Eye Gaze Patterns of Adolescents with Social Anxiety Disorder: Associations Between ASD Features and Fixation Duration to Affective Stimuli

Background: Social Anxiety Disorder (SAD) is characterized by fears of potential evaluation by others. Autism Spectrum Disorder (ASD) is characterized by social communication impairments and restricted interests and repetitive behaviors (RRBs). SAD is a common co-occurring disorder for adolescents with ASD (White et al., 2014), however there is little agreement on how to disentangle features of SAD from ASD impairments. Although extant research has examined features of SAD within individuals with ASD (White et al., 2015), no research to date has examined how the features of ASD might manifest within youth with SAD. Previous eye-tracking research has shown that anxiety is associated with vigilance to angry faces (Mogg et al., 2000). However, the association between ASD features and fixation duration in teens with SAD has not been examined. It was predicted that features of ASD would be associated with heightened fixation duration to angry faces.

Objectives: The objective is to explore the influence of ASD features (i.e., social communication deficits, RRBs, and overall severity) on gaze in teens with SAD.

Methods: Data were drawn from a randomized controlled trial of a computerized treatment to reduce social anxiety in youth with SAD. The eye-tracking task used the NIMH Child Emotional Faces Picture Set (NIMH-ChEFS; Egger et al., 2011) consisting of teen faces. Each stimulus presentation contained a pair of photographs of the same person, one photo depicting an emotional expression and the other depicting a neutral emotional expression. All participants (n=49; Mage=14.35) were between the ages of 12-16 and free of a co-occurring intellectual disability. SAD diagnoses were confirmed by semi-structured clinical interview (ADIS; Silverman & Albano, 1996) and youth with prior ASD diagnosis were excluded. Parents completed the Social Responsiveness Scale-2 (SRS-2; Constantino, 2012) as an index of ASD symptom severity and the youth self-reported on social anxiety via the Screen for Child Anxiety Related Disorders (SCARED; Birmaher et al., 1997).

Results: For the present analyses, social anxiety severity was controlled for in order to uniquely examine the role of ASD features on gaze duration to emotional faces. Partial correlation coefficients indicated that greater parent-reported ASD symptom severity was associated with longer gaze duration to happy faces (r = .34, p = .038). Contrary to our hypotheses, no significant association was present between ASD symptom impairments and gaze duration to angry faces. In addition, social communication difficulties (per the SRS-2 SC subscale) were also associated with longer gaze duration to happy faces (r=.44, p=.006). No significant association was found between RRBs and fixation duration, however.

Conclusions: The findings highlight that elevated ASD impairments are associated with greater fixation duration to happy faces, even after controlling for SAD severity. Socially anxious teens with heightened ASD severity and social communication difficulties might experience difficulties in peer relationships. Therefore, they might avoid looking at angry faces which could signal peer rejection. In turn, happy faces might serve as a security signal or protective factor from peer rejection. Findings highlight the importance of considering ASD features when conducting eye-tracking research with adolescents with SAD.