"Sticky Attention" in Autism: Children Who Fail to Disengage Show Greater Symptoms and More Impaired Social Attention and Intersensory Processing

Background: Children with autism (ASD) show difficulty in disengaging attention away from competing stimulation to attend to a peripheral event (Landry & Bryson, 2004), similar to young infants (sticky attention; Hood, 1995; Johnson et al., 1991). In some studies, a subgroup of children with ASD completely fail to disengage attention and remain fixated on a competing stimulus on some trials. We assessed whether this subgroup of children with ASD also show greater symptom severity and greater impairments in social attention and intersensory processing (attention skills often impaired in ASD; see Bahrick & Todd, 2011). Such comparisons are possible with the Multisensory Attention Assessment Protocol (MAAP; Newell et al., 2007), a single test assessing four indices of attention (disengagement, orienting, maintenance, and intersensory processing) to dynamic, audiovisual social and nonsocial events.

Objectives: We identified a subgroup of children with ASD who, on the MAAP, showed a complete failure to disengage from a central stimulus (silently moving geometric shape) across at least one 10-s presentation of two dynamic audiovisual events.  We assessed if this subgroup showed 1) greater symptom severity (SCQ and SRS), 2) increased latencies to disengage overall, 3) decreased attention maintenance, and 4) decreased intersensory processing, compared with TD children and children with ASD who disengaged.

Methods: Children with ASD (N=18; M=4.19 yrs, SD=.87), who passed the cutoff on the ADOS, and TD children (N=16; M=2.49 yrs, SD=1.15), roughly matched on Mullen adjusted age (ASD: M=2.30, SD=1.23; TD: M=3.44, SD=1.22), participated. In the MAAP, trials of the central visual event were followed 3s later by two side-by-side peripheral events (10s), with the natural soundtrack synchronized with one of the two events. Trials of social (woman speaking) and nonsocial events (objects striking a surface) were presented. Intersensory matching (looking to sound-synchronous events), attention maintenance, disengagement (RT to shift attention from the competing central event), and orienting (RT to shift attention without the competing central event) were assessed.

Results: ASDs overall showed greater symptom severity (SCQ & SRS T scores) than TD children (p < .001), however, ASDs who failed to disengage (N=10) showed greater symptom severity than ASDs who disengaged (N=8; p<.05). ASDs who failed to disengage showed no evidence of intersensory processing, greater latencies to disengage than orient attention, and decreased attention maintenance to social events compared to TD children and ASDs who disengaged (ps<.05). In contrast, TD children and ASDs who disengaged showed no attentional differences.  Finally, none of the groups differed in overall orienting in the absence of competing stimulation, nor in attending to nonsocial events.

Conclusions: Findings demonstrate that children with ASD with the most extreme difficulties in disengaging attention also show the greatest symptom severity and greatest impairments in social attention and intersensory processing. These individuals can be identified using the MAAP, by a failure to disengage from a silently moving geometric shape across a 10s presentation of dynamic audiovisual events. These finding have potential for identifying individuals with ASD who are most impaired and could most benefit from interventions focused on attention and intersensory processing.