Lack of Eye Contact as a Symptom of Autism

Lack of eye contact is a well-known symptom of autism. A form of non-verbal social communication, eye contact can indicate that a person is paying attention, interested, and engaged.

Many people with autism have difficulty looking people in the eyes. However, a lack of eye contact does not automatically mean a person has autism.

This article discusses eye contact in autism. It explains how eye contact is different in people with autism and other reasons why a person may avoid eye contact.

Diagnosing Autism By Eye Contact

Lack of eye contact is one of many criteria used by doctors to diagnose autism. Since there are no physical tests for autism, a diagnosis is based on a spectrum of behaviors.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, one symptom of autism is impairments in the use of multiple nonverbal behaviors such as:

• Eye-to-eye gaze
• Facial expression
• Body posture
• Gestures to regulate social interaction

The DSM-5 defines autism as a persistent lack of social communication and interactions across multiple contexts. Other criteria used for diagnosing autism include:

• A lack of social-emotional reciprocity (the mutual exchange of input and responses)
• A lack of nonverbal communication (including facial expressions)
• An inability to develop, maintain, or understand relationships, often perceived by others as being apathetic or disinterested

A child who lacks eye contact but interacts socially, uses non-verbal communication, and builds close personal bonds is unlikely to be autistic—even if they lack eye contact.

Eye Contact In Autism

Research shows people with autism respond to eye contact differently than neurotypical individuals.

Scientists at Yale University used brain scans to compare reactions to eye contact among people with autism and those without. The study found eye contact prompted activity in different regions of the brain in people with autism than in non-autistics.  

Another study used an electroencephalogram (EEG) to study brain activity in relation to eye contact. Researchers found that typically developing children have a stronger response to a direct gaze than a downcast gaze. Children with autism, however, had a stronger response to a downcast gaze than direct eye contact.

According to the study authors, these findings may indicate children with autism:

• Often lack the usual social motivation that leads other children to make eye contact
• 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
• Can find eye contact to be a very intense and overwhelming sensory experience

Autistic Adults Say Eye Contact Is Painful

Additional research shows adults with autism often experience physical discomfort when making eye contact. Negative physical symptoms associated with eye contact in people with autism include: 

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

The study also found many people with autism find eye contact is invasive, distracting, and confusing. Some reported eye contact should be reserved for intimate relationships and people they trust.

What's more, the study authors noted adults with autism often find processing verbal information more difficult when making eye contact. In other words, a lack of eye contact does not mean a person with autism isn't paying attention.

Most adults in the study said they understood that society deems eye contact important. However, they expressed confusion over how much eye contact is appropriate. Many use strategies to fake eye contact, such as looking just above the person's eyes.

Other Reasons a Child May Avoid Eye Contact

A lack of eye contact does not always indicate a child has autism. A child can avoid eye contact because they:

• Are fearful of or dislike the person who is attempting to make eye contact
• Have a hearing problem and be unaware that they should look at someone
• Feel a general sense of social anxiety or shyness
• Come from a culture that sees direct eye contact as a sign of disrespect (this includes many Asian cultures)

When To Seek an Autism Evaluation

The lack of eye contact on its own should never 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 age 3, lacks eye contact, and exhibits any of the other following traits:

• Failure to respond to their name despite having normal hearing
• Developmental delays in social communication milestones
• Common autism behaviors such as repetitive, non-functional activity, the lack of imaginative play, or the atypical use of toys

If your child displays these behaviors, talk to your pediatrician. You may be referred to a developmental pediatrician or psychologist for an evaluation.

A Word From Verywell

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 be the source of enormous anxiety or overstimulation. Setting realistic, incremental goals is always the best way to ensure that your child gets the most appropriate care specific to their needs.