Visual attention in children with autism spectrum disorder: the role of protagonist positioning in picture books

Objectives This study examines how protagonist positioning in picture books influences gaze behavior in children with autism spectrum disorder (ASD) compared with typically developing (TD) peers.Methods A 2 × 9 mixed design was used with 150 ASD and 150 TD children (aged 5–7 years). Eye movements were recorded using a Tobii X120 eye-tracker.Results Two-way ANOVAs revealed significant main effects of group and significant Group × areas of interest (AOI) interactions for both fixation metrics. Children with ASD showed reduced gaze engagement and descriptively higher fixations in upper regions, though pairwise comparisons did not reach significance after correction. TD children showed no clear regional preference.Conclusion Findings highlight the role of visual design in attentional engagement in ASD. Although children with ASD descriptively showed higher fixations in upper regions, this finding did not survive multiple comparison correction and should be interpreted as a descriptive trend requiring further investigation.