Gender Difference of Gaze Fixation Patterns in 5-Year -Old Children -the Usefulness of Early Detection of Girls with Autism Spectrum Disorder-

Background: It has been suggested that early intervention can improve developmental outcomes of Autism Spectrum disorder (ASD). Delay in the identification of ASD impedes early access to interventions and causes negative developmental outcomes. However, identifying children with ASD is difficult, especially in girls. We need biomarker considering gender difference. Recently, a lot of studies have identified unique gaze fixation patterns in individuals with ASD using eye-tracking systems. Such gaze fixation patterns in individuals with ASD are considered to be associated with social attention. Recently Gaze fixation patterns have attracted attention as the indicator of sociability.

Objectives: The purpose of this study is to clarify the gender difference of gaze fixation patterns in 5-year-old children and analyze these results statistically along with other existing tools, after then to examine the utility for early diagnosis of ASD.

Methods: In the community health check-up spanning three years (2013-2015, N=3804), the participants screened in the community health check-up were 2923 children. The local government officers invited 440 children (included 31 applicants) to additional assessments and an interview based on the results of the screening. We measured the percentage of gaze fixation time allocated to particular objects depicted in movies by 5-year-old children in a community health check-up (n=438) by the double-blind method. Subjects of analysis are ASD (n=64) who diagnosed by DSM-5 criteria and Typical development (TD, n=68) who had no abnormalities in all the experiment. We compared gaze fixation percentage between the two groups and determined the cut-off point by ROC analysis using all 200 girls. In addition, we compared the fitness and the Odds Ratio of using Gaze fixation patterns with other existing tools by logistic regression.

Results: Analyzed the gaze fixation percentage of ‘People’ by gender, there was a significant difference only in girls (p <0.05, ES = 0.96). As a result of ROC analysis in girls, AUC was 0.762 (p<0.001). It indicates moderate predictive ability and diagnostic ability. When we set the cut-off point to gaze fixation percentage 50% (sensitivity 90%, specificity 59%) and combine it with Autism Spectrum Screening Questionnaire (ASSQ) and Strengths and Difficulties Questionnaire (SDQ), the fitness of logistic analysis and the Odds Ratio rose to 3.3 times. In girls, the combination of Parent-interview ASD Rating Scale - Text Revision (PARS-TR) short-version and gaze fixation percentage 50% showed sensitivity 71.5%, specificity 88.7%.

Conclusions: This study suggested the gender difference in the evaluation of sociability in 5-year-old children. We have to select images considering age and gender. Gazing fixation pattern is useful in objectively evaluating social development. There is the possibility to contribute to early identification of girls with ASD by adding gaze fixation patterns.