Can Eye Movement Dictate the Best Treatment for ASD?

The focus on sensorimotor issues in the assessment and treatment of autism spectrum disorders (ASD) continues to rise: There have been several studies indicating how eye movements and eye contact tendencies can assist in determining whether a toddler has an autism spectrum disorder (ASD) and if he or she does, the severity of the child’s developmental disability. These findings are significant in that they may change the way physicians diagnose and treat autism. According to Susan E. Levy, M.D., M.P.H., FAAP, and chair of the AAP Council on Children with Disabilities Autism Subcommittee early detection is key as  children who are identified early and receive treatment have better outcomes than those who are not.

Tiffany Hutchins, who is the assistant professor of communication sciences and disorders at the University of Vermont, led the most recent study, which is scheduled to be published in June’s issue of Research in Autism Spectrum Disorders. The results of her study are being recognized in several national news outlets including, U.S. News and World Report, CBS News, Psychology Today and Tech Times. This 2016 study follows two other studies that also found links between eye contact and autism: These previous studies were conducted in 2010 and 2015.


The 2010 Study – Preference for Geometric Patterns Early in Life as a Risk Factor for Autism

The 110 toddlers involved in the final analysis of this 2010 study ranged in age from 14 to 42 months.

Three different groups of toddlers were included in this study:

  • 22 toddlers who had developmental delay
  • 37 who had autism
  • 51 typically developing (TD) toddlers

Each toddler sat on his or her parent’s lap and watched a one-minute movie, meanwhile, the toddlers’ eye movements were tracked. The movie consisted of moving geometric patterns on one side whereas, on the other side, children were actively moving around performing yoga and dancing.

2010 Study Results

When compared to the other diagnostic groups, all in all, the toddlers with an ASD spent more time fixated on the geometric images than they did on the active children. Toddlers who spent more than 69 percent of their time fixated on the geometric patterns had a 100 percent positive predictive value for the accurate classification of having an ASD. This study indicates that eye tracking can assist in the early detection of autism.


The 2015 Study – Eye Tracking Reveals Abnormal Visual Preference for Geometric Images as an Early Biomarker of an ASD Subtype Associated with Increased Symptom Severity

Six different groups of toddlers were included in this study:

  • 57 who had developmental delay
  • 115 who had an ASD
  • 20 with features associated with ASD
  • 53 who had other conditions, such as exposure to drugs while still in the womb and/or premature birth, etc.
  • 25 TD toddlers who had siblings with one of the autism spectrum disorders
  • 64 TD toddlers

The number of toddlers initially involved in this study totaled 334.

Just as in the 2010 study, toddlers viewed a movie that contained social and geometric images. The number of times a toddler’s eyes shifted and the duration of fixation maintained in each of the areas (geometric images or social images), as well as confirmation statistics for each sample were computed. Furthermore, data from the previous 2010 study were added; thus increasing the number of toddlers by 110: This brings the total number of subjects to 444. The eye tracking procedure was repeated by a subgroup of toddlers.

2015 Study Results

Just as with the original 2010 study, the toddlers with an autism spectrum disorder remained fixated on the geometric images substantially longer than on the social images (69 percent to 31 percent, respectively).

When compared to toddlers who had ASD, but preferred the social images, those toddlers with an autism spectrum disorder who overwhelmingly preferred the geometric images displayed worse cognitive, social and language skills, as well as fewer eye movements while viewing the geometric images.

In conclusion, a heightened visual fondness for the repetition of geometric shapes might be one of the developmental biomarkers indicating an ASD subtype with severe symptoms; thus, affecting the type of treatment a child with an autism spectrum disorder may receive.


The 2016 Study – Conversational Topic Moderates Social Attention in ASD: Talking About Emotions Is Like Driving in a Snowstorm

Although this study is similar to the two previous studies in that they all use eye-tracking technology as a means to monitor the movement of the eye, this study involved monitoring the child’s eye movement as he or she interacted in an emotional conversation.

The reactions of children who have an ASD are similar to those of TD children when looking at a speaking partner’s face as long as the topic involves things people do; but, if the topic changes to things people feel, autistic children look at the speaker’s mouth more frequently than they do at his or her eye region. This shift towards the mouth and away from the eyes is linked to a higher severity of an ASD, poorer intellectual and verbal abilities, and an increase in the limits on his or her executive function.

Hutchins compares the executive function effects that occur when children with autism spectrum disorders talk about emotions to driving in a snowstorm. Hutchins states that when an individual drives a familiar route in good weather, he or she goes on auto pilot; however, when driving through a snowstorm an individual remains focused, each move is full of tension requiring intense effort. This drains the driver’s executive function. For a child with autism, talking about emotions brings about these same feelings; thus, draining his or her executive function.


In Conclusion

Data indicates that a toddler’s eye tracking profile may have prognostic value, which can affect how medical practitioners approach the diagnosis of an ASD and likely the treatments they prescribe. The positive predictive value and specificity of the “Geo Pref Test” were significant in the 2015 study at 86 percent and 98 percent, respectively; thus making this test a substantialbiomarker finding. Furthermore, the study makes early identification of an autism spectrum disorder using objective, biologically-based approaches conceivable; consequently, allowing physicians to move past the traditional clinical observation techniques in the hopes of diagnosing and treating children with ASD as early as possible.

Trina McMillin

Trina brings to Relias a wealth of knowledge and personal experience related to the medical field, dental issues, mental health, and physical therapy techniques. She has worked in various positions over her career which includes being a phlebotomist, laboratory assistant and medical transcriptionist.

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