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Toddlers with autism indifferent to eye contact, study says

by  /  15 December 2016

Toddlers with autism are oblivious to the social information in the eyes, but don’t actively avoid meeting another person’s gaze, according to a new study1.

The findings support one side of a long-standing debate: Do children with autism tend not to look others in the eye because they are uninterested or because they find eye contact unpleasant?

“This question about why do we see reduced eye contact in autism has been around for a long time,” says study leader Warren Jones, director of research at the Marcus Autism Center in Atlanta, Georgia. “It’s important for how we understand autism, and it’s important for how we treat autism.”

If children with autism dislike making eye contact, treatments could incorporate ways to alleviate the discomfort. But if eye contact is merely unimportant to the children, parents and therapists could help them understand why it is important in typical social interactions.

The work also has implications for whether scientists who study eye contact should focus on social brain regions rather than those involved in fear and anxiety.

Lack of eye contact is among the earliest signs of autism, and its assessment is part of autism screening and diagnostic tools. Yet researchers have long debated the underlying mechanism.

The lack-of-interest hypothesis is consistent with the social motivation theory, which holds that a broad disinterest in social information underlies autism features. On the other hand, anecdotal reports from people with autism suggest that they find eye contact unpleasant. Studies that track eye movements as people view faces have provided support for both hypotheses.

The new work is elegant, scientists say. “Among the strengths is the conceptual clarity with which they framed the study, in pitting two hypotheses against one another,” says Jed Elison, assistant professor of child development at the University of Minnesota in Minneapolis, who was not involved in the work.

Gaze indifference:

The study, published 18 November in the American Journal of Psychiatry, is the first to address the issue in toddlers. This makes it more likely to get at the origins of altered gaze patterns in autism than previous studies, Jones says.

Jones’ team showed a series of videos to 38 typically developing toddlers, 26 toddlers being evaluated for autism, and 22 who showed developmental delays in cognition, language or movement, but did not meet criteria for autism. The children were all 2 years old. The researchers used eye-tracking technology to follow the children’s gaze as they watched the videos.

At first, the toddlers see a small blue-and-white circle flash on the screen as chimes sound to draw their attention. As soon as the child looks at the circle, a video of an actress appears in its place. The woman then speaks to the child in an engaging way.

In some cases, the circle’s location directs the child’s gaze to the actress’ eyes. At other times, the circle leads the child to look at another part of the actress’ face or the scene around her, which is set up to look like a child’s room, full of toys and colorful pictures.

When cued by the circle to look at the actress’ eyes, the toddlers with autism don’t look away from her eyes any sooner than the other groups do. This finding suggests that eye contact is not uncomfortable or unpleasant for them.

Conceptual clarity:

During the rest of the video, the typical toddlers tend to look at the actress’ eyes when her voice and facial expressions are emotionally engaging; they sometimes look elsewhere when she is not emotionally expressive.

Toddlers with autism spend less time looking at the actress’ eyes than typical toddlers do, but their eye contact doesn’t vary with the emotional content of her face.

“It’s a very clear and concise story,” says Frederick Shic, associate professor of pediatrics at the University of Washington in Seattle, who was not involved in the work. “There’s not an aversive behavior that’s occurring. This is really gaze indifference.”

Children in the developmental delay group showed gaze patterns similar to those of the typical toddlers. “It really casts that difference of kids with autism into a stark light,” Jones says.

Larger studies are needed to sort out whether all toddlers with autism show this pattern of disinterest, scientists say. What’s more, adolescents and adults with autism often say eye contact is intense or unpleasant for them, so gaze aversion may develop later in life.

  1. Moriuchi J.M. et al. Am. J. Psychiatry (2016) Epub ahead of print PubMed

17 responses to “Toddlers with autism indifferent to eye contact, study says”

  1. Jon Brock says:

    Neat study. One point to consider is that toddlers are watching a video. It would be interesting to see if similar findings hold in interactions with real people.

    • merchantfan says:

      Yes, personally as an autistic adult, I have no trouble looking at an actor’s eyes on TV or at the movies and even enjoy it, but it is painful to look directly in the eyes especially of someone looking at me. Perhaps there are more complex microemotions you can see in person or the pain comes from whatever part of the brain fires when someone looks you directly in the eye. Is it even the same part as when someone looks at a movie?

      • ram says:

        So to clarify, are you saying as my daughter does that you get too much sensory input when you look directly into someone’s eyes? She says she feels them too much when she looks for long, and it’s just painful and/of overwhelming, and that she can’t listen and look at the same time, either.

        • merchantfan says:

          I mean, I wouldn’t definitively say something until we have a better scientific understanding of what’s happening, but my hypotheses about why it hurts me have always been: either *too much* input or the input is coming in in the same amount, but either triggers the wrong part of the brain (the “ow what” response instead of the “oh this is a nice connection” response) or the normal part that that response triggers happens, but *other* connections cause an unpleasant response. Basically, I think there’s definitely a negative neurological response, but the brain is so complex that I couldn’t say for certain what exactly is happening without some brain scans etc.

          • ram says:

            I agree, and I would say that it’s the sensation and experience you and other feel that is the key here, and that brain scans are helpful as a backup to confirm what is happening. Knowing how it feels to you and others can help science and medicine help people to do what they want to do whatever the cause in the brain. Thanks for answering me! You are confirming her description of it being too much.

  2. Michelle Sarabia says:

    Not indifferent. Eyes are overwhelming… AND there are just as many details in the surrounding environment to receive high priority. It is not indifference, but indifferentiation.

  3. Kelly says:

    You cannot assume that looking at a video is the same as interacting with someone in real life. My autistic toddler can look people in the eye all day on a video. That means nothing. Also why are you doing research into something that autistic adults can tell you about? They say eye contact is uncomfortable and sometimes painful. Do you not believe them? Seriously what a waste of time and money this research is.

    • William says:

      So true!

    • merchantfan says:

      Well, it would be good to know what *percentage* of autistic people find eye contact painful, including those that cannot communicate. Adult autistic people who can talk fluently about their experience are only a subset of the population. I also have worked with many autistic children who *do not* find eye contact painful and some who even enjoy making eye contact while having multiple other deficits. But I agree with you about the video issue. I don’t know how many autistic individuals actually have trouble with pictures/videos like many studies use. I can look at pictures and videos as much as I want, it’s only people’s eyes IRL that I find somewhat painful/distracting.

      I’ve always thought that many autism studies should do a better job of collecting information about the specific symptoms of each participant. That way they could break them into groups easier. Especially when you end up with results like “a subset responded to the treatment”. OK, what were they like? Did they have extreme behaviors or minimal behaviors? Were they verbal? Did they have extreme sensory problems or minimal? Many times a study just has to speculate when that information could probably be collected by a standardized parent/teacher questionnaire.

    • Mark Carew says:

      Hi Kelly, I share your frustration at the seeming weakness in the research criteria, when perhaps other options are there staring you in the face as it were. I suspect that eyes have a big part to play in the developmental phases in humans, they use the most brain resource and hence neurological resource, including for example glucose from the blood. The first area to show reduced capacity in a diabetic hypoglychemic (low blood sugar) episode is vision. only basic capacity being maintained, and any attempt to read text for example would be a struggle. More recent study suggests mitochondria variances from mother to child have links, and these are essentially energy related. Eye to eye contact may be terrifying if not on equal terms.

  4. Renata Herrero says:

    through my childhood and young audult life it was unpleasant to look people in the eye. It took me 20 years to develop the ability to look in the eye
    Now i’m mother of an autistic toddler.

    • ram says:

      What sensations did you get when you looked people in the eyes? I am just wondering if it is similar to my daughter and husband’s experiences.

      • Renata Herrero says:

        I remember that looking in the eye just felt unpleasant: just as a sensation i didn’t wanted to feel.
        From toddler to young adult i felt this sensation
        I changed through more than 20 years of hard work, therapy, martial arts, sports and somewhere between 20 -30 years old i started to make eye contact
        Now i am trying that my toddler diagnosed with asd makes eye contact through lot of games and he is doing a little more from 0 to some. Use teacch & floortime
        Hope this helps you


        Other thing i remember id the feeling of intrusion with eye contact asif it hurted.

        • ram says:

          Thank you for replying!! That all makes sense, and I find that people with autism are very sensitive to the energy around them. Even without angry words spoken the energy in a room changes when emotions change, other people come in, or the sound level changes. Looking into people’s eyes means you feel more of their energy, and I can see why that would feel intrusive. Thanks!

  5. Megan M says:

    It would be helpful if the researchers could choose their language more carefully. “Indifference” suggests that the toddlers recognize that they are looking at human eyes but simply aren’t interested. What this study actually seems to show is that toddlers do not notice any difference between human eyes and the rest of the scene they are viewing. That is not “indifference,” it is failure to differentiate.

  6. ram says:

    I disagree with that conclusion. Why don’t you just ask people with autism why they don’t look people in the eye so much? I have. It isn’t related to indifference at all. My daughter with Aspergers explained as a young child and since then that it was too much sensory input for her. She can look at you and she gets so much information from your eyes that she can’t take it for long without it overwhelming her. She can’t listen to you and look at your eyes at the same time for that reason. She can’t stand seeing anything unpleasant in other people’s eyes, either.

    So many kids with autism are sensitive to light, sounds, the feel of the room, their clothes, food textures, etc., so why would you assume that they don’t care or can’t differentiate regarding eye contact? Did you ask those who could speak or otherwise communicate? And no, it isn’t just those who speak well. Yes, each person is different and some may not mind eye contact so much, but I have known many autistic children and adults, and it isn’t a lack of caring or differentiating so much as being so sensitive to so many things and become so overwhelmed that they can’t function in the ways those who aren’t autistic can. All of the pictures of my daughter when she was younger were with her covering her ears or eyes from the stimulation that she couldn’t process then, and she can feel energy shifts in the room. She can look at my friends and know they need a hug or that they have a headache without being told, and of course she can’t stand looking them in the eyes for long. The eyes are intensely personal, announce who we are and are indeed the “windows to the soul”.

    I have listened to several kids/adults with varying degrees of autism describe feeling so much sensory input they can’t begin to process it, and some get caught up in it as in spinning or flapping, too. So everyone is different, but assuming that we know why someone’s gaze shifts without asking or some other evidence isn’t conclusive by any means. Even the non-verbal people with autism that I know resist looking at eyes, and although some might not, there is a reaction and gaze away often, not lack of noticing they are eyes. Just my experiences…not saying everyone’s are the same.

  7. Poly says:

    I agree with the other comments that the study is flawed. Looking at a person’s eyes on a screen isn’t the same thing as looking at a person’s eyes in real life and having them look back into yours. I think the answer to the fundamental question may really be that both disinterest and discomfort are at work. From a young age, speaking for myself, I think people on the spectrum just aren’t aware of the fact that you are supposed to look at a persons eyes when you talk to them. It isn’t intuitive for us. I tend to look at a person’s mouth while they are talking because that is where the movement is, so that is what draws my attention, and I also have some problems with auditory processing delay, so looking at a person’s mouth when they talk helps me to decipher what they are saying more quickly. With that said, as I got older, I came to understand that you are supposed to look at a person’s eyes when they talk, so I sometimes will remind myself to do that. When I do, it is a conscious effort I have to make, and it makes me feel uncomfortable. It feels like I have tunnel vision, and I am just staring into an abyss, unaware of anything else going on around me, and it just feels like I am connecting with the person in a way that is too personal. Maybe it is because I didn’t form the habit from a young age, or maybe it is because it always made me uncomfortable. I would like to see this study done with a live person, rather than a person on a screen. That is the only way to reach an accurate conclusion.

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