Brain Response to Eye Contact May Flag Autism

Deborah Brauser

July 25, 2013

Decreased brain reactivity during eye contact may be a biomarker of social disability and autism spectrum disorder (ASD) in children, new research suggests.

In a small pilot study, activity after making direct eye contact, as measured by electroencephalogram (EEG) recordings, showed that children with ASD had weaker brain responses than did their healthy peers.

"One of the reasons that we're particularly excited about this line of research is that we feel it's a fundamentally different way of studying social disability," James McPartland, PhD, assistant professor of child psychiatry and psychology at the Yale Child Study Center in New Haven, Connecticut, and director of the Yale Developmental Disabilities Clinic, told Medscape Medical News.

"Autism tends to be a problem that exists in the space between 2 people, and that's a very poorly studied space. We're hoping that the results obtained by simulating interactions will be the first of many insights that we'll have by looking at autism in this context."

He presented the preliminary findings at a press briefing organized by the Brain and Behavior Research Foundation to introduce their newest Exceptional Clinical Research prize winners. Dr. McPartland is the recipient of their 2013 Klerman award.

Session moderator Jeffrey Borenstein, MD, chief medical officer at the Brain and Behavior Research Foundation in Great Neck, New York, and chair of the Council on Communications for the American Psychiatric Association, told attendees that "this is extremely exciting research that can have a tremendous impact on people's lives."

"We know that early interventions for [ASD] can make a very big difference for the child. And this research can clearly lead to early intervention," Dr. Borenstein told Medscape Medical News after the presentation.

Challenging to Research

"I've spent many, many hours with children with autism and their families, and that's been very important to guide my science. I've also tried to understand what is important to families," said Dr. McPartland.

Dr. James McPartland

"I think our clinical insights are key, but they're not sufficient. We need ways to understand mechanisms. So my lab tries to pair clinical insights with innovative neuroscience, especially when it comes to studying brain activity as it's related to the nuanced social difficulties that we see in children on the spectrum," he said.

Dr. McPartland noted that although eye contact is the foundation of social interaction, that it is a common problem in ASD, and that it is central to both diagnosis and treatment of the disorder, it is also a challenge for research because of its exclusively interactive nature.

"It's something that has to happen between 2 people," he pointed out.

So for this research, the investigators combined 2 complementary methods of measuring social behavior: eye tracking to record visual attention, or where the participants look, and EEG to measure brain activity with millisecond specificity.

Initial results from a study of healthy adults revealed a specific electrophysiologic marker for eye contact. To follow up, the researchers collected preliminary data from 5 children with ASD and 8 typically developing children — all of whom viewed responsive onscreen faces. When a child looked at the image, the face's eyes would move to look directly at the child.

"By building this type of experiment, we hoped to see brain responses during real interactivity. And we think it paid off," said Dr. McPartland.


The investigators found that the typically developing children had stronger brain activity milliseconds after eye contact, as measured by higher amplitudes on the EEG recordings, than did the children with ASD (mean difference, 1.06 μV).

"We're very excited about these preliminary findings and the potential of this marker to improve standard of care," said Dr. McPartland.

He added that possible clinical applications could include improving the lives of those with ASD and their families through early detection, better prediction of treatment response, and better understanding of variability in outcomes across the life span.

Dr. Jeffrey Borenstein

"Because problems with eye contact are evident so early in life in autism, we hope these tools can help with earlier detection. And we want to know, by looking at these markers of brain activity, who is likely to respond to treatments and who isn't so we don't waste time," he said.

"We want to understand why some people do so well and some people struggle, even with the best interventions. And we hope that this marker will help us do that."

He reported that the investigators hope to continue this research in a larger patient sample. "We'd also like to conduct different experiments to understand the influence of eye contact vs gaze direction, to examine joint attention, and to investigate responsive emotional expression."

The researchers are also conducting studies to see whether these methods can be applied to the development of interventions that can improve eye contact.

"We'd like to see if this can be a therapeutic device unto itself. If we can measure where a person looks, we can build experiments that shape how a person looks. For example, a game that gives points for eye contact or following a person's gaze could enable us to change behavior while measuring brain activity in the context of learning," explained Dr. McPartland.

"Possibly Practice Changing"

"Dr. McPartland is being honored for the discovery of a novel electrophysiological marker of eye contact that predicts social ability in children," said Dr. Borenstein.

"This research can help us to have a tremendous impact clinically on how a child does. Obviously, as the research unfolds and they continue their work, there's an opportunity for this to become part of regular clinical practice," he concluded.

The research presented represents a collaboration between Dr. McPartland and Adam Naples, MD, postdoctoral fellow at the Yale Child Study Center. Parts were reported at the recent International Meeting for Autism Research. The research was funded by the Brain and Behavior Foundation and Atherton family (sponsors of the NARSAD Young Investigator Award) and by the National Institute of Mental Health, the Simons Foundation, the Yale Center for Clinical Investigation, the Waterloo Foundation, the Patterson Trust, and Autism Speaks. The study authors and Dr. Borenstein have disclosed no relevant financial relationships.


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