Attention to faces and gaze-following in social anxiety: preliminary evidence from a naturalistic eye-tracking investigation.

Social attentional biases are a core component of social anxiety disorder, but research has not yet determined their direction due to methodological limitations. Here we present preliminary findings from a novel, dynamic eye-tracking paradigm allowing spatial-temporal measurement of attention and gaze-following, a mechanism previously unexplored in social anxiety. 105 participants took part, with those high (N = 27) and low (N = 25) in social anxiety traits (HSA and LSA respectively) entered into the analyses. Participants watched a video of an emotionally-neutral social scene, where two actors periodically shifted their gaze towards the periphery. HSA participants looked more at the actors' faces during the initial 2s than the LSA group but there were no group differences in proportion of first fixations to the face or latency to first fixate the face, although HSA individuals' first fixations to the face were shorter. No further differences in eye movements were found, nor in gaze-following behaviour, although these null effects could potentially result from the relatively small sample. Findings suggest attention is biased towards faces in HSA individuals during initial scene inspection, but that overt gaze-following may be impervious to individual differences in social anxiety. Future research should seek to replicate these effects.

The developmental trajectory of attentional orienting to socio-biological cues.

It has been proposed that the orienting of attention in the same direction as another's point of gaze relies on innate brain mechanisms which are present from birth, but direct evidence relating to the influence of eye gaze cues on attentional orienting in young children is limited. In two experiments, 137 children aged 3-10 years old performed an adapted pro-saccade task with centrally presented uninformative eye gaze, finger pointing and arrow pre-cues which were either congruent or incongruent with the direction of target presentations. When the central cue overlapped with presentation of the peripheral target (Experiment 1), children up to 5 years old had difficulty disengaging fixation from central fixation in order to saccade to the target. This effect was found to be particularly marked for eye gaze cues. When central cues were extinguished simultaneously with peripheral target onset (Experiment 2), this effect was greatly reduced. In both experiments finger pointing cues (image of pointing index finger presented at fixation) exerted a strong influence on saccade reaction time to the peripheral stimulus for the youngest group of children (<5 years). Overall the results suggest that although young children are strongly engaged by centrally presented eye gaze cues, the directional influence of such cues on overt attentional orienting is only present in older children, meaning that the effect is unlikely to be dependent upon an innate brain module. Instead, the results are consistent with the existence of stimulus-response associations which develop with age and environmental experience.

Rehabilitation of face-processing skills in an adolescent with prosopagnosia: Evaluation of an online perceptual training programme.

In this paper we describe the case of EM, a female adolescent who acquired prosopagnosia following encephalitis at the age of eight. Initial neuropsychological and eye-movement investigations indicated that EM had profound difficulties in face perception as well as face recognition. EM underwent 14 weeks of perceptual training in an online programme that attempted to improve her ability to make fine-grained discriminations between faces. Following training, EM's face perception skills had improved, and the effect generalised to untrained faces. Eye-movement analyses also indicated that EM spent more time viewing the inner facial features post-training. Examination of EM's face recognition skills revealed an improvement in her recognition of personally-known faces when presented in a laboratory-based test, although the same gains were not noted in her everyday experiences with these faces. In addition, EM did not improve on a test assessing the recognition of newly encoded faces. One month after training, EM had maintained the improvement on the eye-tracking test, and to a lesser extent, her performance on the familiar faces test. This pattern of findings is interpreted as promising evidence that the programme can improve face perception skills, and with some adjustments, may at least partially improve face recognition skills.

Both identity and non-identity face perception tasks predict developmental prosopagnosia and face recognition ability.

Developmental prosopagnosia (DP) is characterised by deficits in face identification. However, there is debate about whether these deficits are primarily perceptual, and whether they extend to other face processing tasks (e.g., identifying emotion, age, and gender; detecting faces in scenes). In this study, 30 participants with DP and 75 controls completed a battery of eight tasks assessing four domains of face perception (identity; emotion; age and gender; face detection). The DP group performed worse than the control group on both identity perception tasks, and one task from each other domain. Both identity perception tests uniquely predicted DP/control group membership, and performance on two measures of face memory. These findings suggest that deficits in DP may arise from issues with face perception. Some non-identity tasks also predicted DP/control group membership and face memory, even when face identity perception was accounted for. Gender perception and speed of face detection consistently predicted unique variance in group membership and face memory; several other tasks were only associated with some measures of face recognition ability. These findings indicate that face perception deficits in DP may extend beyond identity perception. However, the associations between tasks may also reflect subtle aspects of task demands or stimuli.

Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide.

Background: Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create "capability" for suicide. Methods: Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts. Results: Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone. Conclusions: These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk.

Why is this an important issue?: Suicide is a leading cause of premature death in autistic people, but we still know little about why autistic people are at greater risk and how we can help. Recent findings suggest that autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) are at even higher risk, but we do not yet understand why. What was the purpose of this study?: This research examined two potential explanations for higher risk of suicide in autistic people with co-occurring ADHD. First, we expected that because these individuals are often very isolated and struggle with independence and employment, they might be more vulnerable to two risk factors for suicide: "thwarted belongingness," the feeling of being alienated from other people, and "perceived burdensomeness," the feeling that one is a burden to others. We also expected that hyperactive/impulsive features associated with ADHD might make people more likely to experience painful and dangerous events. Exposure to events like this is suggested to make people less frightened of dying by suicide and more able to attempt to end their lives. This is called "acquiring capability" for suicide. What did the researchers do?: We asked 314 autistic adults to complete an online survey including measures of thwarted belongingness, perceived burdensomeness, exposure to painful and dangerous events, and acquired capability for suicide. They also completed a scale measuring ADHD features, and symptoms of depression and anxiety. We then looked at which of these factors, if any, explained suicide risk in autistic people with co-occurring ADHD. What were the results of the study?: Our data suggest that autistic people with co-occurring ADHD might be at greater risk of suicide ideation and attempts because they are more likely to experience depression and to feel like a burden to others. We also found that people with high degrees of hyperactive/impulsive features were more likely to experience painful and dangerous events, and, therefore, had greater capability for suicide­because of this, they were more likely to have attempted suicide more times in the past. Exposure to these kinds of traumatic events also increased the risk of suicide all by itself. What do these findings add to what was already known?: Very little is known about why autistic people with co-occurring ADHD might be at even higher risk of suicide than people with either ADHD or autism alone. No studies have examined explanations for suicide in this subgroup. What are potential weaknesses in the study?: Because this study looked at a snapshot of participants' current states, we cannot be sure of the direction of relationships between variables. For example, it might be that experiences of surviving suicide attempts actually make people feel more depressed and more like a burden afterward, rather than these feelings being the risk factors that contributed to suicide attempts. How will these findings help autistic adults now or in the future?: These findings indicate feelings and experiences that are relevant to suicide risk in autistic people with co-occurring ADHD, which might thus be important to target in interventions.

Social attention patterns of autistic and non-autistic adults when viewing real versus reel people.

LAY ABSTRACT: Early research shows that autistic adults do not attend to faces as much as non-autistic adults. However, some recent studies where autistic people are placed in scenarios with real people reveal that they attend to faces as much as non-autistic people. This study compares attention to faces in two situations. In one, autistic and non-autistic adults watched a pre-recorded video. In the other, they watched what they thought were two people in a room in the same building, via a life webcam, when in fact exactly the same video in two situations. We report the results of 32 autistic adults and 33 non-autistic adults. The results showed that autistic adults do not differ in any way from non-autistic adults when they watched what they believed was people interacting in real time. However, when they thought they were watching a video, non-autistic participants showed higher levels of attention to faces than non-autistic participants. We conclude that attention to social stimuli is the result of a combination of two processes. One innate, which seems to be different in autism, and one that is influenced by social norms, which works in the same way in autistic adults without learning disabilities. The results suggest that social attention is not as different in autism as first thought. Specifically, the study contributes to dispel long-standing deficit models regarding social attention in autism as it points to subtle differences in the use of social norms rather than impairments.

Transition to intensive care nursing: a state-wide, workplace centred program-12 years on.

In November 1999, the Queensland Health (QH) Transition to Practice Nurse Education Program - Intensive Care (TPNEP-IC) was initiated in QH Intensive Care Units (ICUs) across Queensland. This 12-month, state-wide, workplace based education program has set minimum standards for intensive care nursing education and therefore minimum standards for intensive care nursing practice in QH. In the 12 years of operation, 824 nurses have completed TPNEP-IC, 761 achieving academic credit status and 453 utilising this academic credit status to undertake postgraduate study in critical/intensive care nursing at three Queensland universities. These outcomes were achieved through the appointment of nurse educators within ICUs who, through a united and strong commitment to this state-wide approach formed collaborative professional networks, which resulted in the development, implementation and maintenance of the program. Furthermore, these networks enabled a framework of support for discussion and dissemination of evidence based practice, to endorse quality processes for TPNEP-IC and to nurture leadership potential among educators. Challenges to overcome included obtaining adequate resources to support all aspects of the program, gaining local management and administrative support, and embedding TPNEP-IC within ICU culture. The 12 years of operation of the program have demonstrated its long term sustainability. The program is being launched through a new blended learning approach utilising e-learning strategies. To capitalise on the current success, a strong commitment by all stakeholders will be required to ensure the ongoing sustainability of the program.

Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample.

BACKGROUND: Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults. METHODS: Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI. RESULTS: While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability. LIMITATIONS: Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community. CONCLUSIONS: Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.

Face specific inversion effects provide evidence for two subtypes of developmental prosopagnosia.

Many studies have attempted to identify the perceptual underpinnings of developmental prosopagnosia (DP). The majority have focused on whether holistic and configural processing mechanisms are impaired in DP. However, previous work suggests that there is substantial heterogeneity in holistic and configural processing within the DP population; further, there is disagreement as to whether any deficits are face-specific or reflect a broader perceptual deficit. This study used a data-driven approach to examine whether there are systematic patterns of variability in DP that reflect different underpinning perceptual deficits. A group of individuals with DP (N = 37) completed a cognitive battery measuring holistic/configural and featural processing in faces and non-face objects. A two-stage cluster analysis on data from the Cambridge Face Perception Test identified two subgroups of DPs. Across several tasks, the first subgroup (N = 21) showed typical patterns of holistic/configural processing (measured via inversion effects); the second (N = 16) was characterised by reduced or abolished inversion effects compared to age-matched control participants (N = 91). The subgroups did not differ on tasks measuring upright face matching, object matching, non-face holistic processing, or composite effects. These findings indicate two separable pathways to face recognition impairment, one characterised by impaired configural processing and the other potentially by impaired featural processing. Comparisons to control participants provide some preliminary evidence that the deficit in featural processing may extend to some non-face stimuli. Our results demonstrate the utility of examining both the variability between and consistency across individuals with DP as a means of illuminating our understanding of face recognition in typical and atypical populations.

Adults with higher social anxiety show avoidant gaze behaviour in a real-world social setting: A mobile eye tracking study.

Attentional biases are a core characteristic of social anxiety (SA). However, research has yielded conflicting findings and failed to investigate these biases in real, face-to-face social situations. Therefore, this study examined attentional biases in SA by measuring participants' eye gaze within a novel eye-tracking paradigm during a real-life social situation. Student participants (N = 30) took part in what they thought was a visual search study, when a confederate posing as another participant entered the room. Whilst all participants avoided looking at the confederate, those with higher SA fixated for a shorter duration during their first fixation on him, and executed fewer fixations and saccades overall as well as exhibiting a shorter scanpath. These findings are indicative of additional avoidance in the higher SA participants. In contrast to previous experimental work, we found no evidence of social hypervigilance or hyperscanning in high SA individuals. The results indicate that in unstructured social settings, avoidance rather than vigilance predominates, especially in those with higher SA.

Does social presence or the potential for interaction reduce social gaze in online social scenarios? Introducing the "live lab" paradigm.

Research has shown that people's gaze is biased away from faces in the real world but towards them when they are viewed onscreen. Non-equivalent stimulus conditions may have represented a confound in this research, however, as participants viewed onscreen stimuli as pre-recordings where interaction was not possible compared with real-world stimuli which were viewed in real time where interaction was possible. We assessed the independent contributions of online social presence and ability for interaction on social gaze by developing the "live lab" paradigm. Participants in three groups ( N = 132) viewed a confederate as (1) a live webcam stream where interaction was not possible (one-way), (2) a live webcam stream where an interaction was possible (two-way), or (3) a pre-recording. Potential for interaction, rather than online social presence, was the primary influence on gaze behaviour: participants in the pre-recorded and one-way conditions looked more to the face than those in the two-way condition, particularly, when the confederate made "eye contact." Fixation durations to the face were shorter when the scene was viewed live, particularly, during a bid for eye contact. Our findings support the dual function of gaze but suggest that online social presence alone is not sufficient to activate social norms of civil inattention. Implications for the reinterpretation of previous research are discussed.

Objective Patterns of Face Recognition Deficits in 165 Adults with Self-Reported Developmental Prosopagnosia.

In the last 15 years, increasing numbers of individuals have self-referred to research laboratories in the belief that they experience severe everyday difficulties with face recognition. The condition "developmental prosopagnosia" (DP) is typically diagnosed when impairment is identified on at least two objective face-processing tests, usually involving assessments of face perception, unfamiliar face memory, and famous face recognition. While existing evidence suggests that some individuals may have a mnemonic form of prosopagnosia, it is also possible that other subtypes exist. The current study assessed 165 adults who believe they experience DP, and 38% of the sample were impaired on at least two of the tests outlined above. While statistical dissociations between face perception and face memory were only observed in four cases, a further 25% of the sample displayed dissociations between impaired famous face recognition and intact short-term unfamiliar face memory and face perception. We discuss whether this pattern of findings reflects (a) limitations within dominant diagnostic tests and protocols, (b) a less severe form of DP, or (c) a currently unrecognized but prevalent form of the condition that affects long-term face memory, familiar face recognition or semantic processing.

Eye-movement strategies in developmental prosopagnosia and "super" face recognition.

Developmental prosopagnosia (DP) is a cognitive condition characterized by a severe deficit in face recognition. Few investigations have examined whether impairments at the early stages of processing may underpin the condition, and it is also unknown whether DP is simply the "bottom end" of the typical face-processing spectrum. To address these issues, we monitored the eye-movements of DPs, typical perceivers, and "super recognizers" (SRs) while they viewed a set of static images displaying people engaged in naturalistic social scenarios. Three key findings emerged: (a) Individuals with more severe prosopagnosia spent less time examining the internal facial region, (b) as observed in acquired prosopagnosia, some DPs spent less time examining the eyes and more time examining the mouth than controls, and (c) SRs spent more time examining the nose-a measure that also correlated with face recognition ability in controls. These findings support previous suggestions that DP is a heterogeneous condition, but suggest that at least the most severe cases represent a group of individuals that qualitatively differ from the typical population. While SRs seem to merely be those at the "top end" of normal, this work identifies the nose as a critical region for successful face recognition.

Reduced gaze following and attention to heads when viewing a "live" social scene.

Social stimuli are known to both attract and direct our attention, but most research on social attention has been conducted in highly controlled laboratory settings lacking in social context. This study examined the role of social context on viewing behaviour of participants whilst they watched a dynamic social scene, under three different conditions. In two social groups, participants believed they were watching a live webcam of other participants. The socially-engaged group believed they would later complete a group task with the people in the video, whilst the non-engaged group believed they would not meet the people in the scene. In a third condition, participants simply free-viewed the same video with the knowledge that it was pre-recorded, with no suggestion of a later interaction. Results demonstrated that the social context in which the stimulus was viewed significantly influenced viewing behaviour. Specifically, participants in the social conditions allocated less visual attention towards the heads of the actors in the scene and followed their gaze less than those in the free-viewing group. These findings suggest that by underestimating the impact of social context in social attention, researchers risk coming to inaccurate conclusions about how we attend to others in the real world.

Giving subjects the eye and showing them the finger: socio-biological cues and saccade generation in the anti-saccade task.

Pointing with the eyes or the finger occurs frequently in social interaction to indicate direction of attention and one's intentions. Research with a voluntary saccade task (where saccade direction is instructed by the colour of a fixation point) suggested that gaze cues automatically activate the oculomotor system, but non-biological cues, like arrows, do not. However, other work has failed to support the claim that gaze cues are special. In the current research we introduced biological and non-biological cues into the anti-saccade task, using a range of stimulus onset asynchronies (SOAs). The anti-saccade task recruits both top-down and bottom-up attentional mechanisms, as occurs in naturalistic saccadic behaviour. In experiment 1 gaze, but not arrows, facilitated saccadic reaction times (SRTs) in the opposite direction to the cues over all SOAs, whereas in experiment 2 directional word cues had no effect on saccades. In experiment 3 finger pointing cues caused reduced SRTs in the opposite direction to the cues at short SOAs. These findings suggest that biological cues automatically recruit the oculomotor system whereas non-biological cues do not. Furthermore, the anti-saccade task set appears to facilitate saccadic responses in the opposite direction to the cues.

Positive and negative emotion enhances the processing of famous faces in a semantic judgment task.

Previous work has consistently reported a facilitatory influence of positive emotion in face recognition (e.g., D'Argembeau, Van der Linden, Comblain, & Etienne, 2003). However, these reports asked participants to make recognition judgments in response to faces, and it is unknown whether emotional valence may influence other stages of processing, such as at the level of semantics. Furthermore, other evidence suggests that negative rather than positive emotion facilitates higher level judgments when processing nonfacial stimuli (e.g., Mickley & Kensinger, 2008), and it is possible that negative emotion also influences latter stages of face processing. The present study addressed this issue, examining the influence of emotional valence while participants made semantic judgments in response to a set of famous faces. Eye movements were monitored while participants performed this task, and analyses revealed a reduction in information extraction for the faces of liked and disliked celebrities compared with those of emotionally neutral celebrities. Thus, in contrast to work using familiarity judgments, both positive and negative emotion facilitated processing in this semantic-based task. This pattern of findings is discussed in relation to current models of face processing.

The saccadic Stroop effect: Evidence for involuntary programming of eye movements by linguistic cues.

The effect of automatic priming of behaviour by linguistic cues is well established. However, as yet these effects have not been directly demonstrated for eye movement responses. We investigated the effect of linguistic cues on eye movements using a modified version of the Stroop task in which a saccade was made to the location of a peripheral colour patch which matched the "ink" colour of a centrally presented word cue. The words were either colour words ("red", "green", "blue", "yellow") or location words ("up", "down", "left", "right"). As in the original version of the Stroop task the identity of the word could be either congruent or incongruent with the response location. The results showed that oculomotor programming was influenced by word identity, even though the written word provided no task relevant information. Saccade latency was increased on incongruent trials and an increased frequency of error saccades was observed in the direction congruent with the word identity. The results argue against traditional distinctions between reflexive and voluntary programming of saccades and suggest that linguistic cues can also influence eye movement programming in an automatic manner.