Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis.

Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low-level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta-analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics. LAY SUMMARY: This review explored how eye gaze (e.g., where a person looks when watching a movie) is associated with social functioning in autism spectrum disorder (ASD). We found evidence that better social functioning in ASD was associated with increased eye gaze toward faces/head and eye regions. Individual characteristics (e.g., intelligence) and the complexity of the social scene also influenced eye gaze. Future research including large longitudinal studies and studies investigating the influence of differing presentations of ASD are recommended.