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Characteristics of Visual Fixation in Chinese Children with Autism during Face-to-Face Conversations

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Title: Characteristics of Visual Fixation in Chinese Children with Autism during Face-to-Face Conversations
Language: English
Authors: Zhao, Zhong, Tang, Haiming, Zhang, Xiaobin, Zhu, Zhipeng, Xing, Jiayi, Li, Wenzhou, Tao, Da, Qu, Xingda, Lu, Jianping
Source: Journal of Autism and Developmental Disorders. Feb 2023 53(2):746-758.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 13
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Descriptors: Children, Autism Spectrum Disorders, Attention, Eye Movements, Interpersonal Communication, Foreign Countries, Human Body
Geographic Terms: China
DOI: 10.1007/s10803-021-04985-y
ISSN: 0162-3257
1573-3432
Abstract: Few eye tracking studies have examined how people with autism spectrum disorder (ASD) visually attend during live interpersonal interaction, and none with the Chinese population. This study used an eye tracker to record the gaze behavior in 20 Chinese children with ASD and 23 children with typical development (TD) when they were engaged in a structured conversation. Results demonstrated that children with ASD looked significantly less at the interlocutor's mouth and whole-face, and more at background. Additionally, gaze behavior was found to vary with the conversational topic. Given the great variability in eye tracking findings in existing literature, future explorations might consider investigating how fundamental factors (i.e., participant's characteristics, tasks, and context) influence the gaze behavior in people with ASD.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1368672
Database: ERIC
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  Value: <anid>AN0162013113;aut01feb.23;2023Feb23.23:34;v2.2.500</anid> <title id="AN0162013113-1">Characteristics of Visual Fixation in Chinese Children with Autism During Face-to-Face Conversations </title> <p>Few eye tracking studies have examined how people with autism spectrum disorder (ASD) visually attend during live interpersonal interaction, and none with the Chinese population. This study used an eye tracker to record the gaze behavior in 20 Chinese children with ASD and 23 children with typical development (TD) when they were engaged in a structured conversation. Results demonstrated that children with ASD looked significantly less at the interlocutor's mouth and whole-face, and more at background. Additionally, gaze behavior was found to vary with the conversational topic. Given the great variability in eye tracking findings in existing literature, future explorations might consider investigating how fundamental factors (i.e., participant's characteristics, tasks, and context) influence the gaze behavior in people with ASD.</p> <p>Keywords: Autism; Chinese; Eye tracking; Face-to-face conversation; Visual fixation</p> <hd id="AN0162013113-2">Introduction</hd> <p>Compromised social communication is a hallmark symptom of the autism spectrum disorder (ASD). Among all the social deficits, abnormal social gaze behavior has long been documented as one of the major characteristics of ASD (Chita-Tegmark, [<reflink idref="bib7" id="ref1">7</reflink>]; Frazier et al., [<reflink idref="bib13" id="ref2">13</reflink>]; Kanner, [<reflink idref="bib23" id="ref3">23</reflink>]). The importance of the atypical visual attention entitled itself to a crucial item in multiple diagnostic instruments such as the Diagnostic and Statistical Manual-V (DSM-V) (American Psychiatric Association, [<reflink idref="bib2" id="ref4">2</reflink>]), <emph>Autism</emph> Diagnostic Observation Schedule (ADOS) (Lord et al., [<reflink idref="bib30" id="ref5">30</reflink>]), and <emph>Autism</emph> Diagnostic Interview-Revised (ADI-R) (Lord et al., [<reflink idref="bib31" id="ref6">31</reflink>]).</p> <p>Early studies investigating how individuals with ASD visually attend had human raters to code the gaze behavior (Mundy et al., [<reflink idref="bib34" id="ref7">34</reflink>]). Typically, manual coding was conducted frame by frame to obtain the gaze allocation, which suffered from two obvious limitations—inaccuracy due to the rater's subjective factors, and extremely time- and labor-consuming (Boraston & Blakemore, [<reflink idref="bib5" id="ref8">5</reflink>]). As a comparison, eye tracking technology can well address these limitations by offering a sensitive and accurate measure of gaze allocation (Mastergeorge et al., [<reflink idref="bib32" id="ref9">32</reflink>]).</p> <p>Recent years have witnessed a mounting interest in applying eye tracking technology to ASD research. Extant findings indicate that gaze behavior in people with ASD is atypical with respect to several aspects. First of all, individuals with ASD exhibit a decreased visual fixation to social stimuli, and an increased fixation to nonsocial stimuli (Klin et al., [<reflink idref="bib26" id="ref10">26</reflink>]). Although inconsistent results were reported (Jones et al., [<reflink idref="bib22" id="ref11">22</reflink>]; Nadig et al., [<reflink idref="bib35" id="ref12">35</reflink>]), the characteristics of reduced visual fixation to socially relevant information in ASD has been supported by two recent meta-analyses (Chita-Tegmark, [<reflink idref="bib7" id="ref13">7</reflink>]; Frazier et al., [<reflink idref="bib13" id="ref14">13</reflink>]). Second, a few studies were in favor of an excessive mouth/diminished eyes hypothesis that individuals with ASD adopt a compensatory strategy of averting gaze from eyes to mouth for the purpose of better interpreting social information (Hutchins & Brien, [<reflink idref="bib20" id="ref15">20</reflink>]; Klin et al., [<reflink idref="bib26" id="ref16">26</reflink>]). The hypothesis was originally derived from the study conducted by Klin et al. ([<reflink idref="bib26" id="ref17">26</reflink>]), who had participants with ASD watch the video "Who is afraid of the Virginia Woolf". Their results showed that the participants with ASD focused more on mouth and less on eyes relative to those with typical development (TD). It was further shown that improved social adjustment and less social impairment were positively correlated to the mouth watching behavior in ASD, but not to eyes looking (Klin et al., [<reflink idref="bib26" id="ref18">26</reflink>]). However, the excessive mouth/diminished eyes hypothesis failed to be replicated in a variety of other studies (Papagiannopoulou et al., [<reflink idref="bib38" id="ref19">38</reflink>]). Finally, some other ASD related features include less visual preference to biological motion (Klin et al., [<reflink idref="bib27" id="ref20">27</reflink>]), higher preference for repetitive movements (Wang et al., [<reflink idref="bib52" id="ref21">52</reflink>]), or even increased visual search performance in local or piecemeal processing tasks (Grinter et al., [<reflink idref="bib17" id="ref22">17</reflink>]). In sum, regardless of significant heterogeneity in their findings, a sizable number of studies have demonstrated that people with ASD adopt a different pattern of gaze behavior from individuals with TD.</p> <p>Despite the vast quantity of publications, however, eye tracking studies investigating the characteristics of gaze behavior in individuals with ASD have been dominated by having participants to look at images (i.e., pictures Fletcher-Watson et al., [<reflink idref="bib12" id="ref23">12</reflink>]; Hanley et al., [<reflink idref="bib18" id="ref24">18</reflink>]) or videos (Klin et al., [<reflink idref="bib26" id="ref25">26</reflink>], [<reflink idref="bib27" id="ref26">27</reflink>]). How people with ASD visually attend in everyday social interaction remains greatly under-studied. A major difference between image viewing and face-to-face interaction lies in the fact that individuals are engaged in a multimodal communication with other person in face-to-face interactions (Falck-Ytter, [<reflink idref="bib10" id="ref27">10</reflink>]). The task is much more perceptually and cognitively demanding, and thus social deficits should be more salient than in image-viewing scenarios (Klin et al., [<reflink idref="bib26" id="ref28">26</reflink>]). In addition, a few studies reported that gaze behavior was different in live interaction from image viewing tasks (Freeth et al., [<reflink idref="bib14" id="ref29">14</reflink>]), and individuals tend to avoid looking at other people in real life (Laidlaw et al., [<reflink idref="bib28" id="ref30">28</reflink>]). Therefore, a strong necessity is witnessed to investigate the characteristics of the social gaze behavior in people with ASD during face-to-face interactions.</p> <p>Only a handful of eye tracking studies have so far examined the gaze behavior in people with ASD occurring in live social interactions (Falck-Ytter, [<reflink idref="bib10" id="ref31">10</reflink>]; Jones et al., [<reflink idref="bib22" id="ref32">22</reflink>]; Hutchins & Brien, [<reflink idref="bib20" id="ref33">20</reflink>]; Noris et al., [<reflink idref="bib37" id="ref34">37</reflink>]; Nadig et al., [<reflink idref="bib35" id="ref35">35</reflink>]; Thorup et al., [<reflink idref="bib47" id="ref36">47</reflink>], [<reflink idref="bib48" id="ref37">48</reflink>]; Falck-Ytter et al., [<reflink idref="bib11" id="ref38">11</reflink>]). Interestingly, there was a great variability among these studies in terms of findings, context/tasks, and examined region of interest (ROI). First, some studies reported significant ASD vs. TD differences (Falck-Ytter, [<reflink idref="bib10" id="ref39">10</reflink>]; Noris et al., [<reflink idref="bib37" id="ref40">37</reflink>]), while others failed to find them (Falck-Ytter et al., [<reflink idref="bib11" id="ref41">11</reflink>]; Jones et al., [<reflink idref="bib22" id="ref42">22</reflink>]; Nadig et al., [<reflink idref="bib35" id="ref43">35</reflink>]). The discrepancy might be explained by the fact that atypical gaze behavior in ASD is context/task dependent. For example, Falck-Ytter et al. ([<reflink idref="bib11" id="ref44">11</reflink>]) found that children with high functioning autism showed a reduced tendency to look at the adult's face when listening to the adult telling a story (Falck-Ytter, [<reflink idref="bib10" id="ref45">10</reflink>]), but not in a cognitive test, in which participants accomplished the digit-span task (Falck-Ytter et al., [<reflink idref="bib11" id="ref46">11</reflink>]). Similarly, Hutchins and Brien ([<reflink idref="bib20" id="ref47">20</reflink>]) reported that children with ASD fixated significantly less on eyes and more on mouth during a conversation about "how people feel", but not about "what people do" (Hutchins & Brien, [<reflink idref="bib20" id="ref48">20</reflink>]). These studies indicated that the type of interaction and the involvement of emotion decoding tasks might influence the social gaze behavior in individuals with ASD.</p> <p>Second, examined ROI varied in different studies, leaving it unclear how participants receive information conveyed by different body features of the social partner. Some studies examined how people with ASD attended to face (Falck-Ytter, [<reflink idref="bib10" id="ref49">10</reflink>]; Falck-Ytter et al., [<reflink idref="bib11" id="ref50">11</reflink>]; Noris et al., [<reflink idref="bib37" id="ref51">37</reflink>]), whereas some on eyes (Jones et al., [<reflink idref="bib22" id="ref52">22</reflink>]), and some on both eyes and mouth (Hutchins & Brien, [<reflink idref="bib20" id="ref53">20</reflink>]). Indeed, different body features signal different information on visual processing characteristics in social interaction. For example, looking at the social partner's face facilitates the detection of information on facial identity (Wallace et al., [<reflink idref="bib49" id="ref54">49</reflink>]), emotion (Sasson et al., [<reflink idref="bib44" id="ref55">44</reflink>]), and intention (Pierno et al., [<reflink idref="bib39" id="ref56">39</reflink>]). Fixation on eyes reflects the eye contact behavior, and diminished eye contact in individuals with ASD has been evidenced by numerous studies (Klin et al., [<reflink idref="bib26" id="ref57">26</reflink>]; Papagiannopoulou et al., [<reflink idref="bib38" id="ref58">38</reflink>]). Mouth looking has been shown to play an important role in understanding social information in conversations, and evidence exists reporting a different mouth looking behavior in individuals with ASD (Hutchins & Brien, [<reflink idref="bib20" id="ref59">20</reflink>]; Klin et al., [<reflink idref="bib26" id="ref60">26</reflink>]). Looking at the body of the social partner enables receiving information about body language of the social partner, which may further help better decode the person's intention (Melinger & Levelt, [<reflink idref="bib33" id="ref61">33</reflink>]). Thus, investigating how individuals with ASD visually attend to specific body features provides crucial clue on how they process important social information.</p> <p>Finally, existing eye tracking studies investigating gaze behavior nested in live social interaction have been dominated by studies from western culture. In reality, a variety of studies showed that culture is a prominent factor that modulates social gaze behavior (Blais et al., [<reflink idref="bib4" id="ref62">4</reflink>]; Caldara et al., [<reflink idref="bib6" id="ref63">6</reflink>]; Kelly et al., [<reflink idref="bib24" id="ref64">24</reflink>]). For example, Blais et al. ([<reflink idref="bib4" id="ref65">4</reflink>]) reported that Western Caucasian participants adopted a different visual scan pattern from East Asian counterparts, with Western Caucasian observers displaying a triangular scan path by making fixations to the eye and mouth regions, and East Asian peers focusing on the central region of the face (Blais et al., [<reflink idref="bib4" id="ref66">4</reflink>]). The underlying reason might be that people from Western cultures process information analytically and Easterners do so in a more holistic manner (Kelly et al., [<reflink idref="bib24" id="ref67">24</reflink>]). The idea that East Asian individuals focus more on the central region received support from a few studies examining Chinese individuals with ASD and TD during face recognition tasks (Yi et al., [<reflink idref="bib54" id="ref68">54</reflink>], [<reflink idref="bib55" id="ref69">55</reflink>]). Given the fact that eye tracking findings regarding face-to-face interaction are mainly derived from Western culture, more evidence should be added into the existing body of literature by reporting people with ASD from non-western cultures.</p> <hd id="AN0162013113-3">Brief Introduction to the Present Study</hd> <p>The eye tracking data of the present study was obtained from a social communication experiment which was an exploratory research project dedicated to quantifying social deficits in children with ASD from the perspective of gaze behavior and body kinematics. Chinese Children with ASD and TD were engaged in a face-to-face, structured conversation with an interlocutor, who was blind to the participant's group membership. The structured conversation consisted of four topics, and five ROIs were examined—the interlocutor's eyes, mouth, whole-face, body without face, and the background. Two specific questions were to be addressed: (<reflink idref="bib1" id="ref70">1</reflink>) whether and how visual fixation to different ROIs was atypical in children with ASD; (<reflink idref="bib2" id="ref71">2</reflink>) whether and how conversational topic modulated the gaze behavior in people with ASD. The present study aimed to expand existing findings by reporting how Chinese children with ASD visually attend during face-to-face conversations.</p> <hd id="AN0162013113-4">Method</hd> <p></p> <hd id="AN0162013113-5">Participants</hd> <p>Based on data reported in previous studies investigating gaze behavior in face-to-face interactions (Falck-Ytter, [<reflink idref="bib10" id="ref72">10</reflink>]; Hutchins & Brien, [<reflink idref="bib20" id="ref73">20</reflink>]), the estimated sample size was thirty-four (<emph>n</emph> = 17 for ASD and TD respectively) using power analysis (between-group <emph>t</emph>-test, <emph>d</emph> = 1, <emph>α</emph> = 0.05, power = 0.8). In our study, twenty children with ASD and twenty-three children with TD were enrolled. Children with ASD were recruited from the Department of Child Psychiatry at a local hospital, which is a first-class mental health center in China. Due to a limited access to rigorous instruments such as the Autism Diagnostic Observation Schedule (ADOS) or the Autism Diagnostic Interview-Revised (ADI-R), the diagnosis of ASD was made by a licensed psychiatrist with no less than 5 years' clinical experience by strictly following the DSM-IV criteria. Afterwards, the ASD diagnosis was further evaluated by a senior psychiatrist. A consultation with at least two additional senior psychiatrists would be involved if disagreement took place. All these procedures ensured the diagnostic accuracy of ASD in our study. In addition, participants with ASD needed to fulfill the following criteria: (a) aged between 6 and 13 years old; (b) at least average non-verbal intellectual ability (IQ was first screened by the psychiatrist and subsequently assessed as <emph>IQ</emph> ≥ 70 with the Raven's Advanced Progressive Matrices); (c) absence of other clinical conditions such as schizophrenia and ADHD, and no children with ASD were on medication at the time of experiment; (d) a preliminary screening was conducted by the psychiatrist to ensure that the participants were capable of maintaining average verbal communication. Participants with TD were included from local schools if aged between 6 and 13, and no psychiatric, motor, vision or other physical disorders were reported. Written informed consent approved by the local ethics committee was provided by the participant's caregivers. Participants were compensated with 200 CNY for their participation in the experiment. The experimental protocol conformed to the Declaration of Helsinki. The subject's demographics is presented in Table 1.</p> <p>Table 1 Subject demographics and group comparisons</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>ASD</p></th><th align="left"><p>TD</p></th><th align="left"><p>Group comparison</p></th><th align="left"><p><italic>p</italic> value</p></th></tr></thead><tbody><tr><td align="left"><p>Sex (M:F)<sup>a</sup></p></td><td align="left"><p>17:2</p></td><td align="left"><p>17:3</p></td><td align="left"><p>χ<sup>2</sup>(1) =.174</p></td><td char="." align="char"><p>.676</p></td></tr><tr><td align="left"><p>Age in months (Mean ± SD)<sup>b</sup></p></td><td align="left"><p>99.6 ± 25.1</p></td><td align="left"><p>108.8 ± 27.0</p></td><td align="left"><p>t(37) = 1.09</p></td><td char="." align="char"><p>.283</p></td></tr><tr><td align="left"><p>IQ (Mean ± SD)<sup>b</sup></p></td><td align="left"><p>100.8 ± 22.7</p></td><td align="left"><p>116.1 ± 22.7</p></td><td align="left"><p>t(37) = 2.45</p></td><td char="." align="char"><p>.019*</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>a</sups>Chi-square test was performed <sups>b</sups>Independent samples t-test was performed *.01 < <emph>p</emph> <.05</p> <hd id="AN0162013113-6">Experimental Setup and Procedure</hd> <p>Participants were engaged into a structured conversation with an interlocutor, who was a 33-year old female at the time of the experiment. The interlocutor was specifically asked to adopt a similar style of nonverbal behavior (i.e., gestures, body movements), and the way she spoke to all participants. This was done to maximally eliminate the possibility that gaze difference found between the ASD and the TD group could be attributed to these potential confounders. The interlocutor was allowed to take a piece of paper to remind her questions of the structured conversation in case any questions might be skipped.</p> <p>Participants wore a head-mounted eye tracker (Tobii Pro Glasses 2, Sampling frequency 50 Hz; Tobii Technology, Stockholm, Sweden) during the conversation, and they were seated 80 cm away from the interlocutor's chair (Fig. 1). Tobii Pro Glasses 2 is a light-weighted, glasses-like eye tracker that tracks the natural gaze behavior of the wearer without constraining head movement. Participants were not told the genuine function of the eye tracker, and they were not suggested to move the glasses or to make abrupt or intense head movements. Once participants (particularly some children with ASD) moved the glasses during the conversation, the accuracy of data recording would be reexamined at the end of the conversation by asking participants to look at the calibration card. Observations from the reexamination suggested that participants could still fixate their gaze at the center of the calibration card even if the glasses were moved. In addition, all participants were asked whether they knew the genuine function of the glasses after the whole experiment, and none of them were aware that it was used for recording eye movement.</p> <p>Graph: Fig. 1 Experimental setup</p> <p>Prior to the start of the conversation, participants were arranged to sit on a chair and to wear the eye tracker under the experimenter's guidance. Afterwards, the one-point calibration procedure was conducted, in which participants focused their gaze on the center point of the calibration card that was placed around the position of the interlocutor's body (within Tobii's recommended calibration distance of 0.5–1.5 m). Next, the interlocutor came in and sat on the other chair once the calibration was completed. The structured conversation was launched by the interlocutor to greet the participant, followed by the chronologically arranged sessions/topics: Generic question (also referred to the 1st session), Hobby sharing (2nd session), Yes–no question (3rd session), and Question raising (4th session) (please refer to "Appendix" section for questions asked in each session). The 1st session enabled both people to get familiar with each other. The 2nd session was to examine the participant's response in hobby sharing, which has been found to elicit a different gaze behavior from generic topics (Nadig et al., [<reflink idref="bib35" id="ref74">35</reflink>]). Different from the 1st session, the 2nd session emphasized more on encouraging participants to talk more. The interlocutor positively responded to what the participants were saying without leading the conversation. Since lack of gestures and interest in social interaction are commonly seen in individuals with ASD (American Psychiatric Association, [<reflink idref="bib2" id="ref75">2</reflink>]), the 3rd and 4th session served the purposes of investigating the extent to which participants used their head to answer yes–no questions, and the behavior of taking initiatives to raise questions respectively.</p> <p>The conversation was videotaped by two still cameras for the purpose of studying the participant's social behavior. One camera (Samsung HMX-F90, sampling frequency 25 Hz) recorded both persons' behavior during the conversation, with each person separated equally on the left and right side of the recording view. The other camera (Logitech C270, sampling frequency 30 Hz) was placed beside the interlocutor to capture the participant's behavior from the front view.</p> <hd id="AN0162013113-7">Eye Tracking Data Analysis</hd> <p>Data of four participants (one ASD and three TDs) were excluded from statistical analysis due to the data loss in the eye tracking process. Therefore, the final sample consisted of 20 TDs (two girls) and 19 ASDs (one girl).</p> <p>The eye tracking data were analyzed with the Tobii Pro Lab software, which enables processing visual fixation data on dynamic stimuli. Note that the interlocutor was a dynamic stimulus since she moved throughout the conversation. The specific function of the Tobii Pro Lab software allowed quantifying how participants looked at different body parts of the interlocutor. To fulfill this purpose, a snapshot image was drawn out from an eye tracking video as the first step. Afterwards, Tobii Pro Lab automatically mapped the gaze points in the video onto the correct spots of the snapshot image with the aid of the real-world mapping algorithm (Herlitz, [<reflink idref="bib19" id="ref76">19</reflink>]). A manual mapping was conducted whenever no gaze was mapped onto the snapshot, or the fixation automatically assigned by Tobii Pro Lab failed to match the correct spot. Both the automatic and manual mapping processes ensured the accuracy of assigning gaze points to correct positions.</p> <p>Five ROIs were drawn manually including eyes, mouth, whole-face, body-no-face, and background (Fig. 2). The body-no-face ROI corresponded to the area of body without face, and the background ROI was the whole visual area excluding the area of the interlocutor's body. In data processing, the raw gaze data was filtered using Tobii Pro Lab without activating the interpolation function. Gaze position was the averaged data from both eyes. If only one eye was detected, the gaze data from this eye was used. The average missing sample rate was 23.37% (ASD: 28.30%, TD: 18.70%; Mann–Whitney <emph>U</emph> = 128, <emph>p</emph> =.08). Fixation was defined with the velocity-threshold identification fixation filter, which meant that a fixation was detected if the velocity of the eye movement was below 30 degrees/s for no less than 60 ms. No significant group difference was found in terms of the total number of visual fixations (Mn ± SD: ASD 335 ± 199, TD 253 ± 65, Mann–Whitney <emph>U</emph> = 143.50, <emph>p</emph> =.19). Finally, the percentage of visual fixation time (PVFT) on the examined five ROIs were individually computed as the fixation time on the specific ROI divided by the total fixation time. Since the children with ASD had significantly longer conversation as compared to the TD peers (Mn ± SD: ASD 421.4 ± 177.0 s, TD 271.7 ± 43.1 s, Mann–Whitney <emph>U</emph> = 39.0, <emph>p</emph> <.01), the use of PVFT instead of the absolute visual fixation time helped eliminate the potential effect of session duration on the gaze behavior.</p> <p>Graph: Fig. 2 Illustration of the regions of interest (ROIs)</p> <hd id="AN0162013113-8">Statistical Analysis</hd> <p>We performed linear mixed-effects models (LMEMs) to examine whether group membership and session (i.e., conversational topic) influenced the PVFT on different ROIs. The lme4 (Bates et al., [<reflink idref="bib3" id="ref77">3</reflink>]) package for R (version 4.0.0) was utilized to perform LMEMs (R core Team, [<reflink idref="bib42" id="ref78">42</reflink>]). Likelihood ratio tests (LR-test) were used in the model comparison and selection processes. The purpose of the LR-test was to determine whether the examined factor was a significant predictor of the dependent variable. The logic of LR-test was to compare two models—one with the examined factor and the other one without. The examined factor was considered as a significant predictor if the <emph>p</emph>-value yielded by the LR-test was lower than.05.</p> <p>All LMEMs started with a null model, which referred to a by-participant random intercept model without incorporating fixed factors. Participant was chosen as the random factor based on the assumption that gaze behavior might vary among participants, and it is common practice to use participant as a random factor in psychological research (Stevenson et al., [<reflink idref="bib46" id="ref79">46</reflink>]). As the second step, session was entered as a fixed factor to examine whether it was a significant predictor. If it was true, a random slope model would be created by adding a by-participant slope of session, and it was retained in subsequent models if the <emph>p</emph>-value was lower than.05. Afterwards, group and the interaction term of group: session individually were entered as fixed factors to examine their significance. The model with the <emph>p</emph>-value lower than.05 in the LR-test was retained and used as the nested model in the following model comparison procedure. By successively adding new factors in the model, the final model would be obtained.</p> <p>For factors with more than two levels, post-hoc pairwise comparisons were conducted with the 'lsmeans' package (Lenth, [<reflink idref="bib29" id="ref80">29</reflink>]) by using Tukey's HSD tests on the significant predictor. Following the principle of effect size calculation in mixed effects models introduced by Westfall et al. ([<reflink idref="bib53" id="ref81">53</reflink>]), effect size d was computed by Eq. (<reflink idref="bib1" id="ref82">1</reflink>). Note that variance_slope in Eq. (<reflink idref="bib1" id="ref83">1</reflink>) would be 0 for intercept only models.</p> <p>1 <ephtml> <math display="block" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mi>d</mi><mo>=</mo><mfrac><mrow><mtext>Difference between the means</mtext></mrow><msqrt><mrow><mtext>Variance</mtext><mi>_</mi><mtext>intercept</mtext><mo>+</mo><mtext>variance</mtext><mi>_</mi><mtext>slope</mtext><mo>+</mo><mtext>variance</mtext><mi>_</mi><mtext>residual</mtext></mrow></msqrt></mfrac></mrow></math> </ephtml></p> <p>Graph</p> <hd id="AN0162013113-9">Results</hd> <p>Table 2 presents the results of model comparison and selection processes to examine whether group, session and the interaction of group: session were significant predictors of the PVFT on all the examined five ROIs.</p> <p>Table 2 Overview of model comparison and selection process</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Dependent variable</p></th><th align="left" rowspan="2"><p>Model</p></th><th align="left" rowspan="2"><p>Nested model</p></th><th align="left" rowspan="2"><p>Added fixed effect</p></th><th align="left" rowspan="2"><p>Random over participant</p></th><th align="left" rowspan="2"><p>AIC</p></th><th align="left" rowspan="2"><p>BIC</p></th><th align="left" rowspan="2"><p>LL</p></th><th align="left" colspan="2"><p>LR test</p></th></tr><tr><th align="left"><p>df</p></th><th align="left"><p>Chi-square</p></th></tr></thead><tbody><tr><td align="left"><p>Eyes</p></td><td align="left"><p>M0</p></td><td align="left" /><td align="left" /><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 399.37</p></td><td char="." align="char"><p>− 390.22</p></td><td char="." align="char"><p>202.69</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>Eyes</p></td><td align="left"><p>M1a</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 398.58</p></td><td char="." align="char"><p>− 386.38</p></td><td char="." align="char"><p>203.29</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>1.2064</p></td></tr><tr><td align="left"><p>Eyes</p></td><td align="left"><p>M1b</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Group</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 398.12</p></td><td char="." align="char"><p>− 385.92</p></td><td char="." align="char"><p>203.06</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>0.3879</p></td></tr><tr><td align="left"><p>Eyes</p></td><td align="left"><p>M1c</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Group: session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 392.18</p></td><td char="." align="char"><p>− 361.68</p></td><td char="." align="char"><p>206.09</p></td><td char="." align="char"><p>7</p></td><td char="." align="char"><p>0.7457</p></td></tr><tr><td align="left"><p>Mouth</p></td><td align="left"><p>M0</p></td><td align="left" /><td align="left" /><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 270.54</p></td><td char="." align="char"><p>− 261.39</p></td><td char="." align="char"><p>138.27</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>Mouth</p></td><td align="left"><p>M1</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 294.10</p></td><td char="." align="char"><p>− 275.81</p></td><td char="." align="char"><p>153.05</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>29.567**</p></td></tr><tr><td align="left"><p>Mouth</p></td><td align="left"><p>M1a</p></td><td align="left"><p>M1</p></td><td align="left"><p>–</p></td><td align="left"><p>+ Session</p></td><td char="." align="char"><p>− 315.15</p></td><td char="." align="char"><p>− 269.40</p></td><td char="." align="char"><p>172.57</p></td><td char="." align="char"><p>9</p></td><td char="." align="char"><p>39.047**</p></td></tr><tr><td align="left"><p>Mouth</p></td><td align="left"><p>M2</p></td><td align="left"><p>M1a</p></td><td align="left"><p>+ Group</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 319.93</p></td><td char="." align="char"><p>− 271.14</p></td><td char="." align="char"><p>15.97</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>6.7834**</p></td></tr><tr><td align="left"><p>Mouth</p></td><td align="left"><p>M3</p></td><td align="left"><p>M2</p></td><td align="left"><p>+ Group: session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 326.90</p></td><td char="." align="char"><p>− 268.95</p></td><td char="." align="char"><p>− 182.45</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>12.965**</p></td></tr><tr><td align="left"><p>Whole-face</p></td><td align="left"><p>M0</p></td><td align="left" /><td align="left" /><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 120.43</p></td><td char="." align="char"><p>− 111.28</p></td><td char="." align="char"><p>63.22</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>Whole-face</p></td><td align="left"><p>M1</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 155.34</p></td><td char="." align="char"><p>− 137.04</p></td><td char="." align="char"><p>83.671</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>40.913**</p></td></tr><tr><td align="left"><p>Whole-face</p></td><td align="left"><p>M1a</p></td><td align="left"><p>M1</p></td><td align="left"><p>–</p></td><td align="left"><p>+ Session</p></td><td char="." align="char"><p>− 150.12</p></td><td char="." align="char"><p>− 104.38</p></td><td char="." align="char"><p>90.062</p></td><td char="." align="char"><p>9</p></td><td char="." align="char"><p>12.781</p></td></tr><tr><td align="left"><p>Whole-face</p></td><td align="left"><p>M2</p></td><td align="left"><p>M1</p></td><td align="left"><p>+ Group</p></td><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 162.08</p></td><td char="." align="char"><p>− 140.73</p></td><td char="." align="char"><p>88.041</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>8.74**</p></td></tr><tr><td align="left"><p>Whole-face</p></td><td align="left"><p>M3</p></td><td align="left"><p>M2</p></td><td align="left"><p>+ Group: session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 162.83</p></td><td char="." align="char"><p>− 132.34</p></td><td char="." align="char"><p>91.42</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>6.7507</p></td></tr><tr><td align="left"><p>Body-no-face</p></td><td align="left"><p>M0</p></td><td align="left" /><td align="left" /><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 235.24</p></td><td char="." align="char"><p>− 226.09</p></td><td char="." align="char"><p>120.62</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>Body-no-face</p></td><td align="left"><p>M1a</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 230.15</p></td><td char="." align="char"><p>− 211.85</p></td><td char="." align="char"><p>121.07</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>0.9026</p></td></tr><tr><td align="left"><p>Body-no-face</p></td><td align="left"><p>M1b</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Group</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 233.31</p></td><td char="." align="char"><p>− 221.11</p></td><td char="." align="char"><p>120.66</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>0.0683</p></td></tr><tr><td align="left"><p>Body-no-face</p></td><td align="left"><p>M1c</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Group: session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 223.04</p></td><td char="." align="char"><p>− 192.54</p></td><td char="." align="char"><p>121.52</p></td><td char="." align="char"><p>7</p></td><td char="." align="char"><p>1.7941</p></td></tr><tr><td align="left"><p>Background</p></td><td align="left"><p>M0</p></td><td align="left" /><td align="left" /><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 97.88</p></td><td char="." align="char"><p>− 88.74</p></td><td char="." align="char"><p>51.94</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>Background</p></td><td align="left"><p>M1</p></td><td align="left"><p>M0</p></td><td align="left"><p>+ Session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 126.08</p></td><td char="." align="char"><p>− 107.78</p></td><td char="." align="char"><p>69.04</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>34.196**</p></td></tr><tr><td align="left"><p>Background</p></td><td align="left"><p>M1a</p></td><td align="left"><p>M0</p></td><td align="left"><p>–</p></td><td align="left"><p>+ session</p></td><td char="." align="char"><p>− 117.87</p></td><td char="." align="char"><p>− 72.12</p></td><td char="." align="char"><p>73.93</p></td><td char="." align="char"><p>9</p></td><td char="." align="char"><p>9.7883</p></td></tr><tr><td align="left"><p>Background</p></td><td align="left"><p>M2</p></td><td align="left"><p>M1</p></td><td align="left"><p>+ Group</p></td><td align="left"><p>Intercept</p></td><td char="." align="char"><p>− 130.70</p></td><td char="." align="char"><p>− 109.35</p></td><td char="." align="char"><p>72.35</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>6.6208*</p></td></tr><tr><td align="left"><p>Background</p></td><td align="left"><p>M3</p></td><td align="left"><p>M2</p></td><td align="left"><p>+ Group: session</p></td><td align="left"><p>–</p></td><td char="." align="char"><p>− 130.76</p></td><td char="." align="char"><p>− 100.26</p></td><td char="." align="char"><p>75.38</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>6.0587</p></td></tr></tbody></table> </ephtml> </p> <p>**<emph>p</emph> <.01 *.01 < <emph>p</emph> <.05</p> <hd id="AN0162013113-10">Eyes ROI</hd> <p>As is shown in Table 2, LR-tests demonstrated that none of session, group, or group: session were significant fixed factors. These results demonstrated that the PVFT on the eyes ROI in the ASD group was not significantly different from that in the TD group (Mn ± SD ASD: 5.58 ± 6.81%, TD: 7.47 ± 9.35%; χ<sups>2</sups>(<reflink idref="bib1" id="ref84">1</reflink>) = 0.39, <emph>p</emph> =.18). In addition, the PVFT onto the eyes ROI did not vary as a function of session (Mn ± SD 1st session: 6.67 ± 7.51%, 2nd session: 4.95 ± 5.81%, 3rd session: 7.38 ± 8.51%, 4th session: 7.21 ± 10.51%; χ<sups>2</sups>(<reflink idref="bib3" id="ref85">3</reflink>) = 1.21, <emph>p</emph> =.14).</p> <hd id="AN0162013113-11">Mouth ROI</hd> <p>LMEM results revealed that group, session and group: session were significant predictors of the PVFT on the mouth ROI. Specifically, the PVFT on the mouth ROI was significantly higher in the TD group (Mn ± SD: 17.10 ± 13.8%) as compared to the ASD group (Mn ± SD: 6.87 ± 9.77%) [χ<sups>2</sups>(<reflink idref="bib1" id="ref86">1</reflink>) = 6.78, <emph>p</emph> <.01, <emph>d</emph> = 0.70]. Post-hoc tests performed on session demonstrated that participants had significantly higher PVFT on mouth in the 3rd session than the other three sessions (1st vs. 3rd: <emph>t</emph>(<reflink idref="bib39" id="ref87">39</reflink>) = − 2.75, <emph>p</emph> <.01, <emph>d</emph> = 0.33; 2nd vs 3rd: <emph>t</emph>(<reflink idref="bib39" id="ref88">39</reflink>) = − 3.73, <emph>p</emph> <.001, <emph>d</emph> = 0.43; 3rd vs. 4th: <emph>t</emph>(<reflink idref="bib39" id="ref89">39</reflink>) = 4.43, <emph>p</emph> <.001, <emph>d</emph> = 0.58). In addition, the PVFT on mouth was significantly higher in the 1st session relative to the 4th session [<emph>t</emph>(<reflink idref="bib39" id="ref90">39</reflink>) = 4.07, <emph>p</emph> <.01, <emph>d</emph> = 0.25]. As for the interaction effect of group: session, results demonstrated that the children with ASD looked significantly less at mouth than the TD peers in all sessions except for the 3rd one (Fig. 3a). In the ASD group, the PVFT on mouth in the 3rd session was significantly higher than those of the other three sessions (Fig. 3b). Regarding the TD children, significant differences were found between the 1st and 2nd, 1st and 4th, 2nd and 3rd, 2nd and 4th, and 3rd and 4th (Fig. 3b). No significant difference was found between the other two sessions.</p> <p>Graph: Fig. 3 The interaction effect of group:session on the PVFT on the mouth ROI. a Comparison between ASD and TD as a function of session; b comparison between sessions for the participants with ASD and TD, respectively. **p <.01, *.01 < p <.05, n.s. non-significant</p> <hd id="AN0162013113-12">Whole-Face ROI</hd> <p>As is shown in Table 2, group and session, but not group: session, were significant predictors of the PVFT on the whole-face ROI. Post-hoc tests demonstrated that the PVFT on the whole-face ROI was significantly lower in the ASD group than in the TD group (Mn ± SD: ASD 22.89 ± 20.40%, TD 40.13 ± 20.11%, χ<sups>2</sups>(<reflink idref="bib1" id="ref91">1</reflink>) = 8.74, <emph>p</emph> <.01, <emph>d</emph> = 0.89). As for the session's effect, both groups of participants looked more at the interlocutor's whole-face in the 3rd session than the other sessions (1st vs. 3rd: <emph>t(</emph>117) = − 4.36, <emph>p</emph> <.01, <emph>d</emph> = 0.52; 2nd vs. 3rd: <emph>t(</emph>117) = − 5.69, <emph>p</emph> <.001, <emph>d</emph> = 0.68; 3rd vs. 4th: <emph>t(</emph>117) = 6.35, <emph>p</emph> <.001, <emph>d</emph> = 0.76; Fig. 4). In addition, significantly higher PVFT on whole-face was found in the 1st as relative to the 4th session [<emph>t</emph>(<reflink idref="bib117" id="ref92">117</reflink>) = 1.99, <emph>p</emph> =.05, <emph>d</emph> = 0.24]. No significant difference was found between the other two sessions.</p> <p>Graph: Fig. 4 The variation of the PVFT on the whole-face ROI with session. **p <.01, *.01 < p <.05</p> <hd id="AN0162013113-13">Body-No-Face ROI</hd> <p>LMEM results illustrated that none of group, session, or group: session was a significant predictor of the PVFT on the body-no-face ROI, suggesting that visual fixation on the interlocutor's body did not vary with the participant's group membership (Mn ± SD ASD: 12.51 ± 18.88%; TD: 13.79 ± 14.59%; χ<sups>2</sups>(<reflink idref="bib1" id="ref93">1</reflink>) = 0.07, <emph>p</emph> =.79), nor with session (Mn ± SD 1st session: 13.44 ± 16.26%, 2nd session: 12.49 ± 19.53%, 3rd session: 12.72 ± 14.57%, 4th session: 14.03 ± 16.98%, χ<sups>2</sups>(<reflink idref="bib3" id="ref94">3</reflink>) = 0.90, <emph>p</emph> =.82).</p> <hd id="AN0162013113-14">Background ROI</hd> <p>In Table 2, LMEMs showed that both group and session, but not group: session, were significant predictors of the PVFT on the background ROI. Participants with ASD directed significantly higher PVFT at background than the TD peers [Mn ± SD: ASD 64.59 ± 26.02%, TD 46.09 ± 22.37%; χ<sups>2</sups>(<reflink idref="bib1" id="ref95">1</reflink>) = 6.62, <emph>p</emph> =.01, <emph>d</emph> = 0.79]. In addition, post-hoc tests demonstrated that both groups of participants looked significantly less at the background in the 3rd session as compared to other sessions (1st vs. 3rd: <emph>t</emph>(<reflink idref="bib117" id="ref96">117</reflink>) = 3.82, <emph>p</emph> <.01, <emph>d</emph> = 0.40; 2nd vs. 3rd: <emph>t</emph>(<reflink idref="bib117" id="ref97">117</reflink>) = 5.46, <emph>p</emph> <.001, <emph>d</emph> = 0.57; 3rd vs. 4th: <emph>t</emph>(<reflink idref="bib117" id="ref98">117</reflink>) = − 5.44, <emph>p</emph> <.001, <emph>d</emph> = 0.57; Fig. 5). No significant difference was found between the other two sessions.</p> <p>Graph: Fig. 5 The variation of the PVFT on the background ROI with session. **p <.01</p> <hd id="AN0162013113-15">IQ's Effect on Visual Fixation</hd> <p>In the present study, there was a significant group difference in nonverbal IQ (Table 1), suggesting that nonverbal IQ might be a potential confounder. To address this concern, additional LMEMs were performed to predict the PVFT on different ROIs by entering IQ as the fixed factor. Results showed that IQ was not a significant predictor for the PVFTs on all ROIs (eyes: χ<sups>2</sups>(<reflink idref="bib1" id="ref99">1</reflink>) = 0.36, <emph>p</emph> =.55; mouth χ<sups>2</sups>(<reflink idref="bib1" id="ref100">1</reflink>) = 0.99, <emph>p</emph> =.32; whole-face: χ<sups>2</sups>(<reflink idref="bib1" id="ref101">1</reflink>) = 2.09, <emph>p</emph> =.14; body-no-face: χ<sups>2</sups>(<reflink idref="bib1" id="ref102">1</reflink>) = 0.49, <emph>p</emph> =.48; background: χ<sups>2</sups>(<reflink idref="bib1" id="ref103">1</reflink>) = 2.73, <emph>p</emph> =.10), implying that the ASD vs. TD group difference in visual fixation might not be explained by the difference in nonverbal IQ.</p> <hd id="AN0162013113-16">Discussion</hd> <p>The present study investigated the characteristics of visual fixation on different ROIs in Chinese children with ASD during face-to-face conversations. Results demonstrated that children with ASD exhibited an atypical gaze pattern as compared to those with TD in certain circumstances. In addition, conversational topic was found to exert a considerable effect on the gaze behavior in face-to-face interaction. Discussion regarding how visual fixation on different ROIs varied with group and conversational topic is detailed in the following text.</p> <p>Concerning the impact of conversational topic on visual fixation, our results demonstrated that participants looked significantly more at the interlocutor's whole-face, and significantly less at background in the 3rd session (yes–no) relative to other sessions. The effect of conversational topic on visual fixation might be largely explained by two factors: cognitive load and the amount of speech made by the interlocutor. Previous studies showed that gaze aversion from the partner could help manage cognitive load (Doherty-Sneddon et al., [<reflink idref="bib9" id="ref104">9</reflink>]; Glenberg et al., [<reflink idref="bib16" id="ref105">16</reflink>]). Thus, tasks with higher cognitive load would be accompanied by a reduced amount of gaze onto the person. In addition, it has been found that a talking mouth attracts other people's visual attention (Gibson, [<reflink idref="bib15" id="ref106">15</reflink>]; Jones et al., [<reflink idref="bib22" id="ref107">22</reflink>]; Klin et al., [<reflink idref="bib26" id="ref108">26</reflink>]). This idea is supported by the study which showed that conversations elicited more visual fixation than other interactive tasks requiring no verbal communication (Jones et al., [<reflink idref="bib22" id="ref109">22</reflink>]). Therefore, the potential reason for the result that participants looked more at the interlocutor's face and less at background in the 3rd session would be that the yes–no question session was dominated by the interlocutor's speaking (a talking mouth), and low cognitive load. Note that participants only had to answer easy yes–no questions in this particular session. Therefore, it was not surprised that the 3rd session induced the highest level of visual fixation on the interlocutor's face.</p> <p>In terms of the ASD vs. TD comparison, significant differences were found in visual fixation to mouth, whole-face and background, but not to eyes and body-no-face. Specifically, our results demonstrated that the children with ASD had significantly reduced fixation on the whole-face ROI, and significantly increased fixation on background. The present study adopted conversation as the social task, in which participants were engaged in a verbal communication. In this scenario, face signaled the most critical social information that participants had to attend to in order to maintain an effective interaction. In contrast, background contained the least information for social interaction. These results were consistent with findings that people with ASD are less likely to pursue critical social information and attend more to irrelevant information (Chita-Tegmark, [<reflink idref="bib7" id="ref110">7</reflink>]; Frazier et al., [<reflink idref="bib13" id="ref111">13</reflink>]; Lord et al., [<reflink idref="bib30" id="ref112">30</reflink>]).</p> <p>As for the visual fixation on eyes, our result showed that the PVFT was comparable in both groups of participants. In fact, although atypical eye contact is a diagnostic indicator of ASD (American Psychiatric Association, [<reflink idref="bib2" id="ref113">2</reflink>]), no consensus has been reached regarding whether individuals with ASD demonstrate reduced eye contact behavior. Evidences supporting both reduced (Hutchins & Brien, [<reflink idref="bib20" id="ref114">20</reflink>]; Klin et al., [<reflink idref="bib26" id="ref115">26</reflink>]; Yi et al., [<reflink idref="bib55" id="ref116">55</reflink>]) and similar (Jones et al., [<reflink idref="bib22" id="ref117">22</reflink>]; Key & Stone, [<reflink idref="bib25" id="ref118">25</reflink>]) amount of attention to eye region in individuals with ASD have been reported. As for our study, one possible explanation for our result on the eye contact behavior might be related to the fact that all participants are Chinese. In general, it is not common for people from Eastern Asia to have eye contact in social interaction (Kelly et al., [<reflink idref="bib24" id="ref119">24</reflink>]), particularly when interacting with an older individual. Noticeably, however, there are a few studies reporting the existence of reduced attention to eye region in Chinese children with ASD when watching images (Yi et al., [<reflink idref="bib54" id="ref120">54</reflink>], [<reflink idref="bib55" id="ref121">55</reflink>]; Wang et al., [<reflink idref="bib51" id="ref122">51</reflink>]; Wan et al., [<reflink idref="bib50" id="ref123">50</reflink>]). As a comparison, the present study is different from these studies with respect to task requirements and the face-to-face context. Some of these studies adopted facial recognition tasks (Wang et al., [<reflink idref="bib51" id="ref124">51</reflink>]; Yi et al., [<reflink idref="bib54" id="ref125">54</reflink>], [<reflink idref="bib55" id="ref126">55</reflink>]), in which participants were obliged to look at the eyes since they provide useful information to accomplish the task. In this scenario, the feature of reduced eye looking behavior would be revealed due to the aversive feeling caused by direct eye contact in individuals with ASD (Spezio et al., [<reflink idref="bib45" id="ref127">45</reflink>]). On the other hand, a fundamental difference between our study and others' involving Chinese children was that face-to-face interaction was adopted in our study and their studies had participants watch images. Face-to-face interaction entails the physical presence of the social partner, which has been shown to elicit a different pattern of neural response and gaze behavior from image viewing condition (Freeth et al., [<reflink idref="bib14" id="ref128">14</reflink>]; Pönkänen et al., [<reflink idref="bib40" id="ref129">40</reflink>]). Both ASD and TD children might have avoided looking at the interlocutor's eyes, perhaps due to the strong effect social presence exerted in face-to-face interaction. This could be observed from the comparison that our participants had lower visual fixation to eyes than those image-viewing studies (Yi et al., [<reflink idref="bib54" id="ref130">54</reflink>], [<reflink idref="bib55" id="ref131">55</reflink>]; Wan et al., [<reflink idref="bib50" id="ref132">50</reflink>]). In sum, our results regarding visual fixation on the eyes ROI might be interpreted by multiple factors including face-to-face interaction, Chinese culture, and task requirements. However, the cultural effect hypothesis should be cautiously tested by comparing with individuals with ASD from other cultures in future studies.</p> <p>In our study, results showed that the children with ASD had a reduced visual fixation on the interlocutor's mouth in all sessions except for the 3rd session (yes–no question). These results echoed previous findings that the existence of the ASD vs. TD difference is context dependent (Hutchins & Brien, [<reflink idref="bib20" id="ref133">20</reflink>]). Further, conversational topic modulated visual fixation on the mouth ROI in a different fashion for ASD from TD. As for participants with ASD, visual fixation on the mouth ROI was significantly higher in the 3rd session as compared to other session, and no difference was found between the 1st, 2nd and 4th session. In comparison, the participants with TD showed the least visual fixation on mouth in the 4th session (i.e., question raising) as compared to other sessions. The 1st and the 3rd session yielded similar amount of visual fixation, which was significantly higher than the 2nd session. All these results implied that social attention in individuals with ASD share both similarities and differences with that of the TD counterparts. Similarities were reflected in a way that participants with ASD had comparable amount of fixation on the interlocutor's mouth in the 3rd session, and that both groups of participants looked more at the interlocutor's mouth in the 3rd session. Regarding the differences, children with ASD showed reduced attention to the interlocutor's mouth in the 1st, 2nd, and 4rd sessions as compared to the TD peers. In comparison to the 3rd session, all the other three sessions required higher level of cognitive thinking, and they were not dominated by the interlocutor's speech. These results suggest that tasks with low cognitive load and a talking mouth could catch the attention of individuals with ASD paralleled to that of the TD individuals, which sheds light on developing attention-catching programs for people with ASD.</p> <p>Power analyses revealed that the effect size of the ASD vs. TD comparison ranged between 0.70 (mouth ROI) and 0.89 (whole-face ROI) in our study, which were around the average level in the existing body of literature. In fact, there was substantial variability in effect size among previous studies. As is shown in the meta-analysis conducted by Chita-Tegmark ([<reflink idref="bib7" id="ref134">7</reflink>]), the overall effect size varied between − 0.83 and 1.81, with the mean effect size of 0.55 (Chita-Tegmark, [<reflink idref="bib7" id="ref135">7</reflink>]). The great variability across different studies might be related to multiple factors including the participant's characteristics (age, severity), stimuli, and experimental design (Mastergeorge et al., [<reflink idref="bib32" id="ref136">32</reflink>]). Indeed, additional explorations are required to clarify the fundamental question—"in what specific situation, how atypical is the gaze behavior in individuals with ASD?".</p> <hd id="AN0162013113-17">Limitations</hd> <p>The present study only examined the gaze behavior in children with at least average nonverbal IQ, and aged between six and thirteen. Since ASD exhibits significant heterogeneity (Jacob et al., [<reflink idref="bib21" id="ref137">21</reflink>]), our findings should be cautiously taken when generalized to a larger population. For example, our results demonstrated that both groups of participants showed similar level of visual fixation on eyes, and we hypothesized that this result might be partially related to cultural effect. Theoretically, cultural effect should be subtle in infants. Therefore, whether these results could be replicated in other population requires more detailed investigation.</p> <p>Having participants engaged in face-to-face interaction was one of the innovations of the present study, and it enabled investigating the behavior of children with ASD in natural environment. On the other hand, it also brought about an obvious limitation—a variety of factors were not controlled (e.g., distractions in the background, and the interlocutor's interactive behavior). For instance, although the interlocutor was asked to maintain a similar fashion of interaction across all participants, it was still possible that she behaved differently with the children with ASD from the TD children since nobody could behave exactly the same with different individuals. As one's visual attention is critically sensitive to the behavior of the interactant, the differences found between participants with ASD and TD could possibly be due to the different interactional behavior of the interlocutor. Nevertheless, we estimated the overall amount of movement the interlocutor made during the conversation using image differencing techniques (Alviar et al., [<reflink idref="bib1" id="ref138">1</reflink>]; Ramseyer & Tschacher, [<reflink idref="bib43" id="ref139">43</reflink>]), which exhibits comparable accuracy in data collection to the one obtained with motion tracking or computer vision techniques (Pouw et al., [<reflink idref="bib41" id="ref140">41</reflink>]). The principle underlying the frame differencing technique is that a video is composed of consecutive frames with a fixed number of pixels. When recording with a still camera, the amount of movement a person is producing at any given time can be directly estimated from the number of pixel change between two consecutive frames (i.e., if the person is absolute still, the number of pixel change between two consecutive frames is 0. The higher the amount of movement, the greater the number of pixel change). Results demonstrated that the amount of the interlocutor's movement was not significantly different when interacting with the ASD group as compared to the TD group [<emph>t</emph>(<reflink idref="bib214" id="ref141">214</reflink>) = 1.76, <emph>p</emph> =.29]. Strictly speaking, however, similar amount of movement does not necessarily imply that the interlocutor had exactly the same movement with these two groups of participants. This is a question that requires serious consideration for all studies which intend to investigate face-to-face interaction, since a real person would not behave exactly the same with different persons, or even with the same person at different times.</p> <p>Verbal capacity was only preliminarily screened by the psychiatrist, and it was not formally assessed in our experiment. It may matter because participants were mainly involved in a verbal communication task in our study. In fact, previous studies reported mixed results regarding whether differences in social attention might be due to differences in verbal capacity. Norbury et al. ([<reflink idref="bib36" id="ref142">36</reflink>]) reported that group difference disappeared after controlling language level (Norbury et al., [<reflink idref="bib36" id="ref143">36</reflink>]). However, other studies revealed that verbal capacity did not significantly affect social attention (Chita-Tegmark, [<reflink idref="bib7" id="ref144">7</reflink>]; Klin et al., [<reflink idref="bib26" id="ref145">26</reflink>]). Despite of this, we would like to acknowledge that controlling the effect of verbal capacity would eliminate its possible effect on gaze performance.</p> <p>The four sessions were arranged chronologically in the same order across all participants, and thus the conversational order might be a potential confounder that influenced gaze performance. In our study, it was assumed that results might be more likely explained by the content than the order of the conversation. It has been postulated that order effects are commonly caused by learning practice or fatigue (Czajkowski et al., [<reflink idref="bib8" id="ref146">8</reflink>]), which induces an increased or decreased performance respectively with time elapsing. As is shown in our results, the overall gaze performance of our participants did not follow either of these two patterns of result. Therefore, the conversational order was less likely a confounder in our experiment. But strictly speaking, futures studies are highly recommended to use counterbalance techniques to eliminate order effects.</p> <hd id="AN0162013113-18">Conclusion</hd> <p>In sum, the present study showed a reduced social attention in children with ASD to certain body features of the social partner. In addition, our results demonstrated that the atypical gaze behavior in children with ASD was context specific. These findings might have valuable implications on ASD diagnosis. The current diagnosis of ASD heavily relies on the informants' (i.e., caregivers, specialists) evaluation, which is mainly based on their experience of face-to-face interaction with the affected individual. Based on our findings, it is reasonably assumed that informants might fail to report reduced attention if they rate the ASD individual's behavior based on their experience in conditions that do not elicit diminished social attentio. Therefore, it is highly recommended that objective measurement of gaze behavior should be developed. Given the significant discrepancy in findings among different studies, it is proposed that future explorations should be dedicated to understanding what fundamental factors influence gaze behavior, and in what specific conditions the abnormal gaze behavior in ASD could be elicited.</p> <hd id="AN0162013113-19">Author Contributions</hd> <p>Zhong Zhao, Xiaobin Zhang, Xingda Qu and Jianping Lu involved in the experimental design and the recruitment of participants. Zhong Zhao, Haiming Tang, Zhipeng Zhu, Jiayi Xing, Wenzhou Li, Da Tao analyzed data and performed the statistics. Zhong Zhao, Haiming Tang, Xiaobin Zhang and Xingda Qu drafted and revised the manuscript.</p> <hd id="AN0162013113-20">Funding</hd> <p>The study was financially supported by the SZU funding project (No. 860-000002110259), the Science and Technology Innovation Committee of Shenzhen (No. JCYJ20190808115205498), Sanming project of medicine in Shenzhen (No. SZSM201612079), Key Realm R&D Program of Guangdong Province (No. 2019B030335001), Shenzhen Key Medical Discipline Construction Fund (No.SZXK042), and Shenzhen Double Chain Grant [2018]256.</p> <hd id="AN0162013113-21">Appendix</hd> <p></p> <hd id="AN0162013113-22">Details of the Four Sessions of the Structured Conversation</hd> <p></p> <p> <ephtml> <table frame="hsides" rules="groups"><tbody><tr><td align="left"><p><italic>General questions</italic></p></td></tr><tr><td align="left"><p>1. What is your name</p></td></tr><tr><td align="left"><p>2. How is your name written</p></td></tr><tr><td align="left"><p>3. What is the name of your school and what grade are you in?</p></td></tr><tr><td align="left"><p>4. Who is your best friend? What is your favorite thing to do together?</p></td></tr><tr><td align="left"><p>5. Could you please share with me the most interesting thing happened last week? Let me know the time, place, people and the whole process of the event</p></td></tr><tr><td align="left"><p>6. What is the plan for your summer vacation?</p></td></tr><tr><td align="left"><p><italic>Interest topic</italic></p></td></tr><tr><td align="left"><p>1. What is your favorite thing to do? And could you tell me why you like doing it?</p></td></tr><tr><td align="left"><p><italic>Yes–no questions</italic></p></td></tr><tr><td align="left"><p>1. Do you like apples?</p></td></tr><tr><td align="left"><p>2. Do you like to go to the zoo?</p></td></tr><tr><td align="left"><p>3. Do you like to go to school?</p></td></tr><tr><td align="left"><p>4. Do you like reading?</p></td></tr><tr><td align="left"><p>5. Do you like painting?</p></td></tr><tr><td align="left"><p>6. Do you like watching cartons?</p></td></tr><tr><td align="left"><p>7. Do you like sports?</p></td></tr><tr><td align="left"><p>8. Do you like watching movies?</p></td></tr><tr><td align="left"><p>9. Do you like traveling?</p></td></tr><tr><td align="left"><p>10. Do you like shopping?</p></td></tr><tr><td align="left"><p><italic>Question-raising</italic></p></td></tr><tr><td align="left"><p>1. Now I have asked you many questions, do you have any questions for me?</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0162013113-23">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0162013113-24"> <title> References </title> <blist> <bibl id="bib1" idref="ref70" type="bt">1</bibl> <bibtext> Alviar C, Dale R, Dewitt A, Kello CT. Multimodal coordination of sound and movement in music and speech. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Characteristics of Visual Fixation in Chinese Children with Autism during Face-to-Face Conversations
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Zhao%2C+Zhong%22">Zhao, Zhong</searchLink><br /><searchLink fieldCode="AR" term="%22Tang%2C+Haiming%22">Tang, Haiming</searchLink><br /><searchLink fieldCode="AR" term="%22Zhang%2C+Xiaobin%22">Zhang, Xiaobin</searchLink><br /><searchLink fieldCode="AR" term="%22Zhu%2C+Zhipeng%22">Zhu, Zhipeng</searchLink><br /><searchLink fieldCode="AR" term="%22Xing%2C+Jiayi%22">Xing, Jiayi</searchLink><br /><searchLink fieldCode="AR" term="%22Li%2C+Wenzhou%22">Li, Wenzhou</searchLink><br /><searchLink fieldCode="AR" term="%22Tao%2C+Da%22">Tao, Da</searchLink><br /><searchLink fieldCode="AR" term="%22Qu%2C+Xingda%22">Qu, Xingda</searchLink><br /><searchLink fieldCode="AR" term="%22Lu%2C+Jianping%22">Lu, Jianping</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Feb 2023 53(2):746-758.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Attention%22">Attention</searchLink><br /><searchLink fieldCode="DE" term="%22Eye+Movements%22">Eye Movements</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Human+Body%22">Human Body</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22China%22">China</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-021-04985-y
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Few eye tracking studies have examined how people with autism spectrum disorder (ASD) visually attend during live interpersonal interaction, and none with the Chinese population. This study used an eye tracker to record the gaze behavior in 20 Chinese children with ASD and 23 children with typical development (TD) when they were engaged in a structured conversation. Results demonstrated that children with ASD looked significantly less at the interlocutor's mouth and whole-face, and more at background. Additionally, gaze behavior was found to vary with the conversational topic. Given the great variability in eye tracking findings in existing literature, future explorations might consider investigating how fundamental factors (i.e., participant's characteristics, tasks, and context) influence the gaze behavior in people with ASD.
– Name: AbstractInfo
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1368672
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1368672
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    Identifiers:
      – Type: doi
        Value: 10.1007/s10803-021-04985-y
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 746
    Subjects:
      – SubjectFull: Children
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Attention
        Type: general
      – SubjectFull: Eye Movements
        Type: general
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Human Body
        Type: general
      – SubjectFull: China
        Type: general
    Titles:
      – TitleFull: Characteristics of Visual Fixation in Chinese Children with Autism during Face-to-Face Conversations
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            NameFull: Zhao, Zhong
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            NameFull: Tang, Haiming
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            NameFull: Zhang, Xiaobin
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            – D: 01
              M: 02
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
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              Value: 53
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