Original articleA group of very preterm children characterized by atypical gaze patterns
Introduction
Very preterm (VP) children tend to show poorer social competence such as peer rejection and social withdrawal, and are at increased risk of being diagnosed with autism spectrum disorder (ASD) [1], [2], [3], [4], [5], [6]. However, the biological mechanisms underlying this increase and the most effective method with which to identify those at most risk remain unclear. Recent studies examining the spontaneous monitoring of dynamic social scenes by individuals with ASD identified atypical viewing behaviors that are related to social disabilities [7], [8], [9] and later diagnoses of ASD [10], [11]. These findings suggest that viewing behaviors during the observation of dynamic social scenes that represent everyday life may be used to better understand the clinical features of those at risk for social difficulties and how to screen for them.
Prospective studies of preterm children using static facial stimuli have reported atypical face processing [12], [13] or decreased visual sensitivity to point-light biological motion in those with periventricular white matter lesions [14], [15]. Williamson and Jakobson [16] asked subjects to interpret dynamic social scenes and found that VP children have difficulties processing nonverbal cues and correctly identifying the emotions of characters. However, because this study required verbal explanations, it was limited to children older than 8 years of age, and differences in linguistic ability may have influenced the results.
A study from our research group used dynamic social scenes and multidimensional scaling (MDS; [17]) to characterize gaze patterns and found that adults and children with ASD exhibit atypical gaze behaviors compared with those displayed by children with typical development (TD, [8]). The same experimental approach applied in children with specific language impairments revealed that their overall gaze patterns were similar to those of TD children but different from those of ASD group [18]. Thus, this non-verbal experimental method is useful for quantitative comparisons of overall social viewing behaviors across a wide range of ages [8], [18].
The present study used this method to investigate how VP children view dynamic social scenes and compared the findings with data from ASD and TD children. This study aimed to determine gaze behaviors that may underlie social difficulties in VP children without ostensive neurological impairments and possibly to identify VP children at higher risk for social difficulties.
Section snippets
Subjects
The present study was performed in the Faculty of Medicine at Juntendo University and assessed 97 participants: 47 VP children (mean chronological age ± SD, 49 ± 25 months, range: 15–120 months), 25 children with ASD (59 ± 21 months, 31–108 months), and 25 TD children (37 ± 23 month, 14–93 months).
The ASD and TD subjects were the same as those used in a previous study by Nakano et al. [8]; the detailed characteristics of the children are included in that article. Briefly, participants with ASD were diagnosed
Full gaze analysis
On the MDS plane, the TD group (blue circles, Fig. 1A) formed a cluster near the center of the plane, whereas the ASD group (green triangles) were distributed toward the periphery. The VP group (red symbols) seemed to form two groups: one in the center that overlapped with the distribution of the TD group and another that formed an annulus in the periphery similar to the distribution of the ASD group. When cluster analysis was applied to the MDS distance of the VP group (Fig. 1B), the
Discussion
The present study found that VP children can be classified into two groups based on how they view social scenes: one group had temporo-spatial gaze patterns similar to those of TD children with a small MDS distance (VP-small), whereas the other had a larger MDS distance (VP-large) and was more similar to children with ASD. Frame-by-frame viewing proportion analyses further demonstrated that the viewing behaviors of the VP-large group were closer to those of the ASD group such that the
Financial support
This research was supported by MEXT KAKENHI Grant No. 26860824 to M. S-H.
Conflicts of Interest
The authors have no conflicts of interest relevant to this article to disclose.
Acknowledgements
The authors thank N. Okamoto for her support, the staff of the high-risk follow-up and all the children and parents who participated in this research.
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