Atypical gaze patterns to facial feature areas in autism spectrum disorders reveal age and culture effects: A meta-analysis of eye-tracking studies.
Eye gaze to the eyes stays low in autism everywhere, but mouth gaze grows with age only in Western cultures.
01Research in Context
What this study did
The team pooled 133 eye-tracking papers that compared people with autism to neurotypical peers.
They asked: Does age or culture change where people look on faces?
Every study tracked gaze while viewers saw photos of eyes, mouths, or whole faces.
What they found
Across all ages and countries, people with autism looked less at eyes.
Mouth looking grew with age in autism, but only in Western samples.
Asian viewers with autism kept low mouth gaze even as they got older.
How this fits with other research
Åsberg Johnels et al. (2017) saw kids with autism look more at mouths during happy faces. The meta-analysis shows this mouth bump only appears in older Western kids, not young or Asian groups.
Kleinert et al. (2007) found autistic adults used mouth cues to judge emotions. The meta-analysis confirms this strategy rises with age, but flags that culture shapes when it starts.
Zhao et al. (2023) later tracked Chinese children in live chat and saw low mouth gaze. That real-world result matches the meta-analysis culture split, giving it teeth outside the lab.
Wang et al. (2023) showed preschoolers with autism can boost eye gaze if they play an active face game. The universal eye-avoid found in the meta-analysis is not fixed; task design can move it.
Why it matters
You now know eye gaze is always lower in autism, but mouth gaze is a moving target.
When you run social skills groups, expect older Western learners to stare at mouths, and Asian learners to keep scanning less.
Pick tasks that make kids actively label faces; that simple switch can pull eyes back up and build the eye contact you want to teach.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a quick face-labeling game at the start of social group to pull eyes toward the eye region before you teach conversation skills.
02At a glance
03Original abstract
Children and adults with autism spectrum disorder (ASD) often present with atypical gaze patterns to others' faces, a finding substantiated throughout the literature. Yet, a quantification of atypical gaze patterns to different facial regions (e.g., eyes versus mouth) in ASD remains controversial. Also few study has investigated how age and culture impacted the pattern of gaze abnormalities in ASD. This research therefore conducted a meta-analysis of eye-tracking studies to evaluate age and culture effect on atypical gaze patterns of face processing in ASD. A total of 75 articles (91 studies) and 4209 individuals (ASD: 2027; controls: 2182) across all age ranges (i.e., childhood through to adulthood) from both Eastern and Western cultures were included in this meta-analysis. Individuals with ASD yielded shorter fixation durations to the eyes than individuals without ASD. Group differences in the time spent fixating on the eyes were not modulated by age, but affected by culture. Effect size in the eastern culture was larger than that in the western culture. In contrast, group differences on time spent looking at the mouth were not significant, but changed with age and modulated by culture. Relative to the neurotypical controls, Western individuals with ASD spent more time looking at the mouth from school age, whereas Eastern individuals with ASD did not gaze longer on mouth until adulthood. These results add to the body of evidence supporting atypical gaze behaviors to eyes in ASD and provide new insights into a potential mouth compensation strategy that develops with age in ASD. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) often show atypical gaze patterns when looking at others' faces compared to neurotypical individuals. This paper examines the role of age and culture on pattern of gaze abnormalities in individuals with ASD. Results show that reduction of gaze on eyes in ASD is stable across all ages and cultures, while increase of gaze on mouth emerges as individuals with ASD get older. The findings provide a developmental insight to the gaze patterns on the autism spectrum across culture.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2607