BACKGROUND

Impaired attention to faces of interactive partners is a marker for autism spectrum disorder (ASD) in early childhood. However, it is unclear whether children with ASD avoid faces or find them less salient and whether the phenomenon is linked with the presence of eye contact or speech.

METHODS

We investigated the impacts of speech (SP) and direct gaze (DG) on attention to faces in 22-month-old toddlers with ASD (n = 50) and typically developing controls (TD, n = 47) using the Selective Social Attention 2.0 (SSA 2.0) task. The task consisted of four conditions where the presence (+) and absence (-) of DG and SP were systematically manipulated. The severity of autism symptoms, and verbal and nonverbal skills were characterized concurrently with eye tracking at 22.4 (SD = 3.2) months and prospectively at 39.8 (SD = 4.3) months.

RESULTS

Toddlers with ASD looked less than TD toddlers at face and mouth regions only when the actress was speaking (direct gaze absence with speech, DG-SP+: d = 0.99, p < .001 for face, d = 0.98, p < .001 for mouth regions; direct gaze present with speech, DG+SP+, d = 1.47, p < .001 for face, d = 1.01, p < .001 for mouth regions). Toddlers with ASD looked less at the eye region only when both gaze and speech cues were present (d = 0.46, p = .03). Salience of the combined DG and SP cues was associated concurrently and prospectively with the severity of autism symptoms, and the association remained significant after controlling for verbal and nonverbal levels.

CONCLUSIONS

The study links poor attention to faces with limited salience of audiovisual speech and provides no support for the face avoidance hypothesis in the early stages of ASD. These results are consequential for research on early discriminant and predictive biomarkers as well as identification of novel treatment targets.