Narrative and visual attention in autism spectrum disorder: a cross-cultural perspective.

Introduction: Narrative, or storytelling, is a primary form of social communication. Prior work has documented differences in narrative in individuals with autism spectrum disorder (ASD), but predominantly focused on English-speaking Western countries. Given the internalization of cultural values and conventions shapes narrative, the extent to which environmental (i.e., cultural and linguistic) factors may interact with ASD to influence the narrative ability remains unclear. The current study applied a cross-cultural approach to investigate narrative quality in ASD between a Western (United States) culture and an Eastern [Chinese (Hong Kong)] culture. Given that visual attention and exploration inform one's experiences and consequently storytelling, visual attention during narration was examined to unravel underlying mechanisms contributing to narrative. Methods: Participants included 56 autistic individuals (US-ASD) and 49 non-autistic controls (US-control) from the US who were native English speakers, as well as 24 autistic individuals (HK-ASD) and 52 controls (HK-control) from the Hong Kong SAR, China (HK), who were native Cantonese speakers, with age matched across groups. Participants narrated a wordless picture book presented on an eye-tracker, with narrative quality and dynamic gaze patterns examined. Results: Group comparisons revealed that autistic individuals from both cultures missed key story components and exhibited elevated rigid gaze patterns towards social stimuli. Cultural variations were also demonstrated, with US-ASD group, but not HK-ASD group, narrating with fewer descriptions and causal attributions of characters' thoughts/emotions. Further, correlational analyses revealed the association between decreased social attention and fewer descriptions of characters' thoughts/emotions across diagnostic and cultural groups. Discussion: Together, the findings highlight a difficulty in overall narrative structure and a pattern of regressive/rigid social attention present in ASD across cultures. In contrast, the difficulty in usage of cognitive/emotional terms and causal attributions in ASD appear to be culturally influenced, and were only present in US-ASD. Gaze-narrative associations detected across diagnosis and cultures emphasize the importance of extrapolating underlying mechanistic processes contributing to social language use in general and in ASD. Findings implicate key features of narrative ability that may be more or less malleable to cultural influences, with implications for the biological underpinnings of ASD and culturally-centered clinical practices.