Mutual gaze and later social attention development in infants at typical and elevated familial likelihood for ASD and/or ADHD.

Researchers studied how babies look at and interact with their parents during play time. They followed babies from different risk groups (typical, high risk for autism, high risk for ADHD) from 4 months to 3 years old. Surprisingly, babies at higher risk for autism or ADHD looked at their parents' faces more than typical babies early on. However, this early eye contact didn't predict who would be diagnosed with autism later.

The study suggests there may be different developmental paths in how children with autism develop social attention skills.

This prospective study examined early social attention development in 118 infants across different neurodevelopmental likelihood groups. Researchers coded mutual gaze during naturalistic parent-infant interactions at 4-7 months and measured face-orienting responses at 8-12 months, with ASD diagnosis confirmed at 36 months. Infants with elevated likelihood for ASD and/or ADHD showed increased mutual gaze compared to typical likelihood peers. However, mutual gaze duration did not predict later ASD diagnosis.

Notably, in the elevated likelihood ASD group, greater early mutual gaze predicted reduced subsequent face orienting, particularly among those later diagnosed with ASD, suggesting an ASD-specific developmental pathway in social attention.

Findings suggest early social attention development in autism is more complex than previously understood. Increased early mutual gaze in at-risk infants may not indicate typical development but rather an atypical trajectory. Clinicians should consider multiple developmental pathways when assessing early social attention in autism risk populations.

Small sample sizes in some subgroups (EL-ADHD n=13, EL-ASD+ADHD n=13). Single-site study design. Limited generalizability due to specific assessment methods. Authors note need for larger, jointly analysed cohorts to refine developmental models.

Atypical social attention is a feature of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), yet this has not yet been studied during toy-free naturalistic parent-infant interactions in infants at elevated likelihood of developing ADHD (EL-ADHD). We coded mutual gaze from caregiver-infant free-play videos recorded at 4-7 months in infants with typical likelihood (TL; n = 37), elevated likelihood of ASD (EL-ASD; n = 55), ADHD (EL-ADHD; n = 13) or both (EL-ASD + ADHD; n = 13). Face-orienting responses were measured using an eye tracking face pop-out task at 8-12 months, and ASD research diagnosis was established at 36 months. Results showed that EL groups engaged in more mutual gaze than TL peers, revealing a broad alteration in dyadic attention across neurodevelopmental likelihood.

However, mutual-gaze duration did not differentiate infants who were later given an ASD diagnosis at age 3 years (n = 14). Furthermore, only in the EL-ASD group greater early mutual gaze predicted reduced subsequent orienting to faces. This association was mainly driven by those diagnosed with ASD at age 3, potentially indicating an ASD-specific developmental pathway. These findings highlight the value of naturalistic paradigms for probing early social attention and the need for larger, jointly analysed EL-ASD and EL-ADHD cohorts to refine neurodevelopmental models of typical and atypical infant social attention.