Atypical eye contact in autistic disorder

Children with autistic disorder (AD) experience difficulty in using eye contact to initiate and sustain social interaction (Daou, Vener & Poulson 2014). These children avoid eye contact and seem to look past others (Daou et al. 2014). These deficits in eye contact may contribute to difficulties in language acquisition and social responsiveness because of diminished object and person engagement and social interaction regulation (Arnold et al. 2000; Carbone et al. 2013; Kékes Szabó & Szokolszky 2013; Senju et al. 2008). Various factors, including sensory modulation, contribute to atypical eye contact in children with AD (Arnold et al. 2000; Carbone et al. 2013; Bhat, Landa & Galloway 2011; Senju et al. 2008). Evidence for and details regarding these possible factors are scarce (Arnold et al. 2000; Bhat et al. 2011; Carbone et al. 2013; Senju et al. 2008), but there are indications that children with AD present with atypical processing of eye contact in the occipital lobe, in most instances (Senju et al. 2008). The gaze-avoidance theory states that children with AD become negatively over-aroused by direct gaze during sensory modulation and consequently avoid it (Kylliäinen et al. 2012). However, these authors found that the approach and avoidance mechanisms of children with AD were lacking (Kylliäinen et al. 2012). These mechanisms typically motivate a person to initiate social eye contact and social engagement. The researchers proposed that an avoidance of the direction or approach of the affective-motivational brain response to direct gaze, more than the intensity of the arousal, may account for a lack in motivation to make eye contact. The lack of eye contact may therefore indicate passive omission rather than deliberate avoidance (Kylliäinen et al. 2012). Rondan and Deruelle (2007) described a processing style in children with AD, which involves focusing on facial features to determine direct gaze. This processing style suggests a cognitive style that prefers featured processing (local perceptual processing style) (Senju et al. 2008). The preferred processing style reflects typical dysfunctional central cognitive processing traits in persons with AD, such as the reduced ability to process global context. Regardless of the reasons behind atypical eye contact in children with AD, the practical implication is that it reduces early face-to-face interactions with caregivers from infancy (Kékes Szabó & Szokolszky 2013). These reduced interactions imply reduced opportunities for social learning through imitation (Ingersoll, Schreibman & Tran 2003) and thus atypical early communication development during caregiver–child interaction. This atypical early development may ultimately have a possible impact on attachment with the primary caregiver. Children with autistic disorder (AD) display atypical eye contact and struggle with the social imitation of eye contact. Impaired social imitation may be indicative of disruptions in motor learning processes. The application of specific motor learning principles, such as external feedback, may suggest which variables will result in positive change in eye contact. The study aimed to determine the effects of knowledge of performance (KP) and knowledge of results (KR) as types of feedback on the frequency and duration of elicited and spontaneous eye contact in children with AD. A two-phase multiple-probe, multi-treatment (cross-over), singleparticipant design with a withdrawal component was used. Mixed treatment effects were obtained. Overall effects suggest that KR results in the greatest positive change over a short period of time regarding frequency and duration for both elicited and spontaneous eye contact. This type of feedback seems to be the most effective for spontaneous eye contact. The provision of KP, after elicited and spontaneous eye contact, produced positive effects for duration only. The current Phase 1 evidence suggests that KR (which is goal-directed with fewer additional instructions) may be more beneficial to children with AD. These findings are in accordance with the limb motor learning literature and may therefore support preliminary evidence for disrupted motor learning during eye contact imitation in children with AD. Augmented feedback in autistic disorder