Lack of Eye Contact as a Symptom of Autism

How the Behavior May Hint at an Autism Diagnosis

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If you've looked up the symptoms of autism, you've probably seen a reference to the "lack of eye contact." While this seems a pretty straightforward description, there is actually much more to the behavior than one might expect.

How Autism Is Diagnosed

"Lack of eye contact" is one of many criteria used by doctors to diagnose autism. It shouldn't suggest that a person who is unable to look others in the eye is inherently autistic; he or she may just be shy.

Rather, the term is used to build a body of evidence by which autism can be confirmed. Since there are no blood and imaging tests to do this, doctors must rely on the spectrum of characteristic behaviors to make a diagnosis. The list can then compared to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

Based on the evidence, the doctor can either confirm or exclude autism as the cause or, alternatively, suggest that the diagnosis is inconclusive.

Eye Contact as a Criteria of Autism

According to the DSM-5, autism is characterized by "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."

What this means is that the child is unable to communicate feelings or thoughts in the way that other children do, including the ability to make eye-to-eye contact. It doesn't suggest that the child doesn't want to look; it is simply that he or she is unable to comprehend the context of eye contact in communication.

As such, a child who converses and uses body language but refuses to make eye contact is unlikely to be autistic. On the other hand, a child who lacks eye contact and other forms of verbal and nonverbal communication (such as speaking or pointing to objects) may, indeed, have symptoms of autism.

Other Diagnostic Criteria

The DSM-5 defines autism as a persistent lack of social communication and interactions across multiple contexts as characterized by the following behaviors:

  1. The lack of social-emotional reciprocity (the mutual exchange of input and responses)
  2. The lack of nonverbal communication (including facial expression)
  3. The inability to develop, maintain, or understand relationships, often perceived by others as being apathetic or disinterested

Clearly, the lack of eye contact can play a part in all of these behaviors.

How to Tell If There Is a Problem

As mentioned earlier, the lack of eye contact on its own should never to be considered symptomatic of autism. This is especially true in infants who may not make eye contact but will generally turn their heads in the direction of a person's face.

However, you may want to investigate autism if your child is under three, lacks eye contact, and exhibits any of the other following traits:

You can then decide whether to contact a developmental pediatrician or psychologist to conduct an evaluation based on the Autism Psychodynamic Evaluation of Changes (APEC) scale.

What Happens Next

If your child is diagnosed with autism, therapy can start to develop or enhance his or her general communication skills.

While some of the focus will be placed on developing eye contact, it is usually not the begin-and-end-all solution. For some, eye-to-eye contact can the source of enormous anxiety and/or overstimulation, while others will respond by staring at someone for an uncomfortably long period of time.

Setting realistic, incremental goals is always the best way to ensure that your child gets the most appropriate care specific to his or her needs.

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Article Sources
  • Haag, G.; Botbol, M.; Graignic, R. 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;104(6):323-36. DOI: 10.1016/j.jphysparis.2010.10.002.

  • Senju, A. and Johnson, M. "Atypical eye contact in autism: models, mechanisms, and development." Neurosci Biobehav Rev. 2009; 33(8):1204-14. DOI: 10.1016/j.neubiorev.2009.06.001.