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Cited by 486Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesChild and Animal Learning Development

Preference for geometric patterns early in life as a risk factor for autism

Open access
Pierce, Karen, Conant, David, Hazin, Roxana, Stoner, Richard, Desmond, Jamie·2011·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2010.113PMC PMC4894313
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Abstract

CONTEXT: Early identification efforts are essential for the early treatment of the symptoms of autism but can only occur if robust risk factors are found. Children with autism often engage in repetitive behaviors and anecdotally prefer to visually examine geometric repetition, such as the moving blade of a fan or the spinning of a car wheel. The extent to which a preference for looking at geometric repetition is an early risk factor for autism has yet to be examined. OBJECTIVES: To determine if toddlers with an autism spectrum disorder (ASD) aged 14 to 42 months prefer to visually examine dynamic geometric images more than social images and to determine if visual fixation patterns can correctly classify a toddler as having an ASD. DESIGN: Toddlers were presented with a 1-minute movie depicting moving geometric patterns on 1 side of a video monitor and children in high action, such as dancing or doing yoga, on the other. Using this preferential looking paradigm, total fixation duration and the number of saccades within each movie type were examined using eye tracking technology. SETTING: University of California, San Diego Autism Center of Excellence. PARTICIPANTS: One hundred ten toddlers participated in final analyses (37 with an ASD, 22 with developmental delay, and 51 typical developing toddlers). MAIN OUTCOME MEASURE: Total fixation time within the geometric patterns or social images and the number of saccades were compared between diagnostic groups. RESULTS: Overall, toddlers with an ASD as young as 14 months spent significantly more time fixating on dynamic geometric images than other diagnostic groups. If a toddler spent more than 69% of his or her time fixating on geometric patterns, then the positive predictive value for accurately classifying that toddler as having an ASD was 100%. CONCLUSION: A preference for geometric patterns early in life may be a novel and easily detectable early signature of infants and toddlers at risk for autism.

Integrity signals

Registry

Crossref · 10.1001/archgenpsychiatry.2010.113

Cites

70 of 70 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Geometric responders with autism spectrum disorder exhibited significantly fewer saccades when viewing their preferred geometric stimuli compared with all other groups.

    “Follow-up t tests revealed that the geometric responders with an ASD had a unique saccade signature and exhibited significantly fewer saccades when they were viewing their preferred geometric stimuli in comparison with all other groups (all P< .01).”
    Quote in the paperSubstantial claim
  • Findingown data

    The percentage of viewing time spent on dynamic geometric images differed significantly among the diagnostic groups.

    “Overall, the percentage of time that toddlers spent viewing DGI was significantly different between diagnostic groups (F 2,107 =11.8;P< .001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among autism spectrum disorder toddlers, geometric responders and social responders did not differ on Mullen visual reception, fine motor, receptive language, expressive language, or early learning composite scores.

    “There were also no differences in the visual reception (t 35 = -0.99;P = .32),fine motor (t 35 =-1.7;P=.32), receptive language (t 35 =-0.98;P = .33),expressive language (t 35 =-0.42;P=.67), or early learning composite (t 35 =-1.2;P = .22)scores.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Geometric responders with autism spectrum disorder spent significantly more time fixating on dynamic geometric images than other groups during all three periods of the movie.

    “follow-up t tests revealed that geometric responders with an ASD spent significantly more time fixating on DGI than other groups during all 3 periods.”
    Quote in the paperSubstantial claim
  • Findingown data

    With two exceptions, none of the toddlers with developmental delay showed a preference for dynamic geometric images.

    “Additionally, with 2 exceptions, none of the toddlers with DD showed a preference for DGI.”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 14
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The phenomenon was not ubiquitous across the autism spectrum disorder sample: 40% were geometric responders, while the remaining 60% preferred dynamic social images.

    “While a considerable portion of the ASD sample, namely 40%, were geometric responders, in that they preferred to visually examine DGI, the remaining 60% of participants with an ASD performed similar to the TD and DD contrast groups in that they preferred DSI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Excluding one typically developing toddler who preferred geometric patterns, 50% viewing time on dynamic social images marked the end of the range for typically developing toddlers, who all preferred dynamic social images.

    “Excluding 1 TD toddler who preferred geometric patterns, 50% of viewing time on DSI marks the end of the range for TD toddlers, who all preferred DSI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Each toddler's preference for a particular movie type was relatively stable, with a mean change in percentage of preference of 15.62% (range 1%-36%; SD 9.2).

    “Each toddler's preference for a particular movie type was relatively stable.The mean change in percentage of preference within our sample was 15.62% (range, 1%-36%; SD, 9.2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among the 15 toddlers with autism spectrum disorder who preferred dynamic geometric images, more than half spent more than 70% of their time viewing them, with several exceeding 90%, a pattern absent in other groups.

    “Of the 15 toddlers with an ASD who preferred DGI, more than half spent more than 70% of their time visually examining DGI, with several toddlers exceeding 90% DGI viewing time, a pattern not found in any other group”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Forty percent of the autism spectrum disorder group spent more than half of viewing time on dynamic geometric images, compared with 1.9% of typically developing toddlers and 9% of toddlers with developmental delay.

    “Forty percent of the ASD group spent greater than 50% of viewing time fixated on DGI in contrast to only 1.9% of TD toddlers and 9% of toddlers with DD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When geometric responders with autism spectrum disorder viewed social stimuli, they exhibited significantly more saccades than typically developing toddlers and toddlers with developmental delay; the difference from social responders with autism spectrum disorder was P=.02 and did not meet the Bonferroni threshold.

    “In contrast, when the geometric responders with an ASD viewed their nonpreferred stimuli, namely the social stimuli, they exhibited a significantly greater number of saccades in contrast to TD toddlers and toddlers with DD.The significance level in contrast to social responders with an ASD was P = .02,but this did not meet the Bonferroni correction threshold of less than .0125”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a small significant increase in dynamic geometric image fixation across time in all groups, with no group by time interaction.

    “Although there was a small, significant increase in DGI fixation across time in all groups (F 2,212 = 12.7; P<.001), there was no group X time interaction (F 6,212 = 0.667; P>.05)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A preference for geometric patterns was not associated with general cognitive delay, as there was no relationship between IQ and fixation time within the autism spectrum disorder group.

    “A preference for geometric patterns was not associated with general cognitive delay in that there was no relationship between IQ and fixation time within the ASD group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only the geometric responders, not the entire ASD group, showed fewer saccades.

    “Results revealed that it was only the geometric responders, not the group as a whole, who displayed a reduced number of saccades.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Over half of the ASD toddlers in the study preferred DSI, just like the TD and DD toddlers.

    “more than half of the toddlers with an ASD in the study behaved just like those who were TD or DD: they preferred DSI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Test-retest reliability was calculated as the percentage of preference difference between test time 1 and test time 2.

    “Test-retest reliability was calculated as the percentage of preference difference between test time 1 and test time 2.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    A preference for geometric patterns alone may be an intriguing novel identifier of early autism.

    “While a preference for geometric patterns alone may be an intriguing novel identifier of early autism, results also illustrated a distinct pattern of saccades within the”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Any subject with total fixation time less than 30 seconds, or 50% of the experiment, was excluded from analyses.

    “Any subject with total fixation time less than 30 seconds (ie, 50% of the experiment) was excluded from analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Enhanced visuospatial abilities in autism may stem from a local processing bias.

    “It is thought that enhanced visuospatial abilities in autism may stem from a local processing bias.30 , 31”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30]

      Not checked in the free run.

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  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The side of presentation of dynamic geometric images and dynamic social images was randomized across subject and diagnosis so that half of the toddlers saw dynamic social images on the left.

    “To control for preference that may be mediated by spatial location, the side of presentation of DGI and DSI scenes was randomized across subject and diagnosis so that 50% of toddlers saw a movie containing DSI on the left.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Autism Diagnostic Observation Schedule-Toddler Module was newly validated for use with infants as young as 12 months.

    “Autism Diagnostic Observation Schedule-Toddler Module (ADOS-T), newly validated for use with infants as young as 12 months, 43”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43]

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Typically developing toddlers were matched to autism spectrum disorder toddlers on age and sex; developmental delay toddlers were matched to autism spectrum disorder on chronological age, verbal and nonverbal developmental quotient, and overall functioning; there were no significant differences between autism spectrum disorder and developmental delay groups on these measures.

    “Thirty-seven TD toddlers were matched on a 1-1 basis to toddlers with an ASD based on age (±3 months) and sex.The remaining 14 TD toddlers were matched based on the chronological age range of the ASD group.Subjects with DD served as a contrast group and were matched to the ASD group based on chronological age, verbal and nonverbal developmental quotient as assessed by the Mullen Scales of Early Le”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Individuals with autism have deficits in shifting visual attention and longer disengagement latencies.

    “because individuals with autism have deficits in shifting visual attention 32 -37 and have been known to exhibit longer disengagement latencies, 20 , 38”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [32]

      Not checked in the free run.

    • cites [33]

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    • cites [20]

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    • cites [38]

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  • May combine two claims.

    Study design and conductcitation

    All but one of the autism spectrum disorder toddlers were tracked and diagnosed using the ADOS-T until at least age 24 months, an age shown to be reliable for autism diagnosis.

    “While several of the toddlers with an ASD were only a year old at the time of testing, all but 1 have been tracked and diagnosed using the ADOS-T until at least age 24 months, an age shown to be reliable for the diagnosis of autism.20 , 43 , 46 -49”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [20]

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    • cites [43]

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    • cites [46]

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    • cites [48]

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  • May combine two claims.

    Interpretationown data

    A preference for dynamic geometric images may be a risk factor for autism, as this preference was observed in a toddler at risk for autism spectrum disorder as young as 14 months.

    “Furthermore, a preference for DGI may be a risk factor for autism in that this preference was observed in a toddler at risk for an ASD as young as 14 months.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Bonferroni correction was used with a significance level set at P < .0125 for all post hoc comparisons.

    “Bonferroni correction was used with a significance level set at P < .0125for all post hoc comparisons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many children with autism engage in a variety of repetitive behaviors.

    “Many children with autism engage in a variety of repetitive behaviors 26 and, anecdotally, often prefer to attend to visual repetition, such as the moving blade of a fan or the spinning of a car wheel.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The typically developing group had significantly higher verbal and nonverbal developmental quotients and adaptive behavior scores and significantly lower ADOS-T scores than the autism spectrum disorder group.

    “As expected, the TD group had a significantly higher verbal developmental quotient, nonverbal developmental quotient, and adaptive behavior score and significantly lower ADOS-T scores than the ASD group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Twenty-eight toddlers were excluded from final analyses because of noncompliance during testing, which almost always resulted in less than 50% valid trials.

    “Twenty-eight (10 with an ASD, 11 with TD, 7 with DD) were excluded from final analyses because of noncompliance during testing, which almost always resulted in less than 50% valid trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Autism involves difficulties in shifting attention and in disengaging attention.

    “Based on research documenting deficits in shifting 32 -37 and disengaging attention 20 in autism”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [32]

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Final diagnoses for autism spectrum disorder participants older than 30 months were confirmed with the Autism Diagnostic Interview-Revised.

    “Final diagnoses for participants with an ASD older than 30 months were confirmed with the Autism Diagnostic Interview-Revised.50”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Eye movements guide learning.

    “It is undeniable that eye movements guide learning.58”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All standardized assessments were administered by two highly experienced PhD-level psychologists.

    “All standardized assessments were administered by 2 highly experienced PhD-level psychologists with more than 10 years' combined experience in autism.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    One minute has been shown previously to be the average attention span of a one-year-old.

    “1 minute has been previously demonstrated to be the average attention span of a 1-year-old, 62”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Only one-third of the total sample took part in test-retest reliability.

    “only one-third of the overall sample participated in test-retest reliability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Within this subgroup, the pattern is more saccades for non-preferred stimuli and fewer for preferred stimuli.

    “for this particular subgroup, the profile appears to be increased saccades during the viewing of nonpreferred stimuli and decreased saccades while viewing preferred stimuli.”
    Quote in the paperSubstantial claim
31 of 31

  • The paper relies on this without support.

    The paper assumes that the question of whether a preference for geometric repetition is an early autism risk factor has not yet been examined.

    “The extent to which a preference for looking at geometric repetition is an early risk factor for autism has yet to be examined.”
    “The early developmental profile of unusual preferences for visual repetition in autism is largely unknown and unexplored.”

  • The paper relies on this without support.

    The paper assumes, on anecdotal grounds, that children with autism often prefer to attend to visual repetition.

    “Many children with autism engage in a variety of repetitive behaviors 26 and, anecdotally, often prefer to attend to visual repetition, such as the moving blade of a fan or the spinning of a car wheel.”

  • The paper relies on this without support.

    The paper assumes that a prior study found that eye gaze patterns at 6 months did not predict later diagnostic outcome.

    “examined the clinical outcome of these subjects and found that, contrary to their expectations, eye gaze patterns at 6 months did not predict diagnostic outcome.”

  • The paper relies on this without support.

    The geometric preference seen in a subgroup of ASD toddlers at 14-42 months is present earlier in life and is not caused by the ASD diagnosis.

    “some infants at risk for an ASD begin life with an unusual preference for geometric repetition.”

  • The paper relies on this without support.

    The exclusion of about 20% of the sample due to poor compliance did not substantially bias the results.

    “approximately 20% of the overall sample was dropped from analyses because of poor compliance during testing, with the impact of such exclusion unknown.”

  • The paper relies on this without support.

    The one-third of the sample that completed test-retest reliability is representative of the whole sample.

    “only one-third of the overall sample participated in test-retest reliability.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Preference for non-social patterns in toddlers is a robust predictor of ASD.

    “preference for non-social patterns in toddlers has recently been identified as a robust predictor of ASD [58]”

    From The social motivation theory of autism (2012) · cites this paper as [58]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Viewing-time ANOVA degrees of freedom imply a fourth group

    Minor

    The viewing-time comparison names three diagnostic groups, but its numerator degree of freedom is 3, which corresponds to four groups in a one-way ANOVA. The paper specifies three levels for diagnostic group and uses a numerator degree of freedom of 2 for another comparison of those groups.

  • Figure caption overstates the social-image saccade comparisons

    Minor

    The results say the comparison with social responders with an ASD had P=.02 and did not meet the stated significance threshold. The Figure 5 caption instead says geometric responders had significantly more saccades than all other groups when viewing social images.

  • TD sex counts exceed the stated group size

    Minor

    The table lists 35 male and 17 female TD toddlers, totaling 52, but gives the TD group size as 51.

    Reported 51 · recomputed 52

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 7

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  2. Bryson SE, Zwaigenbaum L, Brian J, Roberts W, Szatmari P, Rombough V, McDermott C. A prospective case series of high-risk infants who developed autism. J Autism Dev Disord. 2007; 37(1):12-24. [PubMed: 17211728]
  3. Morgan B, Maybery M, Durkin K. Weak central coherence, poor joint attention, and low verbal ability. Dev Psychol. 2003; 39(4):646-656. [PubMed: 12859119]
  4. Elsabbagh M, Volein A, Holmboe K, Tucker L, Csibra G, Baron-Cohen S, Bolton P, Charman T, Baird G, Johnson MH. Visual orienting in the early broader autism phenotype. J Child Psychol Psychiatry. 2009; 50(5):637-642. [PubMed: 19298466]
  5. Luyster R, Gotham K, Guthrie W, Coffing M, Petrak R, Pierce K, Bishop S, Esler A, Hus V, Oti R, Richler J, Risi S, Lord C. The Autism Diagnostic Observation Schedule-toddler module. J Autism Dev Disord. 2009; 39(9):1305-1320. [PubMed: 19415479]
  6. Chawarska K, Klin A, Paul R, Macari S, Volkmar F. A prospective study of toddlers with ASD. J Child Psychol Psychiatry. 2009; 50(10):1235-1245. [PubMed: 19594835]
  7. Mottron L, Dawson M, Soulières I, Hubert B, Burack J. Enhanced perceptual functioning in autism. J Autism Dev Disord. 2006; 36(1):27-43. [PubMed: 16453071]

Cited by

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Related

Authors
Pierce, K., Conant, D., Hazin, R., Stoner, R., & Desmond, J.
Affiliations
University of California San Diego (US)
ORCID
Pierce, Karen
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2011-01-03
Volume
68
Issue
1
Pages
101
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2010.113
PMC
PMC4894313
OpenAlex
W2122623425
Cited by
486
References
68
Citations by year
2026: 26 · 2025: 29 · 2024: 28 · 2023: 25 · 2022: 26 · 2021: 41 · 2020: 62 · 2019: 32 · 2018: 50 · 2017: 30 · 2016: 30 · 2015: 24 · 2014: 23 · 2013: 18 · 2012: 30
FWCI
11.44
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH080134, P50MH081755)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Developmental and Educational Psychology › Child and Animal Learning Development
Keywords
autism spectrum disorder, early risk factors, toddlers, preferential looking, visual fixation, saccades, social image, early detection, developmental delay
MeSH terms
Age Factors, California, Developmental Disabilities, Child Development Disorders, Pervasive, Child, Preschool, Female, Fixation, Ocular, Humans, Infant, Male, Neuropsychological Tests, Pattern Recognition, Visual, Photic Stimulation, Risk Factors, Saccades, Early Diagnosis

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