Social and Object Attention in Autism Is Modulated By Biological Sex and Gender-Typicality of Objects

Background: Decreased attention to social stimuli is a consistently replicated feature of Autism Spectrum Disorder (ASD). Due to the sex imbalance in ASD diagnoses, previous eye-tracking studies consist largely of males. However, recent literature suggests that females with ASD differ from males, with ASD girls appearing more socially motivated than ASD boys (Sedgewick et al., 2016). Emerging evidence suggests that ASD girls may also differ in social attention, with some attentional patterns similar to TD girls (Harrop et al., 2018a, 2018b). Therefore, a naturalistic eye-tracking paradigm may reveal differences in social attention and motivation in ASD girls.

Objectives: The aim of this current study was to understand the impact and interplay between biological sex and gender on social attention in ASD.

Methods: 79 children (ages 6-10) participated: 46 ASD (21 female); 33 typically developing (TD; 17 female). Subjects completed a dynamic eye-tracking paradigm with 18 silent videos of child actor pairs playing independently (Solo Condition), together (Joint Condition) or in parallel. Pairs played with toys that were either gender-typically male (Lego, action hero, science kit) or gender-typically female (My Little Pony, Barbie, cooking set). Actor sex was manipulated, so that the effect of gender/sex congruence between toy and actor could be explored. Dependent variables included percent of time attending to faces and hands with toys across conditions.

Results: In the joint play condition, children with ASD spent proportionally less time attending to faces compared to TD children, F = 2.8; p = .05. In the solo play condition, there was a marginal group*sex effect, where ASD males allocated proportionally less time to faces, F = 3.7; p = .059. No significant effects were found for overall attention to hands with toys. However, sex differences were found when the gender of the toy was taken into account, with females spending proportionally more time attending to hands with toys when a female toy was presented, F = 4.45; p= .02. Children showed an attentional preference for gender/sex congruent play, with females allocating proportionally more attention to female toys matched with a female actor, F = 5.7; p = .02 and males spending proportionally more time attending to male toys matched with a male actor, F = 3.97; p= .05.

Conclusions: Our data support previous findings of a disjointed attentional profile among ASD females. ASD females attended more to female-oriented stimuli than ASD males, with attention patterns comparable to TD females. This extends previous findings of more female-typical interests among ASD females (Harrop et al., 2018a, Sutherland et al., 2017). Our findings largely replicate previous findings of reduced social attention in ASD. However, when the scene was socially lean (children playing alone), ASD females attended to faces to the same degree as both TD males and females. This aligns with previous findings, which suggest that ASD females share features with both TD girls and ASD boys (Harrop et al., 2018b). These findings highlight the importance of considering the gender-typicality of objects when developing stimuli for children with ASD.