When individuals with autism view social situations, they focus attention twice as much on the mouths and the bodies of people as on their eyes, Yale researchers report in an Archives of General Psychiatry article.

The researchers used eye-tracking technology to measure what autistic individuals focused on while viewing social scenes in the movie "Who's Afraid of Virginia Woolf?" The movie was chosen for the number of scenes involving intense verbal and nonverbal exchange between the protagonists in a relatively bare environment with few inanimate distractions. The study included 15 men with autism who had I.Q.'s in the normal range and 15 controls. The researchers measured the length of time their eyes fixated on four regions: mouth, eyes, body and objects.

"We found that the more the study participants looked at mouths, the more socially competent they were in real life, which is surprising because we expected that the more they focused on eyes the more competent they would be, as this is the normative pattern," says first author Ami Klin, the Harris Associate Professor of Child Psychology and Psychiatry at the Yale Child Study Center. "This set of results suggests that individuals with autism not only look much less at eyes, but also do not seem to gain much information when they do fixate on eyes."

Autism is a neurological disorder marked by extensive social disability. About 70% of individuals with autism have a degree of mental retardation, but the rest have I.Q.'s in the normal range. Autism affects a person's capacity for understanding other people, sensing their feelings and establishing relationships.

According to Klin, the positive correlation between a focus on mouths and social competence might suggest that individuals with autism who have normal I.Q.'s are overly focused on the words coming out of mouths and miss the very important nonverbal cues conveyed through the eyes. Klin says that most individuals primarily convey mental states -- such as intentions and feelings -- through their eyes, and these signals may contradict the content of their words, as in instances of irony and sarcasm.

"The strong focus on the mouths, and by extension, on speech, might be a way of compensating for the social cues they miss from being unable to 'read' the eyes of a speaker," says Warren Jones, who collaborated with Klin in the eye-tracking studies.

Klin, Jones and their team also found that the more individuals with autism focused on objects, the less socially competent they were. They were not focusing on people at all and therefore missed social cues, both verbal and nonverbal, say the researchers.

"This is the first time in autism research that we have results on an experimental measure to actually predict level of social competence in real life," says Klin. "This will be very helpful in designing more powerful genetic, neuroimaging and psychopharmacological studies that rely on quantified measures of social disability (or how autistic a person is) rather than simply describing people as either affected or not affected."

The study also has other important implications. Chief among these is the potential for this technology to be used in the early detection of autism. Because the social skills studied, such as looking preferentially at eyes rather than mouths, emerge in the first few months of life, it is very likely that a vulnerability for autism could be detected as early as that. This is of great importance because current research indicates that the earlier children with autism are identified and treated, the better their prognosis is. The Yale group is already conducting eye-tracking studies in infants and toddlers to explore this possibility.

Other authors on the study included Robert Schultz, associate professor in the Yale Child Study Center and associate professor of anesthesiology at Yale; Dr. Fred R. Volkmar, the Harris Professor of Child Psychiatry, and professor of pediatrics and psychology at Yale; and the late Dr. Donald J. Cohen, who was the Sterling Professor of Child Psychiatry, director and professor of the Child Study Center and professor of pediatrics, psychiatry and psychology at Yale.

-- By Karen Peart

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