Letter | Published:

Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism

Nature volume 504, pages 427431 (19 December 2013) | Download Citation


Deficits in eye contact have been a hallmark of autism1,2 since the condition’s initial description3. They are cited widely as a diagnostic feature4 and figure prominently in clinical instruments5; however, the early onset of these deficits has not been known. Here we show in a prospective longitudinal study that infants later diagnosed with autism spectrum disorders (ASDs) exhibit mean decline in eye fixation from 2 to 6 months of age, a pattern not observed in infants who do not develop ASD. These observations mark the earliest known indicators of social disability in infancy, but also falsify a prior hypothesis: in the first months of life, this basic mechanism of social adaptive action—eye looking—is not immediately diminished in infants later diagnosed with ASD; instead, eye looking appears to begin at normative levels prior to decline. The timing of decline highlights a narrow developmental window and reveals the early derailment of processes that would otherwise have a key role in canalizing typical social development. Finally, the observation of this decline in eye fixation—rather than outright absence—offers a promising opportunity for early intervention that could build on the apparent preservation of mechanisms subserving reflexive initial orientation towards the eyes.

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  1. 1.

    et al. Neural correlates of eye-gaze detection in young children with autism. Cortex 41, 342–353 (2005)

  2. 2.

    , & Absence of preferential looking to the eyes of approaching adults predicts level of social disability in 2-year-olds with autism spectrum disorder. Arch. Gen. Psychiatry 65, 946–954 (2008)

  3. 3.

    Autistic disturbances of affective contact. Nerv. Child 2, 217–250 (1943)

  4. 4.

    , , , & Autism and pervasive developmental disorders. J. Child Psychol. Psychiatry 45, 135–170 (2004)

  5. 5.

    , , & Autism Diagnostic Observation Schedule 2nd edn (Western Psychological Services, 2008)

  6. 6.

    Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. MMWR Surveillance Summaries 61, 1–19 (2012)

  7. 7.

    et al. Autism recurrence in half siblings: strong support for genetic mechanisms of transmission in ASD. Mol. Psychiatry 18, 137–138 (2013)

  8. 8.

    & Neuroscience: the emerging biology of autism spectrum disorders. Science 337, 1301–1303 (2012)

  9. 9.

    The Ontogeny of Information: Developmental Systems and Evolution 2nd edn (Duke Univ. Press, 2000)

  10. 10.

    & Heterogeneity and homogeneity across the autism spectrum: the role of development. J. Am. Acad. Child Adolesc. Psychiatry 48, 471–473 (2009)

  11. 11.

    & Of human bonding: newborns prefer their mothers' voices. Science 208, 1174–1176 (1980)

  12. 12.

    , & Eye contact and face scanning in early infancy. Science 198, 853–855 (1977)

  13. 13.

    Subcortical face processing. Nature Rev. Neurosci. 6, 766–774 (2005)

  14. 14.

    , & A predisposition for biological motion in the newborn baby. Proc. Natl Acad. Sci. USA 105, 809–813 (2008)

  15. 15.

    Functional brain development in humans. Nature Rev. Neurosci. 2, 475–483 (2001)

  16. 16.

    , , , & The evolution of social orienting: evidence from chicks (Gallus gallus) and human newborns. PLoS ONE 6, e18802 (2011)

  17. 17.

    , , & The enactive mind — from actions to cognition: lessons from autism. Phil. Trans. R. Soc. B 358, 345–360 (2003)

  18. 18.

    , , , & Two-year-olds with autism fail to orient towards human biological motion but attend instead to non-social, physical contingencies. Nature 459, 257–261 (2009)

  19. 19.

    et al. Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study. Pediatrics 128, e488–e495 (2011)

  20. 20.

    , , & Autism spectrum disorders in the second year: stability and change in syndrome expression. J. Child Psychol. Psychiatry 48, 128–138 (2007)

  21. 21.

    & Functional Data Analysis 2nd edn (Springer-Verlag, 2006)

  22. 22.

    , & Functional data analysis for sparse longitudinal data. J. Am. Stat. Assoc. 100, 577–590 (2005)

  23. 23.

    & Applied Longitudinal Data Analysis (Oxford Univ. Press, New York, 2003)

  24. 24.

    & Data Analysis and Regression 37 (Addison-Wesley, 1977)

  25. 25.

    Cross-validatory choice and assessment of statistical predictions. J. R. Stat. Soc. B 36, 111–147 (1974)

  26. 26.

    , & Traits contributing to the autistic spectrum. PLoS ONE 5, e12633 (2010)

  27. 27.

    , & Tracking memory’s trace. Proc. Natl Acad. Sci. USA 98, 5282–5287 (2001)

  28. 28.

    & In Theories of Infant Development (eds & ) 121–141 (Blackwell, 2004)

  29. 29.

    & Advances in autism genetics: on the threshold of a new neurobiology. Nature Rev. Genet. 9, 341–355 (2008)

  30. 30.

    et al. Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders. J. Autism Dev. Disord. 37, 748–759 (2007)

  31. 31.

    , , & Face processing in children with autism: effects of stimulus contents and type. Autism 11, 265–277 (2007)

  32. 32.

    , & Inhibition of eye blinking reveals subjective perceptions of stimulus salience. Proc. Natl Acad. Sci. USA 108, 21270–21275 (2011)

  33. 33.

    & The Neurology of Eye Movements 3rd edn (Oxford Univ. Press, 1999)

  34. 34.

    , & Estimation of functional derivatives. Ann. Stat. 37, 3307–3329 (2009)

  35. 35.

    & Estimating derivatives for samples of sparsely observed functions, with application to online auction dynamics. J. Am. Stat. Assoc. 104, 704–717 (2009)

  36. 36.

    & Pairwise curve synchronization for functional data. Biometrika 95, 875–889 (2008)

  37. 37.

    , & In Best Practices in Quantitative Methods for Developmentalists (eds , & ) Monogr. Soc. Res. Child Dev. 71, 65–87 (2006)

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This work was supported by grants from the Simons Foundation and the National Institute of Mental Health (R01 MH083727). Additional support was provided by the Marcus Foundation, the Whitehead Foundation, and the Georgia Research Alliance. We wish to thank the families and children for their time and participation. We also wish to thank S. Habayeb, S. Glazer, M. Ly, T. Tsang, J. Jones, A. Trubanova, J. Borjon, J. Moriuchi, K. Rice, J. Northrup, L. Edwards, J. Xu, S. Shultz, A. Krasno, C. Zampella, K. Knoch, D. Lin, K. Carr and A. Blank for their assistance in data collection and processing; P. Lewis, J. Paredes, P. Gorrindo and M. Ackerman for assistance in designing and building laboratory hardware and software; G. Ramsay and C. McCracken for discussions of data analysis and statistics; I. Zilber, A. Margolis, D. Blum, M. Dye, D. Simeone, A. Smith and K. O’Loughlin for project supervision, coordination, and data collection; T. Babitz for administrative support; and K. Chawarska, C. Saulnier, K. Bearss, S. Macari, R. Paul, A. Carney, T. Goldsmith, A. Steiner, G. Gengoux, D. Goudreau, E. Loring, J. McGrath and A. Gupta for their contributions to the clinical characterization of the samples.

Author information


  1. Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia 30329, USA

    • Warren Jones
    •  & Ami Klin
  2. Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30022, USA

    • Warren Jones
    •  & Ami Klin
  3. Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30022, USA

    • Warren Jones
    •  & Ami Klin


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W.J. and A.K. developed the initial idea and design of the study, interpreted data, wrote the final manuscript, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. W.J. and A.K. performed final revision of the manuscript for content. A.K. supervised participant characterization. W.J. supervised technological developments and technical aspects of experimental procedure, data acquisition and analysis.

Competing interests

The authors declare no competing financial interests.

Corresponding authors

Correspondence to Warren Jones or Ami Klin.

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