12- to 46-month-old typically developing children (n = 39), matched on mental age, were compared on measures of social orienting, joint attention, and attention to another's distress. Children with autism performed significantly worse than the comparison groups in all of these domains. Combined impairments in joint attention and social orienting were found to best distinguish young children with ASD from those without ASD. Structural equation modeling indicated that joint attention was the best predictor of concurrent language ability. Social orienting and attention to distress were indirectly related to language through their relations with joint attention. These results help to clarify the nature of social attention impairments in autism, offer clues to developmental mechanisms, and suggest targets for early intervention.     

Low-level visual attention and its relation to joint attention in autism spectrum disorder

Visual attention is integral to social interaction and is a critical building block for development in other domains (e.g., language). Furthermore, atypical attention (especially joint attention) is one of the earliest markers of autism spectrum disorder (ASD). The current study assesses low-level visual attention and its relation to social attentional processing in youth with ASD and typically developing (TD) youth, aged 7 to 18 years. The findings indicate difficulty overriding incorrect attentional cues in ASD, particularly with non-social (arrow) cues relative to social (face) cues. The findings also show reduced competition in ASD from cues that remain on-screen. Furthermore, social attention, autism severity, and age were all predictors of competing cue processing. The results suggest that individuals with ASD may be biased towards speeded rather than accurate responding, and further, that reduced engagement with visual information may impede responses to visual attentional cues. Once attention is engaged, individuals with ASD appear to interpret directional cues as meaningful. These findings from a controlled, experimental paradigm were mirrored in results from an ecologically valid measure of social attention. Attentional difficulties may be exacerbated during the complex and dynamic experience of actual social interaction. Implications for intervention are discussed.     

Additive effects of social and non‐social attention during infancy relate to later autism spectrum disorder

Emerging findings from studies with infants at familial high risk for autism spectrum disorder (ASD), owing to an older sibling with a diagnosis, suggest that those who go on to develop ASD show early impairments in the processing of stimuli with both social and non‐social content. Although ASD is defined by social‐communication impairments and restricted and repetitive behaviours, the majority of cognitive theories of ASD posit a single underlying factor, which over development has secondary effects across domains. This is the first high‐risk study to statistically differentiate theoretical models of the development of ASD in high‐risk siblings using multiple risk factors. We examined the prediction of ASD outcome by attention to social and non‐social stimuli: gaze following and attentional disengagement assessed at 13 months in low‐risk controls and high‐risk ASD infants (who were subsequently diagnosed with ASD at 3 years). When included in the same regression model, these 13‐month measures independently predicted ASD outcome at 3 years of age. The data were best described by an additive model, suggesting that non‐social attention, disengagement, and social attention as evidenced by gaze following, have a cumulative impact on ASD risk. These data argue against cognitive theories of ASD which propose that a single underlying factor has cascading effects across early development leading to an ASD outcome, and support multiple impairment models of ASD that are more consistent with recent genetic and neurobiological evidence.     

Young children with autism show atypical brain responses to fearful versus neutral facial expressions of emotion

Evidence suggests that autism is associated with impaired emotion perception, but it is unknown how early such impairments are evident. Furthermore, most studies that have assessed emotion perception in children with autism have required verbal responses, making results difficult to interpret. This study utilized high-density event-related potentials (ERPs) to investigate whether 3-4-year-old children with autism spectrum disorder (ASD) show differential brain activity to fear versus neutral facial expressions. It has been shown that normal infants as young as 7 months of age show differential brain responses to faces expressing different emotions. ERPs were recorded while children passively viewed photos of an unfamiliar woman posing a neutral and a prototypic fear expression. The sample consisted of 29 3-4-year-old children with ASD and 22 chronological age-matched children with typical development. Typically developing children exhibited a larger early negative component (N300) to the fear than to the neutral face. In contrast, children with ASD did not show the difference in amplitude of this early ERP component to the fear versus neutral face. For a later component, typically developing children exhibited a larger negative slow wave (NSW) to the fear than to the neutral face, whereas children with autism did not show a differential NSW to the two stimuli. In children with ASD, faster speed of early processing (i. e. N300 latency) of the fear face was associated with better performance on tasks assessing social attention (social orienting, joint attention and attention to distress). These data suggest that children with ASD, as young as 3 years of age, show a disordered pattern of neural responses to emotional stimuli.     

婴幼儿面孔注意偏向：先天倾向与发展轨迹——来自正常和孤独症婴幼儿的证据

正常发展(Typically developing, TD)婴儿的先天面孔注意倾向稳定地存在于不同发展阶段不同刺激情景中, 且在生命第一年内呈现短暂下降后快速增强的发展趋势。TD婴幼儿的视觉注意在第4至6周之间发生由皮下控制向皮层控制的关键性转变之后, 伴随面孔视觉经验的不断积累, 逐渐形成的面孔特异性皮层网络对面孔的优先选择性反应逐渐增强。而孤独症谱系(Autism Spectrum Disorder, ASD)婴幼儿具备初始的面孔注意先天倾向, 但在面孔皮层发育关键期内逐渐偏离正常轨道, 在1岁左右表现出面孔注意障碍。该群体先天的感知注意损伤或社会动机缺失可能导致其在关键性转变期内的面孔视觉经验输入不足, 进而阻碍面孔特异性皮层网络的正常发展。未来研究可考虑采用生物遗传学方法和近红外脑成像技术探索新生儿面孔注意先天倾向的起源, 系统考察社会场景中感知觉特征和社会性特征对ASD高危婴儿面孔注意发展轨迹尤其是关键性转变期的影响作用。     

自闭症谱系障碍个体的注意解离

注意解离是注意定向网络的重要组成部分, 指在注意转移过程中对原来刺激进行注意分离的过程。自闭症个体注意解离的早期受损会直接影响其它重要功能的发展, 尤其是唤醒调节和共同注意发展。采用间隙重叠范式的研究发现, 自闭症个体注意解离能力是否异常还存在争议, 被试年龄及取样、测量指标和刺激特征可能是影响的因素; 其神经机制可能涉及额叶、顶叶、小脑和胼胝体等脑区。未来应从脑机制研究入手, 综合考虑被试特征、研究方法和刺激特征对注意解离结果的影响, 明确其在自闭症早期预测和识别中的作用。     

注意和记忆对孤独症儿童词汇发展滞后的影响

孤独症语言障碍的表现之一是词汇发展滞后, 可能与其注意和记忆损伤有关。当前研究结果表明, 孤独症儿童在学习词汇时难以利用社会注意提供的有效信息, 且其注意易受到无关刺激干扰, 这可能导致其形成的物体-词汇的联结不稳定, 影响其进一步将这种联结整合到心理词典并保存在记忆中。未来研究应探究联合注意影响孤独症儿童词汇学习的发展轨迹和机制, 儿童的词汇知识对其词汇记忆的影响, 并关注自然场景中孤独症儿童的词汇学习过程和个体差异。     

高功能孤独症儿童的合作行为

合作行为是一种重要的亲社会行为, 对儿童的社会适应具有重要意义, 而孤独症儿童的典型特征是社会功能存在缺陷, 从而导致合作行为的缺乏。以往研究未能就孤独症儿童在不同合作任务类型中的表现做出区分, 本研究采用经典的囚徒困境博弈和合作性工具任务比较了6~12岁的高功能孤独症儿童和正常发展儿童在不同任务中的合作行为。结果显示高功能孤独症儿童和正常儿童在囚徒困境中的合作行为没有显著差异, 然而, 他们在工具性任务中表现出比正常儿童更低水平的合作行为。这说明高功能孤独症儿童在对认知能力有不同要求的合作任务中的表现不同。     

Selective attention and attention switching: towards a unified developmental approach

We review and relate two literatures on the development of attention in children: one concerning flexible attention switching and the other concerning selective attention. The first is a growing literature on preschool children’s performances in an attention‐switching task indicating that children become more flexible in their attentional control during the preschool years. The second literature encompasses a large and robust set of phenomena for the same developmental period that indicates a protracted course of development for selective attention in children. We ask whether developmental changes in processes of selective attention may contribute to more flexible attention switching. We consider the two sets of phenomena with respect to this question and propose an empirical agenda for their joint study that may lead ultimately to a unified account of the development of selective attention and attention switching.     

The effects of early foster care intervention on attention biases in previously institutionalized children in Romania

Children raised in institutions experience psychosocial deprivation that can negatively impact attention skills and emotion regulation, which subsequently may influence behavioral regulation and social relationships. The current study examined visual attention biases in 8‐year‐old children who were part of the Bucharest Early Intervention Project (BEIP). Relations among attention biases and concurrent social outcomes were also investigated. In early childhood, 136 children abandoned at birth or shortly thereafter into institutional care were randomized to receive a high‐quality foster care intervention or care‐as‐usual within the context of the Bucharest Early Intervention Project (BEIP). At 8 years of age, 50 care‐as‐usual, 55 foster care, and 52 community controls performed a behavioral dot‐probe task, and indices of attention biases to threat and positive stimuli were calculated. Concurrent data on social behavior were collected. Children placed into the foster care intervention had a significant attention bias toward positive stimuli, while children who received care‐as‐usual had a significant bias toward threat. Children in the foster care intervention had a significantly larger positive bias when compared to the care‐as‐usual group. A positive bias was related to more social engagement, more prosocial behavior, less externalizing disorders, and less emotionally withdrawn behavior. The magnitude of positive bias was predicted by age of placement into foster care among children with a history of institutionalization. An attention bias towards positive stimuli was associated with reduced risk for behavioral problems amongst children who experienced early psychosocial deprivation. Research assessing attention biases in children experiencing early environmental stress may refine our understanding of the mechanisms underlying risk for later psychiatric and social disorders and inform prevention efforts.     

Visual attention and academic performance in children with developmental disabilities and behavioural attention deficits

Despite well‐documented attention deficits in children with intellectual and developmental disabilities (IDD), distinctions across types of attention problems and their association with academic attainment has not been fully explored. This study examines visual attention capacities and inattentive/hyperactive behaviours in 77 children aged 4 to 11 years with IDD and elevated behavioural attention difficulties. Children with autism spectrum disorder (ASD; n = 23), Down syndrome (DS; n = 22), and non‐specific intellectual disability (NSID; n = 32) completed computerized visual search and vigilance paradigms. In addition, parents and teachers completed rating scales of inattention and hyperactivity. Concurrent associations between attention abilities and early literacy and numeracy skills were also examined. Children completed measures of receptive vocabulary, phonological abilities and cardinality skills. As expected, the results indicated that all groups had relatively comparable levels of inattentive/hyperactive behaviours as rated by parents and teachers. However, the extent of visual attention deficits varied as a result of group; namely children with DS had poorer visual search and vigilance abilities than children with ASD and NSID. Further, significant associations between visual attention difficulties and poorer literacy and numeracy skills were observed, regardless of group. Collectively the findings demonstrate that in children with IDD who present with homogenous behavioural attention difficulties, at the cognitive level, subtle profiles of attentional problems can be delineated.     

Auditory joint attention skills: Development and diagnostic differences during infancy

To date, joint attention skill assessments have focused on children’s responses to multimodal bids (RJA) and their initiation of bids (IJA) to multimodal spectacles. Here we gain a systematic view of auditory joint attention skills using a novel assessment that measures both auditory and multimodal RJA and IJA. In Study 1, 47 typically developing (TD) children were tested 5 times from 12 to 30 months to document auditory joint attention skill development. In Study 2, 113 toddlers (39 TD, 33 autism spectrum disorder [ASD], and 41 non-ASD developmental disorders [DD]; average age 22.4 months) were tested to discern the effects of ASD. Our findings fit well within the established depiction of joint attention skills with one important caveat: auditory items were far more difficult to execute than multimodal ones. By 24 months, TD children passed multimodal RJA items at the near-ceiling level, an accomplishment not reached even by 30 months for auditory RJA items. Intentional communicative IJA bids also emerged more slowly to auditory spectacles than to multimodal spectacles. Toddlers with DD outperformed toddlers with ASD on multimodal RJA items but toddlers in both groups rarely passed any auditory RJA items. Toddlers with ASD often monitored their partner’s attention during IJA items, albeit less often than toddlers with DD and TD toddlers, but they essentially never produced higher-level IJA bids, regardless of modality. Future studies should investigate further how variations in bids and targets affect auditory joint attention skills and probe the relation between these skills and language development.     

Autism and attention deficit hyperactivity disorder: assessing attention and response control with the integrated visual and auditory continuous performance test.

Symptoms of attention deficit hyperactivity disorder (ADHD) have been widely reported in children with autism spectrum disorder (ASD). The current study investigated attention and response control in children with ASD, ADHD, and typical development using the Integrated Visual and Auditory Continuous Performance Test. Results indicate that many children with ASD show significant deficits in visual and auditory attention and greater deficits in impulsivity than children with ADHD or typical development. These findings suggest that many of the children with ASD demonstrate significant ADHD-like deficits. These findings are discussed in the context of symptoms, subtypes, and comorbidity.     

Gaze cueing of attention: visual attention, social cognition, and individual differences

During social interactions, people's eyes convey a wealth of information about their direction of attention and their emotional and mental states. This review aims to provide a comprehensive overview of past and current research into the perception of gaze behavior and its effect on the observer. This encompasses the perception of gaze direction and its influence on perception of the other person, as well as gaze-following behavior such as joint attention, in infant, adult, and clinical populations. Particular focus is given to the gaze-cueing paradigm that has been used to investigate the mechanisms of joint attention. The contribution of this paradigm has been significant and will likely continue to advance knowledge across diverse fields within psychology and neuroscience.     

Social stimulation and joint attention in young autistic children

The present study was designed to examine the effects of social stimulation on the joint attention behavior of 20 autistic children under 6 years of age, 20 receptive language-matched Down syndrome children, and 20 receptive language matched-normally-developing infants. Children's social and non-social engagement states were measured during two experimental play sessions and during free play with parent. For all groups, joint attention was increased when adult play behavior closely followed and was contingent on the behavior of the children; however, the autistic children were significantly less responsive to the experimental manipulation than control subjects. In contrast, the autistic children were no less responsive in terms of other forms of social engagement. Results are interpreted as supporting a model of joint attention deficits in autism that involves factors inherent to the disorder in transaction with social context.     

Visual attention and action: How cueing,direct mapping,and social interactions drive orienting

Despite considerable interest in both action perception and social attention over the last 2 decades, there has been surprisingly little investigation concerning how the manual actions of other humans orient visual attention. The present review draws together studies that have measured the orienting of attention, following observation of another’s goal-directed action. Our review proposes that, in line with the literature on eye gaze, action is a particularly strong orienting cue for the visual system. However, we additionally suggest that action may orient visual attention using mechanisms, which gaze direction does not (i.e., neural direct mapping and corepresentation). Finally, we review the implications of these gaze-independent mechanisms for the study of attention to action. We suggest that our understanding of attention to action may benefit from being studied in the context of joint action paradigms, where the role of higher level action goals and social factors can be investigated.     

Joint attention and children with autism: a review of the literature

Preverbal communication and joint attention have long been of interest to researchers and practitioners. Both attending to social partners and sharing attentional focus between objects or events and others precede the onset of a child's first lexicon. In addition, these prelinguistic acts also appear to have important implications with regard to learning to socialize. The construct of joint attention has been noted as an early developing area prior to the transition to symbolic communication. Thus, the importance of joint attention in typically developing children, and the lack thereof in children with autism, has interested researchers for use in diagnosis and intervention for autism. That is, joint attention has been gaining momentum as an area that not only helps characterize children with autism, but also as a prognostic indicator and a potential intervention goal. In this paper, the status of the literature about initiation of joint attention by young typically developing children and young children with autism was examined. Empirical studies regarding joint attention behaviors, including eye gaze alternation, the use of protodeclaratives and protoimperatives, and studies that investigated joint attention as a predictor of language acquisition were reviewed. Possible areas for future research for children with autism are discussed.     

孤独症儿童潜在早期识别标志——发声异常及原因探析

孤独症谱系障碍(Autism Spectrum Disorder, ASD)儿童的早期识别及早期干预对其发育结果至关重要。发声是指儿童学会说话之前发出的声音。已有研究表明, 非类言语和类言语发声异常是ASD儿童2岁前的潜在识别标志。ASD儿童发声异常的理论解释主要有动机导向、神经运动导向、感知觉导向和社会反馈导向理论。未来研究可考虑探讨发声异常作为ASD儿童独特的早期识别标志的可能性, 加强哭声在ASD儿童早期筛查中的研究, 探索基于最具预测性声学参数集的自动学习分类模型, 探究内在动机与社会动机对ASD儿童类言语发声的影响和进一步探究ASD儿童类言语发声异常的神经机制。从而为ASD儿童的早期识别及早期干预提供更加客观的理论依据。     

Electrophysiological evidence of heterogeneity in visual statistical learning in young children with ASD

Statistical learning is characterized by detection of regularities in one's environment without an awareness or intention to learn, and it may play a critical role in language and social behavior. Accordingly, in this study we investigated the electrophysiological correlates of visual statistical learning in young children with autism spectrum disorder (ASD) using an event‐related potential shape learning paradigm, and we examined the relation between visual statistical learning and cognitive function. Compared to typically developing (TD) controls, the ASD group as a whole showed reduced evidence of learning as defined by N1 (early visual discrimination) and P300 (attention to novelty) components. Upon further analysis, in the ASD group there was a positive correlation between N1 amplitude difference and non‐verbal IQ, and a positive correlation between P300 amplitude difference and adaptive social function. Children with ASD and a high non‐verbal IQ and high adaptive social function demonstrated a distinctive pattern of learning. This is the first study to identify electrophysiological markers of visual statistical learning in children with ASD. Through this work we have demonstrated heterogeneity in statistical learning in ASD that maps onto non‐verbal cognition and adaptive social function.     

Attention to repeated events in human infants (Homo sapiens): effects of joint visual attention versus stimulus change

The goal of this study was to examine the effect of joint visual attention on infants' behavior during subsequent events. Thirty-seven mother-infant (aged from 9 to 13 months) pairs were twice shown a pair of line drawing stimuli on a computer screen. For the control group, the mother never paid attention to the stimuli. For experimental group 1, the mother pointed to one stimulus in the first presentation but did not point to it in the second presentation. The infants gazed longer at the stimulus pointed to by their mothers in the first presentation. In the second presentation, during which mothers did not attend to the stimuli, infants gazed longer at the stimulus which had been pointed to by the mothers in the first presentation. In experimental group 2, one of two stimuli blinked during the first presentation but not the second presentation. Infants gazed for longer at the blinking stimulus in the first presentation, but there was no difference in looking time toward the two stimuli in the second presentation. These results suggest that joint visual attention affects infants' looking behavior during subsequent events, and that simple stimulus change does not. Accepted after revision: 2 May 2001 Electronic Publication