Lack of Eye Contact as a Symptom of Autism

Lack of eye contact may or may not be a symptom of autism

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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." In other words, children (and adults) with autism are less likely to look directly at another person's eyes, which suggests that they are less engaged with others or less responsive to people in general. Lack of eye contact, however, isn't as simple as it seems. Not only can it occur for many different reasons, but it may also have quite a few causes.

How Autism Is Diagnosed

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."

"Lack of eye contact" is one of many criteria used by doctors to diagnose autism, but lack of eye contact alone is not enough to suggest that a diagnosis is appropriate. It is, instead, just one of many signs and behaviors which may suggest autism. 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.

Why Do Children with Autism Lack Eye Contact?

There are many reasons why any child might not make eye contact; by no means all of those reasons relate to autism. For example, they may:

  • be fearful of or dislike the person who is requesting eye contact
  • have low hearing and be unaware of the request for eye contact
  • feel a general sense of social anxiety or shyness
  • be from a culture that sees direct eye contact as a sign of disrespect (this includes many Asian cultures)

Children with autism, however, generally seem to avoid eye contact for different reasons. While studies are not absolutely conclusive, findings suggest that children with autism:

  • often lack the usual social motivation that leads other children to make eye contact
  • can find eye contact to be a very intense and overwhelming sensory experience
  • find it difficult to focus both on spoken language and on another person's eyes at the same time
  • may not understand that watching another person's eyes is more revealing than, for example, watching that person's mouth or hands

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 and does play a part in all of these behaviors. A child who lacks eye contact but does interact social, use non-verbal communication, and builds close personal bonds is unlikely to be autistic—even if she lacks eye contact.

How to Tell If There Is a Problem

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.