Preference for Eyes Predicts Later Autism-Related Characteristics in Children with a Family History of Autism

Preference for Eyes Predicts Later Autism-Related Characteristics in Children with a Family History of Autism | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 22 July 2025 V1 Latest version Share on Preference for Eyes Predicts Later Autism-Related Characteristics in Children with a Family History of Autism Authors : Esin Gurcan 0000-0001-9421-0348 and M.D. Rutherford 0000-0002-7685-8076 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175321648.85824617/v1 310 views 107 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Autism is characterized by difficulties in initiating and maintaining social interactions and communication, and displays reduced attention to faces, particularly in the eye region. Family members of autistic individuals are more likely to exhibit autism-like traits and also show reduced attention to the eye region during infancy. The current study tested 9-month-old infants (n = 47, 68.07% white) with (first-degree relatedness = 9, male = 55.56%, second-degree relatedness = 9, male = 66.67%) and without a familial history of autism (n= 29,male = 44.83%) for their preference for eyes, using side-by-side images of faces with open versus closed eyes. The same infants were later assessed longitudinally for autism-related characteristics. A stronger preference for open eyes predicted lower autism-related scores later in infants with a first-degree relative with autism. These findings provide valuable insights into how early eye preference may predict later autism outcomes in infants at elevated likelihood for autism. Preference for Eyes Predicts Later Autism-Related Characteristics in Children with a Family History of Autism Esin Gürcan 1 , M.D. Rutherford 1 1 Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON Correspondence should be addressed to M.D. Rutherford: [email protected] Acknowledgments We would like to express our gratitude to the families and children who participated in this study. We also extend our thanks to undergraduate research assistants for their invaluable help with data: Joleen Awad, Rachel Goddard, Abby Lang, Yuti Patel, Amal Qazi, Mohid Siddique, Sofie Bastel, Olivia Cheng, and Mindy Tat. Autism is characterized by difficulties in initiating and maintaining social interactions and communication, and displays reduced attention to faces, particularly in the eye region. Family members of autistic individuals are more likely to exhibit autism-like traits and also show reduced attention to the eye region during infancy. The current study tested 9-month-old infants (n = 47, 68.07% white) with (first-degree relatedness = 9, male = 55.56%, second-degree relatedness = 9, male = 66.67%) and without a familial history of autism (n= 29,male = 44.83%) for their preference for eyes, using side-by-side images of faces with open versus closed eyes. The same infants were later assessed longitudinally for autism-related characteristics. A stronger preference for open eyes predicted lower autism-related scores later in infants with a first-degree relative with autism. These findings provide valuable insights into how early eye preference may predict later autism outcomes in infants at elevated likelihood for autism. Keywords: eyes, face, autism, familial history, infancy , eye-tracker Introduction A preference for looking towards faces appears early in life. A recent study by Ronga et al. (2025) investigated fetal preference for face-like configurations using upright and inverted dot patterns, measured through eye lens movements. They found that the preference for face-like configurations is measurable by 26 weeks of gestation. Infants also prefer upright over inverted faces, as well as top-heavy over bottom-heavy configurations (Macchi Cassia et al., 2004), as do 3-month-olds (Macchi Cassia et al., 2006). This attraction to face-like patterns gradually becomes more fine-tuned through visual experience (Simion et al., 2015). This early sensitivity may be due to an upper visual field advantage in the superior colliculus (Sprague et al., 1973; Atkinson et al., 1992). Face and Eye Region Processing in Autism and BAP Autism is a neurodevelopmental condition characterized by challenges in social skills and communication (APA, 2013). Autism is heritable. A meta-analysis of twin studies estimated the heritability of autism to be between 64% and 91% (Tick et al., 2016). Relative recurrence risk is 10.3 for first-degree, 3.3 for maternal half-siblings and 2.9 for paternal half-siblings (Sandin et al., 2014). The Broader Autism Phenotype (BAP) refers to characteristics of autism seen in family members of autistic individuals (Kanner, 1943). A review by Dawson et al. (2005) revealed that by 3 years of age, autistic individuals process the faces with reduced attention to the eyes, rather than holistic facial processing, which might lead to the social difficulties. Early markers of autism often include a lack of interest in social cues, reduced attention to the eye region, and impairments in joint attention (Landa et al., 2007; Osterling et al., 2002; Vacas et al., 2021; Bacon et al., 2020). Yirmiya and colleagues (2005) found that siblings of autistic individuals (ASIBs) are less emotionally responsive during the still-face paradigm and display lower caregiver synchrony at 4 months of age. In addition, infants with a familial history of autism also show weaker preferences for social cues in the first 6 months (Rutherford, 2013) and a linear decline in attention to eyes over mouths from 3 to 12 months (Rutherford et al., 2015). Eyes play an important role in face processing and attract attention, as they help identify identities and emotions (Itier and Batty, 2009). Reduced fixation to the eye region was observed in two-year-old autistic toddlers (Jones et al., 2008), with a decline in eye-region attention becoming apparent between 2 and 6 months of age (Jones & Klin, 2013). Tanaka and Sung (2016) proposed the ”eye-avoidance” hypothesis, suggesting that face processing difficulties in autistic individuals may arise from avoidance of the eye region, which is often perceived as threatening and may elicit social anxiety or strong emotional reactions. However, Moriuchi and colleagues (2017) challenged this theory, as their findings showed that autistic children do not avoid eye contact; rather, reduced attention to the eyes stems from a lack of automatic social engagement, with discomfort emerging as a secondary outcome later in life. These suggestions are supported by evidence from neural measures, such as reduced activity in the fusiform face area and decreased amygdala volume observed in ASIBs, which are associated with atypical responses to faces and eyes (Dalton et al., 2007). Atypical neural responses to eye gaze have also been observed in ASIBs during the second half of the first year of life, in response to both static (Elsabbagh et al., 2009) and dynamic eye gaze stimuli, with these responses correlating with the later emergence of autism (Elsabbagh et al., 2012). Supporting this, Zwaigenbaum et al. (2005) suggest that the second half of the first year may be a critical period for predicting later autism development. Thus, even without a later autism diagnosis, individuals with a genetic predisposition may show reduced interest in social cues—particularly the eyes—during the second half of the first year of life, which may be associated with the later emergence of autism-like traits. Materials & Methods Participants Participants were enrolled in a longitudinal study starting in 2005. Participants were primarily recruited through maternity wards, as well as via flyers distributed in clinics, pediatricians’ offices, and other local outreach efforts. Infants with extremely low birth weight (<2500 grams or 5.5 pounds) or preterm birth (before 37 weeks) were excluded. Participants’ familial history of autism was recorded along with which family member had received an autism diagnosis. Elevated likelihood group refers to infants had first-degree relatives (siblings or parents), or distant relatives (aunts, uncles, grandparents, half-siblings) with autism. Infants in the comparison group had no reported familial history of autism. Participants’ gaze preferences were assessed with an eye tracker during the first year of life. They viewed faces and biological motion (see measurements for details). Infant preference was measured at four time points: 3, 6, 9, and 12 months of age. At 2 years of age, their social and extracurricular activities, as well as attendance to daycare to understand their social life, were recorded. At 3 years of age, Peabody Picture Vocabulary Test (PPVT) was used to assess their receptive vocabulary. At 4 years of age, children’s adaptive functioning, early learning skills, and social understanding were evaluated using the Vineland Adaptive Behavior Scales (VABS-II), the Mullen Scales of Early Learning (MSEL), and a Theory of Mind (ToM) assessment, respectively. ToM assessments were also assessed at 7 years and using age-appropriate ToM assessment tools. Cognitive development was assessed using the Wechsler Intelligence Scale for Children (using WISC-IV and WISC-V). Each participant was assessed for autism characteristics using the ADOS-G or the ADOS-2. See Fig. 1. [PLEASE INSERT FIG 1 HERE] [PLEASE INSERT TABLE 1 HERE] Eye-Tracker Assessment Participants completed six eye-tracking tasks. Infants were seated in a car seat. In the earlier assessments conducted between 2005 and 2009, the Eye-Trac 6000 by ASL was used (for further details, see Rutherford, 2013). For assessments conducted after 2009, the Tobii T60 XL Eye Tracker was used (for further details, see Zhou et al., 2025). Infants were positioned 65 cm from the screen. For both systems (ASL 6000 and Tobii T60 XL), a calibration was conducted prior to each task. During calibration, three points appeared and moved across the screen to three locations: the left corner, right corner, and top center. Successful calibration required infants to fixate on all three designated points. If the gaze error exceeded 1° of visual angle, the calibration was considered unsuccessful and repeated. The task began only after successful calibration was achieved. In assessments using the Eye-Trac 6000, an HP Intel Pentium M computer was used to control the eye tracker, and stimuli were presented on a NEC monitor with a 46 cm screen, a resolution of 1024 × 768 pixels, and a refresh rate of 85 Hz. In the Tobii T60 XL assessments, stimuli were displayed on a 24-inch monitor with a resolution of 1024 × 768 pixels and a sampling rate of 60 Hz. Eye tracking was embedded within the Tobii monitor, eliminating the need for a separate control computer. Tobii Studio 3.2.3 software was used to present the stimuli. The eye-tracking tasks included five face perception tasks (open vs. closed eyes, gaze following, face preference, averted vs. directed gaze, and eyes vs. mouth), as well as one biological motion detection task (Rochat et al., 1997). The experimental paradigm began with a 3-second attention-getting cartoon accompanied by a sound (e.g., a whistle), followed by stimulus presentation. The five face perception tasks involved the presentation of dynamic full-face stimuli, except for the face preference task, which consisted of static images. All face stimuli were shown for 5 seconds, except in the gaze-following task (which was presented for 3 seconds). In all cases, the models remained still during the 5-second presentation period, without any audio component. The biological motion task was presented for 90 seconds. Each trial concluded with a 3-second blank screen. The face perception tasks included 10 trials each, except for the face preference task, which included 8 trials, resulting in a total of 48 trials across all face tasks (see the detailed procedure of all the tasks used in the study; Zhou et al., 2025). Data from the open versus closed eyes task were analyzed; data from the other tasks were not included in this analysis. Stimuli were two videos of the same individual, one with eyes open and the other with eyes closed (see Fig. 2). Each face was 27 cm in width (21.78° visual angle) and 17 cm in height (14.9° visual angle). Ten different models (five male; one East Asian, one South Asian, one Middle Eastern, and seven White) were used. The side on which the eye-open condition was presented appeared on the left, and in the other half, on the right. The preference for open eyes was: [PLEASE INSERT FIG 2 HERE] Autism Diagnostic Observation Schedule ( ADOS) The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured play-based assessment tool that measures autistic characteristics. At the start of the study, participants were assessed using the Autism Diagnostic Observation Schedule–Generic (ADOS-G; Lord et al., 2000). After its release, the ADOS (ADOS-2) was used. Autism Diagnostic Observation Schedule – Generic (ADOS-G) The Autism Diagnostic Observation Schedule – Generic (ADOS-G) is designed for administration from 12 months of age through adulthood. It includes four modules each designed for specific developmental level and expressive language abilities. The ADOS-G generates three subcomponent scores—Social, Communication, and Social-Communication—which contribute to the overall score used to classify individuals as having autism, autism spectrum, or non-autism. The scoring criteria vary depending on the module used (see Lord et al., 2000, for details). Autism Diagnostic Observation Schedule–2 (ADOS-2; Lord et al., 2012) The ADOS-2 was created to incorporate necessary updates in response to the release of the DSM-5. The ADOS-2 (Lord et al., 2012) includes five modules. Four of these modules are similar to those in the ADOS-G, but with modifications in scoring procedures and criteria based on individuals’ language levels. In addition to those four modules, a new Toddler Module was introduced. The updated modules included revised norms aligned with DSM-5 criteria and introduced the Comparison Severity Score (CSS), which allows for the comparison of ADOS results across different ages. The ADOS-2 also combined the Social and Communication subcomponents into a single domain called Social Affect and introduced the Restricted and Repetitive Behavior (RRB) domain. The scores from these two domains together comprise the total score used to classify individuals into one of three groups: autism, autism spectrum, or non-autism (see more details, Lord et al., 2012) Results Data analysis was conducted using the PROCESS macro (Hayes, 2022) in the R software package version 4.2.2. Invalid trials were defined as trials in which the proportion of looking time at the AOI was less than 25%, based on criteria suggested by previous studies (Chawarska et al., 2012, 2013, 2016; Wang et al., 2018). The normality assumptions were tested for all variables using the Shapiro–Wilk test, and none met the assumption of normality, except preference for eyes open. Consequently, Spearman’s rank correlation was used for correlations between continuous variables, Pearson correlation was applied for preference for eye-open , while point-biserial correlations were employed for associations between continuous and categorical variables. To mitigate the risk of inflated Type I error due to multiple comparisons, the Bonferroni correction was applied. A moderation analysis using PROCESS Model 1 was conducted to examine the moderating effects of preference for the eyes open and familial history of autism across varying degrees of relatedness on subsequent autism development. Familial history of autism was treated as a categorical variable with three levels: 1 = first-degree relatedness, 2 = no familial history, and 3 = distant relatedness (i.e., distant familial history of autism). Covariates included dichotomous variables of sex (coded as 1 for male and 2 for female), breastfeeding status (coded as 1 for not breastfed and 2 for breastfed), and a continuous variable of age in months at the time of ADOS testing. Comparison scores were not available for participants tested with the ADOS-G. Therefore, age at testing was included as a covariate to account for the potential impact of age at the time of ADOS assessment. Continuous variables were mean-centered, as suggested by Hayes (2022). Preference for open eyes was mean-centered prior to the analysis to create interaction terms, allowing for interpretation at the average level of eye preference. The conceptual model of the moderation is illustrated in Figure 3. Given that moderator variable ( W ) is a categorical variable (first-degree, distant relatedness, and no familial history of autism), dummy coding used in the moderation results. The intercept was first-degree relatedness. The relatedness to autism variable was dummy-coded as follows: W1 represented the contrast between no familial history and first-degree relatedness, while W2 represented the contrast between distant familial history (second-degree) and first-degree relatedness. Correlation Results Correlations among the variables of interest are presented in Table 2. Due to the violation of the normality assumption, Spearman’s rho correlation analysis was applied, and the Bonferroni correction was used to prevent the inflation of Type I error due to multiple comparisons. According to Spearman’s rho correlations, ADOS scores were negatively associated with the child’s breastfeeding status. Additionally, a significant association was found between the testing age and ADOS scores: older age groups were more likely to score higher on the ADOS assessment. However, after applying the Bonferroni correction, only the association between testing age and ADOS scores remained significant, suggesting that breastfeeding might not have a protective effect (see results in Table 2). [PLEASE INSERT TABLE 2 HERE] Moderation Analysis Moderation analysis using Hayes’ PROCESS Macro (Model 1) was conducted to examine the predictive relationship between early preference for the eyes-open condition and later ADOS scores in individuals with varying degrees of familial history of autism. The conceptual model of the moderation analysis based on Hayes (2022)’s suggestion is depicted in the Figure 3. [PLEASE INSERT FIG 3 HERE] Our model predicting later ADOS scores explained variance 48%. F (8, 38) = 4.31, p < .001, R² = .48. None of the covariates were significant (see Table S1). The contribution of the moderation effect to the model was F (2, 38) = 5.10, p =.01, R² = .14. Another model was applied removing the non-significant covariate variables to reduce the complexity of the model. This model explained 38% of the variance. F (5, 42) = 5.20, p < .001, R² = .38, and the contribution of the moderation effect to the model was 21% ( F (2, 42) = 7.04, p =.002, R² = .21). In addition, as shown in Table 3, due to the non-significance of W2 and the small sample sizes in both the first- and second-degree autism-relatedness groups, an alternative model was applied in which these two groups were combined into a single category labeled ’familial history of autism.’ The results are presented in the Supplementary Files (S2). The moderation effect remained significant after merging these two groups [PLEASE INSERT TABLE 3 HERE] As presented in Table 3, preference for the eye-present condition was a significant negative predictor of later ADOS scores. This suggests that individuals who showed a stronger early preference for looking at the eyes were more likely to exhibit lower ADOS scores (autism-related characteristics) later on. In our results, the W1 contrast was significant, indicating a difference in ADOS scores between individuals with a first-degree familial history of autism and those with no familial history. The negative and significant effect indicates that individuals without a familial history of autism exhibited lower ADOS scores compared to those with a first-degree relative. In contrast, the W2 contrast was not significant, suggesting there is no evidence of a difference in ADOS scores between individuals with first-degree and second-degree (distant) familial histories of autism. Both interaction effects (X × W1 and X × W2) were significant, suggesting that the effect of early preference for eyes varies across levels of familial relatedness to autism. The simple slopes for each relatedness group are presented in Table 4 and illustrated in Figure 4. [PLEASE INSERT TABLE 4 HERE] As shown in Table 4 and illustrated in Figure 4, there was a negative trend in the effect of early preference for the eyes-present condition on ADOS scores among individuals with a first-degree relative of autistic individuals ( p = .002), whereas no effect was observed in the other relatedness groups. [PLEASE INSERT FIG 4 HERE] Discussion Greater preference for the eyes-open condition at 9 months was associated with lower ADOS scores later in development, across levels of relatedness. The moderation (preference to eyes-open and ADOS) was only significant among children with a first-degree relative with an autism diagnosis. This effect was robust even after removing the non-significant covariates. Our findings align with Jones et al. (2008) findings that a preference for the eye region is associated with ADOS social scores. Similarly, infants with a familial history of autism have a reduced preference to look at the faces compared to the comparison group at 10 months, regardless of whether they were later diagnosed with autism (Thorup et al., 2024). Our findings highlighted the relationship between relatedness and autism development. Previous research has shown that first-degree relatives of a proband with autism are approximately 10 times more likely to develop autism, while the likelihood decreases to around three times that of non-relatives for second-degree relatives (Sandin et al., 2014). This could explain our results, as the relationship between eye preference and ADOS scores disappears for the second-degree relative group. However, autism is highly heterogeneous, which may account for the variability in social attention patterns observed in infants with a familial history of autism. Understanding this heterogeneity is crucial, particularly when working with family members, infants, and premature infants (Lord, 2019). It has been suggested that current diagnostic practices (e.g., ambiguous criteria for social skill assessment), instead of the biological mechanisms, may explain the “heterogeneity” among those with an autism diagnosis (Mottron & Bzdok, 2020). Thus, applying more strict diagnostic criteria or categorizing individuals into subgroups (e.g., through cluster analysis) may help clarify the complexity of autism (Cruz Puerto & Sandín Vázquez, 2024). Analyses of specific subgroups may allow a better understanding of autistic development. Limitations One of the limitations of this study is the small sample sizes within each group, which reduces generalizability, lowers the statistical power to detect effects, and increases the potential influence of individual data points, with the risk of overfitting the model. Furthermore, given the non-normal distribution of several variables, the assumptions underlying regression analyses are likely to be violated. However, bootstrapped estimates aligned with the non-bootstrapped estimates, suggesting robustness despite these sampling issues. Across the decades of this longitudinal study, ADOS assessments varied since the ADOS-G was used early in the study and the ADOS-2 was introduced while the study was running. This prevents us from obtaining consistent ADOS CSS scores across the entire sample. Even though we included ADOS testing age as a covariate variable and found no significant effects, using a consistent diagnostic measure would enhance the interpretability of the findings. Conclusion Among children with autism in the family, a preference for faces with open eyes in infancy is associated with fewer autistic characteristics in childhood. The current study provides valuable insight into how early attention for eyes relates to later ADOS scores among relatives of autistic individuals. Given that the ADOS provides a clinically reliable diagnosis of autism (Kamp-Becker et al., 2018), these findings warrant further investigation into early social attention infants who have relatives with autism. References Atkinson, J., Hood, B., Wattam-Bell, J., & Braddick, O. (1992). Changes in Infants’ Ability to Switch Visual Attention in the First Three Months of Life. Perception (London) , 21 (5), 643–653. https://doi.org/10.1068/p210643 Bacon, E. C., Moore, A., Lee, Q., Carter Barnes, C., Courchesne, E., & Pierce, K. (2020). Identifying prognostic markers in autism spectrum disorder using eye tracking. Autism. , 24 (3), 658–669. https://doi.org/10.1177/1362361319878578 Cruz Puerto, M. and Sandín Vázquez, M. (2024), Understanding heterogeneity within autism spectrum disorder: a scoping review, Advances in Autism , Vol. 10 No. 4, pp. 314-322. https://doi.org/10.1108/AIA-12-2023-0072 Dalton, K. M., Nacewicz, B. M., Alexander, A. L., & Davidson, R. J. (2007). Gaze-Fixation, Brain Activation, and Amygdala Volume in Unaffected Siblings of Individuals with Autism. Biological Psychiatry (1969) , 61 (4), 512–520. https://doi.org/10.1016/j.biopsych.2006.05.019 Dawson, G., Webb, S. J., & McPartland, J. (2005). Understanding the Nature of Face Processing Impairment in Autism: Insights from Behavioral and Electrophysiological Studies. Developmental Neuropsychology , 27(3), 403–424. Elsabbagh, M., Mercure, E., Hudry, K., Chandler, S., Pasco, G., Charman, T., Pickles, A., Baron-Cohen, S., Bolton, P., & Johnson, M. H. (2012). Infant Neural Sensitivity to Dynamic Eye Gaze Is Associated with Later Emerging Autism. Current Biology , 22(4), 338–342. https://doi.org/10.1016/j.cub.2011.12.056 Elsabbagh, M., Volein, A., Csibra, G., Holmboe, K., Garwood, H., Tucker, L., Krljes, S., Baron-Cohen, S., Bolton, P., Charman, T., Baird, G., & Johnson, M. H. (2009). Neural Correlates of Eye Gaze Processing in the Infant Broader Autism Phenotype. Biological Psychiatry, 65(1), 31–38. https://doi.org/10.1016/j.biopsych.2008.09.034 Hayes, A. F. (2022). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (Third edition.). Guilford Publications. Itier, R. J., & Batty, M. (2009). Neural bases of eye and gaze processing: The core of social cognition. Neuroscience and Biobehavioral Reviews ., 33(6), 843–863. https://doi.org/10.1016/j.neubiorev.2009.02.004 Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism. Nature (London) , 504 (7480), 427–431. https://doi.org/10.1038/nature12715 Jones, W., Carr, K., & Klin, A. (2008). Absence of preferential looking to the eyes of approaching adults predicts level of social disability in 2-year-old toddlers with autism spectrum disorder. Archives of General Psychiatry , 65(8), 946–954. https://doi.org/10.1001/archpsyc.65.8.946 Kamp-Becker, I., Albertowski, K., Becker, J., Ghahreman, M., Langmann, A., Mingebach, T., Poustka, L., Weber, L., Schmidt, H., Smidt, J., Stehr, T., Roessner, V., Kucharczyk, K., Wolff, N., & Stroth, S. (2018). Diagnostic accuracy of the ADOS and ADOS-2 in clinical practice. European Child & Adolescent Psychiatry , 27 (9), 1193–1207. https://doi.org/10.1007/s00787-018-1143-y Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry , 64(7), 853–864. https://doi.org/10.1001/archpsyc.64.7.853 Lord C, Rutter M, DiLavore PC, Risi S, Gotham, K, & Bishop S. (2012). Autism Diagnostic Observation Schedule, Second Edition. Torrence, CA: Western Psychological Services. Lord, C. (2019). Recognising the heterogeneity of autism. The Lancet. Psychiatry , 6 (7), 551–552. https://doi.org/10.1016/S2215-0366(19)30220-2 Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000). The Autism Diagnostic Observation Schedule-Generic: A Standard Measure of Social and Communication Deficits Associated with the Spectrum of Autism. Journal of Autism and Developmental Disorders , 30 (3), 205–223. https://doi.org/10.1023/A:1005592401947 Macchi Cassia, V. M., Turati, C., & Simion, F. (2004). Can a Nonspecific Bias Toward Top-Heavy Patterns Explain Newborns’ Face Preference? Psychological Science , 15 (6), 379–383. https://doi.org/10.1111/j.0956-7976.2004.00688.x Macchi Cassia, V., Kuefner, D., Westerlund, A., & Nelson, C. A. (2006). A behavioural and ERP investigation of 3-month-olds’ face preferences. Neuropsychologia , 44 (11), 2113–2125. https://doi.org/10.1016/j.neuropsychologia.2005.11.014 Moriuchi, J. M., Klin, A., & Jones, W. (2017). Mechanisms of Diminished Attention to Eyes in Autism. The American Journal of Psychiatry , 174 (1), 26–35. https://doi.org/10.1176/appi.ajp.2016.15091222 Mottron, L., & Bzdok, D. (2020). Autism spectrum heterogeneity: fact or artifact? Molecular Psychiatry , 25 (12), 3178–3185. https://doi.org/10.1038/s41380-020-0748-y Rochat, P., Morgan, R., & Carpenter, M. (1997). Young infants’ sensitivity to movement information specifying social causality. Cognitive Development , 12 (4), 537–561. https://doi.org/10.1016/S0885-2014(97)90022-8 Ronga, I., Poles, K., Pace, C., Fantoni, M., Luppino, J., Gaglioti, P., Todros, T., & Garbarini, F. (2025). At First Sight: Fetal Eye Movements Reveal a Preference for Face‐Like Configurations From 26 Weeks of Gestation. Developmental Science , 28 (2), e13597-n/a. https://doi.org/10.1111/desc.13597 Rutherford, M.D. (2013). Social Attention is measurably and increasingly atypical across the first six months in the broader autism phenotype. Journal of Psychology & Psychotherapy . 3 (4): 1 – 7 Sandin, S., Lichtenstein, P., Kuja-Halkola, R., Larsson, H., Hultman, C. M., & Reichenberg, A. (2014). The Familial Risk of Autism. JAMA : The Journal of the American Medical Association , 311 (17), 1770–1777. https://doi.org/10.1001/jama.2014.4144 Simion, F., & Giorgio, E. D. (2015). Face perception and processing in early infancy: inborn predispositions and developmental changes. Frontiers in Psychology , 6 , 969–969. https://doi.org/10.3389/fpsyg.2015.00969 Sprague, J. M., Berlucchi, G., Rizzolatti, G., & Jung, R. (1973). The Role of the Superior Colliculus and Pretectum in Vision and Visually Guided Behavior. In Visual Centers in the Brain (pp. 27–101). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-65495-4_2 Tanaka, J. W., & Sung, A. (2016). The “Eye Avoidance” Hypothesis of Autism Face Processing. Journal of Autism and Developmental Disorders , 46 (5), 1538–1552. https://doi.org/10.1007/s10803-013-1976-7 Thorup, E., Bölte, S., & Falck-Ytter, T. (2024). Less frequent face looking in infancy is related to autism likelihood status but not diagnosis: A study of parent-infant interaction. Research in Autism Spectrum Disorders. , 115 , Article 102422. https://doi.org/10.1016/j.rasd.2024.102422 Tick, B., Bolton, P., Happé, F., Rutter, M., & Rijsdijk, F. (2016). Heritability of autism spectrum disorders: a meta-analysis of twin studies. Journal of Child Psychology and Psychiatry , 57 (5), 585–595. https://doi.org/10.1111/jcpp.12499 Vacas, J., Antolí, A., Sánchez-Raya, A., Pérez-Dueñas, C., & Cuadrado, F. (2021). Visual preference for social vs. non-social images in young children with autism spectrum disorders. An eye tracking study. PloS One , 16 (6), e0252795-. https://doi.org/10.1371/journal.pone.0252795 Yirmiya, N., Gamliel, I., Pilowsky, T., Feldman, R., Baron-Cohen, S., & Sigman, M. (2006). The development of siblings of children with autism at 4 and 14 months: social engagement, communication, and cognition. Journal of Child Psychology and Psychiatry , 47 (5), 511–523. https://doi.org/10.1111/j.1469-7610.2005.01528.x Zhou, X., Siddiqui, H., & Rutherford, M. D. (2025). Face perception and social cognitive development in early autism: A prospective longitudinal study from 3 months to 7 years of age. Child Development , 96 (1), 104–121. https://doi.org/10.1111/cdev.14144 Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience. , 23 (2), 143–152. https://doi.org/10.1016/j.ijdevneu.2004.05.001 Tables Table 1 Sample Characteristics Immediate Family Distant Family Comparison Preference for eye-open 54.92 (7.18) 56.03 (10.47) 53.78 (11.15) 0.52 0.82 ADOS 9.22 (10.99) 6.89 (8.12) 2.86 (2.81) 2.48 0.29 ADOS testing age (in months) 33.11 (11.10) 61.89 (31.64) 37.07 (19.88) 8.63 0.01 Fisher’s Exact Test Results p Sex (male: female) 5:4 6:3 13:16 0.60 Breastfed (yes: no) 8:1 7:2 25:4 0.85 Met ADOS autism criteria (autism: non-autism) 3:6 3:6 3:26 0.09 Note . Normality was assessed using Shapiro-Wilk tests for all demographic and assessment variables. Only the preference for open eyes met the normality assumption ( W = 0.96, p = 0.078). ANOVA results are reported for preference for open eyes, but due to violations of normality, Kruskal-Wallis H tests were used for other assessments, along with Fisher’s exact test for demographic variables. Table 2 Correlation Results ADOS Preference for eye-open -0.03 0.82 ADOS Testing age 0.44* 0.002 Number of Siblings 0.13 0.39 Breastfed -0.30 0.041 Preference for eye-open ADOS Testing age 0.13 0.37 Number of Siblings 0.23 0.13 Breastfed 0.09 0.54 ADOS Testing age Number of Siblings 0.08 0.62 Breastfed -0.20 0.17 Number of Siblings Breastfed -0.15 0.32 Note: * refers to the significance level after Bonferroni correction. Table 3 Preference for eyes predicts ADOS scores LL UL Constant 9.63 1.83 5.25 < .001 5.93 13.33 Preference for eye-present ( X ) -1.03 0.27 -3.82 < .001 -1.58 -0.49 W1 (first-degree × comparison) -6.81 2.09 -3.26 0.002 -11.03 -2.59 W2 (first-degree × distant relatedness) -2.65 2.61 -1.02 0.31 -7.91 2.61 X × W1 1.07 0.29 3.75 0.001 0.50 1.65 X × W2 0.97 0.33 2.97 0.005 0.31 1.64 Table 4 A preference for eyes predicts ADOS scores in infants with first-degree relatives with autism LL UL First-degree -1.03 0.27 -3.82 < .001 -1.58 -0.49 No familial history 0.04 0.09 0.42 0.68 -0.15 0.23 Distant relatedness -0.06 0.19 -0.32 0.75 -0.43 0.32 Figures Fig 1 Sample Size Flow Chart Note. 1. Participants enrolled to Early Autism Study from 2005 to 2022. 2. Includes participants excluded due to missing data in the open vs. closed eye tracker paradigm at 9 months. Reasons include missed lab appointments, calibration or usability issues with eye-tracking data, or study dropout. Also includes participants with invalid trials, defined as looking at the eyes-present condition less than 25% of the time. 3. Final sample size with valid data for 9 months. 4. Included participants attended both eye tracker assessment at 9 months and later ADOS assessment. 5. Included the participants were assessed using the ADOS-G version 6. Included the participants were assessed using the ADOS-2 version Fig 2 Open vs Closed Eyes Paradigm Fig 3 Conceptual model of the simple moderation model Fig 4 Interaction Between Early Eye Preference (Mean-Centered) and Degree of Familial Autism History on ADOS Scores Information & Authors Information Version history V1 Version 1 22 July 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords autism eye-tracker eyes face familial history infancy Authors Affiliations Esin Gurcan 0000-0001-9421-0348 McMaster University Department of Psychology Neuroscience & Behaviour View all articles by this author M.D. Rutherford 0000-0002-7685-8076 [email protected] McMaster University Department of Psychology Neuroscience & Behaviour View all articles by this author Metrics & Citations Metrics Article Usage 310 views 107 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Esin Gurcan, M.D. Rutherford. Preference for Eyes Predicts Later Autism-Related Characteristics in Children with a Family History of Autism. Authorea . 22 July 2025. DOI: https://doi.org/10.22541/au.175321648.85824617/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.175321648.85824617/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fed72c00e51aa64',t:'MTc3OTMwMjIwMA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();