Differential mask effects on emotion recognition and eye movements in Psychotic-like experiences and autism: Insights from hidden Markov Modeling.

Background: Facial mask wearing may disrupt facial emotion recognition (FER). The impact of masks on FER and associated eye movement patterns among individuals with autism spectrum disorder (ASD) and those with psychotic-like experiences (PLEs) remained unclear.

Methods: 180 ethnic Chinese individuals completed the FER task with eye-tracking, including two separate samples: 37 PLEs with 53 matched controls, and 45 ASD with 45 matched controls. The eye movement data were analyzed using Eye Movement analysis with Hidden Markov Models (EMHMM). MANCOVA was used to examine the mask and group effects on the performances and eye movements of FER, while regression analyses explored associations with subclinical measures.

Results: Facial masks impaired FER in all subjects. Differential effects of masks from matched controls on eye movement patterns and visual scanning consistency were only observed in the PLEs. The maladaptation of accuracy and visual scanning consistency due to masks were associated with subclinical psychotic symptoms and delusional ideations respectively. ASD presented poorer accuracy, slower reaction times, and less consistent eye movements compared to controls and PLEs. Imaginative cognition was related to the maladaptation of accuracy and eye movement due to masks in ASD. Schizotypal traits showed differential associations with eye movements in PLEs and ASD.

Conclusions: This study reveals maladaptation of eye movement behaviors during FER due to masks in PLEs, and distinct associations between FER with subclinical features in PLEs and ASD. It sheds light on the complex social cognitive processing and real-world social challenges faced by these populations in mask-prevalent environments.