Minimally verbal children with autism may see the point, but do not (always) point to what they see:A behavioral and eye-tracking study in visual perceptual processing

During typical development, non-social visual object recognition emerges in the first year of life, engaging low-level visual cues and higher-level mechanisms involving inference and prior knowledge. How these processes function in minimally verbal autism (mvASD) remains poorly understood. We studied children with mvASD (n=22, 6-11 years) using touchscreen-based oddball and contour-detection tasks targeting low-level stimuli (e.g. shape and orientation), and mid-level stimuli (e.g. illusory Kanizsa contours and 3D shapes). Pointing and eye-gaze responses were measured. Typically developing children (n=22, 6-12 years) served as a reference group. Accuracy and reaction-time profiles among mvASD participants were heterogeneous across experimental visual tasks and standardized developmental measures. All mvASD participants detected targets in the easiest condition, and approximately half succeeded across low-level tasks. Overall performance declined with increasing visual complexity, consistent with attenuated inference-based processing; communication ability and nonverbal reasoning together accounted for approximately 69% of between-participant variance in visual task performance. Critically, exploratory analyses suggested systematic perception-action dissociations rather than random error. First, the majority of participants who failed to point correctly (n=9) reliably fixated the correct target. Second, in the Kanizsa oddball task, nearly half of successful mvASD participants pointed to local inducers rather than the illusory figure center, unlike TDs. Third, more participants showed within-age-range nonverbal reasoning performance on Ravens colorful progressive matrices when responding by puzzle placement than by pointing. These converging findings challenge interpretations of mvASD performance as reflecting perceptual or cognitive capacity alone, suggesting visual signals may guide action selection differently in mvASD. Lay SummaryMinimally verbal children with autism showed individual differences in visual processing tasks. While developmental measures like communication ability and reasoning skills predicted most of the variation in performance, exploratory observations revealed an intriguing pattern: the same children sometimes succeeded when using their eyes to indicate answers but failed when pointing or performing better when placing puzzle pieces than pointing in a booklet to identical visual display. Several children who correctly detected illusory triangular shapes consistently touched the corner pieces rather than the triangle centers. These patterns suggest that performance depends not only on developmental and visual perceptual abilities, but also on how children are asked to respond. Parents and educators should consider: might a child who fails a pointing-based test succeed with a different response method?