Early social gaze fixation and later inattention and hyperactivity–impulsivity symptoms in children: A longitudinal population‐based cohort study

Aim: To examine whether gaze patterns related to ASD are also associated with later inattention and hyperactivity-impulsivity symptoms and whether such gaze patterns may reflect broader neurodevelopmental vulnerability. Methods: Using data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, we examined whether gaze fixation on social information at age 4 was longitudinally associated with inattention and hyperactivity-impulsivity symptoms at age 8. Of 6571 children with gaze data, 3043 whose caregivers completed the ADHD Rating Scale (ADHD-RS) were included. Social gaze-defined as fixation on the eyes in human-face stimuli and on people in people-geometry stimuli-was measured using Gazefinder®. Percentile scores for inattention and hyperactivity-impulsivity were analyzed separately for boys and girls using generalized linear models. Results: In boys, shorter gaze fixation on social information at age 4 was significantly associated with higher inattention and hyperactivity-impulsivity percentiles at age 8. In girls, no significant associations were observed in the primary complete-case analyses after full adjustment; however, significant associations for the small window stimulus emerged after inverse-probability weighting. Conclusion: Reduced social gaze at age 4, measured using an eye-tracking system originally developed for ASD, was associated with later inattention and hyperactivity-impulsivity symptoms. These findings suggest that early alterations in social gaze may represent a developmental characteristic associated with broader neurodevelopmental vulnerability and later behavioral symptoms, including inattention and hyperactivity-impulsivity.