Comorbidity Matters: Social Visual Attention in a Comparative Study of Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Their Comorbidity

Chara Ioannou; Divya Seernani; Maria Elena Stefanou; Andreas Riedel; Ludger Tebartz van Elst; Nikolaos Smyrnis; Christian Fleischhaker; Monica Biscaldi-Schaefer; Giuseppe Boccignone; Christoph Klein

doi:10.3389/fpsyt.2020.545567

Comorbidity Matters: Social Visual Attention in a Comparative Study of Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Their Comorbidity

Front Psychiatry. 2020 Sep 30:11:545567. doi: 10.3389/fpsyt.2020.545567. eCollection 2020.

Authors

Affiliations

¹ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Freiburg, Freiburg, Germany.
² School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom.
³ Department of Psychiatry and Psychotherapy, Medical Faculty, University of Freiburg, Freiburg, Germany.
⁴ Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
⁵ Department of Computer Science, University of Milan, Milan, Italy.
⁶ Department of Child and Adolescent Psychiatry, University Hospital Cologne, Cologne, Germany.

Abstract

Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) represent two common neurodevelopmental disorders with considerable co-occurrence. Their comorbidity (ASD + ADHD) has been included in the latest diagnostic guidelines (DSM-V, 2013). The present study focuses on social visual attention that i) is a main aspect of social attention reflecting social cognition and ii) its atypicalities have been suggested as a potential biomarker for ASD. Considering the possible shared background of both disorders and their comorbidity, it is important to compare such traits directly. Here, 73 children and adolescents paired for age and IQ diagnosed with ASD (N = 12), ADHD (N = 21), comorbid ASD + ADHD (N = 15), and "typically developing" (TD) controls (N = 25), were shown static real-life social scenes while their gaze movements were recorded with eye-tracking. Scenes with two levels of social complexity were presented: low complexity (one person depicted) and high (four interacting individuals). Gaze fixation variables were investigated. Fixation duration on faces was significantly reduced only in ASD + ADHD which also required longer time to fixate all faces at least once. Fixation duration on faces in ASD was reduced, compared to TD, only when looking at scenes with high versus low social complexity. ADHD individuals did not differ from TD. Concluding, the observed alterations of social visual attention support the existence of possible dysfunctional particularities differentiating ASD, ADHD, and ASD + ADHD, which can be revealed with the new method of eye-tracking technique. The objective gaze measurements provided contribute to the development of biomarkers enabling early diagnosis, amelioration of care and further interventions specified for each group.

Keywords: attention-deficit/hyperactivity disorder; autism spectrum disorder; comorbidity; eye tracking; neurodevelopmental disorders; social cognition.