Face perception, attention, and memory as predictors of social change in autistic children.

Objective: Social perception and attention markers have been identified that, on average, differentiate autistic from non-autistic children. However, little is known about how these markers predict behavior over time at both short and long time intervals.

Methods: We conducted a large multisite, naturalistic study of 6- to 11-year-old children diagnosed with ASD ( = 214). We evaluated three markers of social processing: social perception via the ERP N170 Latency to Upright Faces; social attention via the Eye Tracking (ET) OMI (Oculomotor Index of Gaze to Human Faces) that captures percent looking to faces from three tasks; and social cognition via the NEPSY Face Memory task. Each was evaluated in predicting social ability and autistic social behaviors derived from parental interviews and questionnaires about child behavior at + 6 months (T3) and + 4 years (T4).

Results: Adjusting for baseline performance, time between measurements, age, and sex, our results suggest differential prognostic relations for each of the markers. The ERP N170 Latency to Upright Faces showed limited prognostic relations, with a significant relation to short term changes in face memory. The ET OMI was related to face memory over both short and long term. Both the ET OMI and Face Memory predicted long-term autistic social behavior scores.

Conclusions: In the context of a large-scale, rigorous evaluation of candidate markers for use in future clinical trials, our primary markers had significant but small-effect prognostic capability. The ET OMI and Face Memory showed significant long-term predictive relations, with increased visual attention to faces and better face memory at baseline related to increased social approach and decreased autistic social behaviors 4 years later.

Supplementary Information: The online version contains supplementary material available at 10.1186/s11689-025-09646-0.