Social referencing skills in children with autism spectrum disorder: A systematic review

Backgrounth Children with autism spectrum disorder (ASD) often exhibit severe and persistent deficits in social behaviors. An area of socialization that develops towards the end of the first year of life is social referencing, wherein infants when confronted with a new or unusual event, look at an adult, and base their subsequent behavior on the facial expression of the adult. Method: We undertook a systematic review to highlight the existing conceptualizations of social referencing, and study the social referencing repertoire in children with ASD. We searched five databases for studies published until December 2018. Articles included reported behavioral measures of social referencing and were specific to individuals with ASD or those at elevated risk for ASD. Results: Of the 54 articles meeting eligibility for full-text review, eight met inclusion criteria and the data were synthesized narratively. Deficits in social referencing were reported in seven studies, and data from all studies indicated atypical attention shifts between social and non-social stimuli in children with ASD. Conclusions: A deficiency exists in spontaneous looking behaviors and possibly in differential responding to affective cues among children with ASD. The variations in the definitions and measurement methods present in the literature call for additional research that examines both referential looking and differential cue responding components within an ambiguous context. Guidelines for future research and clinical implications are discussed.