Visual scanning of faces in 22q11.2 deletion syndrome: Attention to the mouth or the eyes? Linda Campbell a,b,c, ⁎, Kathryn McCabe a,b , Kate Leadbeater a , Ulrich Schall a,b,c , Carmel Loughland a,b,c , Dominique Rich d a Priority Research Centre for Brain and Mental Health, University of Newcastle, NSW, Australia b Schizophrenia Research Institute Australia (SRI), Sydney, NSW, Australia c Hunter Medical Research Institute, Australia d Centre for Brain and Mental Health Research, University of Newcastle, Australia abstract article info Article history: Received 21 January 2009 Received in revised form 11 June 2009 Accepted 11 June 2009 Keywords: Emotion face processing Visual scanpaths Eye-gaze avoidance Social functioning Previous research demonstrates that people with 22q11.2 deletion syndrome (22q11DS) have social and interpersonal skill deficits. However, the basis of this deficit is unknown. This study examined, for the first time, how people with 22q11DS process emotional face stimuli using visual scanpath technology. The visual scanpaths of 17 adolescents and age/gender matched healthy controls were recorded while they viewed face images depicting one of seven basic emotions (happy, sad, surprised, angry, fear, disgust and neutral). Recognition accuracy was measured concurrently. People with 22q11DS differed significantly from controls, displaying visual scanpath patterns that were characterised by fewer fixations and a shorter scanpath length. The 22q11DS group also spent significantly more time gazing at the mouth region and significantly less time looking at eye regions of the faces. Recognition accuracy was correspondingly impaired, with 22q11DS subjects displaying particular deficits for fear and disgust. These findings suggest that 22q11DS is associated with a maladaptive visual information processing strategy that may underlie affect recognition accuracy and social functioning deficits in this group. © 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction One of the most common microdeletion disorders is the 22q11.2 deletion syndrome (22q11DS), which affects 1 in every 4000 live births. (Oscarsdottir et al., 2004). It is estimated that 20–50% of children with 22q11DS have an autism spectrum disorder (Fine et al., 2005; Vorstman et al., 2006) and that 30% will go on to develop severe psychiatric disorder (e.g., schizophrenia) in adulthood (Murphy et al., 1999). Like autism and schizophrenia, 22q11DS is associated with significant social dysfunction. The early literature report a broad range of impairments in social skills and behaviours including withdrawal, shyness, interaction problems and limited facial expressions (Golding-Kushner et al., 1985; Gerdes et al., 1999; Swillen et al., 1999a,b; Niklasson et al., 2001). These deficits in social ability are not only detrimental to the establishment of positive social relationships in people affected by 22q11DS, but ultimately may lead to social isolation in this group. Although social skill deficits have been routinely reported in people with 22q11.2, there is a lack of empirical studies examining the cognitive and perceptual mechanisms that may underlie these difficulties. Several studies have used visual scanpath technology to examined face processing deficits in other clinical groups including autism spectrum disorders (ASDs; (Jemel et al., 2006)) and schizophrenia (Loughland et al., 2002). The ability to perceive and accurately process facial information is important for positive interpersonal and social communication. This study is the first to undertake this research in 22q11.2 deletion syndrome. Faces are complex, highly salient and biologically meaningful visual stimuli that provide a wealth of information about other people including their gender, age and person's identity. They allow us to make inferences about the emotions and intentions of others and their eye gaze can help orientate our attention to objects or events in our immediate environment. Unlike complex non-face stimuli that are recognised in terms of their isolated component features, faces are recognised holistically based on the configural relationships that exist between features (Young et al., 1987; Tanaka and Farah, 2003). Face perception is therefore a relatively automatic process. Emotion percep- tion requires the activation of a specific network of different brain regions including the amygdala, hippocampus, fusiform gyrus, thalamus and medial and inferior frontal cortex. For example, fearful faces are associated with increased amygdala activation (LeDoux, 1995; Morris et al., 1996; Adolphs, 2002; Vuilleumier and Pourtois, 2007). Damage to one or more of these brain regions can result in an inability to accurately process facial information (Phillips et al., 2003). One way to examine the strategies people employ while viewing face stimuli is to record their visual scanpaths. Visual scanpaths are a schematic map of fixations (when the fovea is directed toward and Psychiatry Research 177 (2010) 211–215 ⁎ Corresponding author. Priority Research Centre for Brain and Mental Health Studies, PO Box 833, Newcastle, NSW, 2300 Australia. Tel.: +61 4924 6648; fax: +61 4924 6608. E-mail address: Linda.e.campbell@newcastle.edu.au (L. Campbell). 0165-1781/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2009.06.007 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres