Local and Global Visual Processing in 3-Year-Olds With and Without Autism
Journal of Autism and Developmental Disorders
Local and Global Visual Processing in 3-Year-Olds With and Without Autism
Elisabeth Nilsson Jobs 0 1 2 4
Terje FalckY‑tter 0 1 2 4
Sven Bölte 0 1 2 4
0 Center of Psychiatry Research, Stockholm County Council , Stockholm , Sweden
1 Division of Neuropsychiatry, Department of Women's & Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet , Stockholm , Sweden
2 Uppsala Child and Baby Lab, Department of Psychology, Uppsala University , 751 42 Uppsala , Sweden
3 Elisabeth Nilsson Jobs
4 Child and Adolescent Psychiatry, Stockholm County Council , Stockholm , Sweden
Research on visual local and global perception in Autism Spectrum Disorder (ASD) is incomplete in young children. We investigated 35 three-year-old siblings of children with ASD, either diagnosed (n = 12) or not diagnosed (n = 23) with ASD as well as 14 controls with typical development and with no family history of ASD. Data from the local tasks Children's Embedded Figures Test, Hidden Pictures, Figure-Ground and the global tasks Closure and Fragmented Picture Test were collected. Enhanced performance on the local task Hidden Pictures differentiated children with ASD from the other groups. Implications of these results are discussed.
Autism; Neurodevelopmental disorder; Cognition; Visual perception; Local processing; Child development
Several cognitive models of Autism Spectrum Disorder
(ASD) suggest that attention to detail is related to the
(Mottron et al. 2006; Plaisted 2001; Baron-Cohen
2002; Happé and Frith 2006)
. Detail focus is often referred
to as local perception as opposite to global perception, i.e.,
focusing on the whole of e.g., a picture or integrating parts
of a feature into a whole. Children with typical development
(TD) can perceive both local and global features already at
an early age
(Stiles et al. 1991)
and there are indications that
individuals with TD develop a global visual default mode,
Electronic supplementary material The online version of this
supplementary material, which is available to authorized users.
perceiving global and local information as accurate when
instructed to, but are faster at reporting global features in
(Campana et al. 2016)
. This global
precedence has been found to remain in many
individuals throughout life
(Bruyer and Scailquin 2000)
can vary depending on ethnicity
(McKone et al. 2010)
(Dale and Arnell 2013)
. In individuals with
ASD, on the other hand a visual local processing default
mode has been found in spontaneous responses
(Wang et al.
2007; Happé and Frith 2006)
although processing global
information in ASD appear as accurate as in TD when
explicitly and accurately demanded
(Koldewyn et al. 2013)
A local default mode has also been found in individuals with
elevated autistic traits
(Stevenson et al. 2016)
. A common
paradigm to examine local–global default modes is to use
stimuli where both global and local information levels are
present, as they allow to investigate the trade-off effects in
the perception and interference of one stimulus level in the
presence of another. Findings of local-to-global and
globalto-local interference in individuals with ASD or autistic
traits have been mixed
(Plaisted et al. 1999, 2006; Rinehart
et al. 2000; Nayar et al. 2017; Deruelle et al. 2006;
Stevenson et al. 2016; Van der Hallen et al. 2015, 2017)
Another approach is to examine local and global
processing skills separately. Given evidence that local processing
matures before global processing during typical
(Guy et al. 2016)
, and the indications that local and
global processes are independent
(Porporino et al. 2004)
it appears reasonable to study these functions separately in
ASD and TD, particularly in young children
. Local figure-ground tests
(e.g., Shah and Frith
1983; Witkin et al. 1971)
and visual search tasks have been
quite common with results showing faster reaction times
or higher accuracy in children with ASD in comparison to
children with TD
(Morgan et al. 2003; Kaldy et al. 2011;
Pellicano 2006; Happé and Frith 2006; O’Riordan and
and positive correlations between autistic
symptoms and local performance
(Gliga et al. 2015; Cheung
et al. 2016; Koldewyn et al. 2013; van Eylen et al. 2015)
However, other studies find no group differences or
(White and Saldana 2011; Muth et al. 2014;
Horlin et al. 2016)
. Regarding research on global
performance, tasks vary considerably, tapping into both visual and
other cognitive abilities such as matching
(Booth et al. 2003)
, puzzle-like tasks or deduction
of the whole object from a part
(Jolliffe and Baron-Cohen
2001; Nakano et al. 2010)
. A few studies have used visual
global object/animate integration tasks in line with the
definition of visual closure according to the Cattell-Horn-Carroll
(CHC) factorial model of cognitive abilities
McGrew 2012; Flanagan and Dixon 2013, p. 8)
. Here, tasks
such as fragmented pictures
(Snodgrass and Corwin 1988;
Kessler et al. 1993)
are used, i.e., animates or objects
presented in a fragmented, shattered way that are to be
recognised. Using fragmented stimuli is of particular interest
when investigating children as possible confounds, such as
of motor skills and deduction are controlled to a relatively
high degree. Similar to results on local tasks, results
differ from no difference between individuals with ASD and
TD (Mottron et al. 2003) to global processing being slower
or less accurate in individuals with ASD compared to TD
(Booth and Happé 2016; Bölte et al. 2007; Scheurich et al.
or mixed results
(van Eylen et al. 2015)
. To the best
of the authors knowledge, research including global
performance, either as part of “trade-off” paradigms or real object/
animate integration tasks in pre-school children with ASD
has not been conducted.
In conclusion, the understanding of local and global
processing in pre-school aged children with ASD is incomplete.
Therefore, the objective of the current study was to examine
local and global visual processing using separate measures
for local and global perception, in 3-year-olds. An
increasingly applied methodology to study early trajectories in ASD
is high-risk (HR) for ASD sibling research
(Bölte et al. 2013;
Zwaigenbaum et al. 2015)
. HR-siblings are younger
brothers or sisters to individuals diagnosed with ASD. Compared
to about 1–2% in the general population (CDC 2016), the
prevalence of ASD in siblings is about 14–20%
et al. 2013)
. In the current study we used cross sectional
assessments of 3-year-olds that had been ascertained in a HR
ASD longitudinal sibling design. We examined HR siblings
with ASD (HR-ASD group), high-risk siblings without ASD
(HR-noASD group) and low risk (LR) for ASD children, i.e.,
TD controls (LR group). We expected superior local
performance in the HR-ASD group compared to the other groups.
For global performance we tentatively expected superior
performance in the HR-noASD and LR groups compared
to the HR-ASD group.
The project was approved by the Regional Ethical Board in
Stockholm. Participants were part of the longitudinal Early
Autism SwEden (EASE; smasyskon.se) sibling project,
including siblings with HR and LR for ASD. Diagnosis at
36 months, reliable at this age in most cases
(Ozonoff et al.
, was based on consensus of two experienced clinicians
according to DSM-5 criteria
, endorsed by information from the Autism
Diagnostic Observation Schedule-2
(ADOS-2; Lord et al. 2012)
module 1 or 2; the Autism Diagnostic Interview-Revised
(ADI-R; Lord et al. 1994)
; the Vineland Adaptive Behavior
(VABS-II; Sparrow et al. 2005; McDonald 2014;
and the Mullen Scales of Early Learning
(MSEL; Mullen 1995)
. Parents were also asked to complete
a checklist about their child’s expressive vocabulary
containing 22 words used in the global tasks requiring verbal
answers. Subsequent to diagnostic assessment, the HR
siblings were divided into those with ASD (HR-ASD group)
and without ASD (HR-noASD group). One child in the LR
group fulfilled criteria for ASD, and was excluded from
the analysis. One child from each of the three groups was
excluded from the final sample, due to a general inability
to perform the local and global tasks. Thus, excluding four
children, 49 three-year-old children were included in total
(Table 1), 12 in the HR-ASD group (5 boys, 7 girls), 23 in
the HR-noASD group (7 boys, 16 girls) and 14 in the LR
group (6 boys, 8 girls). Groups were largely comparable for
age, MSEL: verbal IQ and expressive vocabulary according
to the parent checklist, but not MSEL, where there was a
group difference for non-verbal IQ between the LR and the
HR-ASD group. As expected, autistic symptoms and traits,
differed between groups, the HR-ASD group had higher
ADOS-comparison scores and lower VABS-II scores on
the social domain than both HR-noASD and LR groups.
Scores on the ADI-R differed between the LR group and
both HR-noASD and HR-ASD groups, but not between the
latter groups. Regarding other neurodevelopmental
symptoms, in the HR-noASD group six children had signs of
ADHD, two of speech and language impairment and one of
developmental delay. In the HR-ASD group two children had
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signs of ADHD and three of receptive language. In the LR
group there were no signs of other developmental concerns.
We used tasks in accordance with the CHC definitions of
local and global performance
(“flexibility of closure” and
“closure speed”: Flanagan and Dixon 2013, p. 8)
and procedures are presented in a more comprehensive way
in the supplementary material (Online resource 1).
In this modified version of the Children´s Embedded
(CEFT; Karp and Konstadt 1963)
six pictures and
the triangle-shape were used. The child was first asked to
detect the triangle shape in the picture, and was given a
cutout triangle model to search for the triangle after 10 s, if
not finding it spontaneously. Total exposure time for each
picture was 30 s. Spontaneous pointing at the triangle was
given 2 points and detection with the model-triangle was
given 1 point (max. 12). If the child did not find the target
within total exposure time, 0 points were given. Response
latency was measured from the picture being visible to the
participant and to him or her pointing spontaneously at the
triangle. Due to variations in planning performance of the
participants moving the triangle, no exact response latency
was calculated for the model triangle condition. Finding the
target with the model was counted as 20 s and not finding
the triangle was counted as 30 s, the latter being maximum
In the Figure Ground task
(FG; Roid and Miller 1997)
child was asked to point to a part or a detail in each of 14
realistic coloured complex pictures. Exposure time was 20 s
for each picture. For accuracy, 1 point was given for pointing
at the target within 20 s and 0 points when failing to detect
the target. (max. 14). Response latency was measured for the
five most frequently answered items from the picture being
visible to the participant to the pointing at the target. If the
participant failed to detect the target, the response latency
was set to maximum exposure time, i.e., 20 s.
In Hidden Pictures
(HP; Roid and Sampers 2004)
slightly differently depicted stars in the first picture and
nine X-shapes in the other, are hidden in coloured realistic
sceneries. Participants were asked to find and point at as
many targets as possible. For the X-shape task, the target
was pointed out after 10 s if the child had not found any
X-shapes. Time limit was 30 s for finding stars and 45
for finding X-shapes. Accuracy was measured as the total
amount of correct targets for stars and X-shapes (max. 16).
Response latency was measured from the picture being
visible to the participant to the pointing at the first star and
X, respectively. When pointing out the target after 10 s, the
latency was measured as 10 s plus the time lapse from the
administrator pointing at the X to the participant pointing
at another X. If the participant failed to find the targets,
the latencies were set at total exposure times, i.e., 30 s for
the star task and 45 s for the X-shape task.
In the The Fragmented Picture Test
(FPT; Kessler et al.
1993; Snodgrass and Vanderwart 1980)
the participant is
exposed to a fragmented animate or object that gets more
and more complete and the threshold is set to the picture
were the object is correctly named. In this modified
version four levels (towards completion) retouched into seven
levels, were used. The tasks were presented in Windows
2010 Power Point-format on a lap-top computer screen.
Each picture-sequence was pre-programmed to be shown
for 4 s. Accuracy was the sequence of correct detection.
One point was assigned to the complete picture and seven
to the most fragmented. No or wrong answers were given 0
points (max. 28). This measure reflects both accuracy and
response latency as each sequence was set at 4 s. However,
results are reported as accuracy scores in the analyses.
In Gestalt Closure
(GC; Kaufman and Kaufman 2004)
the child is supposed to name an inkblot drawing
representing fragmented objects or animates. The test was
administered according to the manual with the stopping
rule of ending the test after four successive failures.
Accuracy was the sum of correct answers, 1 point for each
correct answer (max. 24). Response latency was based on
the six most frequently answered items (butterfly, clock,
flower, face, dog, bed), calculated from the picture being
visible to the child, to the first syllable of the correct
naming of the target. At least three items had to be correctly
answered for the calculation of mean. Maximum exposure
time was 15 s.
All tasks were administered on one occasion in a clinical lab
setting lasting about 20 min with a parent present. The order
of the tasks was administered according to Latin square
counterbalancing. Sessions were video-recorded for off line
analyses using an XProtect Smart Client video system. For
the global GC test Adobe Premiere Pro SC5 software was
used for off-line auditory and visual analyses. Time
resolution was 25 frames per second (i.e. each frame lasts 40 ms).
Response latencies were manually coded and stored in an
excel file (in seconds).
Statistics were performed in SPSS 24
Statistical analyses were conducted variable-wise as the
distribution of missing values varied among tasks due to missing
recordings or participants looking away or being distracted,
compromising analyses of latency or accuracy scores. The
number of participants in each task is presented in Table 2.
According to Shapiro Wilk testing, 3 out of 27 variables
were not normally distributed (global GC, local HP
accuracy, HP latency in the HR-noASD group). Considering the
majority of data being normally distributed and analysis of
variance (ANOVA) being robust against moderate violations
(Lix et al. 1996)
, parametric inference statistics
were chosen. One-way ANOVAs were calculated for group
comparisons. Moreover, analyses of covariance (ANCOVA)
were conducted, controlling for NVIQ. A two-tailed
alphalevel of 5% was applied for significance. Homogeneity was
violated for accuracy and latency on HP and were analysed
by Brown and Forsyth´s F*. All other variables were
analysed by F. Post hoc were conducted with Bonferroni (when
F-value) or Games-Howell tests (When Brown and Forsyth´s
F*), the latter given different sample sizes. Effect-sizes for
significant results were calculated with Cohen´s d, using
pooled standard deviations (sp) given the difference in
sample size, and partial eta squared (partial η2) for the ANCOVA
result. Corrections for multiple comparisons across the
oneway ANOVAs were conducted by the method of False
(Benjamini and Hochberg 1995)
. Apart from
this correction across the ANOVAs, the Bonferroni/Games
Howell p values were also corrected for multiple
comparisons by false discovery rate, when the main result between
groups was significant. Post-hoc power analysis (G-power,
F-test, post-hoc ANOVA one way) showed that this study had
acceptable power to detect large effects (1 − β = 0.64), but
not medium or small effects (1− β = 0.01–0.56).
Mean, SD and range for local and global measures and
results are presented in Table 2. There was a between-group
effect, after correcting for multiple comparisons across the
one-way ANOVAs, on HP accuracy (F* (2, 39.46) = 7.34,
p = .018), with post hoc Games Howell tests showing the
HR-ASD group to have higher scores than both HR-noASD
(p = .003, sp = 2.69, d = 1.23) and LR groups (p = .001,
sp = 1.84, d = 1.90). Applying correction for multiple
comparisons also within the Games-Howell test for the
HPresults, the results remained significant between the HR-ASD
group on one hand, and the HR-noASD group (p = .041) and
the LR group (p = .027), on the other. There were no group
differences for accuracy and response latency for the other
local measures (F/F* (2, 36–42) ≤ 2.18, p ≥ .401), nor for the
global measures (F (2, 40–43) ≤ 1.80, p ≥ .401).
As non-verbal IQ differed between the LR and
HRASD groups (see Table 1), a between group ANCOVA
was conducted with HP accuracy scores as dependent
variable and MSEL’s nonverbal IQ as covariate. The effect
remained between groups (F (2, 39) = 3.99, p = .027, partial
η2 = 0.170), and pairwise comparisons with Bonferroni
correction showed that the HR-ASD group had higher accuracy
scores (Ma = 13.68) than the LR (Ma = 10.48, p = .049) and
HR-noASD (Ma = 10.60, p = .035) groups.
In this study we examined visual processing in early ASD
testing separate measures for local and global performance
in siblings with ASD (HR-ASD), siblings with no ASD
(HR-noASD group) and typically developing children (LR
group) and found a group difference for the local measure
HP. Consistent with our prediction and in line with
theories of enhanced visual local processing
(e.g., Mottron et al.
, 3-year old children with ASD performed superior to
the other groups. However, and against our expectations,
there were no differences for global measures.
Unlike other studies
(Morgan et al. 2003; Pellicano 2006)
higher accuracy or shorter latencies in ASD were neither
found on the CEFT nor the FG test. These tasks pose other
executive demands than the HP, such as keeping attention
when turning pages and processing different backgrounds,
and, for the FG, also presenting different targets in each task.
As executive functions are often found to be altered in
individuals with ASD
(Lai et al. 2017)
, executive control,
flexibility and planning might thus have camouflaged potential
superior local visual processing. It could well be that the
simpler testing set-up in HP, such as looking for several
targets in the same background, using only two pictures, leads
to clearer differences between groups, particularly in young
ages. However, talking against this, the result on the global
GC did not differ between groups despite similar executive
demands in the task. Unlike the other two local tasks, HP
demands to find several of the same targets, different in size
and angle. Superior HP performance in ASD could then
either reflect that individuals with ASD show better visual
form constancy (i.e., the ability to recognize similarity in
form despite differences in sizes and angels) or enhanced
visual search of finding several targets in a background.
Our results on global tasks are consistent with research
reporting no global disadvantage related to ASD or autism
(Mottron et al. 2003; Wang et al. 2007)
inconsistent with specific fragmented picture research by
Booth and Happé (2016), finding inferior global
performance in ASD. Compared to the latter, our sample differed
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in age, gender and IQ. It is also possible that divergent
trajectories of global performance might not have emerged yet
in 3-year olds.
Our findings should be interpreted with adequate caution
given that they are based on small sample size, limiting
generalizability and power to detect small and medium
differences on local and global tasks. Nevertheless, the result
on HP remained sound, even after corrections for multiple
comparisons both between and within ANOVAs. There were
also limitations concerning tasks used in this study, as some
of them originally were constructed for use in older children
and were here implemented in 3-year-olds for the first time.
Moreover, latency measures were operationalized by only a
few items, possibly limiting their accuracy, and the number
of participants that completed the different tasks varied. In
addition, unlike other studies, more girls than boys
participated, possibly affecting results (
Bölte et al. 2011
Lai et al.
Kimchi et al. 2009
This study shows that enhanced local performance is evident
in children with ASD already at the age of 3, reflected by
superior performance on the local measure Hidden Picture,
independent of general developmental level and vocabulary.
Our findings suggest that the testing of visual local
performance, for example by a task as the HP, could add value to
the clinical characterization of children with early suspicion
of ASD. Further research on larger samples of young
children with ASD is needed to investigate Hidden Pictures in
relation to other local measures, visual search tasks as well
as in relation to performance on form constancy.
Author Contributions ENJ conceived of and designed the study,
collected the data, performed the data analysis, had the major part in the
interpretation of data and drafted the manuscript. SB contributed to the
design of the study and interpretation of results. TFY contributed to
overall study design and management. All authors revised the
manuscript critically and approved the final version.
Funding This research was supported by the Swedish Research
Council (with FAS, FORMAS and VINNOVA), the ESFCOST Action
BM1004 “ESSEA”, the Bank of Sweden Tercentenary Foundation,
and the European Research Council; the Innovative Medicines
Initiative Joint Undertaking (Grant agreement number 115300), which
comprises financial contribution from the European Union’s Seventh
Framework Programme (FP7/2007–2013) and in-kind contributions
from companies belonging to the European Federation of
Pharmaceutical Industries and Associations (EU-AIMS).
Compliance with Ethical Standards
Conflict of interest Elisabeth Nilsson Jobs, Sven Bölte and Terje
Falck-Ytter declare no conflict of interest related to this article. Sven Bölte
discloses that he has in the last 5 years acted as an author, consultant
or lecturer for Shire, Medice, Roche, Eli Lilly, Prima Psychiatry,
GLGroup, System Analytic, Kompetento, Expo Medica, and Prophase.
He receives royalties for text books and diagnostic tools from Huber/
Hogrefe, Kohlhammer and UTB.
Ethical Approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the
institutional and/or national research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://creativeco
mmons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appropriate
credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
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