Social attention: a possible early indicator of efficacy in autism clinical trials

Recent conceptualizations of the diagnostic features of autism spectrum disorder (ASD) emphasize two core features: social communication and repetitive behaviors [1]. Decades of research have sought to clarify the nature of the social communication impairments, highlighting impaired or atypical 'social attention' as a key measurable construct that helps define the core impairment of social communication. In this paper, we provide a brief overview of behavioral and neuropsychological research on social attention impairments in autism and their relationship to deficiencies in neural circuitry related to social reward. We offer a framework for considering social attention as a potential moderator or mediator of response to early behavioral intervention, and a biomarkera that could potentially be useful as an early indicator of efficacy of behavioral and pharmacological treatments aimed at addressing the social communication impairments in autism.Typical infants show preferential attention to people, including their eyes, faces, and movements from the first days of life. Faces, voices, and body movements are biologically relevant stimuli that are normally a strong focus of attention beginning early in life. Young children with autism, in contrast, pay less attention to other people and their actions and focus their attention instead on non-social objects [2]. Three to four-year-old children with ASD fail to show normal preferences for speech sounds [3-5]. Pierce et al. [6] reported that toddlers with ASD, aged 14 to 42 months, prefer to visually examine geometric images more than social images. Chawarska et al. [7] found that, unlike toddlers with typical development or developmental delay, toddlers with ASD did not have difficulty disengaging their attention from a face when presented with a competing stimulus. Impaired eye contact is an early emerging, cardinal feature of ASD present by at least 1 year of age in children with early onset autism [8,9]. A failure to ori