Elsevier

Brain and Development

Volume 39, Issue 3, March 2017, Pages 218-224
Brain and Development

Original article
A group of very preterm children characterized by atypical gaze patterns

https://doi.org/10.1016/j.braindev.2016.10.001Get rights and content

Abstract

Objective

Very preterm (VP) children are at risk for social difficulties, including autism spectrum disorder (ASD). This study used eye tracking to determine viewing behaviors that may reflect these difficulties.

Design

The gaze patterns of 47 VP (mean gestational age: 28 weeks, mean birth weight: 948 g, and mean chronological age: 49 months) were assessed while viewing dynamic social scenes and compared with those of 25 typically developing (TD) and 25 children with ASD. The temporo-spatial gaze patterns were summarized on a two-dimensional plane using multidimensional scaling (MDS) and the median of the TD children was used to characterize the gazes of the VP children. Time spent viewing the face was also compared.

Results

The VP children formed two clusters: one had a mean MDS distance comparable to that of TD group (n = 32; VP-small), and the other had a larger mean distance comparable to that of ASD group (n = 15; VP-large). The VP-large were similar to the ASD group by spending significantly less time viewing the face. Their performance was comparable to the TD during the initial 1 s, but they could not remain focused on the face thereafter.

Conclusions

The VP children were objectively classified into two groups based on gaze behaviors. One group was comparable to TD children, whereas the other had difficulty maintaining attention and exhibited atypical viewing behaviors similar to those of the ASD group. Our method may be useful in identifying VP children at higher risk for experiencing social difficulties.

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.

References (29)

  • K. Treyvaud et al.

    Psychiatric outcomes at age seven for very preterm children: rates and predictors

    J Child Psychol Psychiatry

    (2013)
  • K. Ritchie et al.

    Social development of children born very preterm: a systematic review

    Dev Med Child Neurol

    (2015)
  • W. Jones et al.

    Absence of preferential looking to the eyes of approaching adults predicts level of social disability in 2-year-old toddlers with autism spectrum disorder

    Arch Gen Psychiatry

    (2008)
  • T. Nakano et al.

    Atypical gaze patterns in children and adults with autism spectrum disorders dissociated from developmental changes in gaze behaviour

    Proc Biol Sci

    (2010)
  • Cited by (0)

    View full text