Eyes on Autism

Eye contact may hold the key to early autism diagnosis.

Posted Nov 08, 2013

              Warren Jones and Ami Klin, at the Marcus Autism Center and Emory University, have produced important new findings about signs of autistic spectrum disorder (ASD) in early infancy that will aid both diagnosis and treatment of autistic children. Their research, published in Nature, made CNN and the front page of the New York Times.

              Jones and Klin’s findings potentially carry landmark significance for clinical approaches to ASD. Until now no one had found any reliable grounds for diagnosing ASD in infants before the second year of life, when toddlers, who are subsequently diagnosed, begin to exhibit symptoms such as failing to seek comfort, failing to point to direct others’ attention and failing to respond appropriately to others’ pointing, and failing to give eye contact. Infants, who appear to develop typically through their first year of life, evolve during their second year into young children with a host of psychological and cognitive abnormalities.

The Eyes Have It

              These new findings suggest, as some have suspected, that changes in the amount of time that infants spend looking at others’ eyes over the first months of life, specifically from the second through the sixth month of life, do seem to offer critical diagnostic information about persons likely to manifest ASD. Proceeding with the evidence that ASD has a significant, though bafflingly complex, genetic basis, Jones and Klin studied two groups of infants differentiated on the basis of having an older, full sibling who had received an ASD diagnosis as opposed to infants who had no near relatives diagnosed with ASD. Ten members of the first group were subsequently diagnosed with ASD, whereas but one member of the latter group was. The findings arose from comparisons of the performance of these eleven children with that of twenty-five typically developing children, all of whom came from the second group.

              Since neither when nor comparatively how long young infants are looking at others’ eyes is easy to detect, the researchers precisely monitored and measured, at ten different ages over these children’s first two years, what they looked at in videos of actors portraying normal caregivers’ interactions (such as pat-a-cake) in naturalistic settings. The children did not differ in the time they looked at the videos, as opposed, for example, to closing their eyes or looking away.

              Crucially, children who are subsequently diagnosed with ASD start out over the first month or so of life looking at others’ eyes at the same rates other children do; however, from the second through twenty-fourth months, the proportion of time that children who develop ASD fixate on the eyes declines. At two years of age they are looking at others’ eyes at about half the rate that typically developing toddlers do, whose visual attention to eyes gradually increases over the same period of development.

Early Diagnosis, Early Intervention

              This research is intriguing on multiple fronts. For clinicians these findings leave open at least the possibility that people with ASD are not born with an immutable penchant for socially maladjusted behaviors but, instead, may have a narrow window at the beginning of life, when they may not differ behaviorally from typically developing infants. During that initial period they appear to possess standard equipment, which is then unsettled very soon thereafter by any of a number of possible disruptive factors, but probably including matters of gene expression. With ASD, as with most atypical patterns, early diagnosis introduces the possibility of early interventions.

              Jones and Klin note that decreasing attention to others’ eyes correlates with the severity of the social impairments connected with ASD. Their study furnishes evidence for the significant role that eye contact seems to play in typical social development. Whatever fixating on others’ eyes may contribute to the development of standard social skills, though, it is unlikely that it is necessary, as congenitally blind children do not manifest the social abnormalities of people with ASD even though they cannot see others’ eyes.

              In my previous blog post I wrote about the public’s frustrations with the apparent fickleness of science, since continuing research often leads to new discoveries that substantially modify the prevailing wisdom and, sometimes, completely reverse it. What research often produces, however, is new findings and new insights that help scientists sort through available hypotheses, enabling them to ask questions that are simultaneously more sophisticated and more penetrating.