Autism Eye Contact: It’s not Easy for ASD Kids | #parenting


Eye contact avoidance is an issue that troubles many parents with children on the spectrum. Should your child with autism be encouraged to make eye contact; and how should the child’s avoidance be managed without inducing anxiety or stress? These and other controversial questions are sometimes answered with a narrow, neurotypical view.

Neurotypical society puts enormous value on eye contact. Eye contact is used to connect, to show interest, facilitate communication, and is often encouraged as a sign of respect. For many individuals with autism spectrum disorder (ASD), eye contact is troublesome, possibly because they don’t perceive the eyes as socially engaging or significant. The subject is further complicated by the vast difference between individuals on the spectrum.

People with autism give a wide range of answers when asked why they find eye contact tough; some say it makes them extremely uncomfortable or distressed, some say they avoid it because it’s just not that important to them, and others say they find eye contact distracting—especially when competing sensory inputs are present during social interactions.

It’s little wonder then that author John Elder Robison decided to call his memoir: Look Me in the Eye; My Life with Asperger’s. In his touching recount he describes how his unique habits, including an avoidance of eye contact earned him the label of “social deviant”.

In this article poor eye contact as a sign of autism will be examined. The specific challenges and difficulties of making eye contact for children with autism will be discussed, with a special emphasis on advice and tips to make it easier for parents and children to manage eye contact comfortably.

Reduced eye contact is a prominent symptom of autism used in early screening and diagnostic instruments and evaluations (American Psychiatric Association). Parents are often warned about unusual eye contact and its significance as a red flag for autism.

Focusing on babies’ ability to make eye contact with caregivers, a study (Jones & Klin, 2013) found signs of autism as early as two months after birth. It was found that typical children became more interested in eyes as they grew up, whereas children with autism started losing interest between the ages of two and six months.

The study used eye-tracking technology to observe where babies focused their gaze. The data showed a marked difference between typical children and those with autism. Whereas typical children spent more time focused on the caregivers’ eyes (than the mouth, body or object region) the children with autism’s interest in the caregiver’s eyes steadily declined after two months of age.

This loss of interest in other people’s eyes is probably the earliest behavioral marker of autism discovered to date. Interestingly, the researchers also found the steeper the decline in eye fixation in the first two years of life, the greater the social impairment at the age of two years (Jones & Klin, 2013).

Another study (Moriuchi et al., 2017) noted the difference between neurotypical children and those with autism when cued to look at a specific area. Surprisingly children with ASD looked for longer at regions they had been cued to look at; if they were cued to look at the eyes they looked for longer than the neurotypical children. 

This may support the theory of gaze indifference (discussed below) proposing that children with autism have decreased eye contact not because they’re unable or averse to it, but rather because they simply don’t recognize the significance of eye contact.

Avoidance or atypical eye contact is, however, not an autism diagnosis by itself. Children may display unusual eye contact because of shyness or anxiety, an undiagnosed hearing problem, or even because their culture may view a direct gaze as disrespectful. 

Accepting decreased interest in eye contact as a symptom of autism leads to the next (complicated!) question: why is it difficult or uncomfortable for people with autism to make eye contact?

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Older children and adults are able to voice why they avoid eye contact. But what about babies, toddlers, young and nonverbal children? Contrasting theories have been proposed for a long time. Some feel children with autism are gaze avoidant because they find eye contact unpleasant, while those who disagree propose a gaze indifference theory. 

Gaze aversion theory

The gaze aversion theory suggests individuals with autism experience anxiety and feelings of threat in response to eye gaze. Research supporting this theory found eye contact activates certain brain mechanisms to abnormally high levels in individuals with autism, when they are forced to look in the eyes (Hadjikhani et al., 2017). Other studies have refuted these findings and accordingly proposed a gaze indifference theory.

Gaze indifference theory

The gaze indifference theory offers evidence of hypoactivity (abnormally inactive or underactivity) in various areas of the “social brain” system (Moriuchi et al.,2017) advancing the idea that individuals on the spectrum don’t regard the eyes as engaging. This research suggests toddlers with ASD do not have decreased eye contact because it is stressful to them, rather eye contact is not particularly significant or engaging to them.

Moriuchi et al. (2017) did not use the evidence supporting gaze indifference to completely refute the gaze aversion theory and all the research supporting it. Instead some interesting observations were made about anxiety (due to eye contact) developing only as a child gets older—rather than a natural aversion to eye contact. This would explain why young kids are merely indifferent to eye contact, while older kids and adults often report an aversion to eye contact.

So what can parents do to facilitate eye contact in a way that helps a child recognize its value without inducing stress and anxiety? Perhaps the best way is to focus on the child instead of conventional social expectations.

Even if we recognize and respect the child’s indifference or aversion to eye contact, society encourages eye contact to navigate social situations. 

Explaining the social reasoning behind eye contact

Encouraging eye contact is much easier if your child is older and you’re able to explain why

eye contact is important. Following the conclusions of research mentioned earlier, your child may not grasp the significance of eye contact. Therefore an explanation could be the first step to help them make sense of the social motivation behind eye contact. 

Use encouraging language (appropriate to their level of understanding) to explain some of the basics of eye contact. Ideas include:

  • Teachers may require eye contact to ensure the child is listening or paying attention
  • Eye contact delivers important social cues. Forget your natural understanding when explaining this to your child; they may be unaware how a direct gaze could indicate interest, attention or expectation
  • You could also explain eye contact’s important role in nonverbal communication, and how people see steady eye contact as a sign that someone is interested or engaged in a conversation or other type of social interaction

Practice makes perfunctory

While your child may not grasp the significance of eye contact (especially at a young age), the behavior could be learned through practice and praise. If your child is taught to feel more comfortable with eye contact it may lessen the aversion to direct gaze experienced by many older children and adults with autism.

Start slowly, especially if your child appears hesitant. If your child manages to look somewhere in the eye region, give praise and build up to full eye contact.

Try practicing eye contact when your child is relaxed. A great time would be when they are communicating about something that interests them. If you pay attention to what they’re trying to communicate with a direct, interested gaze—rather than the distracted glance from a phone we’re all guilty of—you’ll be modeling the exact behavior you’re encouraging.

When your child feels more comfortable and looks into your eyes when communicating, smile, give praise, and let him/her know how much you like it when he/she engages with you. Help your child to understand that you hear and understand him/her better when they are facing you and looking in your eyes. A great time to practice this is when they ask you for something. Get down to the child’s level, and tell him/her how much you love looking into their beautiful eyes.

Summing-up

When we understand the probable insignificance children with autism attach to eye contact, it becomes easier to manage our expectations. With patience and understanding, eye contact can be learned and practiced. A young child with autism who becomes aware of the social motivation behind eye contact may be inspired to acquire this skill. This may alleviate some of the anxiety many children experience later on, when society expects them to look me in the eye!

References:

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association [APA], 2013).

Hadjikhani, N., Åsberg Johnels, J., Zürcher, N.R. et al. Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Sci Rep 7, 3163 (2017). https://doi.org/10.1038/s41598-017-03378-5

Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504(7480), 427–431. https://doi.org/10.1038/nature12715 Moriuchi, J. M., Klin, A., & Jones, W. (2017). Mechanisms of diminished attention to eyes in autism. American Journal of Psychiatry, 174(1), 26-35.



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