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For whom does eye tracking track: A brief report on social attention as a precision biomarker for clinical trials in autism

Year: 2026
Type: article
Abstract: Autism spectrum disorder (ASD) is characterized by social communication impairments and atypical social attention, yet pharmacological interventions targeting these core symptoms remain elusive. Biomarkers such as eye tracking offer promise for improving outcome measurement in clinical trials; however, their utility may vary across autism clinical phenotypes. This pilot study examines whether eye-tracking sensitivity to treatment differs by baseline clinical characteristics in autistic adolescents and young adults enrolled in a randomized, double-blind, placebo-controlled, cross-over trial of intranasal (IN) ketamine. Twenty-one participants (ages 14–29) completed eye-tracking paradigms assessing proportion of looking to facial regions (eyes, nose, mouth) and social versus geometric scenes pre- and post-dose. Change scores from post-dose to pre-dose were correlated with parent-reported symptoms of social communication skills. Results revealed phenotype-dependent patterns: individuals with greater impairment in baseline social awareness shifted attention toward the eyes, whereas those with less impairment in their social awareness increased fixation to the nose. Fearful faces showed the broadest coupling with social communication skills, and increased geometric preference was associated with poorer social cognition. Findings underscore that biomarker informativeness is not uniform but interacts with individual clinical profiles, highlighting the need for precision measurement alongside precision medicine in autism clinical trials.
DOI: 10.1016/j.bionps.2026.100143
Language: English
Open Access status: gold
Estimated APC paid: $2,930
OpenAlex ID: W7221094477
FWCI:
Cites: 32
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Related to: 10