Understanding Lack of Eye Contact in Autism: Causes & Implications

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by challenges with social communication, restrictive interests, and repetitive behaviors. One of the most well-known traits associated with autism is lack of eye contact. However, the reasons behind this symptom are nuanced. This article will explore the meaning, causes, and implications of lack of eye contact in autism.

Understanding Lack of Eye Contact in Autism
Understanding Lack of Eye Contact in Autism

What Role Does Eye Contact Play in an Autism Diagnosis?

Difficulty with eye contact is listed as one diagnostic criterion for autism in the DSM-5, the handbook used by clinicians to diagnose mental health conditions. Specifically, the DSM-5 notes “abnormalities in eye contact” as an example of issues autistic individuals may have with nonverbal communication.

However, lack of eye contact alone is not enough for an autism diagnosis. The DSM-5 criteria state that an autism diagnosis requires persistent deficits in social communication and social interaction across multiple contexts. This includes:

  • Deficits in social-emotional reciprocity
  • Abnormal nonverbal communication behaviors
  • Difficulties developing and maintaining relationships

So while lack of eye contact may contribute to an autism diagnosis, clinicians also look for other symptoms like lack of interest in peers, poor understanding of social cues, and repetitive speech or movements.

Why Do Many Autistic People Avoid Eye Contact?

Research reveals that autistic individuals process direct eye gaze differently than neurotypical peers. Brain imaging studies show that various regions of the brain activate when autistic and neurotypical people make eye contact.

Additional studies using electroencephalography (EEG) indicate that neurotypical children have a stronger neurological response to direct eye gaze compared to indirect gaze. However, autistic children showed the opposite pattern, with more brain activity in response to indirect gaze.

According to researchers, these findings suggest that autistic individuals:

  • May not find eye contact as socially motivating as neurotypical people
  • Can feel overwhelmed trying to process spoken language and eye contact simultaneously
  • May not intuitively understand the social significance of eye contact
  • Can experience eye contact as intensely stimulating or even painful

Indeed, many autistic adults report that direct eye contact causes physical discomfort, including:

  • Dizziness
  • Headaches
  • Increased heart rate
  • Nausea
  • Pain
  • Tremors

Autistic people often find eye contact invasive, distracting, confusing, and best reserved for close relationships. Making eye contact while processing speech can also be challenging for autistic individuals.

As a result, autistic people may avoid eye contact to minimize discomfort, not because they are uninterested or ignoring the speaker. Some autistic individuals use strategies like looking near the eyes to approximate eye contact.

When Lack of Eye Contact May Indicate Autism

Lack of eye contact does not definitively mean a child is autistic. Some other reasons a child may avoid eye contact include:

  • Disliking or fearing the person attempting eye contact
  • Being unable to see or hear the person
  • Feeling shy or socially anxious
  • Belonging to a culture that sees direct eye contact as disrespectful

However, lack of eye contact combined with other developmental delays may indicate autism. According to experts, seek an autism evaluation if your child under 3 years old avoids eye contact and shows any of the following:

  • Does not respond to their name when called
  • Has delays in social communication skills
  • Exhibits repetitive behaviors or limited imaginative play
  • Has intense, narrow interests

Bring up these concerns with your child’s doctor. They can refer you to a developmental pediatrician or psychologist for an autism assessment if needed.

The Complex Role of Eye Contact in Autism

In summary, lack of eye contact is a common but complex trait in autism. Autistic individuals may not understand the social importance of eye contact, find it uncomfortable, or get overwhelmed trying to process speech and make eye contact simultaneously.

However, lack of eye contact alone does not indicate autism. Look for lack of eye contact alongside difficulties with relationships, communication challenges, and repetitive behaviors when considering autism.

If your child is avoiding eye contact and showing other developmental delays, talk to their doctor about having an autism evaluation. Early intervention with evidence-based therapies can greatly improve outcomes for autistic children.

Getting Started with ABA Therapy in Maryland

Applied behavior analysis (ABA) is the gold standard treatment for autism spectrum disorder. This structured therapy uses positive reinforcement to build communication, social, academic, and adaptive skills. Extensive research shows ABA can improve outcomes for autistic individuals across their lifespan.

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References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  2. Hirsch, J., Zhang, X., Noah, J. A., & Ono, K. E. (2022). Neural correlates of eye contact and social function in autism spectrum disorder. PLoS ONE, 17(11), e0265798. https://doi.org/10.1371/journal.pone.0265798
  3. Lauttia, J., Hlminen, T. M., Leppanen, J. M., & Hietanen, J. K. (2019). Atypical pattern of frontal EEG asymmetry for direct gaze in young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49, 3592–3601. https://doi.org/10.1007/s10803-019-04062-5
  4. Trevisan, D. A., Roberts, N., Lin, C., & Birmingham, E. (2017). How do adults and teens with self-declared autism spectrum disorder experience eye contact? A qualitative analysis of first-hand accounts. PLoS ONE, 12(11), e0188446. https://doi.org/10.1371/journal.pone.0188446
  5. Uono, S., & Hietanen, J. K. (2015). Eye contact perception in the West and East: A cross-cultural study. PLoS ONE, 10(2), e0118094. https://doi.org/10.1371/journal.pone.0118094
  6. Jones, E. J., Gliga, T., Bedford, R., Charman, T., & Johnson, M. H. (2014). Developmental pathways to autism: A review of prospective studies of infants at risk. Neuroscience & Biobehavioral Reviews, 39, 1-33. https://doi.org/10.1016/j.neubiorev.2013.12.001
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