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Nature. 2013 Dec 19;504(7480):427-31. doi: 10.1038/nature12715. Epub 2013 Nov 6.

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

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1] Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA [2] Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30022, USA [3] Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30022, USA.


Deficits in eye contact have been a hallmark of autism since the condition's initial description. They are cited widely as a diagnostic feature and figure prominently in clinical instruments; 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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