Social Attention and Empathy in High Functioning Women with Autism Spectrum Disorders

Background : Females with autism spectrum disorders (ASD) have become the focus of research only recently after clinical reports of an altered phenotype. This altered phenotype may be responsible for delays in diagnosing females on the spectrum. There is, however, limited research into the female phenotype and its possible underlying mechanisms. A promising avenue in ASD research is social attention. Social attention has been shown to relate strongly to ASD symptoms, and information on this mechanism in the female population may provide us with valuable information for diagnostic assessment and treatment of this specific group.

Objectives : The present study investigates social attention using sensitive and ecologically valid measures by assessing gaze fixation patterns. In addition, social attention is related to the behavioral level by examining its relation to informant ratings of empathic abilities.

Methods : Participants consisted of 31 adult women with ASD and 29 non-clinical controls. Social attention was assessed by measuring eye fixation patterns using eye tracking while participants watched four real-life movie clips in which children displayed differing emotions. Empathic abilities were assessed using the informant reported Interpersonal Reactivity Index (IRI).

Results : Results show decreased fixation duration on the face and mouth in women with ASD compared to non-clinical controls. No differences were found in fixation duration on the eyes, objects and outside the areas of interest. Women with ASD showed reduced cognitive empathy, and more personal distress in stressful situations compared to non-clinical controls. Additionally, there was a negative correlation between personal distress and total fixation duration to the face for this group.

Conclusions : The current findings suggest subtle impairments in social attention in women with ASD, though fixation on the eyes was normal. Since lack of eye contact is the hallmark of ASD, this may put women with ASD at risk of underdiagnosis. As the pattern of impairment is contrary to the current research findings on the male population, it warrants caution in assuming that current research findings regarding social attention in individuals with ASD automatically apply to the female ASD population. In addition, the negative relationship between face fixation and feelings of personal distress is suggestive of the involvement of the arousal system, with a possibility that women with ASD have problems downregulating their arousal in social situations.