Joint Attention Difficulties in Autistic Adults: An Interactive Eye-Tracking Study

Background: Joint attention – the ability to coordinate attention with a social partner – is critical for social communication, learning, and the regulation of interpersonal relationships. Infants and young children with autism demonstrate impairments in both initiating and responding to joint attention bids in naturalistic settings. However, little is known about joint attention abilities in adults with autism.

Objectives: In the current study we investigated joint attention abilities of autistic adults using a novel “virtual reality” task.

Methods: We tested 17 autistic adults and 17 age- and nonverbal IQ-matched controls. During testing, participants interacted via an eye-tracker with an on-screen avatar whom they were led to believe was controlled by another participant but was in fact programmed to respond dynamically to the participant’s own eye-movements. Together, the participant and avatar completed a “Catch the Burglar” task that required them both to initiate and respond to joint attention bids. Participants also completed a non-social control task that required the same pattern of eye-movements to be made in response to arrow rather than eye gaze cues.

Results: Compared to control participants, autistic adults completed significantly fewer trials successfully. They were also significantly slower to respond to joint attention bids in the first block of testing but performed as well as controls in the second block. Importantly, there were no group differences in the non-social task. In interviews conducted after the study, autistic participants commented that they initially found it challenging to communicate using eye gaze, but were able to develop strategies that allowed them to achieve joint attention.

Conclusions: This study provides the first evidence that subtle difficulties in joint attention persist into adulthood, at least for some autistic adults. The results contrast with previous studies of autism that find little evidence of impairment on computer-based gaze-cueing tasks. This, we argue, highlights the importance of embedding joint attention episodes in realistically complex social interactions in which participants have to determine the relevance of multiple social cues. Our study also demonstrates the potential and feasibility of virtual reality paradigms for studying social interaction difficulties within a controlled yet ecologically valid experimental context.