Receptive language processing in children with Autism Spectrum Disorder: evidence from eye-tracking measures

Background: Receptive language difficulties are common in children with Autism Spectrum Disorder (ASD) and may reflect differences in underlying attentional and processing mechanisms rather than linguistic impairments alone. Visual attention plays a central role in guiding children toward linguistically relevant stimuli during language comprehension. Eye-tracking offers a noninvasive method to examine real-time visual attention; however, its association with standardized receptive language performance in children with ASD remains insufficiently understood. Methods: This cross-sectional study included 33 children aged 4;0–7;11 years, comprising 16 children with ASD and 17 typically developing (TD) peers. Receptive language abilities were assessed using the receptive subtest of the Turkish Early Language Development Test (TEDİL). Visual attention during receptive language tasks was measured using a remote eye-tracking system. Eye-tracking indices included target looking proportion, time to first fixation on the target, and target fixation duration. Group differences were examined using analyses of covariance controlling for age. Within the ASD group, correlations and multiple linear regression analyses were conducted to examine associations between eye-tracking measures and receptive language performance. Results: Children with ASD demonstrated significantly lower target looking proportions, longer latencies to first fixation, and shorter target fixation durations compared to TD peers. Within the ASD group, higher receptive language scores were significantly associated with greater target looking proportion and shorter time to first fixation. Regression analyses indicated that target looking proportion explained additional variance in receptive language performance beyond chronological age. Conclusions: Findings suggest that less efficient visual attention is associated with receptive language difficulties in children with ASD. Eye-tracking provides process-level information that complements standardized assessments by capturing attentional dynamics during language comprehension. Integrating eye-tracking measures into language assessment may support more sensitive identification of processing differences and inform targeted intervention approaches for children with ASD.