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Visual systemizing preference in children with autism: A randomized controlled trial of intranasal oxytocin

  • Lane Strathearn (a1) (a2) (a3), Sohye Kim (a2) (a3), D. Anthony Bastian (a2) (a4), Jennifer Jung (a2), Udita Iyengar (a2) (a5), Sheila Martinez (a2), Robin P. Goin-Kochel (a2) (a3) and Peter Fonagy (a2) (a5)...

Several studies have suggested that the neuropeptide oxytocin may enhance aspects of social communication in autism. Little is known, however, about its effects on nonsocial manifestations, such as restricted interests and repetitive behaviors. In the empathizing–systemizing theory of autism, social deficits are described along the continuum of empathizing ability, whereas nonsocial aspects are characterized in terms of an increased preference for patterned or rule-based systems, called systemizing. We therefore developed an automated eye-tracking task to test whether children and adolescents with autism spectrum disorder (ASD) compared to matched controls display a visual preference for more highly organized and structured (systemized) real-life images. Then, as part of a randomized, double-blind, placebo-controlled crossover study, we examined the effect of intranasal oxytocin on systemizing preferences in 16 male children with ASD, compared with 16 matched controls. Participants viewed 14 slides, each containing four related pictures (e.g., of people, animals, scenes, or objects) that differed primarily on the degree of systemizing. Visual systemizing preference was defined in terms of the fixation time and count for each image. Unlike control subjects who showed no gaze preference, individuals with ASD preferred to fixate on more highly systemized pictures. Intranasal oxytocin eliminated this preference in ASD participants, who now showed a similar response to control subjects on placebo. In contrast, control participants increased their visual preference for more systemized images after receiving oxytocin versus placebo. These results suggest that, in addition to its effects on social communication, oxytocin may play a role in some of the nonsocial manifestations of autism.

Corresponding author
Address correspondence and reprint requests to: Lane Strathearn, Center for Disabilities and Development, University of Iowa Children's Hospital, 100 Hawkins Drive, 213F CDD, Iowa City, IA 52246-1011; E-mail:
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This work was funded by the Baylor College of Medicine Junior Faculty Seed Funding Program, 2009–2010 (Grant 2531915102), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD065819). Peter Fonagy was partially supported by the NIHR [National Institute for Health Research] Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS [National Health Service] Trust and by an NIHR Senior Investigator Award (NF-SI-0514-10157). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health, the NHS, the NIHR, or the UK Department of Health.

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