Context-Specific Dyadic Attention Vulnerabilities During the First Year in Infants Later Developing Autism Spectrum Disorder

J Am Acad Child Adolesc Psychiatry. 2020 Feb 13;S0890-8567(20)30074-5. doi: 10.1016/j.jaac.2019.12.012. Online ahead of print.


Objective: Although some eye-tracking studies demonstrate atypical attention to faces by 6 months of age in autism spectrum disorder (ASD), behavioral studies in early infancy return largely negative results. We examined the effects of context and diagnosis on attention to faces during face-to-face live interactions in infants at high familial risk (HR) and low familial risk (LR) for ASD.

Method: Participants were 6-, 9-, and 12-month-old siblings of children with ASD who were later determined to have ASD (n = 21), other developmental challenges (HR-C; n = 74), or typical development (TD) (HR-TD; n = 32), and low-risk, typically developing controls (LR-TD; n = 49). Infants were administered the Social Orienting Probes task, consisting of five conditions: Dyadic Bid, Song, Peek-a-boo, Tickle, and Toy Play. Attention to an unfamiliar examiner's face was coded by blinded raters from video recordings.

Results: At all ages, the ASD group spent less time looking at the examiner's face than the HR-C, HR-TD, and LR-TD groups during the Dyadic Bid and Tickle conditions (all p <.05), but not during the Song, Peek-a-Boo, or Toy Play conditions (all p >.23). Lower attention to faces during Dyadic Bid and Tickle conditions was significantly correlated with higher severity of autism symptoms at 18 months.

Conclusion: During the prodromal stages of the disorder, infants with ASD exhibited subtle impairments in attention to faces of interactive partners during interactions involving eye contact and child-directed speech (with and without physical contact), but not in contexts involving singing, familiar anticipatory games, or toy play. Considering the convergence with eye-tracking findings on limited attention to faces in infants later diagnosed with ASD, reduced attention to faces of interactive partners in specific contexts may constitute a promising candidate behavioral marker of ASD in infancy.

Keywords: attention; autism; infancy; social behavior; social interaction.