Autism Symptoms and Eye Contact

"No Eye Contact" May Be a Sign of Autism -- Or Not!

Eye Contact
Eye Contact. Getty

If you've looked up the symptoms of autism, you've probably seen a reference to "lack of eye contact." While this sounds like a straightforward description of a behavior, however, there's more to "lack of eye contact" than meets the eye.

How Eye Contact Fits into the Criteria for Autism

In the actual diagnostic criteria, "lack of eye contact" is part of a much larger collection of symptoms, including "marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction." In other words, a child who is conversing and using body language typically, but refuses to make eye contact, is unlikely to be exhibiting a symptom of autism.

A child who is unable to make eye contact and also has a hard time using spoken language, pointing to objects, or otherwise communicating wants and needs, may indeed have symptoms of autism.

Here's how eye contact falls into Part A of the criteria for autism in DSM 5 (the manual for mental and developmental disorders):

A.      Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1.       Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2.       Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3.       Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

As you can see, lack of eye contact does not stand alone as a symptom, nor is it always a symptom of autism.

When Should I Worry About Lack of Eye Contact as a Symptom of Autism?

How do you know if a child's lack of eye contact is sufficient to warrant worry? There is no absolute answer to that question, but of course the amount of eye contact to expect will increase as your child gets older.

Infants don't intentionally make eye contact, but they typically turn their heads and look at faces. Older children look up when they're spoken to, and generally look toward the speaker. Eye to eye contact per se will vary with individuals and with cultural norms: in some parts of the world, it's considered rude to look directly into the eyes, while in other parts of the world it's considered a sign of trustworthiness.

It makes sense to investigate lack of eye contact when it arises before your child turns three and:

  • Your child does not respond to hearing his name called and he is not hard of hearing
  • Your child has other developmental delays related to social communication (lack of back-and-forth interaction, unawareness of others' emotions, delayed speech, lack of facial expression)
  • Your child also has other symptoms related to autism such as repetitive but non-functional behaviors (flapping hands, spinning, rocking), atypical use of toys, lack of imaginative play, etc.)

If your child is not making eye contact but does not have any of the other symptoms listed, it is unlikely that she is autistic. On the other hand, she may have other issues that should be addressed. Alternatively, ​she may simply be too involved in her own play to look you in the eyes whenever you call her name.  

What To Do if You Are Concerned

If you have concerns about your child's lack of eye contact, you can request an evaluation by a qualified doctor or practitioner (typically a developmental pediatrician or psychologist). They may administer any number of tests, but the Autism Psychodynamic Evaluation of Changes (APEC) scale is probably the most useful, as it includes specific measurements of expression of emotion in relationships, eye contact, body image, graphic productions, exploration of space and objects, time perception, and verbal language.

It is possible to teach most children with autism to make more eye-to-eye contact, and modify or improve their body language and gesturing. On the other hand, many people on the autism spectrum report that eye-to-eye contact can be anxiety-producing or over-stimulating. What's more, therapy occasionally results in a child who, attempting to comply with the command "look me in the eye," winds up staring too directly into the eyes of conversational partners. Therapy, therefore, should focus on communication skills in general, rather than on enforced eye-to-eye gaze.

More about Testing for Autism Spectrum Disorders

Learn More About Autism Symptoms, Types of Autism and Autism Diagnosis

Sources:

G. Haag et al. "The Autism Psychodynamic Evaluation of Changes (APEC) scale: A reliability and validity study on a newly developed standardized psychodynamic assessment for youth with Pervasive Developmental Disorders." J Physiol Paris. 2010 Oct 19.

A. Senju. "Atypical eye contact in autism: models, mechanisms and development." Neurosci Biobehav Rev. 2009 Sep;33(8):1204-14.

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