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Face Perception and Social Cognitive Development in Early Autism: A Prospective Longitudinal Study from 3 Months to 7 Years of Age

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Title: Face Perception and Social Cognitive Development in Early Autism: A Prospective Longitudinal Study from 3 Months to 7 Years of Age
Language: English
Authors: Xiaomei Zhou (ORCID 0000-0002-1264-0553), Hasan Siddiqui, M. D. Rutherford (ORCID 0000-0002-7685-8076)
Source: Child Development. 2025 96(1):104-121.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 18
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Nonverbal Communication, Social Cognition, Adjustment (to Environment), Theory of Mind, Child Development, Behavior Development, Social Development, Young Children
DOI: 10.1111/cdev.14144
ISSN: 0009-3920
1467-8624
Abstract: Autism spectrum condition (ASC) is characterized by atypical attention to eyes and faces, but the onset and impact of these atypicalities remain unclear. This prospective longitudinal study examined face perception in infants who develop ASC (N = 22, female = 5, 100% White) compared with typically developing infants (N = 131, female = 65, 55.6% White), tracking social-cognitive and ASC development through age seven. Reduced interest in direct gaze and eyes during infancy correlated with atypical development of adaptive behavior at age four and theory of mind at age seven. Principal component analyses revealed less integrated processing of facial features and eye-gaze information in ASC infants, potentially impacting their childhood social functioning. These findings highlight the intertwined nature of social-cognitive development and ASC.
Abstractor: As Provided
Notes: https://osf.io/k7w3e/?view_only=359f306f2f874db1a0cab93737e59fca
Entry Date: 2025
Accession Number: EJ1455453
Database: ERIC
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  Value: <anid>AN0181984182;cdv01jan.25;2025Jan03.02:49;v2.2.500</anid> <title id="AN0181984182-1">Face perception and social cognitive development in early autism: A prospective longitudinal study from 3 months to 7 years of age </title> <p>Autism spectrum condition (ASC) is characterized by atypical attention to eyes and faces, but the onset and impact of these atypicalities remain unclear. This prospective longitudinal study examined face perception in infants who develop ASC (N = 22, female = 5, 100% White) compared with typically developing infants (N = 131, female = 65, 55.6% White), tracking social‐cognitive and ASC development through age seven. Reduced interest in direct gaze and eyes during infancy correlated with atypical development of adaptive behavior at age four and theory of mind at age seven. Principal component analyses revealed less integrated processing of facial features and eye‐gaze information in ASC infants, potentially impacting their childhood social functioning. These findings highlight the intertwined nature of social‐cognitive development and ASC.</p> <p></p> <ulist> <item> Abbreviations</item> <p></p> <item> ADOS‐2 Autism Diagnostic Observation Schedule, second edition</item> <p></p> <item> AOI area of interest</item> <p></p> <item> ASC autism spectrum condition</item> <p></p> <item> CSS calibrated severity score</item> <p></p> <item> ELCS Early Learning Composite Score</item> <p></p> <item> ISI interstimulus interval</item> <p></p> <item> LMM linear mixed effects model</item> <p></p> <item> MSEL Mullen Scales of Early Learning</item> <p></p> <item> PCA principal component analyses</item> <p></p> <item> ToM theory of mind</item> <p></p> <item> VABS‐II Vineland Adaptive Behavior Scales, second edition</item> <p></p> <item> WISC‐IV Wechsler Intelligence Scale for Children‐fourth edition</item> </ulist> <hd id="AN0181984182-2">INTRODUCTION</hd> <p>Processing faces and eye‐gaze information is critical for humans to navigate the social world. Accurate processing of identity and social–emotional information derived from faces is important for understanding other people's identity, emotions, and focus of attention, thereby promoting effective social communications and interactions. The ability to process faces begins early in life and has been linked to a range of social‐cognitive processes, such as language acquisition, emotional regulation, and social learning (Gross & John, [<reflink idref="bib23" id="ref1">23</reflink>]; Pascalis et al., [<reflink idref="bib45" id="ref2">45</reflink>]).</p> <p>Many aspects of face perception have been reported to be disrupted in one of the most common disorders of social interaction: Autism spectrum condition (ASC). ASC is a group of neurodevelopmental conditions characterized by difficulties in social interaction and communication and the presence of restricted interests, and repetitive behaviors (American Psychiatric Association, [<reflink idref="bib1" id="ref3">1</reflink>]). Children and adults with autism show decreased looking to faces (Guillon et al., [<reflink idref="bib24" id="ref4">24</reflink>]), to the internal features of the face (Chawarska & Shic, [<reflink idref="bib9" id="ref5">9</reflink>]), fixate less on or avoid the eyes region (Jones et al., [<reflink idref="bib30" id="ref6">30</reflink>]; but see Falck‐Ytter et al., [<reflink idref="bib18" id="ref7">18</reflink>]), and are less sensitive to orientation of faces (Van Der Geest et al., [<reflink idref="bib53" id="ref8">53</reflink>]) when compared with individuals without autism. They also show less accurate judgment of gaze direction and processing of emotional expressions (Humphreys et al., [<reflink idref="bib28" id="ref9">28</reflink>]; also see Harms et al., [<reflink idref="bib25" id="ref10">25</reflink>] for a review). It has been reported that individuals with autism have difficulties in tasks that measure face perception and recognition, especially in tasks with memory demands (Weigelt et al., [<reflink idref="bib57" id="ref11">57</reflink>] for a review). A recent meta‐analysis of 112 studies on children and adults revealed that impairments in face perception in children and adults with ASC are reliable across a wide range of task paradigms and age groups (Griffin et al., [<reflink idref="bib22" id="ref12">22</reflink>]). Furthermore, face recognition accuracy in childhood (age 6–12) significantly predicts ASC symptom severity scores in adolescence (age 12–19), as suggested by a 7‐year longitudinal study of 87 children (Eussen et al., [<reflink idref="bib17" id="ref13">17</reflink>]).</p> <p>While alterations in face processing were frequently reported in children and adults with ASC, whether atypical process of faces emerge in infancy, and to what extent these atypicalities predict later autistic symptoms and social‐cognitive development is less clear. Studies of infants who have older siblings with an ASC diagnosis shed lights on these critical questions. However, current evidence remains mixed. For example, some researchers reported the preference for face over non‐face stimuli found in typically developing 24‐month‐old infants was absent in infants later diagnosed with ASC (Sasson & Touchstone, [<reflink idref="bib48" id="ref14">48</reflink>]). In contrast, some researchers found both ASC and non‐ASC infants show a comparable face over non‐face (e.g., noise, checkerboards) preference between six to 15 months of age (Droucker et al., [<reflink idref="bib13" id="ref15">13</reflink>]; Elsabbagh et al., [<reflink idref="bib15" id="ref16">15</reflink>]). In addition, some studies revealed that around 6 and 7 months, ASC and non‐ASC infants differ in their looking at faces (Chawarska et al., [<reflink idref="bib7" id="ref17">7</reflink>]), whereas some studies found no group differences at this age when both viewing videos of faces and engaging in a face‐to‐face interaction (Shic et al., [<reflink idref="bib50" id="ref18">50</reflink>]; Young et al., [<reflink idref="bib58" id="ref19">58</reflink>]). Another study suggests that group difference in gaze to faces was absent at 6 months but emerges at a later time around 12 months (Ozonoff et al., [<reflink idref="bib43" id="ref20">43</reflink>]). There is also inconsistency regarding how ASC and non‐ASC infants scan internal features of faces and looking at eyes versus mouth region (Key & Stone, [<reflink idref="bib32" id="ref21">32</reflink>]; Rutherford et al., [<reflink idref="bib47" id="ref22">47</reflink>]; Wagner et al., [<reflink idref="bib54" id="ref23">54</reflink>]). To date, there is a lack of systematic examination of the manifestation of early alternations of visual perception of faces.</p> <p>Moreover, mutual eye contact and process of eye‐gaze information plays a vital role in infant social development, and facilitates identity, sex, and facial expression perception (Farroni et al., [<reflink idref="bib19" id="ref24">19</reflink>]). Typically developing infants use eye‐gaze information effectively at a young age. Days‐old infants prefer to look at a face with open rather than closed eyes (Batki et al., [<reflink idref="bib5" id="ref25">5</reflink>]) and look longer at direct than averted gaze (Farroni et al., [<reflink idref="bib19" id="ref26">19</reflink>]). At around 2 months of age, infants begin to preferentially look at the eyes region of face (Maurer, [<reflink idref="bib39" id="ref27">39</reflink>]), and by about 4 months of age they can discriminate direction of eye‐gaze and use gaze information to learn about objects and faces (Reid & Striano, [<reflink idref="bib46" id="ref28">46</reflink>]). However, whether anomalies in eye perception and gaze perception arise during infancy in autism remains unclear.</p> <p>Although some studies reported that high‐risk infants, and infants later diagnosed with ASC showed reduced attention to eye regions (Jones & Klin, [<reflink idref="bib31" id="ref29">31</reflink>]), less eye contact (Ozonoff et al., [<reflink idref="bib43" id="ref30">43</reflink>]), and reduced attention to the target of another person's gaze (until 13 months, Bedford et al., [<reflink idref="bib6" id="ref31">6</reflink>]; Parsons et al., [<reflink idref="bib44" id="ref32">44</reflink>]), other studies reported that high‐risk infants and infants developing with ASC did not differ from neurotypical infants in eye‐gaze processing (Elsabbagh et al., [<reflink idref="bib14" id="ref33">14</reflink>]). For example, Jones and Klin found that between 2 to 6 months, infants later diagnosed with ASC exhibited a decline in eyes fixation compared with the infants without ASC when viewing videos of socially engaging models (Jones & Klin, [<reflink idref="bib31" id="ref34">31</reflink>]). However, Chawarska et al. ([<reflink idref="bib8" id="ref35">8</reflink>]) found that 6‐month‐old infants with and without ASC looked equally long at the models' eyes in social interactive scenes in dynamic videos. Shic et al. ([<reflink idref="bib50" id="ref36">50</reflink>]) found eye‐to‐mouth looking time was not different in the ASC and control groups; both groups tend to fix more on eyes when viewing static images of faces, and less when the face model was speaking. Studies also suggested that group differences in preference for direct over averted gaze are present at 5 months of age (Nele et al., [<reflink idref="bib42" id="ref37">42</reflink>]), and infants with ASC tend to have prolonged latency in P400 responding to direct gaze compared with the control group (Elsabbagh et al., [<reflink idref="bib16" id="ref38">16</reflink>]).</p> <p>Across the above‐mentioned studies, there is heterogeneity of stimuli and task type, age of participants tested, aspects of face perception, and the complexity of facial stimuli (e.g., varying vs. unified background; static vs. facial movement), which may contribute to the inconsistency of the results. Overall, it is difficult to draw strong conclusions regarding the existence of the fundamental differences in face and gaze perception in infants who later develop ASC and those who do not. Visual processing of face and gaze information involves complicated analyses of facial configuration and understanding of referential meanings of eye gaze. A systematic longitudinal examination of different aspects of face perception in infancy is needed to elucidate the developmental trajectory of face perception and help clarify the developmental origins of early autism.</p> <p>In addition, although the concurrent and predictive relations between infant face perception and social‐communicative abilities have been highlighted in several studies (de Klerk et al., [<reflink idref="bib12" id="ref39">12</reflink>]; Morales et al., [<reflink idref="bib40" id="ref40">40</reflink>]; Young et al., [<reflink idref="bib58" id="ref41">58</reflink>]), the majority of these studies focus on the influences on social‐communicative development in infancy and toddlerhood (e.g., 18 months–2 years). Its long‐term effect on the children's social and cognitive development remains unclear. To our knowledge, only one study examined face preference at 7 months of age and its relation to face processing, social‐communicative and ASC development at 7 years of age (Shephard et al., [<reflink idref="bib49" id="ref42">49</reflink>]) and it focused on neural indices of face perception in sibling of children with ASC.</p> <p>To understand commonalities and differences in the developmental trajectory of face perception in individuals with and without ASC, and to understand the longitudinal role of early infant visual perception in social‐cognitive and autistic development, we conducted this 7‐years prospective longitudinal study. We tracked visual attention to face and eye‐gaze from 3 months to 12 months using eye‐tracking measures of five face perception tasks, and then measured social functioning, adaptive behavior, intellectual and theory of mind (ToM) development from 3 to 7 years of age. By comparing the developmental trajectory of face and social‐cognitive development in infant siblings of children with autism, and low‐risk infants, and using linear mixed effect models, principal component analysis, the present study aims to address: (<reflink idref="bib1" id="ref43">1</reflink>) do atypicalities in face perception in ASC emerge in early infancy? (<reflink idref="bib2" id="ref44">2</reflink>) to what extent does early face perception predict later ASC and social‐cognitive development in childhood? (<reflink idref="bib3" id="ref45">3</reflink>) what aspect(s) of infant face perception best predict social‐communicative and ASC development in childhood?</p> <hd id="AN0181984182-3">METHOD</hd> <p></p> <hd id="AN0181984182-4">Participants</hd> <p>This study included 153 participants who were part of a longitudinal study of infants at high‐ and low‐familial risk for autism (<ulink href="http://earlyautismstudy.org/">http://earlyautismstudy.org/</ulink>). High‐risk infants (<emph>N</emph> = 72, 39 female, 38.0% White) had at least one relative (e.g., sibling, parent, aunt, uncle, cousin, grandparent) with a diagnosis of ASC, which was independently confirmed by clinicians prior to the participants' enrollment in the study. Low‐risk infants (<emph>N</emph> = 81, 46 female, 80.2% White) had older sibling(s) who were developing typically and had no family history of ASC, confirmed by an Infant Intake Screen Questionnaire (see Section S1). Exclusion criteria included preterm birth, birth complications, extremely low birth weight, and any diagnosed developmental disorder other than ASC. Infant and child participants were tested in‐person at the Rutherford laboratory at McMaster University. Data was collected between 2015 and 2023.</p> <p>Participants were divided into three groups for final analyses: (<reflink idref="bib1" id="ref46">1</reflink>) the Low risk‐no ASC, (<reflink idref="bib2" id="ref47">2</reflink>) High risk‐no ASC, and (<reflink idref="bib3" id="ref48">3</reflink>) the ASC group. The Low risk‐no ASC group included 74 infants (33 female, 81.1% White) who had no known family members with ASC and scored below the ASC cut off on an Autism Diagnostic Observation Schedule, second edition (ADOS‐2 assessment; Lord et al., [<reflink idref="bib36" id="ref49">36</reflink>]). The ADOS‐2 assessment was administered by one of the authors (MDR), who was trained to reliability. The High risk‐no ASC group included 57 infants (30 female, 30.0% White) who had a relative with ASC and who scored below the ASC cut off on an ADOS‐2 assessment. Finally, the ASC group comprised 22 infants (5 female, 100% White) who scored above criteria for diagnosis using the ADOS‐2, regardless of the risk groups in which the participants were originally assigned during recruitment (Chawarska et al., [<reflink idref="bib8" id="ref50">8</reflink>]; Rutherford et al., [<reflink idref="bib47" id="ref51">47</reflink>]; Shic et al., [<reflink idref="bib50" id="ref52">50</reflink>]). Demographic information of the final sample is presented in Table 1.</p> <p>1 TABLE Participant characteristics and task summary.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Low risk‐no ASC</th><th align="left">High risk‐no ASC</th><th align="left">ASC</th><th align="left"><italic>p</italic> (3 groups)</th></tr></thead><tbody valign="top"><tr><td align="left">Sample size</td><td align="char" char=".">74</td><td align="char" char=".">57</td><td align="char" char=".">22</td><td align="left" /></tr><tr><td align="left">Sex (% female)</td><td align="char" char=".">45.95%</td><td align="char" char=".">54.39%</td><td align="char" char=".">22.73%</td><td align="left" /></tr><tr><td align="left">Race (% White)</td><td align="char" char=".">90.63%</td><td align="char" char=".">83.33%</td><td align="char" char=".">63.64%</td><td align="left" /></tr><tr><td align="left">Parent characteristics</td><td align="left" /></tr><tr><td align="left">Parent education</td><td align="char" char=".">3.51</td><td align="char" char=".">3.09</td><td align="char" char=".">3.22</td><td align="char" char=".">.007<xref ref-type="fn" rid="tfn4" /></td></tr><tr><td align="left">Interest in faces (percent looking) in infancy (means across 5 face tasks)</td></tr><tr><td align="left">3 months (n = 92)</td><td align="char" char=".">0.56 (0.02)</td><td align="char" char=".">0.60 (0.03)</td><td align="char" char=".">0.53 (0.03)</td><td align="char" char=".">.144</td></tr><tr><td align="left">6 months (n = 118)</td><td align="char" char=".">0.61 (0.01)</td><td align="char" char=".">0.57 (0.03)</td><td align="char" char=".">0.61 (0.03)</td><td align="char" char=".">.255</td></tr><tr><td align="left">9 months (n = 127)</td><td align="char" char=".">0.58 (0.01)</td><td align="char" char=".">0.58 (0.02)</td><td align="char" char=".">0.60 (0.02)</td><td align="char" char=".">.666</td></tr><tr><td align="left">12 months (n = 123)</td><td align="char" char=".">0.58 (0.02)</td><td align="char" char=".">0.57 (0.02)</td><td align="char" char=".">0.57 (0.03)</td><td align="char" char=".">.898</td></tr><tr><td align="left">Social‐cognitive development</td></tr><tr><td align="left">a. Adaptive Behavior Composite Score</td></tr><tr><td align="left">4 years (n = 77)</td><td align="char" char=".">105.18 (1.55)</td><td align="char" char=".">102.23 (2.49)</td><td align="char" char=".">92.69 (7.00)</td><td align="char" char=".">.029<xref ref-type="fn" rid="tfn3" /></td></tr><tr><td align="left">b. Early Learning Composite Score</td></tr><tr><td align="left">4 years (n = 68)</td><td align="char" char=".">243.09 (5.72)</td><td align="char" char=".">239.95 (5.68)</td><td align="char" char=".">207.00 (15.99)</td><td align="char" char=".">.032<xref ref-type="fn" rid="tfn3" /></td></tr><tr><td align="left">c. Intellectual Development (WISC‐IV)</td></tr><tr><td align="left">7 years (n = 36)</td><td align="char" char=".">105.16 (3.30)</td><td align="char" char=".">107.45 (4.11)</td><td align="char" char=".">87.67 (13.17)</td><td align="char" char=".">.088</td></tr><tr><td align="left">d. Theory of mind</td></tr><tr><td align="left">4 years (n = 81)</td><td align="char" char=".">49.47 (3.33)</td><td align="char" char=".">46.67 (3.67)</td><td align="char" char=".">44.44 (7.17)</td><td align="char" char=".">.749</td></tr><tr><td align="left">7 years (n = 41)</td><td align="char" char=".">66.67 (1.72)</td><td align="char" char=".">75.46 (2.40)</td><td align="char" char=".">62.70 (4.59)</td><td align="char" char=".">.006<xref ref-type="fn" rid="tfn4" /></td></tr><tr><td align="left">ADOS‐2</td><td align="left" /></tr><tr><td align="left">2 years (n = 93)</td><td align="char" char=".">1.73 (0.27)</td><td align="char" char=".">2.70 (0.46)</td><td align="char" char=".">16.25 (2.43)</td><td align="char" char="."><.001<xref ref-type="fn" rid="tfn5" /></td></tr><tr><td align="left">3 years (n = 18)</td><td align="char" char=".">1.80 (1.11)</td><td align="char" char=".">1.33 (0.44)</td><td align="char" char=".">11.75 (2.46)</td><td align="char" char="."><.001<xref ref-type="fn" rid="tfn5" /></td></tr><tr><td align="left">4 years (n = 35)</td><td align="char" char=".">2.00 (0.46)</td><td align="char" char=".">2.17 (0.44)</td><td align="char" char=".">13.83 (2.83)</td><td align="char" char="."><.001<xref ref-type="fn" rid="tfn5" /></td></tr><tr><td align="left">7 years (n = 7)</td><td align="char" char=".">4.00 (2.00)</td><td align="char" char=".">‐</td><td align="char" char=".">12.50 (2.87)</td><td align="char" char=".">.075</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: Data are reported as group means with standard errors in parentheses, when applicable. Parent education was reported as the highest level attained on a 3‐point scale: (<reflink idref="bib1" id="ref53">1</reflink>) high school graduate, (<reflink idref="bib2" id="ref54">2</reflink>) college (<reflink idref="bib3" id="ref55">3</reflink>) university. Parent education was the average of mother and father's education level on the scale.</p> <ulist> <item>2 Abbreviations: ADOS‐2, Autism Diagnostic Observation Schedule, second edition; ASC, autism spectrum condition; WISC, Wechsler Intelligence Scale for Children.</item> <item>3 * <emph>p</emph> < .05;</item> <item>4 ** <emph>p</emph> < .01;</item> <item>5 *** <emph>p</emph> < .001.</item> </ulist> <hd id="AN0181984182-5">Procedure</hd> <p>This study received clearance from the university research ethics board. Participants visited the lab four times in their first year, at 3, 6, 9, and 12 months of age, and at each visit, they completed the same five eye‐tracking tasks measuring their looking at faces, their visual attention to facial features, and their eye gaze following (see detailed description below). The same cohort of participants later returned for measurement of social‐cognitive development, and ASC development when they reached their second, third, fourth, and seventh birthday.</p> <p>The characteristics of participants and a summary of tasks administered at each age are presented in Table 1. Participants' adaptive behavior was measured at 4 years of age using the Vineland Adaptive Behavior Scales, second edition (VABS‐II; Sparrow et al., [<reflink idref="bib51" id="ref56">51</reflink>]). Early learning ability was measured at 4 years of age using the Mullen Scales of Early Learning (MSEL; Mullen, [<reflink idref="bib41" id="ref57">41</reflink>]). Intellectual development was measured at 7 years of age using the Wechsler Intelligence Scale for Children‐fourth edition (WISC‐IV; Wechsler, [<reflink idref="bib56" id="ref58">56</reflink>]). A battery of ToM task with varying difficulties was developed and administered at 4, and 7 years of age (see detailed description below). An Infant Intake Screening Questionnaire was administered and reviewed at each of the eight visits from infancy to childhood. Parents provided written informed consent at each visit after receiving a detailed description of the session and the overall longitudinal study.</p> <hd id="AN0181984182-6">Measures</hd> <p></p> <hd id="AN0181984182-7">Eye‐tracking measures of face processing in infancy</hd> <p>Five face perception tasks were presented using Tobii Studio (version 3.2.3) software on a 24‐inch monitor with a resolution of 1024 by 768 pixels, which was approximately 65 cm from the participants' eyes. Eye movements were tracked using a Tobii T60 XL Eye Tracker, with a sampling rate of 60 Hz. The eye‐tracking camera tracked eye gaze bilaterally, using UV light reflected from the pupil and a corneal reflection of an infrared light.</p> <p>Each testing session started with a 3‐point calibration procedure to ensure eye‐tracking accuracy. During the calibration, the screen displayed a ball that moved rapidly across the screen and stopped in three different locations (top center, left and right corner). Calibration was achieved when participants successfully fixated at the three locations. If any validation points resulted in an error value greater than 1.0°, participants were recalibrated. Following successful calibration and validation, the task was initiated.</p> <p>Five face perception tasks comprising 10 blocks of 48 trials were presented to participants in a fixed, pre‐randomized order (see Figure 1). In each block, infants started with an eye open versus closed trial, followed by an eye versus mouth trial, a face preference trial, a gaze following trial, and a direct versus averted gaze trial. All face tasks had 10 trials in total, except for the face preference task, which had eight trials in total. Therefore, the first eight blocks consisted of 40 trials of five tasks, and the last two blocks consisted of eight trials of four tasks (i.e., without the face preference task). An attention getter with sound was displayed between trials to re‐orient the participants' attention to the center of the screen. Face stimuli for the Gaze Following Task were displayed for 3 s, and stimuli for the rest of the four tasks were displayed for 5 s, resulting in a total of approximately 7.5‐min test session for each visit. The same testing procedure was used for all four infant visits (i.e., 3, 6, 9 and 12 month).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0001.jpg" title="1 Overview of longitudinal assessment of social cognitive development from infancy to childhood, as well as demonstration of five face tasks in infancy. Note that adaptive behavior (Vineland Adaptive Behavior Scales [VABS]) and early learning (Mullen Scales of Early Learning [MSEL]) assessment was also administered at 3 years of age, but there was no sufficient data generated at this time point. IQ assessment was also conducted at 4 years of age, but only 7 years measurement generated sufficient data for final analyses." /> </p> <p></p> <p>A total of 44 models' faces (22 female) were used to generate stimuli in the five tasks. Static images of four models' faces were used in the face preference task, and short video clips of 10 models' faces were used in each of the other four tasks. Face images and video clips were taken by a Canon camera against a uniform gray background using uniform distance and lighting in the laboratory. All faces showed a neutral expression and upper shoulder, neck, and hair were external features visible to participants. The models in the video clips were not static; however, they were instructed to maintain a natural stillness (or to close their eyes and adjust their gaze accordingly) to suit the specific filming purposes.</p> <hd id="AN0181984182-9">Task 1: Eye Open versus Closed Task</hd> <p>In each of 10 trials, infants viewed a video clip showing two faces of the same individual. One face showed a person with eyes open, and the other showed the same person with eyes closed for 5 s, and the two faces were displayed side‐by‐side on the screen. Each face was 25 × 17 cm (width × height), subtended 21.78° × 14.9° of visual angle. To avoid habituation, different models (<emph>n</emph> = 10, 5 female models) were used in each trial. The left or right position of the faces was counterbalanced such that face with the eyes open appeared on the left side in half of the trials. The dependent measurement is the amount of time infants spent looking toward the eyes open image, divided by the total looking time on the screen.</p> <hd id="AN0181984182-10">Task 2: Eyes versus Mouth Task</hd> <p>In each of 10 trials, infants were presented with a video displaying a face for 5 s. Each face was 25 × 17 cm wide centered on the computer screen. The face subtended 21.78° × 14.9° of visual angle. The eye tracker measured whether an infant was looking into the "eyes" region of interest, which is approximately 3 cm tall and 8.5 cm wide, or the equally sized "mouth" region of interest. Each trial included face of a different model to retain the interest of infant (<emph>n</emph> = 10 models in total, 6 female). The dependent measurement is the amount of time infants spent looking toward eyes region, divided by the total looking time on both eyes and mouth region.</p> <hd id="AN0181984182-11">Task 3: Face Preference Task</hd> <p>In each of eight trials, infants viewed an image of a face and a foil image of the same size (25 × 17 cm) and matched for luminance and contrast. The two images were displayed side‐by‐side on the computer screen, subtended of 45.26° × 14.9° of visual angle. The face image is a color photograph of a face, with hair combed or pulled off the face, and includes the neck and some shoulders. The foil image was created by phase‐scrambling the face image, a process that preserves the spatial frequency content of the image, while randomizing the phase. Specifically, the phase and amplitude components of the face images were separated, and the phase component replaced with the phase of a Gaussian white noise patch matched in size to the original image (Hoffman et al., [<reflink idref="bib27" id="ref59">27</reflink>]). Because infants use more of the low end of the spatial frequency range to recognize faces and ignore the high spatial frequencies in face processing, care was taken to ensure that the foil and the face image had the same range of high, low and medium frequency components.</p> <p>Four models' face images were used across eight trials. In half of the trials, face images of the four models were presented on the left side of the screen, and in another half, face images of the same four models were presented on the right side of the screen. The dependent measurement is the amount of time infants spent looking toward the face image, divided by the total looking time on the screen.</p> <hd id="AN0181984182-12">Task 4: Gaze Following Task</hd> <p>This task was designed as an attention cuing paradigm. In each of 10 trials, infants were presented a video clip of a face looking directly at them for 1000 ms, followed by the same person looking to the right or left for 1000 ms. The change creates the appearance that the person has quickly looked to the side. Next, there is a 1000 ms interstimulus interval (ISI) during which eye direction was measured. Because novelty is important in attracting the attention of infants, a novel model was used in each trial. Face in each video was 25 × 17 cm, subtended 21.78° × 14.9° of visual angle. The dependent measurement is the amount of time infants looked toward the right and the left half of the screen during the ISI, which corresponds to looking toward (congruent looking) or away (incongruent looking) from the model's eye gaze. Thus, the proportional time that infants followed the model's gaze direction (congruent looking) over entire looking time (congruent + incongruent looking) was calculated for each trial.</p> <hd id="AN0181984182-13">Task 5: Direct versus Averted Gaze Task</hd> <p>During each trial, a video clip of two faces of the same individual was displayed to an infant for 5 s. One face showed the person looking directly at the camera (direct gaze) and the other showed the same individual looking 30° to the left or right (averted gaze). Face in each video was 50 × 17 cm in size and subtended 45.26° × 14.9° of visual angle. Different models' faces (<emph>n</emph> = 10 models in total) were displayed across trials to retain the interest of infant. The dependent measurement was the amount of time infants spent looking toward the direct gaze image, divided by the total looking time on the screen.</p> <hd id="AN0181984182-14">Measures of social‐cognitive and ASC development in childhood</hd> <p>Assessments were conducted individually in a quiet room. The 2‐ and 3‐year visit took about 1‐h, 4‐year visit took about 2 h, and 7‐year visit took about 2.5 h.</p> <hd id="AN0181984182-15">Measure 1: VABS‐II</hd> <p>Children's adaptive functioning was assessed at 4 years of age (<emph>n</emph> = 77) using the VABS‐II, parent/caregiver form (Sparrow et al., [<reflink idref="bib51" id="ref60">51</reflink>]). The VABS‐II is a semi‐structured parent interview designed to assess adaptive behavior in individuals from birth through 90 years of age across four domains: communication, daily living skills, socialization, and motor skills. Sum of the domain standard scores were then standardized into the Adaptive Behavior Composite Score. The test took between 30 and 60 min.</p> <hd id="AN0181984182-16">Measure 2: MSEL</hd> <p>Children's early learning ability was measured using the MSEL (Mullen, [<reflink idref="bib41" id="ref61">41</reflink>]) at age four (<emph>n</emph> = 68). The MSEL is a normed standardized developmental measure of language, cognitive and motor functioning in individuals from birth to 68 months of age. Scores across four domains, visual reception, fine motor, receptive language, and expressive language, are combined to yield an overall Early Learning Composite Score (ELCS). The test took between 40 and 60 min.</p> <hd id="AN0181984182-17">Measure 3: WISC‐IV</hd> <p>The WISC‐IV (Wechsler, [<reflink idref="bib56" id="ref62">56</reflink>]) was administered at 7 years of age (<emph>n</emph> = 36) to assess the general intelligence. It yields a full‐scale IQ score and five primary index scores, including verbal comprehension index, visual spatial index, fluid reasoning index, working memory index, and processing speed index. The WISC‐IV took about 45–65 min.</p> <hd id="AN0181984182-18">Measure 4: ToM</hd> <p>Two batteries of ToM tasks were developed and administered at age four (<emph>n</emph> = 81) and seven (<emph>n</emph> = 41) to assess a variety of different aspects of ToM ability in children (see Sections S4 and S5 for ToM scoring). Specifically, 4‐year‐old ToM task consists of nine subtasks measuring children's understanding of desire, false belief, ability to distinguish between appearance and reality, and other people's feelings and emotion. Percentage of ToM scores at 4 years of age were calculated by using their raw score divided by a total score of 9.</p> <p>Seven‐year‐old ToM task consists of nine subtasks measuring children's understanding of other people's intention and desire (subtask 1–2), perception and knowledge (subtask 3), first and second order false belief (subtask 5–6), making lies and jokes (subtask 7) as well as their inference of other people's traits (subtask 8), and intention and outcomes in moral judgment (subtask 9). Percentage of ToM scores at 7 years of age were calculated by using their raw score divided by a total score of 42. Nine subtasks for both age groups were presented in the order of ascending difficulty, which in total took about 60 min to administer.</p> <hd id="AN0181984182-19">Measure 5: ADOS‐2</hd> <p>The ADOS‐2 was used to assess child participants' autism‐related social and communication behavior characteristics. It is a semi structured standardized assessment using developmentally appropriate social and toy‐based interactions in a 30‐ to 45‐min session designed to elicit symptoms of autism in four areas: social interaction, communication, play, and repetitive, restrictive behaviors (Lord et al., [<reflink idref="bib36" id="ref63">36</reflink>]). ADOS calibrated severity scores (CSS) were calculated using the guideline published in Gotham et al. ([<reflink idref="bib21" id="ref64">21</reflink>]).</p> <p>The ADOS‐2 was administered at 2, 3, 4 and 7 years of age. And 20.9% of child participants (<emph>n</emph> = 32) took the ADOS‐2 more than once. Of these participants, 75% of child participants' ASC classification remains unchanged across visits, whereas 25% of child participants' ASC classification changed across visits. Most changes occurred between 2 to 4 years of age. Half of the participants were initially diagnosed with ASC at 2 years of age but changed to no ASC at 4 years of age. And the other half changed from no ASC to ASC. The rate of change in our study is consistent with a recent study (Waizbard‐Bartov & Miller, [<reflink idref="bib55" id="ref65">55</reflink>]). For those who changed across visits, diagnostic criteria for their most recent ADOS assessment were used. Of the 153 participants, 61% took the ADOS‐2 at 2 years of age (<emph>M</emph><subs>age</subs> = 2 years 1 month and 0 days), 11% took at the 3 years of age (<emph>M</emph><subs>age</subs> = 3 years 2 months and 22 days), 24% took at the 4 years of age (<emph>M</emph><subs>age</subs> = 3 years 3 months and 23 days), and 4% were assessed at 7 years of age (<emph>M</emph><subs>age</subs> = 7 years 6 month and 22 days).</p> <hd id="AN0181984182-20">Statistical analyses</hd> <p></p> <hd id="AN0181984182-21">Eye‐tracking analysis of infant's face perception development</hd> <p>Eye fixation data were generated through the Tobii Studio I‐VT fixation filter applied to the raw eye movement data. The threshold velocity was set to 30°/s (as recommended by the filter), and eye movement records above the velocity threshold were discarded from the analyses. Average proportion of fixation duration on target area of interests (AOI) across trials was calculated to index infants' preference for eyes open (task1), for eyes over mouth (task2), for face over foil images (task3), for following eye gaze (task4), and for direct gaze (task5).</p> <p>To examine how the performance in each of the face tasks develops longitudinally in individuals with and without ASC, we first applied the linear mixed effects models (LMM) in <emph>R</emph> (<emph>lme4</emph> package, Bates et al., [<reflink idref="bib3" id="ref66">3</reflink>]) to perform separate analyses of face perception in each of the five tasks. Secondly, given the large number of repeated measures used to assess five aspects of face perception infancy, we ran principal component analyses (PCA) to clarify relations among five face tasks and determine the importance of tasks in affecting the ASD development.</p> <p>LMM models outperform repeated ANOVA for longitudinal data analyses because it allows us to examine general grand mean trajectories, ASC group means, and most importantly, within these general patterns, assess individual variation in intercept (i.e., starting points) and slopes (i.e., rate of change over time). It also has more flexibility in dealing with missing data in longitudinal studies(Magezi, [<reflink idref="bib37" id="ref67">37</reflink>]). Instead of listwise‐deleting the whole participant who missed any single one timepoint test in repeated ANOVA, results are weighted by the amount of data contributed by each participant in LMMs.</p> <p>Specifically, we ran LMM model analysis in R (version 4.1.0) using the <emph>lme4</emph> package (Bates et al., [<reflink idref="bib3" id="ref68">3</reflink>]). Separate LMM model was run for each of the five face perception tasks. In each model, we included proportional time looking at the target interest areas as the dependent variable and added fixed effects of age (3 to 12 months), ASC groups (Low risk‐No ASC, High risk‐No ASC, ASC), as well as their interaction. Preliminary analyses revealed that sex did not have a significant effect in each face task, nor did it interact with other variables, all <emph>p</emph>s > .097, thus was excluded in LMM model analyses. We included participants as a random intercept to account for the repeated‐measures nature of the data. We started from a complete general linear mixed‐effects model with all factors, before removing factors that were not statistically significant in a stepwise manner until the simplest, best‐fit, model was reached. Models with and without age as a random slope were also compared to decide whether the rate of change in proportional looking time on target interest areas varies across participants. Significance was calculated using the lmerTest package (Kuznetsova et al., [<reflink idref="bib33" id="ref69">33</reflink>]). Figures were plotted using the <emph>ggplot2</emph> command in R. Full LMM models for each of the five face perception task are found in Section S1.</p> <hd id="AN0181984182-22">RESULTS</hd> <p></p> <hd id="AN0181984182-23">The development of face perception in individuals with and without ASC in infancy</hd> <p></p> <hd id="AN0181984182-24">Linear mixed effects model</hd> <p>For both the Face Preference Task, and the Eyes versus Mouth Task, we found age was a significant main effect (Wald <emph>χ</emph><sups>2</sups>(<reflink idref="bib3" id="ref70">3</reflink>) = 32.11. <emph>p</emph> < .001, and Wald <emph>χ</emph><sups>2</sups>(<reflink idref="bib3" id="ref71">3</reflink>) = 12.23, <emph>p =</emph> .007, respectively). Although preference for face over scrambled images increased with age in the first year, eyes over mouth preference decreased with age (see Section S3 for full results of post hoc Bonferroni‐corrected pairwise comparisons). The main effect of group and age by group interaction were not significant for the two tasks, <emph>p</emph>s > .060. Therefore, increased looking at faces, and at mouths with age was comparable in the three groups. Moreover, additional models with age as a random slope did not significantly improve model fit for both tasks (for the Face Preference Task: <emph>χ</emph><sups>2</sups>(<reflink idref="bib9" id="ref72">9</reflink>) = 16.26. <emph>p</emph> = .062; and for the Eyes vs. Mouth Task: <emph>χ</emph><sups>2</sups>(<reflink idref="bib9" id="ref73">9</reflink>) = 9.54. <emph>p</emph> = .389), suggesting that the age‐related change in face preference and eyes preference did not differ across participants. Taken together, these results indicate that for both individuals with and without ASC, there was an increased preference for face, but a decreased preference for eyes across the infants' first year of age, and that there were no significant individual differences in these age‐related changes (Figure 2a,b).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0002.jpg" title="2 Linear mixed effects model showing age as a significant predictor of the eyes over month preference (a) and face preference (b), and age as a significant random slope for the "Eyes open versus closed task" (c), the "Gaze following task" (d), and for the "Averted versus direct gaze task" (e). In (a) and (b), each line represents estimated mean preference for eyes over mouth and preference for faces from three to 12 months of age. Different ASD groups are colored coded, with dark gray, blue and red lines representing the low risk‐no ASD, high risk‐no ASD and ASD groups respectively. Black dots on each line represent corresponding means at each age points. Shaded areas represent confidence intervals. In (c–e), each line represents an estimated individual developmental trajectory of dependent variables for each participant in infancy. Note representative 45 participants, 15 from each ASD group were randomly chosen to show in the plots." /> </p> <p></p> <p>For the other three tasks (Gaze Following, Direct vs. Averted Gaze, and Eyes Open vs. Closed Task), the main effect of age, ASC groups, and age by ASC interaction were non‐significant, <emph>p</emph>s > .152. The random slope of age was significant for each of the three tasks (see Figure 2c,d,e, <emph>χ</emph><sups>2</sups>(<reflink idref="bib9" id="ref74">9</reflink>) = 24.88, <emph>p</emph> = .003 for the Gaze Following Task, <emph>χ</emph><sups>2</sups>(<reflink idref="bib9" id="ref75">9</reflink>) = 36.53, <emph>p</emph> < .001 for the Direct vs. Averted Gaze Task, and <emph>χ</emph><sups>2</sups>(<reflink idref="bib9" id="ref76">9</reflink>) = 26.00, <emph>p</emph> = .002 for and the Eye Open vs. Closed Task). These results together suggested that individual infants significantly varied in their development of looking time to open eyes, to direct gaze, and to following gaze direction in their first year.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0003.jpg" title="3 Pairwise correlation of five face perception tasks (a). FP is the face preference task, DA is the direct versus verted gaze task, OC is the eyes open versus closed task, GF is the gaze following task, and EM is the eyes versus mouth task. The size of the circle is proportional to the rank coefficient. Principal component analysis biplot (b) of face perception performance in the low risk‐no autism spectrum condition (ASC) (left), high risk‐no ASC (middle) and ASC group (right)." /> </p> <p></p> <p>Separate mixed ANOVA analyses also revealed non‐significant ASC group differences for each face perception task in infancy (<emph>p</emph>s > .202). In addition, Bayesian statistics were used to evaluate the strength of the evidence for the current pattern of results. Consistent with results from the LMMs and classic ANOVA analyses, Bayesian 4 (age) × 3 (ASC groups) mixed ANOVA found for the face preference task, the data were 4.45 times more likely under the model with age as the only main effect, than under the next‐best model with age and ASD group as the main effect. Follow‐up post hoc comparison tests provided strong evidence (BF<subs>10</subs> = 18.19) for an increase face preference from 3 to 12 months. Moreover, for all of the other tasks, neither task had the best model with the significant main effect or interaction involving ASD groups. In fact, the evidence favoring model with ASD group differences is minimal (BF<subs>10</subs>s < 0.287; see Supporting Information for the full Bayesian Results).</p> <hd id="AN0181984182-27">Principal component analysis</hd> <p>To clarify relations among five face tasks and determine the importance of each task with respect to ASD development, we conducted three PCA, using the data from each group separately (see Table 2 for full loadings). The PCA was conducted using the <emph>pcaMethods</emph> library in <emph>RStudio</emph>. Prior to the analyses, we used the <emph>svdImpute</emph> method in the <emph>pca</emph> function to interpolate data using the expectation maximum method. All data was mean centered.</p> <p>2 TABLE Principal component analyses (PCA) loadings for the three autism spectrum condition (ASC) groups in the five face perception tasks. PCA scores larger than 0.3 are shown in boldface.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Tasks</th><th align="left">Principal component 1</th><th align="left">Principal component 2</th></tr></thead><tbody valign="top"><tr><td align="left">PCA loadings for the low risk‐no ASD group</td></tr><tr><td align="left">Eyes open versus closed</td><td align="char" char=".">−0.04</td><td align="char" char=".">−0.15</td></tr><tr><td align="left">Eyes versus mouth</td><td align="char" char=".">−0.99</td><td align="char" char=".">0.09</td></tr><tr><td align="left">Face preference</td><td align="char" char=".">−0.03</td><td align="char" char=".">0.03</td></tr><tr><td align="left">Gaze following</td><td align="char" char=".">−0.08</td><td align="char" char=".">−0.98</td></tr><tr><td align="left">Direct versus averted gaze</td><td align="char" char=".">0.02</td><td align="char" char=".">0.04</td></tr><tr><td align="left">Variance (%)</td><td align="char" char=".">54.93%</td><td align="char" char=".">18.27%</td></tr><tr><td align="left">PCA loadings for the high risk‐no ASD group</td></tr><tr><td align="left">Eyes open versus closed</td><td align="char" char=".">0.04</td><td align="char" char=".">−0.27</td></tr><tr><td align="left">Eyes versus mouth</td><td align="char" char=".">−0.94</td><td align="char" char=".">−0.27</td></tr><tr><td align="left">Face preference</td><td align="char" char=".">0.02</td><td align="char" char=".">−0.27</td></tr><tr><td align="left">Gaze following</td><td align="char" char=".">−0.20</td><td align="char" char=".">0.86</td></tr><tr><td align="left">Direct versus averted gaze</td><td align="char" char=".">−0.12</td><td align="char" char=".">−0.21</td></tr><tr><td align="left">Variance (%)</td><td align="char" char=".">46.57%</td><td align="char" char=".">17.55%</td></tr><tr><td align="left">PCA loadings for the ASC group</td></tr><tr><td align="left">Eyes open versus closed</td><td align="char" char=".">0.08</td><td align="char" char=".">−0.17</td></tr><tr><td align="left">Eyes versus mouth</td><td align="char" char=".">0.95</td><td align="char" char=".">0.02</td></tr><tr><td align="left">Face preference</td><td align="char" char=".">0.08</td><td align="char" char=".">−0.66</td></tr><tr><td align="left">Gaze following</td><td align="char" char=".">0.03</td><td align="char" char=".">0.72</td></tr><tr><td align="left">Direct versus averted gaze</td><td align="char" char=".">−0.30</td><td align="char" char=".">−0.08</td></tr><tr><td align="left">Variance (%)</td><td align="char" char=".">39.07%</td><td align="char" char=".">35.30%</td></tr></tbody></table> </ephtml> </p> <p>The Kaiser‐Meyer‐Olkin measures of sampling adequacy for each of the three ASC groups were greater than 0.47, indicating that the data were suitable for factor analysis. Bartlett's test of sphericity was significant <emph>p</emph>s < .001, suggesting that the correlation matrix was not an identity matrix and was suitable for PCA. For the Low Risk‐no ASC group (see Figure 3), the analyses returned two components. The first component (PC1) explained 54.93% of the overall variance, whereas the second component (PC2) explained 18.27% of the overall variance. Higher scores in PC1 were associated with lower scores in the Eyes versus Mouth task, and higher scores in PC2 were associated with lower scores in the Gaze Following Task.</p> <p>Consistent with the Low Risk‐no ASC group, PCA analyses returned two components for the High Risk‐no ASC group. The first, and second component explained 46.57%, and 17.55% of the overall variance, respectively. Increase in the PC1 scores was primarily associated with decline in their Eyes over Mouth Preference scores. Increase in the PC2 scores was associated with an increase in the Gaze Following scores.</p> <p>For the ASC group, the analyses also returned two components, but the tasks involved were different. The first (PC1) and the second component (PC2) explained 39.07%, and 35.30% of the variance in the data respectively. Higher scores in PC1 were associated with higher scores in the Eyes versus Mouth Task, and lower scores in the Direct versus Averted Gaze Task. Additionally, higher scores in PC2 were associated with higher scores in the Gaze Following Task, and lower scores in the Face Preference Task. Scores in PC2 were also weakly negatively correlated with Eyes Open versus Closed scores. Overall, the Principal Components score in the no ASC groups (both high and low risks) were strongly associated with one task each, rather than the diverging task performance characterized in the ASC group.</p> <hd id="AN0181984182-28">Social‐cognitive development in children with and without ASC</hd> <p>Social‐cognitive development includes children's adaptive behavior, early learning abilities, intellectual development, and ToM development. First, two‐way ANOVAs, with sex and ASC groups as between‐subjects variables were performed for each of the social‐cognitive tests to examine whether social‐cognitive abilities in childhood change as a function of participants' sex and ASC groups. Second, linear regression analyses were performed to examine the prediction of social cognitive performances on the ASC severity scores.</p> <p>We found that the main effects of sex and sex by ASC group interactions were not significant for all measures, <emph>p</emph>s > .162. However, the main effects of ASC groups were significant in the VABS, <emph>F</emph>(<reflink idref="bib2" id="ref77">2</reflink>, 71) = 3.82, <emph>p</emph> = .027, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0001" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .10, the communication and daily living skills in the Vineland scale (<emph>F</emph>(<reflink idref="bib2" id="ref78">2</reflink>, 70) = 3.33, <emph>p</emph> = .042, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0002" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .09; <emph>F</emph>(<reflink idref="bib2" id="ref79">2</reflink>, 70) = 3.90, <emph>p</emph> = .025, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0003" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .10; see Figure 4), in the Mullen early learning skills, <emph>F</emph>(<reflink idref="bib2" id="ref80">2</reflink>, 57) = 3.60, <emph>p</emph> = .034, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0004" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .11, and fine motor skills, <emph>F</emph>(<reflink idref="bib2" id="ref81">2</reflink>, 57) = 6.08, <emph>p</emph> = .004, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0005" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .18, as well as ToM at 7 years of age, <emph>F</emph>(<reflink idref="bib2" id="ref82">2</reflink>, 34) = 5.95, <emph>p</emph> = .006, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0006" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .26. However, there were no group differences in the ToM at 4 years of age, <emph>F</emph>(<reflink idref="bib2" id="ref83">2</reflink>, 75) = 0.29, <emph>p</emph> = .748, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0007" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .01, and WISC test at 7 years of age, <emph>F</emph>(<reflink idref="bib2" id="ref84">2</reflink>, 30) = 2.42, <emph>p</emph> = .106, <ephtml> <math altimg="urn:x-wiley:00093920:media:cdev14144:cdev14144-math-0008" display="inline" overflow="scroll" xmlns="http://www.w3.org/1998/Math/MathML"><semantics><mrow><msubsup><mi>η</mi><mi mathvariant="normal">p</mi><mn>2</mn></msubsup></mrow></semantics></math> </ephtml>  = .14, and in other sub‐measures, <emph>p</emph>s > .205. Specifically, children with ASC scored significantly lower in adaptive behavior and early learning abilities than children who did not develop ASC, <emph>p</emph>s < .029, with no significant differences in the low risk‐no ASC and high risk‐no ASC group, <emph>p</emph>s = 1.00. ToM scores at 7 years of age were higher in the high risk‐no ASC group than the low risk‐no ASC, and the ASC group, <emph>p</emph>s < .021, with no difference between the low risk‐no ASC and the ASC group, <emph>p</emph> = .984. ToM ability at 4 years of age, and intellectual development at 7 years of age were not significantly different in the three groups of child participants.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0004.jpg" title="4 (a–c) Violin plots showing adaptive behavior (a), early learning at 4 years of age (b), and ToM at 7 years of age (c) in three autism spectrum condition (ASC) groups. Group means were represented by block dots in each violin boxes, that were connected with black lines to make group comparisons. (d) Adaptive behavior, early learning at 4 years of age, intellectual and ToM ability at 7 years of age negatively predict the Autism Diagnostic Observation Schedule (ADOS) severity scores. Gray, blue and red dots in each of the scatter plots represent low risk‐no ASC, high risk‐no ASC, and ASC groups respectively. ASC, autism spectrum condition; ToM, theory of mind; WISC, Wechsler Intelligence Scale for Children." /> </p> <p></p> <p>Linear regression analyses (Figure 4d) revealed that ADOS CSS (Gotham et al., [<reflink idref="bib21" id="ref85">21</reflink>]) were significantly negatively predicted by the Vineland composite scores, <emph>β</emph> = −0.07, <emph>t</emph> = −4.20, <emph>p</emph> < .001, by Mullen ELCS, <emph>β</emph> = −0.02, <emph>t</emph> = −2.39, <emph>p</emph> = .002, by WISC scores, <emph>β</emph> = −0.05, <emph>t</emph> = −2.76, <emph>p</emph> = .010, and by ToM ability at 7 years of age <emph>β</emph> = −0.08, <emph>t</emph> = −2.32, <emph>p</emph> = .026, but not at 4 years of age, <emph>β</emph> = 0.01, <emph>t</emph> = 2.76, <emph>p</emph> = .795.</p> <hd id="AN0181984182-30">Infant face perception predicts social‐cognitive development, and the effect of ASC groups</hd> <p>Multiple linear regression analyses were conducted for each social‐cognitive measures, and their subtasks, with five face parameters as the predictors. A stepwise regression approach was used to avoid collinearity of the model. Results indicated that proportional time looking at direct over averted gaze in infancy positively predicted communication skills at 4 years of age, <emph>β</emph> = 35.78, <emph>t</emph> = 2.10, <emph>p</emph> = .041. Proportional time looking at eyes over mouth in infancy negatively predicted daily living skills at 4 years of age, <emph>β</emph> = −12.16, <emph>t</emph> = −2.01, <emph>p</emph> = .050, and positively predicted the ToM ability at 7 years of age. <emph>β</emph> = 13.14, <emph>t</emph> = 2.19, <emph>p</emph> = .038 (see Figure 5). Performance in other face tasks did not significantly predict social‐cognitive measures, and subdomain measures, <emph>p</emph>s > .104.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0005.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0005.jpg" title="5 The predictive role of infant face perception on social‐cognitive measures (a: Communication skills; b: Daily living skills; c: Theory of mind) and the impact of autism spectrum condition (ASC) group. (d) Is the simple slope plot showing different predictions of eyes preference on the theory of mind for the three groups." /> </p> <p></p> <p>An overall face composite score was computed by averaging proportional time looking at the areas of interest across five face tasks and four time points. Simple Linear regression revealed face composite score was not predictive of any social‐cognitive and sub‐measures, <emph>p</emph>s > .131.</p> <p>To further explore whether the strength of the three predictions differs across the ASC groups, we tested the moderating effect (or interaction effect) of ASC groups (moderator, W) on the relationship between face perception (X) and social‐cognitive outcomes (Y), with the Hayes PROCESS Macro Model 1 bootstrapping using ordinary least squares regression. In each moderating model, ASC group was dummy coded with the low risk‐no ASC group as the reference group, sex was controlled as a covariate, and proportional time was mean centered to control for multicollinearity.</p> <p>The moderating effect of ASC group was not significant for the direct gaze preference predicting communication skills in adaptive functioning, <emph>β</emph>s <emph>> −</emph>4.61, <emph>p</emph>s > .728, and for the eyes over mouth preference predicting daily living skills in adaptive functioning, <emph>β</emph>s <emph>> −</emph>19.34, <emph>p</emph>s > .184, suggesting a similar pattern for each ASC group. However, we found ASC group had a marginal moderating effect on the relation between eyes over mouth preference and ToM ability at 7 years of age, specifically between the control group and the high risk‐no ASC group, <emph>β =</emph> −20.69, <emph>p</emph> = .058. For the control group, proportional time looking at eyes in infancy significantly positively predicted ToM ability at 7 years of age, <emph>β =</emph> 12.981, <emph>p</emph> = .035. However, this prediction was not significant for the high‐risk group, <emph>β =</emph> 1.51, <emph>p</emph> = .905. There was no significant difference when comparing the ASC and the control group, <emph>β =</emph> −19.74, <emph>p</emph> = .186. The results of the moderation analysis are summarized in Table 3.</p> <p>3 TABLE Moderation analysis of the interaction between autism spectrum condition (ASC) groups and infant face perception in predicting social‐cognitive outcomes.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Outcomes</th><th align="left">Predictor</th><th align="left"><italic>β</italic></th><th align="left">95% CI</th><th align="left"><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Theory of mind at age 7</td><td align="left">Eyes over mouth (X)</td><td align="char" char=".">14.76</td><td align="char" char=".">64.02, 72.85</td><td align="char" char=".">.14</td></tr><tr><td align="left">High risk‐no ASC group (W1)</td><td align="char" char=".">11.13</td><td align="char" char=".">3.23, 26.29</td><td align="char" char="."><.001</td></tr><tr><td align="left">ASC group (W2)</td><td align="char" char=".">6.36</td><td align="char" char=".">5.49, 16.78</td><td align="char" char=".">.111</td></tr><tr><td align="left">X × W1</td><td align="char" char=".">−20.69</td><td align="char" char=".">−1.58, 14.30</td><td align="char" char=".">.058</td></tr><tr><td align="left">X × W2</td><td align="char" char=".">−19.74</td><td align="char" char=".">−43.85, 2.47</td><td align="char" char=".">.186</td></tr><tr><td align="left">Sex (C)</td><td align="char" char=".">−6.89</td><td align="char" char=".">−12.46, −1.33</td><td align="char" char=".">.017</td></tr><tr><td align="left">Daily living skills in adaptive functioning at age 4</td><td align="left">Eyes over mouth (X)</td><td align="char" char=".">−12.93</td><td align="char" char=".">−27.13, 1.27</td><td align="char" char=".">.073</td></tr><tr><td align="left">High risk‐no ASC group (W1)</td><td align="char" char=".">−0.35</td><td align="char" char=".">−6.98, 6.29</td><td align="char" char=".">.917</td></tr><tr><td align="left">ASC group (W2)</td><td align="char" char=".">−6.89</td><td align="char" char=".">−14.72, 0.93</td><td align="char" char=".">.083</td></tr><tr><td align="left">X × W1</td><td align="char" char=".">−19.35</td><td align="char" char=".">−48.22, 9.53</td><td align="char" char=".">.185</td></tr><tr><td align="left">X × W2</td><td align="char" char=".">12.06</td><td align="char" char=".">−19.90, 44.03</td><td align="char" char=".">.453</td></tr><tr><td align="left">Sex (C)</td><td align="char" char=".">−0.41</td><td align="char" char=".">−6.25, 5.43</td><td align="char" char=".">.888</td></tr><tr><td align="left">Communication skills in adaptive functioning at age 4</td><td align="left">Direct over averted gaze (X)</td><td align="char" char=".">28.21</td><td align="char" char=".">−16.75, 73.16</td><td align="char" char=".">.215</td></tr><tr><td align="left">High risk‐no ASC group (W1)</td><td align="char" char=".">1.14</td><td align="char" char=".">−6.15, 8.44</td><td align="char" char=".">.755</td></tr><tr><td align="left">ASC group (W2)</td><td align="char" char=".">−8.09</td><td align="char" char=".">−17.88, 0.26</td><td align="char" char=".">.057</td></tr><tr><td align="left">X × W1</td><td align="char" char=".">−4.61</td><td align="char" char=".">−66.27, 57.05</td><td align="char" char=".">.882</td></tr><tr><td align="left">X × W2</td><td align="char" char=".">15.30</td><td align="char" char=".">−72.56, 103.16</td><td align="char" char=".">.729</td></tr><tr><td align="left">Sex (C)</td><td align="char" char=".">−1.59</td><td align="char" char=".">−8.17, 4.99</td><td align="char" char=".">.632</td></tr></tbody></table> </ephtml> </p> <p>Finally, Binary logistic regression was conducted to examine the extent to which infant face perception predicts whether a participant belongs to an ASC or no ASC group. We found none of the face tasks nor the overall face composite score significantly predicted the ASC categorization in childhood, <emph>β</emph>s > −0.23, <emph>p</emph>s > .263. Figure 6 shows the relation between each face task and ASC participants' ADOS severity score.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/CDV/01jan25/cdev14144-fig-0006.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="cdev14144-fig-0006.jpg" title="6 Relation between face perception infancy and autism spectrum condition (ASC) severity score in childhood. Proportional time looking at face with open eyes (a), at eyes over mouth (b), at faces over scrambled pattern (c), following eye gaze (d), at direct gaze over averted gaze (e), and an overall face index across five eye‐tracking tasks (f). ADOS, Autism Diagnostic Observation Schedule." /> </p> <p></p> <hd id="AN0181984182-33">DISCUSSION</hd> <p>Using large longitudinal samples this 7 years prospective longitudinal study examined the developmental trajectory of visual attention to faces in infants who later developed with ASC and others who did not. We tested the predictive effect of early infant face perception on ASC and social‐cognitive development in childhood, including their adaptive functioning, early learning, intellectual and ToM development.</p> <p>Linear mixed effect model revealed group‐wise, age‐related, and individual differences in the development of face perception. Although face preference increased with age in the first year of life, preference for looking at the eyes over the mouth decreased with age in the first year of life. Notably, we found that these patterns showed no differences between infants who later developed ASC and typically developed infants. Consistent with past studies (Frank et al., [<reflink idref="bib20" id="ref86">20</reflink>]; Libertus et al., [<reflink idref="bib35" id="ref87">35</reflink>]), increased visual attention to faces in the first year reflects an increased social relevance of faces in both neurotypical and ASC infants' social interaction, which can be driven by both face‐specific characteristics and by interests in a wealth of social signals that can be extracted from faces, including another person's identity, emotional expressions, and focus of attention. Decreased visual attention to eyes over mouth in the first year might be driven by language learning, especially at around the end of the first year of age, when first words are being produced (Rutherford et al., [<reflink idref="bib47" id="ref88">47</reflink>]), and looking at the mouth can aid in cross‐modal perception of audio‐visual information to support language comprehension (Lewkowicz & Hansen‐Tift, [<reflink idref="bib34" id="ref89">34</reflink>]).</p> <p>In addition to the group‐level age‐related changes, our study provided novel evidence that infants across all three ASC groups showed different starting points (random intercept) and large individual differences in their developmental trajectory (random slope) of proportional time in looking at faces with eyes open, to direct gaze, and to following eye gaze during the first year of life. There is a lack of consistent age differences and shows large individual differences in the rate of development within both ASC and neurotypical infants. These findings are consistent with studies of language development which suggest that early stages of language learning, such as word comprehension, and basic grammar understanding, are characterized by idiosyncratic variation (Bates et al., [<reflink idref="bib4" id="ref90">4</reflink>]). Although many factors may underlie the absence of age differences and individual differences, one factor could be the nature of the three tasks used, as they may be less likely to elicit a clear attentional pattern. In the direct versus averted gaze and the gaze following task, the model exhibited an averted gaze or a shift in gaze direction without any accompanying objects to attend to. Infants may interpret these changes in gaze direction differently, with some consistently find direct gaze engaging, whereas others may be unclear where to look at, resulting in changes in their preferential looking over time. Similarly, in the eyes open versus closed task, some infants may find the models with open eyes engaging, whereas others may prefer faces with closed eyes, potentially due to relatively lower exposure to such faces in their daily lives. Examining factors contributing to these individual differences exceeds the scope of the present study. Nonetheless, our study highlights the unique path in developing a visual preference for attending to open eyes, to direct gaze, and for following the direction of another person's eye gaze over time in early infancy. This striking individual variation calls for further detailed examination in future studies.</p> <p>Across five face perception tasks, there were no group differences in face perception in the first year of life, a pattern confirmed by both linear mixed effect modeling analyses, Bayesian and ANOVA analyses. Similar to the typically developed infants, infants later diagnosed with ASC exhibit a clear preference for looking at a face, an overall preference for eyes over mouth region, but a shift from eyes to mouth region as they age in the first year of life. These results align with past studies that examined different aspects of face perception separately and also found no group differences in face perception in infancy. Infants later diagnosed with ASC display a comparable and intact engagement with faces, eyes, and the mouth region in the first year of life (Droucker et al., [<reflink idref="bib13" id="ref91">13</reflink>]; Elsabbagh et al., [<reflink idref="bib15" id="ref92">15</reflink>]; Young et al., [<reflink idref="bib58" id="ref93">58</reflink>]). However, these findings contradict other studies that showed group difference in infancy (Chawarska et al., [<reflink idref="bib7" id="ref94">7</reflink>]; Jones & Klin, [<reflink idref="bib31" id="ref95">31</reflink>]). Results of our study provide no evidence supporting the social orienting model of autism, which suggests less engagement with faces early in life (Chevallier et al., [<reflink idref="bib10" id="ref96">10</reflink>]; Dawson et al., [<reflink idref="bib11" id="ref97">11</reflink>]).</p> <p>We argue that despite the significant methodological differences in stimulus types, number of distractors, and dynamics of faces viewed across studies, the most consequential difference may be the visual salience of social stimuli in infants' visual field. In many studies that demonstrated ASC group differences, faces are presented against colored and naturally varying background, alongside several visual distractors, (e.g., toys) and often accompanied by affective speech and movements (Chawarska et al., [<reflink idref="bib8" id="ref98">8</reflink>]; Jones & Klin, [<reflink idref="bib31" id="ref99">31</reflink>]). In contrast, in all of our face tasks, the target AOI took up a considerable proportion of the screen (e.g., in the direct gaze task, the face with open eyes took up 50% of the screen), and was presented with a relatively stable background devoid of visual distractors, making faces and facial features visually salient to our infant participants, which may easily capture infants' visual attention to the target AOI. Several studies used face pop out paradigm, where the face image was visually salient among other objects, and revealed that both high‐ and low‐risk infants showed a similar preference for faces (Elsabbagh et al., [<reflink idref="bib15" id="ref100">15</reflink>]). As highlighted in a review of eye‐tracking studies, although decreased visual attention to social stimuli like faces has been found in high‐risk infants and infants later diagnosed with ASC, these effects appear to be context‐dependent. Future studies should consider the silence of the faces within infants' visual field and systematically examine how these context factors shape ASC infants' visual attention to faces in the first year of life.</p> <p>Using PCA, our study provided the first evidence of a divergent performance among the five face perception tasks in infants later developed ASC compared with typically developed infants. For both high‐ and low‐risk infants who did not develop ASC, eyes‐over‐mouth preference, and gaze following emerged as the two most important and independent variables for explaining overall variances in face perception performance. This suggests that for typically developed infants, processing eyes information and following the direction of eye gaze play a separate but consistent role in face perception performance. In contrast, PCA analyses revealed heterogeneity in task performance within each of the two principal components, which were characterized by a negative correlation between eyes over mouth preference and direct gaze preference in one component, and by a negative correlation between face preference and eye gaze following in another component. These findings offer novel evidence suggesting a lack of unified visual and attentional mechanism that allows ASC infants to systematically coordinate and integrate face, facial features, and eye‐gaze related information in their first year of age. We argue that the elevated levels of disorganized processing of featural and gaze information in the visual domain, which emerges early in infancy, are likely to intertwined with the commonly reported disorganized processing of speech information in auditory domain. Together, these patterns shape the social cognitive development over time. Such disorganized patterns might be rooted in the gene expressions that cause autism and associated with the abnormal structural and functional development of frontal, temporal lobes, amygdala and other brain areas involved face and language perception (Hashem et al., [<reflink idref="bib26" id="ref101">26</reflink>]).</p> <p>Consistent with some past studies (Young et al., [<reflink idref="bib58" id="ref102">58</reflink>]), we found no evidence for proportional looking in face perception task directly predicting participants' ASC severity score nor their ASC categorization in childhood. However, a longitudinal design provides direct evidence suggesting that early visual attention to face and eye‐gaze information in infancy has a long‐term, cascading effect on the social‐cognitive development of both children with and without ASC. Specifically, preference for direct gaze in infancy positively predicts communication skills, and attention to mouth positively predicts daily living skills at 4 years of age. This pattern is similar to the ASC and no ASC group, as revealed by a non‐significant moderation effect of ASC group. Our findings highlight the critical role of visual attention to direct gaze and to eyes and mouth in infancy on the development of communication and daily living skills to adaptive to the social world for both ASC and no ASC children.</p> <p>Direct gaze can elicit mutual gaze, allow the establishment of joint attention, and facilitate imitation and identity recognition (Farroni et al., [<reflink idref="bib19" id="ref103">19</reflink>]; Mason et al., [<reflink idref="bib38" id="ref104">38</reflink>]). Attention to direct gaze may provide a more communicative and interactive context between infants their social partners during their social interaction, thus enhancing the development of advanced communication skills through years of practice and reinforcement. Solving daily living problems often relies on the communicative skills that require individuals to request, ask, answer and describe events in daily life. Selective attention to the mouth in infancy has been found associated with expressive language skills (Tsang et al., [<reflink idref="bib52" id="ref105">52</reflink>]), which may be beneficial for solving daily living problems.</p> <p>Although there was a strong positive prediction of infant eyes over mouth preference on ToM development in the neurotypical individuals, this linkage is lacking in the high risk‐no ASC group. Although the differences between ASC and control group was not statistically significant, there appears to be a trend suggesting a similar lack of linkage in the ASC group (Figure 5). ToM ability is a multifaceted social‐cognitive skill that requires individuals to infer and understand another's mental state, including beliefs, thoughts, intentions and feelings (Baron‐Cohen, [<reflink idref="bib2" id="ref106">2</reflink>]). Several reasons might be attributable to the moderating effect of ASC group. First, the development of ToM builds on basic language skills and demands a higher level of working memory, executive function, which are typically impaired in high risk and ASC children (Baron‐Cohen, [<reflink idref="bib2" id="ref107">2</reflink>]). Under these conditions, increased attention to eyes during infancy may not necessarily enable the development of advanced ToM in childhood. Secondly, significant heterogeneity in cognitive and sensory capacities within ASC might offset the association between the infant eyes' preference and ToM in this group.</p> <p>Collectively, this prospective longitudinal study sheds light on the developmental trajectory of face perception and its long‐term influence on the social‐cognitive development in autism. It highlights that exposure to a variety of facial features and emotional expressions during infancy could be beneficial for the specialization of social brain networks (Johnson, [<reflink idref="bib29" id="ref108">29</reflink>]), and help mitigate the negative outcomes associated with ASC during individual development.</p> <hd id="AN0181984182-34">Limitations</hd> <p>One limitation of the study is the use of relatively static and simplistic face stimuli. Although real face stimuli were used, they differ from the dynamic and visually complex faces infants encounter in their daily lives, often accompanied by other visual distractors. Therefore, caution is advised in terms of generalizing the findings to face perception in naturalistic infant settings. Future studies should benefit from including more naturalistic face stimuli.</p> <p>Secondly, we focused on the development face perception in the first year of life, thus only tracked development from 3 to 12 month of age. Our study could not address whether ASC group differences emerge at later stages. It would be informative for future research to extend the tracking of face perception beyond 12 months of age to address this question.</p> <p>Third, we have a lower number of participants tested at a later age point. This study is a part of an ongoing longitudinal study, some of the participants have not reached the later ages, and the COVID‐19 pandemic impeded our ability to collect data during a critical period. Future studies could benefit from including more data from older child participants.</p> <p>Lastly, there are many ways to measure infants' visual attention using eye‐tracking, such as first fixation and the number of fixation counts. For the purpose of the study, we focused on the proportional fixation duration/time on the AOI. Although this approach provides valuable insights, it may not fully capture the characteristics of infants' visual attention. Therefore, comparing differences in these parameters could offer a more comprehensive understanding of the developmental nature of infants' visual perception of faces.</p> <hd id="AN0181984182-35">ACKNOWLEDGMENTS</hd> <p>We are grateful to all the infants, children and families who participated in the study. We also thank many undergraduate students who contributed to data collection, and coding for this paper. Lastly, we thank our anonymous reviewers for their comments.</p> <hd id="AN0181984182-36">DATA AVAILABILITY STATEMENT</hd> <p>All data have been made publicly available via OSF and can be accessed at https://osf.io/k7w3e/?view%5fonly=359f306f2f874db1a0cab93737e59fca. The materials necessary to attempt to replicate the findings presented here are not publicly accessible. The design and analysis plans for this study were not preregistered.</p> <p>GRAPH: Data S1.</p> <ref id="AN0181984182-37"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM‐5 (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596</bibtext> </blist> <blist> <bibl id="bib2" idref="ref44" type="bt">2</bibl> <bibtext> Baron‐Cohen, S. 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  Label: Availability
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 18
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Nonverbal+Communication%22">Nonverbal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Cognition%22">Social Cognition</searchLink><br /><searchLink fieldCode="DE" term="%22Adjustment+%28to+Environment%29%22">Adjustment (to Environment)</searchLink><br /><searchLink fieldCode="DE" term="%22Theory+of+Mind%22">Theory of Mind</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Development%22">Behavior Development</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Development%22">Social Development</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/cdev.14144
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0009-3920<br />1467-8624
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Autism spectrum condition (ASC) is characterized by atypical attention to eyes and faces, but the onset and impact of these atypicalities remain unclear. This prospective longitudinal study examined face perception in infants who develop ASC (N = 22, female = 5, 100% White) compared with typically developing infants (N = 131, female = 65, 55.6% White), tracking social-cognitive and ASC development through age seven. Reduced interest in direct gaze and eyes during infancy correlated with atypical development of adaptive behavior at age four and theory of mind at age seven. Principal component analyses revealed less integrated processing of facial features and eye-gaze information in ASC infants, potentially impacting their childhood social functioning. These findings highlight the intertwined nature of social-cognitive development and ASC.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Note
  Label: Notes
  Group: Note
  Data: https://osf.io/k7w3e/?view_only=359f306f2f874db1a0cab93737e59fca
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1455453
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1455453
RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1111/cdev.14144
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 104
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Nonverbal Communication
        Type: general
      – SubjectFull: Social Cognition
        Type: general
      – SubjectFull: Adjustment (to Environment)
        Type: general
      – SubjectFull: Theory of Mind
        Type: general
      – SubjectFull: Child Development
        Type: general
      – SubjectFull: Behavior Development
        Type: general
      – SubjectFull: Social Development
        Type: general
      – SubjectFull: Young Children
        Type: general
    Titles:
      – TitleFull: Face Perception and Social Cognitive Development in Early Autism: A Prospective Longitudinal Study from 3 Months to 7 Years of Age
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Xiaomei Zhou
      – PersonEntity:
          Name:
            NameFull: Hasan Siddiqui
      – PersonEntity:
          Name:
            NameFull: M. D. Rutherford
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0009-3920
            – Type: issn-electronic
              Value: 1467-8624
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              Value: 96
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Child Development
              Type: main
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