Autism spectrum disorder (ASD) affects 1 in 36 children in the United States. An estimated 15% of children with ASD have an ophthalmologic disorder, most commonly amblyopia or strabismus. However, the impact of visual disorders on ASD symptoms is unknown. For example, visual attention, particularly to social stimuli, is consistently abnormal in studies of individuals with ASD. Ophthalmologic disorders such as amblyopia are also associated with abnormal visual attention. Yet the potential additive effect of visual disorders on visual attention in children with ASD has not been previously studied.

In this proposal, we will assess visual attention in children with ASD with (ASD+/VD+) and without (ASD+/VD-) visual disorders and evaluate its impact on social communication and adaptive behavior. Visual attention will be measured using eye tracking, whereby a high-resolution camera determines the direction of eye gaze while children watch images and videos on a computer monitor. Machine learning techniques, necessary because over 5 million comparisons are required to fully analyze differences in eye tracking behavior while viewing a single image, will be applied to assess eye movements toward social and non-social attributes on a pixel-by-pixel basis. Neuropsychological assessments will be used to measure social communication and adaptive behavior. Statistical analyses will compare measures of visual attention, social behavior, and adaptive behavior in the two groups. Based on our promising preliminary data (described in the proposal), we anticipate that our results will demonstrate that children with ASD+/VD+ have reduced visual attention to social stimuli, which translates to greater abnormalities of social communication and adaptive behavior. This pilot study will provide the foundation for future longitudinal studies to assess the effect of ophthalmologic treatment on ASD symptoms; therefore, our research has the potential to identify a novel therapeutic target in this increasingly prevalent disorder with high societal impact.

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