With the overarching objective to gain better insights into social attention in autistic adults, the present study addresses three outstanding issues about face processing in autism. First, do autistic adults display a preference for mouths over eyes; second, do they avoid direct gaze; third, is atypical visual exploration of faces in autism mediated by gender, social anxiety or alexithymia? We used a novel reinforced preferential looking paradigm with a group of autistic adults (n = 43, 23 women) pairwise matched on age with neurotypical participants (n = 43, 21 women). Participants watched 28 different pairs of 5 s video recordings of a speaking person: the two videos, simultaneously displayed on the screen, were identical except that gaze was directed at the camera in one video and averted in the other. After a 680 ms transition phase, a short reinforcement animation appeared on the side that had displayed the direct gaze. None of the groups showed a preference for mouths over eyes. However, neurotypical participants fixated significantly more the stimuli with direct gaze, while no such preference emerged in autistic participants. As the experiment progressed, neurotypical participants also increasingly anticipated the appearance of the reinforcement, based on the location of the stimulus with the direct gaze, while no such anticipation emerged in autistic participants. Our autistic participants scored higher on the social anxiety and alexithymia questionnaires than neurotypicals. Future studies should match neurotypical and autistic participants on social anxiety and alexithymia and complement questionnaires with physiological measures of anxiety. The absence of preference for direct versus averted gaze in the autistic group is probably due to difficulties in distinguishing eye gaze direction, potentially linked to a reduced spontaneous exploration or avoidance of the eye region. Social attention and preference for direct versus averted gaze correlated with alexithymia and social anxiety scores, but not gender.

中文翻译：

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自闭症成人不偏爱直接凝视与回避凝视：强化的偏爱观察范式

为了更好地了解自闭症成人的社会注意力，本研究的首要目标是解决自闭症患者面部处理的三个突出问题。首先，自闭症成年人是否更喜欢嘴巴而不是眼睛？第二，他们是否避免直视；第三，自闭症患者面部的非典型视觉探索是否由性别、社交焦虑或述情障碍介导？我们对一组自闭症成人（n = 43, 23 名女性）与神经典型参与者（n = 43, 21 名女性）的年龄配对使用了一种新颖的强化偏好观察范式。参与者观看了说话人的 28 对不同的 5 秒视频记录：同时显示在屏幕上的两个视频是相同的，只是在一个视频中注视着相机而在另一个视频中则避开了。经过 680 ms 的过渡阶段后，显示出直视的一侧出现了一个简短的强化动画。没有一个组表现出对嘴的偏好超过眼睛。然而，神经典型的参与者通过直接注视明显更多地关注刺激，而在自闭症参与者中没有出现这种偏好。随着实验的进行，神经型参与者也越来越多地基于直接注视刺激的位置来预期强化的出现，而自闭症参与者则没有这种预期。我们的自闭症参与者在社交焦虑和述情障碍问卷中的得分高于神经典型者。未来的研究应该在社交焦虑和述情障碍上匹配神经典型和自闭症参与者，并用焦虑的生理测量来补充问卷。自闭症患者对直接凝视和回避凝视缺乏偏好可能是由于难以区分眼睛凝视方向，这可能与自发探索或避开眼睛区域的减少有关。直接与回避凝视的社会关注和偏好与述情障碍和社交焦虑评分相关，但与性别无关。