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Cited by 412Autism Spectrum Disorder ResearchChild and Animal Learning DevelopmentFace Recognition and Perception

Atypical attentional networks and the emergence of autism

Open access
Keehn, Brandon, Müller, Ralph-Axel, Townsend, Jeanne·2013·Neuroscience & Biobehavioral Reviews
DOI 10.1016/j.neubiorev.2012.11.014PMC PMC3563720
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Abstract

The sociocommunicative impairments that define autism spectrum disorder (ASD) are not present at birth but emerge gradually over the first two years of life. In typical development, basic attentional processes may provide a critical foundation for sociocommunicative abilities. Therefore early attentional dysfunction in ASD may result in atypical development of social communication. Prior research has demonstrated that persons with ASD exhibit early and lifelong impairments in attention. The primary aim of this paper is to provide a review of the extant research on attention in ASD using a framework of functionally independent attentional networks as conceptualized by Posner and colleagues: the alerting, orienting and executive control networks (Posner and Petersen, 1990; Petersen and Posner, 2012). The neural substrates and typical development of each attentional network are briefly discussed, a review of the ASD attention literature is presented, and a hypothesis is proposed that links aberrant attentional mechanisms, specifically impaired disengagement of attention, with the emergence of core ASD symptoms.

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Crossref · 10.1016/j.neubiorev.2012.11.014

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Claims the paper makes

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  • Premisecitation

    Non-social attentional strengths and weaknesses in ASD, and their neurofunctional correlates, are associated with greater autism symptomatology.

    “Further, non-social attentional strengths (e.g., visual search) and weaknesses (e.g., novelty detection) in ASD and their neurofunctional correlates have also been associated with increased autism symptomatology (Belmonte, Gomot, & Baron-Cohen, 2010; Gomot, Belmonte, Bullmore, Bernard, & Baron-Cohen, 2008; Joseph, Keehn, Connolly, Wolfe, & Horowitz, 2009; Keehn & Joseph, 2008; Keehn, Lincoln, Mull”
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    • cites Belmonte et al., 2010 source

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    • cites Gomot et al., 2008 source

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    • cites Keehn & Joseph, 2008

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  • Interpretationreasoning

    Early problems with attention in ASD may lead to atypical development of social communication.

    “Therefore early attentional dysfunction in ASD may result in atypical development of social communication.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The sociocommunicative impairments that define ASD are absent at birth and emerge gradually over the first two years of life.
    • Rests on an assumption: In typical development, basic attentional processes provide a critical foundation for sociocommunicative abilities.
  • Premisecitation

    Findings from single-gene disorders with elevated ASD rates suggest a link between ASD symptoms and attentional dysfunction.

    “In addition, findings from single gene disorders that have increased rates of ASD (e.g., fragile X syndrome) suggest an association between ASD symptomatology and attentional dysfunction (Cornish et al., 2012; Roberts et al., 2012; Scerif et al., 2011).”
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    • cites Cornish et al., 2012 source

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  • Premisecitation

    Atypical attentional function may be among the earliest features that distinguish infants who later receive an ASD diagnosis.

    “and may be one of the earliest characteristics that distinguish infants who later receive an ASD diagnosis (Zwaigenbaum et al., 2005).”
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    • cites Zwaigenbaum et al., 2005 source

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  • Interpretationreasoning

    Attentional processes may influence the development of higher-level sociocommunicative functions.

    “Together, these findings suggest that attentional processes may impact the development of higher-level sociocommunicative functions.”
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    Premisecitation

    People with ASD show attention impairments that begin early and persist throughout life.

    “Prior research has demonstrated that persons with ASD exhibit early and lifelong impairments in attention.”
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    • cites Allen & Courchesne, 2001

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    • cites Burack et al., 1997

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    Premisenone given

    The alerting network achieves and maintains sensitivity to incoming information.

    “The alerting network is responsible for achieving and maintaining a state of sensitivity to incoming information.”
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    Premisecitation

    Tonic alertness and the waking state in infants change rapidly between 2 and 24 weeks.

    “The development of tonic alertness and the waking state – e.g.,. increased periods with open eyes, toy manipulation, and babbling – in infants changes rapidly between 2 and 24 weeks (Dittrichova & Lapackova, 1964).”
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    • cites Dittrichova & Lapackova, 1964

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    Premisecitation

    The locus coeruleus-norepinephrine system is the core arousal center, and the locus coeruleus projects to thalamic nuclei and terminates in cerebral cortex.

    “The nuclei of the reticular formation in the brain stem, specifically the locus coeruleus-norepinephrine (LC-NE) system, is the core arousal center (see Robbins & Everitt, 1995, for review). The LC projects to the thalamic nuclei and terminates in cerebral cortex (Foote, Bloom, & Aston-Jones, 1983).”
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    • cites Robbins & Everitt, 1995

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    • cites Foote et al., 1983 source

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    Premisecitation

    The alerting network is an interacting system of internal state-dependent mechanisms that can raise or lower information processing capacity and affect the breadth of selective attention.

    “The alerting network is an interacting system of internal state-dependent attentional mechanisms that can increase or decrease information processing capacity (Kahneman, 1973) and influence the breadth of selective attention (Easterbrook, 1959).”
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    Premisecitation

    Posner and Petersen conceptualized attention as three functionally independent networks: alerting, orienting, and executive control.

    “Posner and Petersen (1990; 2012) conceptualized attention as consisting of three functionally independent attentional networks, which are responsible for a distinct set of cognitive processes: the alerting, orienting, and executive control networks.”
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    • cites Posner and Petersen, 1990 source

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    • cites Petersen & Posner, 2012 source

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    Premisecitation

    Alertness has tonic and phasic components.

    “Alertness has been divided into tonic and phasic components (see Sturm & Willmes, 2001, for review).”
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    • cites Sturm & Willmes, 2001 source

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    Interpretationnone given

    Early deficits in disengaging attention produce a cascade of impairments and ultimately contribute to the emergence of the ASD phenotype.

    “Specifically, we posit that early deficits in disengaging attention result in cascade of impairments and ultimately contribute to the emergence of the ASD phenotype.”
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    Premisecitation

    Early infant attention serves to achieve an optimal arousal state and depends on external stimulation and internal arousal.

    “Early infant attention functions to achieve an optimal state of arousal and is dependent on the amount of external stimulation and on the level of internal arousal (Karmel, Gardner, & Magnano, 1991).”
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    • cites Karmel et al., 1991

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    Premisecitation

    Stimulus orienting measured by heart-rate deceleration increases rapidly during the first year, with no significant developmental changes between 14 and 26 weeks.

    “Stimulus orienting (i.e., a phasic OR), as measured by a deceleration of heart rate (HR), increases rapidly during the first year of life with no significant developmental changes occurring in infants between 14 and 26 weeks of age (see Reynolds & Richards, 2008, for review).”
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    • cites Reynolds & Richards, 2008

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    Premisenone given

    The efficiency and degree of phasic alerting is modulated by tonic alertness, and goal-directed changes in tonic alertness affect task performance.

    “The efficiency and degree of phasic alerting is modulated by the level of tonic alertness, while goal-directed changes in levels of tonic alertness affect task performance.”
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    Premisenone given

    Novelty detection requires a mismatch between an existing representation and a novel stimulus, and a phasic orienting response does not occur without perception of a novel stimulus.

    “Novelty detection is a fundamental characteristic of Sokolov’s OR, and is dependent on a mismatch between an individual’s pre-existing representation and a novel stimulus; a phasic OR does not take place without the perception of a novel stimulus.”
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    Premisecitation

    The Nc component appears in the first year during attentive states, increasing in amplitude and decreasing in latency with development.

    “The Nc component appears in the first year of life during attentive states, increasing in amplitude while decreasing in latency with development (Richards, 2003).”
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    • cites Richards, 2003 source

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    The P3 response is modality-independent and is generally elicited with an odd-ball paradigm.

    “The modality-independent P3 response is generally elicited using an odd-ball paradigm (analogous to a continuous performance task; see Figure 2C), which requires a manual response to a prespecified target displayed infrequently amongst standard stimuli (some odd-ball paradigms also include a third novel non-target stimuli).”
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    Premisecitation

    P3a and P3b reflect activity of separate neural generators and neurotransmitter systems.

    “Previous research has demonstrated that these components reflect activity of separate neural generators and neurotransmitter systems (Polich, 2007) and involve regions such as the temporal-parietal junction, lateral prefrontal cortex, and the locus coeruleus (see Nieuwenhuis, Aston-Jones, & Cohen, 2005, for discussion).”
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    Premisecitation

    Developmental changes in the P3 from childhood to adulthood include decreased latency and changes in scalp distribution.

    “Developmental changes of the P3 component from early child- to adulthood include decreased latency (Courchesne, 1978; Cycowicz, Friedman, & Rothstein, 1996; Zenker & Barajas, 1999) and changes in scalp distribution (Courchesne, 1978; Cycowicz et al., 1996).”
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    • cites Courchesne, 1978 source

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    • cites Cycowicz et al., 1996 source

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    • cites Zenker & Barajas, 1999

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    Premisecitation

    Phasic alerting mechanisms continue to develop until age 8, when they may have reached adult levels.

    “Behaviorally, phasic alerting mechanisms continue to develop until age 8 years, at which point they may have matured to adult levels (Morrison, 1982).”
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    • cites Morrison, 1982 source

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    Premisecitation

    The Nc component has been hypothesized to represent an orienting response insensitive to novelty and stimulus probability, although novelty and meaningfulness may contribute to larger Nc responses.

    “This component has been hypothesized to represent an OR that is insensitive to novelty and stimulus probability (Nelson & Collins, 1992; Richards, 2003), although stimulus novelty (Reynolds & Richards, 2005) and/or meaningfulness (de Haan & Nelson, 1999) may play a role in larger Nc responses.”
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    • cites Nelson & Collins, 1992

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    • cites Richards, 2003 source

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    Premisecitation

    Sustained attention ability increases rapidly from 2 to 6 months of age.

    “However, sustained attention (i.e., the voluntary maintenance of alertness) undergoes a more protracted developmental time course, with the ability to sustain attention increasing rapidly from 2 to 6 months of age (Richards, 1995).”
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    • cites Richards, 1995

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    Premisecitation

    The P3 component consists of a frontocentral P3a subcomponent and a parietal P3b subcomponent.

    “Briefly, the P3 component consists of two subcomponents: 1) a frontocentral P3a (or “novelty P3”; Friedman, Cycowicz, & Gaeta, 2001) component that habituates rapidly and is associated with the redirection of attention monitoring during stimulus discrimination, and 2) a parietal P3b component that reflects a memory comparison and facilitates context maintenance.”
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    • cites Friedman et al., 2001 source

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    Premisecitation

    The Nc component occurs between 350 and 800 ms after stimulus onset at central electrode sites.

    “The Nc component occurs between 350–800ms post-stimulus onset at central electrode sites.”
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    • cites Courchesne, 1977 source

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    Interpretationreasoning

    Developmental decreases in alerting scores are likely caused by changes in tonic alertness, because younger children have difficulty maintaining appropriate tonic alertness.

    “Developmental decreases in alerting scores are likely due to changes in the level of tonic alertness; younger children have difficulty maintaining appropriate levels of tonic alertness.”
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    Premisecitation

    Heart-rate measures show decreased HR deceleration or relative acceleration and increased baseline HR in ASD compared with TD individuals.

    “Heart rate measures have shown decreased HR deceleration (or a relative acceleration) (Palkovitz & Wiesenfeld, 1980) and increased baseline HR (Ming, Julu, Brimacombe, Connor, & Daniels, 2005) in ASD as compared to TD individuals.”
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    • cites Palkovitz & Wiesenfeld, 1980

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    Premisecitation

    Evidence for hyperarousal in ASD includes increased skin conductance levels and more frequent skin conductance responses.

    “Studies examining skin conductance have demonstrated increased skin conductance levels (SCL) and frequency of skin conductance responses (SCR) (Palkovitz & Wiesenfeld, 1980).”
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    • cites Palkovitz & Wiesenfeld, 1980

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    Premisecitation

    Alerting scores increase between ages 4 and 7, remain similar between ages 6 and 10, and 10-year-old children show significantly higher alerting scores than adults.

    “The alerting score which reflects both phasic and tonic components of alertness (Posner, 2008), increases between the ages of four and seven years (Mezzacappa, 2004), but remains similar between the ages of six to ten years (Rueda et al., 2004). However, the process continues to mature as 10-year-old children show significantly higher alerting scores than adults (Rueda et al., 2004).”
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    • cites Mezzacappa, 2004 source

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    Premisecitation

    Sustained attention measured by continuous performance tests increases significantly from 3 to 6 years and continues developing into late childhood and adolescence, reaching adult-like levels around age 12.

    “Sustained attention abilities, as measured by the CPT, increase significantly from 3 to 6 years of age (Akshoomoff, 2002; Kerns & Rondeau, 1998; Levy, 1980) and continue to develop into late childhood and adolescence, reaching adult-like levels around the age of 12 years (Lin, Hsiao, & Chen, 1999).”
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    Interpretationreasoning

    Increased ASD activation to active novelty detection may reflect over-focusing in the ASD group, which could lead to maladaptive allocation of attention.

    “However, the authors suggest that increased ASD activation to active novelty detection may reflect over-focusing in the ASD group, which could result in maladaptive allocation of attention.”
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    Premisecitation

    Courchesne et al. reported decreased P3a amplitudes to novel auditory stimuli and reduced P3b to target auditory compared with standard stimuli in ASD versus TD adolescents.

    “More specifically, Courchesne et al. (1984; 1985) reported decreased P3a amplitudes to novel auditory stimuli, as well as reduced P3b to target auditory compared to standard stimuli in ASD as compared to TD adolescents.”
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    • cites Courchesne et al., 1984 source

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    Premisecitation

    In fMRI, passive detection of novel auditory stimuli produced greater activation in bilateral TPJ and right inferior and middle frontal regions in TD than ASD participants, while active novelty detection produced greater activation in right prefrontal cortex and left inferior parietal lobule in ASD than TD participants.

    “Passive detection of novel auditory stimuli resulted in greater activation in bilateral temporal parietal junction (TPJ) and right inferior and middle frontal regions in TD compared to ASD participants. In contrast, active novelty detection task (requiring behavioral response) resulted in significantly greater activation in the right prefrontal cortex and left inferior parietal lobule in the ASD”
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    • cites Gomot et al., 2008 source

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    Premisecitation

    Electrophysiological measures show atypical phasic alerting in ASD, including reduced N1c amplitude, reduced or absent Nc response, and reduced Nc amplitudes in 10-month-old at-risk infants.

    “The N1c component, which reflects automatic attentional capture resulting from an auditory stimulus, is reduced in amplitude in ASD as compared to TD children (Bruneau, Bonnet-Brilhault, Gomot, Adrien, & Barthelemy, 2003; Orekhova et al., 2009). Reduced (Courchesne et al., 1985) or absent (Ciesielski, Courchesne, & Elmasian, 1990) Nc response has also been shown in adolescents and adults with ASD.”
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    • cites Bruneau et al., 2003 source

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    • cites Orekhova et al., 2009 source

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    • cites Courchesne et al., 1985 source

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    Interpretationcitation

    Alerting and executive networks may interact more in individuals with ASD, and difficulty controlling arousal may produce impaired executive control abilities.

    “These findings suggest that alerting and executive networks may interact to a greater degree in individuals with ASD, and as a result difficulty controlling the level of arousal may produce impaired executive control abilities (discussed in greater detail in Section 3.1).”
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    Premisecitation

    Evidence in ASD includes increased plasma norepinephrine, increased pupil diameter, aberrant skin conductance responses and levels, atypical heart rate, abnormal electrophysiological alerting and novelty detection responses, and atypical neurofunctional activation of the alerting network.

    “There is evidence for increased plasma-levels of norepinephrine (Lam, Aman, & Arnold, 2006), increased pupil diameter, aberrant skin conductance responses and levels, atypical heart rate, abnormal electrophysiological alerting response (Nc, N1c) and novelty detection (P3), and atypical neurofunctional activation of the alerting network in persons with ASD.”
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    • cites Lam et al., 2006 source

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    Premisecitation

    Increased arousal was related to poorer response inhibition performance in ASD but not TD individuals.

    “Similarly, Raymaeker and colleagues (2004) demonstrated that increased arousal was related to poorer response inhibition performance in ASD but not TD individuals.”
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    • cites Raymaeker et al., 2004

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    Interpretationreasoning

    Although some studies report unimpaired phasic and endogenous tonic alertness in ASD, the reviewed evidence suggests that under some conditions or in some individuals there are impairments of tonic and phasic components of the alerting network in ASD.

    “Although some studies report unimpaired phasic and endogenous tonic alertness in ASD, the evidence reviewed here suggests that under some conditions or in some individuals, there are impairments of tonic (arousal) and phasic components of the alerting network in ASD.”
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    Premisecitation

    TD children show no correlations between network scores, whereas children with ASD show significant correlations between alerting and executive control networks.

    “Interestingly, whereas there were no correlations between network scores for TD children (as reported previously; see Rueda et al., 2004), children with ASD exhibited significant correlations between alerting and executive control networks suggesting that these two networks may not function as independently in children with ASD.”
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    Interpretationcitation

    Increased activation in ASD relative to TD in right frontoparietal regions has been interpreted as over-focusing, while decreased activation to novel information during passive tasks may indicate a default processing state that rejects or ignores novelty.

    “Specifically, increased activation in ASD (relative to TD peers) in right frontoparietal regions has been interpreted as over-focusing (Gomot et al., 2008), while atypically decreased activation to novel information in ASD during passive tasks may be indicative of a default processing state that rejects or ignores novelty (Gomot et al., 2006).”
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    • cites Gomot et al., 2008 source

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    Premisenone given

    Attention may be directed reflexively or voluntarily to a spatial location based on central or peripheral cues.

    “Attention may also be directed reflexively (automatically) or voluntarily to a spatial location based on central (endogenous) or peripheral (exogenous) cues.”
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    Premisenone given

    The orienting network selects information from sensory input.

    “The orienting network is responsible for the selection of information from sensory input.”
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    Premisecitation

    Non-spatial cues that increase phasic alertness can facilitate attention orienting, and disengaging and re-orienting attention may attenuate arousal levels.

    “For example, non-spatial cues (that result in increased phasic alertness) can facilitate attention orienting (Callejas et al., 2004; 2005), while disengaging and re-orienting attention may serve to attenuate arousal levels (Derryberry & Rothbart, 1988).”
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    • cites Callejas et al., 2004 source

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    • cites Derryberry & Rothbart, 1988 source

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    Premisecitation

    Reflexive orienting occurs to non-predictive peripheral and central cues, while predictive peripheral and central cues engage voluntary and reflexive orienting mechanisms that interact in a super-additive manner.

    “In commonly used spatial attention testing paradigms, reflexive orienting occurs to both peripheral and central (arrows, gaze) non-predictive (i.e., 50% trials validly cued) cues. Predictive (e.g. 80% of trials validly cued) peripheral and central (arrows, gaze) cues engage voluntary as well as reflexive orienting mechanisms, which interact in a super-additive manner (Olk, Cameron, & Kingstone, 20”
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    • cites Olk et al., 2008 source

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    Premisecitation

    Visuospatial orienting is defined as disengaging, shifting, and reengaging attention.

    “Posner and colleagues (1984) have defined visuospatial orienting as disengaging, shifting, and reengaging attention.”
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    • cites Posner et al., 1984 source

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    Interpretationreasoning

    Alerting abnormalities in ASD cannot be characterized simply by atypical tonic arousal levels, but may also include impairments in regulating alertness across situations and differences in active and passive tasks.

    “Thus, alerting abnormalities in ASD cannot be characterized simply by atypical tonic levels of arousal, but may also include the impairments in regulating levels of alertness across different situations and differences in active and passive tasks.”
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    Premisecitation

    Orienting visual attention facilitates processing over a localized area.

    “In contrast to the phasic alerting mechanisms that respond homogeneously across the visual field, orienting visual attention facilitates processing over a localized area (e.g., Mangun & Hillyard, 1991).”
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    • cites Mangun & Hillyard, 1991

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    Premisecitation

    Acetylcholine is the neuromodulator associated with the orienting network, and increased acetylcholine results in more rapid attention reorienting.

    “Acetylcholine (ACh) is the neuromodulator associated with the orienting network, with increased levels of ACh resulting in more rapid attention reorienting (Thiel, Zilles, & Fink, 2005; Witte, Davidson, & Marrocco, 1997).”
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    • cites Thiel et al., 2005 source

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    • cites Witte et al., 1997 source

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    Premisecitation

    By 3 months, infants are sensitive to direction of gaze and direct attention towards gaze-cued locations.

    “By the age of 3 months, infants are also sensitive to direction of gaze and direct their attention towards gaze-cued locations (Hood, Willen, & Driver, 1998).”
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    • cites Hood, Willen, & Driver, 1998

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    Premisecitation

    Acetylcholine may expand the attentional spotlight so that attentional misdirection does not elicit a reorienting response.

    “Specifically, ACh may act to expand the attentional spotlight so that attentional misdirection does not elicit a reorienting response (Thiel et al., 2005).”
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    • cites Thiel et al., 2005 source

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    Premisecitation

    Evidence from individuals with cortical and subcortical lesions suggests reflexive orienting is likely mediated by subcortical and more posterior cortical regions, while frontal-parietal regions underlie voluntary orienting.

    “Evidence from individuals with cortical and subcortical lesions suggests that reflexive orienting is likely mediated by subcortical and more posterior cortical regions, while a network of frontal-parietal regions underlie voluntary orienting (Rafal, 1998).”
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    • cites Rafal, 1998

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    Premisecitation

    Research using endogenous cuing paradigms suggests that the development of orienting may reach adult-like levels by 8 to 9 years of age.

    “This is consistent with research using endogenous cuing paradigms, which suggests that the development of orienting may reach adult-like levels by 8 to 9 years of age (Goldberg, Maurer, & Lewis, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Goldberg, Maurer, & Lewis, 2001

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

    Premisecitation

    The cerebellum may play a role in both covert and overt orienting of attention.

    “Furthermore, the cerebellum may also play a role in both covert and overt orienting of attention (Akshoomoff, Courchesne, & Townsend, 1997; Pelisson, Goffart, Guillaume, & Quinet, 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Akshoomoff et al., 1997 source

      Not checked in the free run.

    • cites Pelisson et al., 2003 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Overt orienting to exogenous cues is limited in 2-month-old infants, but clear orienting including facilitation and inhibition by peripheral cues appears by 4 months, with speed of spatial attention shifting increasing from 4 to 7 months.

    “Overt orienting to exogenous cues is limited in 2-month-old infants; however, clear orienting including facilitation and inhibition by peripheral cues appears by 4 months of age, with speed of spatial attention shifting increasing from 4 to 7 months (M. H. Johnson & Tucker, 1996).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites M. H. Johnson & Tucker, 1996

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Abnormal function of the network underlying reflexive orienting and relatively spared, though still atypical, network underlying more voluntary orienting in ASD.

    “These results are in agreement with previous neuroimaging findings that suggest abnormal function of the network underlying reflexive orienting and relatively spared, though still atypical, network underlying more voluntary orienting in ASD (Haist, Adamo, Westerfield, Courchesne, & Townsend, 2005).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Retrospective home video analysis reported that ASD infants orient to visual stimuli less, do not orient towards people or human voices as frequently as TD infants, and orient to name significantly less compared to TD and DD infants.

    “Studies using retrospective home video analysis have also reported that ASD infants orient to visual stimuli less (Baranek, 1999), do not orient towards people or human voices as frequently as TD infants (Maestro et al., 2002), and orient to name significantly less as compared to TD and DD infants (Osterling & Dawson, 1994; Osterling et al., 2002).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Baranek, 1999 source

      Not checked in the free run.

    • cites Maestro et al., 2002 source

      Not checked in the free run.

    • cites Osterling & Dawson, 1994 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Individuals with ASD do not reflexively orient attention to shifts in gaze, but can use volitional control of attention.

    “These findings suggest that individuals with ASD do not reflexively orient attention to shifts in gaze, but can use volitional control of attention (but see Wainwright-Sharp & Bryson, 1993, for example of impaired volitional orienting).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Children with ASD showed significantly increased latencies to disengage visual attention on overlap trials, but similar response latencies to shift visual attention on gap trials compared to both comparison groups.

    “Landry and Bryson (2004) examined gap-overlap performance in children with ASD, CA-matched children with Downs syndrome, and MA-matched TD children, and demonstrated that the ASD group showed significantly increased latencies to disengage visual attention (on overlap trials), but similar response latencies to shift visual attention on gap trials compared to both comparison groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Landry & Bryson, 2004

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children and adolescents with ASD showed intact endogenous, but impaired exogenous orienting.

    “Renner and colleagues (2006) showed intact endogenous, but impaired exogenous orienting in children and adolescents with ASD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Renner et al., 2006 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Conflicting results may be due to low statistical power and cohort effects in very small sample studies, or large differences in gap-overlap paradigms.

    “However, conflicting results may in some cases be due to low statistical power and cohort effects in very small sample studies (ASD n = 7 in Kawabuko et al., 2004), or large differences in gap-overlap paradigms (e.g., Leekam et al., 2000).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Set shifting continues to develop between 8 and 13 years of age and does not reach adult levels until approximately 15 years of age.

    “The currently limited literature suggests that this executive component continues to develop between 8 and 13 years of age (Lehto, Juujarvi, Kooistra, & Pulkkinen, 2003), and does not reach adult levels until approximately 15 years of age (Huizinga et al., 2006).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lehto et al., 2003 source

      Not checked in the free run.

    • cites Huizinga et al., 2006 source

      Not checked in the free run.

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

    Premisecitation

    Neural substrates of executive control include regions within the prefrontal cortex (orbitofrontal, ventrolateral, dorsolateral), medial frontal regions (ACC), and subcortical regions such as basal ganglia and cerebellum.

    “The neural substrates of executive control include regions within the prefrontal cortex – orbitofrontal, ventrolateral prefrontal, and dorsolateral prefrontal cortex (DLPFC) – as well as medial frontal regions (anterior cingulate cortex; ACC) and subcortical regions such as the basal ganglia and cerebellum (Heyder, Suchan, & Daum, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Heyder, Suchan, & Daum, 2004

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Executive control is not mediated by a unitary mechanism, but can be dissociated into at least three separate but associated functions - set shifting, working memory, and inhibition - in TD children and adults.

    “Recent studies have shown that executive control is not mediated by a unitary mechanism, but can be dissociated into at least three separate but associated functions – set shifting, working memory, and inhibition, – in TD children and adults (Huizinga, Dolan, & van der Molen, 2006; Miyake et al., 2000).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Huizinga, Dolan, & van der Molen, 2006 source

      Not checked in the free run.

    • cites Miyake et al., 2000 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Investigations of children, adolescents, and adults with ASD have revealed slower, less efficient visual orienting abilities and fewer express saccades; reflexive orienting may be more impaired than volitional shifts of attention, although there is some conflicting evidence.

    “Furthermore, investigations of children, adolescents, and adults with ASD have revealed slower, less efficient visual orienting abilities and fewer express saccades; reflexive orienting may be more impaired than volitional shifts of attention, although there is some conflicting evidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Impaired disengagement has been demonstrated in low-functioning adults with ASD and at-risk infants.

    “Impaired disengagement has also been demonstrated in low-functioning adults with ASD (Kawakubo et al., 2007) and at-risk infants (Elsabbagh et al., 2009; Zwaigenbaum et al., 2005).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Kawakubo et al., 2007 source

      Not checked in the free run.

    • cites Elsabbagh et al., 2009 source

      Not checked in the free run.

    • cites Zwaigenbaum et al., 2005 source

      Not checked in the free run.

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

    Premisecitation

    Working memory functions develop gradually during the preschool period and continue to develop between 8 and 13 years of age, reaching adult-like levels after age 15 years.

    “Working memory functions, such as capacity and the ability to manipulate online information, develop gradually during the preschool period (see Garon, Bryson, & Smith, 2008, for review), and continue to develop between 8 and 13 years of age (Lehto et al., 2003), reaching adult-like levels after age 15 years (Huizinga et al., 2006).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Garon, Bryson, & Smith, 2008 source

      Not checked in the free run.

    • cites Lehto et al., 2003 source

      Not checked in the free run.

    • cites Huizinga et al., 2006 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    By age 11 years, children perform at adult levels on the Eriksen Flanker task and Stop-Signal task.

    “By age 11 years, children perform at adult levels on the Eriksen Flanker task and Stop-Signal task (Huizinga et al., 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huizinga et al., 2006 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Simple inhibitory processes come online within the first year of life and develop during preschool years, while more complex inhibitory processes appear later in preschool years and continue to develop through school age.

    “Simple inhibitory processes come online within the first year of life and develop during preschool years, while more complex inhibitory processes appear later in preschool years and continue to develop through school age (Garon et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Garon et al., 2008 source

      Not checked in the free run.

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

    Premisecitation

    Performance on the ID/ED subtest of the CANTAB appears to reach adult levels by approximately 8 years of age.

    “Surprisingly, performance on the Intradimensional/Extradimensional (ID/ED) subtest of the CANTAB appears to reach adult levels by approximately 8 years of age (De Luca et al., 2003; Luciana & Nelson, 1998).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites De Luca et al., 2003 source

      Not checked in the free run.

    • cites Luciana & Nelson, 1998

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with ASD demonstrate relatively intact inhibitory and working memory processes, but impaired cognitive flexibility/set shifting abilities.

    “Ozonoff and colleagues (2005) concluded that individuals with ASD demonstrate relatively intact inhibitory and working memory processes, but impaired cognitive flexibility/set shifting abilities (although see Geurts, Corbett et al., 2009, for discussion of intact cognitive flexibility).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ozonoff et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adults with ASD show impaired attention shifting between auditory and visual modalities, similar to patients with cerebellar lesions.

    “Courchesne and colleagues (1994) found impaired attention shifting between auditory and visual modalities in adults with ASD, similar to patients with cerebellar lesions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Courchesne et al., 1994 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The WCST is not a pure measure of set shifting abilities, and impaired performance in ASD may be due to alternative factors.

    “however, the WCST is not a pure measure of set shifting abilities, and thus impaired performance in ASD may be due to a number of alternative factors (see Geurts, Corbett et al., 2009, for a more detailed discussion).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Results of studies examining working memory in ASD are inconsistent, possibly due to varying capacity, maintenance, and manipulation demands of each task.

    “The results of studies examining working memory in ASD are inconsistent, possibly due to the varying degree of capacity, maintenance, and manipulation demands of each task.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    These deficits reflect slowed rather than absent shifts, as both groups were able to shift attention when given more time (>2.5s).

    “These deficits reflect slowed rather than absent shifts as both groups were able to shift attention when given more time (>2.5s).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Courchesne et al., 1994 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children and adults with ASD show equivalent verbal working memory but impaired spatial working memory performance.

    “Williams and colleagues (2005) reported equivalent performance of verbal working memory (N-back, Letter-Number Sequencing), but impaired spatial working memory performance (Spatial Span, Finger-Windows subtests) in children and adults with ASD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Williams et al., 2005 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Working memory deficits in ASD may be due to load and/or poor or inefficient use of strategies.

    “Yet, close inspection suggests that the working memory deficits may be due to load (Garcia-Villamisar & Della Sala, 2002) and/or poor or inefficient use of strategies (Corbett et al., 2009; Steele et al., 2007).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    On tasks that isolate inhibitory processing, individuals with ASD have shown typical levels of performance; when measures of inhibition are paired with other executive components, deficits in inhibitory abilities may be observed.

    “On tasks that tend to isolate inhibitory processing from other executive functions, individuals with ASD have shown typical levels of performance (e.g. Ozonoff & Strayer, 1997); although when measures of inhibition are paired with other executive components (e.g. set switching), deficits in inhibitory abilities may be observed in ASD (e.g. Ozonoff, Strayer, McMahon, & Filloux, 1994).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Ozonoff & Strayer, 1997 source

      Not checked in the free run.

    • cites Ozonoff et al., 1994

      Not checked in the free run.

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

    Interpretationnone given

    The degree to which executive control abilities improve with development remains unclear.

    “The degree to which executive control abilities improve with development remains unclear.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The prepotency to saccade towards a peripheral target may be one of the more difficult actions to inhibit, requiring an extended period to mature.

    “This indicates that the prepotency to saccade towards a peripheral target may be one of the more difficult actions to inhibit, and therefore requires an extended period in order to mature.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Executive control is not a unitary construct, but consists of at least three independent, but associated components: set shifting, working memory, and inhibition.

    “Executive control is not a unitary construct, but instead consists of at least three independent, but associated components: set shifting, working memory, and inhibition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The trajectory of development appears similar in ASD and TD individuals; however, there are conflicting reports of age-related improvement or decline, which may be related to the executive component tested.

    “The trajectory of development appears similar in ASD and TD individuals (Luna et al., 2007); however, there are conflicting reports of age-related improvement (Happé et al., 2006) or decline (Solomon et al., 2008), which may be related to the executive component tested (Ozonoff et al., 2004).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    Executive dysfunction in ASD may result from poor coordination among brain regions needed for complex executive tasks.

    “Just and colleagues (2007) have hypothesized that executive dysfunction in ASD may result from poor coordination between brain regions necessary to complete complex executive tasks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Just et al., 2007 source

      Not checked in the free run.

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

    Premisecitation

    Reductions in functional connectivity in ASD may depend on age.

    “although these reductions in functional connectivity may be age-dependent (Lee et al., 2009)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lee et al., 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    These executive components are mediated primarily by prefrontal cortex and undergo more protracted development compared to the other attentional networks.

    “These components are mediated primarily by prefrontal cortex and undergo more protracted development compared to the other attentional networks.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Individuals with ASD may show both hyper- and hypo-aroused states, reflecting impaired arousal modulation or separate subgroups.

    “As reviewed above, individuals with ASD may demonstrate both hyper- and hypo-aroused states, which may be a reflection of either impaired modulation of arousal or separate subgroups of individuals with ASD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Abnormal arousal levels have developmental consequences for restricted and repetitive behaviors.

    “3) restricted and repetitive behaviors”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Dawson & Lewy, 1989a

      Not checked in the free run.

    • cites Gold & Gold, 1975

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Abnormal arousal levels have developmental consequences for reduced attention to social information.

    “2) reduced attention to social information”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Dawson & Lewy, 1989a

      Not checked in the free run.

    • cites Gold & Gold, 1975

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Abnormal arousal levels have developmental consequences for the efficiency of executive control abilities.

    “5) reduced efficiency of executive control abilities”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Dawson & Lewy, 1989a

      Not checked in the free run.

    • cites Gold & Gold, 1975

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    Abnormal arousal levels have developmental consequences for over-focused attention.

    “4) over-focused attention”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Dawson & Lewy, 1989a

      Not checked in the free run.

    • cites Gold & Gold, 1975

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Abnormal arousal levels have developmental consequences for the perception of novel information.

    “abnormal arousal levels would have developmental consequences in a variety of domains including: 1) abnormal perception of novel information”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Dawson & Lewy, 1989a

      Not checked in the free run.

    • cites Gold & Gold, 1975

      Not checked in the free run.

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

    Interpretationreasoning

    Reduced P3 amplitude in ASD could reflect atypical subcortical modulation of the LC-NE system.

    “Reduced amplitude of the P3 component in ASD could also reflect atypical subcortical modulation of the LC-NE system”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Social dysfunction may result from an abnormal reward system associated with social stimuli.

    “This would be in agreement with a previous theory of ASD that suggests that social dysfunction may result from an abnormal reward system associated with social stimuli (Dawson et al., 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dawson et al., 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    One model of ASD hypothesizes that the disorder reflects an abnormally increased ratio of excitation to inhibition.

    “One model of ASD has hypothesized that the disorder may reflect an abnormally increased ratio of excitation to inhibition (Hussman, 2001; Rubenstein & Merzenich, 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hussman, 2001 source

      Not checked in the free run.

    • cites Rubenstein & Merzenich, 2003 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    Atypical subcortical-cortical anatomical connectivity could result in reduced P3a amplitudes in ASD.

    “The idea that atypical subcortical-cortical anatomical connectivity could result in reduced P3a amplitudes in ASD has been previously hypothesized (Dawson & Lewy, 1989b).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dawson & Lewy, 1989b

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Repeated early overarousal during social interactions may make social information aversive and reduce intrinsic reward from social interactions in ASD.

    “Following repeated instances of overarousal during early social interactions, social information may become aversive and individuals with ASD may not perceive social interactions as intrinsically rewarding.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Increased pupil diameter in ASD may indirectly reflect increased tonic LC-NE activity, which could reduce phasic responsiveness to novel stimuli.

    “thus increased pupil diameter in ASD may indirectly reflect increased tonic activity of the LC-NE system, which could result in reduced phasic responsiveness to novel stimuli.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Research to date has only started to characterize when and how attentional impairments emerge in ASD.

    “The current body of research has only begun to describe the onset and development of attentional impairments in ASD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increased amygdala activity in ASD in response to attention to eyes and subsequent gaze avoidance have been replicated.

    “These results were replicated by Kliemann et al. (2012), who also report increased amygdala activity in ASD in response to attention to eyes, and, moreover, subsequent gaze avoidance as measured by the frequency of shifting attention away from the eye region.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kliemann et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    ASD may involve atypical arousal regulation, possibly with hyper- and hypoarousal subgroups.

    “ASD may be characterized by dysmodulation of arousal (perhaps with subgroups of hyper- and hypoarousal) and impaired novelty processing, slowed attentional disengagement and shifting, and poorer performance on complex executive control tasks (i.e. requiring more than one executive function).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Inattention to faces and atypical face processing may be secondary to impaired attention disengagement and develop later because of earlier overarousal during face-to-face exchanges.

    “which may in turn suggest that inattention to faces and atypical face processing are secondary to impaired attention disengagement and develop later due to earlier overarousal during face-to-face exchanges.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Avoidance of eye contact may be a strategy used by individuals with ASD to reduce arousal and may lead to dysfunctional face and gaze processing strategies.

    “These authors hypothesized that the avoidance of eye contact may be a strategy used by individuals with ASD in order to reduce arousal, and may result in dysfunctional face and gaze processing strategies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dalton et al., 2005 source

      Not checked in the free run.

97 of 97

  • The paper relies on this without support.

    The sociocommunicative impairments that define ASD are absent at birth and emerge gradually over the first two years of life.

    “The sociocommunicative impairments that define autism spectrum disorder (ASD) are not present at birth but emerge gradually over the first two years of life.”

  • The paper relies on this without support.

    In typical development, basic attentional processes provide a critical foundation for sociocommunicative abilities.

    “In typical development, basic attentional processes may provide a critical foundation for sociocommunicative abilities.”

  • The authors state this as an assumption.

    Abnormal disengagement of attention is a primary disturbance in ASD.

    “the current framework makes the initial assumption that abnormal disengagement of attention represents a primary disturbance in ASD.”

  • The paper relies on this without support.

    Attentional function in ASD can be understood through the framework of three attentional networks: alerting, orienting, and executive control.

    “This paper reviews attentional function in ASD within the framework of three attentional networks.”

  • The paper relies on this without support.

    Atypical attentional disengagement is a primary impairment in ASD.

    “The proposed developmental framework attempts to explain the diverse and heterogeneous nature of ASD by exploring the hypothesis that atypical attentional disengagement may be one of many primary impairments associated with the disorder.”
5 of 5

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?

  • Attentional differences appear to be an early precursor to core processes affected in autism, including joint attention, arousal regulation, and perceptual processing.

    “attentional differences appear to be an early precursor to core processes affected in autism (including joint attention, arousal regulation, and perceptual processing; Keehn et al., 2013).”

    From Cognitive Profile in Autism and ADHD: A Meta-Analysis of Performance on the WAIS-IV and WISC-V (2024) · cites this paper as Keehn et al., 2013

The citation lists haven’t been fetched yet

References 321 · Cited by 412

Authors
Keehn, B., Müller, R.-A., & Townsend, J.
Affiliations
  • Boston Children's Hospital (US)
  • San Diego State University (US)
  • University of California San Diego (US)
Corresponding author
Keehn, Brandon
ORCID
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2013-02
Volume
37
Issue
2
Pages
164-183
ISSN
0149-7634 (ISSN-L)
DOI
10.1016/j.neubiorev.2012.11.014
PMC
PMC3563720
OpenAlex
W2067020152
Cited by
412
References
321
Citations by year
2026: 36 · 2025: 20 · 2024: 32 · 2023: 22 · 2022: 24 · 2021: 35 · 2020: 60 · 2019: 39 · 2018: 30 · 2017: 29 · 2016: 28 · 2015: 22 · 2014: 19 · 2013: 16
FWCI
1.44
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Autism Speaks (AS7629)
  • National Institute of Mental Health (R01MH081023)
  • National Institute of Neurological Disorders and Stroke (P50 NS 22343, R21NS070296, P50NS022343)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Developmental and Educational Psychology › Child and Animal Learning Development
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Face Recognition and Perception
Keywords
autism spectrum disorder, attentional networks, attentional disengagement, alerting network, orienting network, executive function, social communication development
MeSH terms
Attention, Autistic Disorder, Brain, Child Development, Humans, Infant, Neural Pathways, Orientation, Executive Function

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

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