Description:
<jats:sec><jats:title>Background</jats:title><jats:p>Impaired attention to faces of interactive partners is a marker for autism spectrum disorder (<jats:styled-content style="fixed-case">ASD</jats:styled-content>) in early childhood. However, it is unclear whether children with <jats:styled-content style="fixed-case">ASD</jats:styled-content> avoid faces or find them less salient and whether the phenomenon is linked with the presence of eye contact or speech.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We investigated the impacts of speech (<jats:styled-content style="fixed-case">SP</jats:styled-content>) and direct gaze (<jats:styled-content style="fixed-case">DG</jats:styled-content>) on attention to faces in 22‐month‐old toddlers with <jats:styled-content style="fixed-case">ASD</jats:styled-content> (<jats:italic>n</jats:italic> = 50) and typically developing controls (<jats:styled-content style="fixed-case">TD</jats:styled-content>,<jats:italic> n</jats:italic> = 47) using the Selective Social Attention 2.0 (<jats:styled-content style="fixed-case">SSA</jats:styled-content> 2.0) task. The task consisted of four conditions where the presence (+) and absence (−) of <jats:styled-content style="fixed-case">DG</jats:styled-content> and <jats:styled-content style="fixed-case">SP</jats:styled-content> were systematically manipulated. The severity of autism symptoms, and verbal and nonverbal skills were characterized concurrently with eye tracking at 22.4 (<jats:italic>SD </jats:italic>= 3.2) months and prospectively at 39.8 (<jats:italic>SD </jats:italic>= 4.3) months.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Toddlers with <jats:styled-content style="fixed-case">ASD</jats:styled-content> looked less than <jats:styled-content style="fixed-case">TD</jats:styled-content> toddlers at face and mouth regions only when the actress was speaking (direct gaze absence with speech, <jats:styled-content style="fixed-case">DG</jats:styled-content>−<jats:styled-content style="fixed-case">SP</jats:styled-content>+: <jats:italic>d </jats:italic>= 0.99, <jats:italic>p </jats:italic>< .001 for face, <jats:italic>d </jats:italic>= 0.98, <jats:italic>p </jats:italic>< .001 for mouth regions; direct gaze present with speech, <jats:styled-content style="fixed-case">DG</jats:styled-content>+<jats:styled-content style="fixed-case">SP</jats:styled-content>+, <jats:italic>d </jats:italic>= 1.47, <jats:italic>p </jats:italic>< .001 for face, <jats:italic>d = </jats:italic>1.01, <jats:italic>p </jats:italic>< .001 for mouth regions). Toddlers with <jats:styled-content style="fixed-case">ASD</jats:styled-content> looked less at the eye region only when both gaze and speech cues were present (<jats:italic>d </jats:italic>= 0.46, <jats:italic>p </jats:italic>= .03). Salience of the combined <jats:styled-content style="fixed-case">DG</jats:styled-content> and <jats:styled-content style="fixed-case">SP</jats:styled-content> cues was associated concurrently and prospectively with the severity of autism symptoms, and the association remained significant after controlling for verbal and nonverbal levels.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The study links poor attention to faces with limited salience of audiovisual speech and provides no support for the face avoidance hypothesis in the early stages of <jats:styled-content style="fixed-case">ASD</jats:styled-content>. These results are consequential for research on early discriminant and predictive biomarkers as well as identification of novel treatment targets.</jats:p></jats:sec>