Autism and eye contact

Today’s answer is by developmental pediatrician Amanda Bennett, behavior analyst Megan Carolan Tomkinson and psychologist Judith Miller. Dr. Bennett is the director of the Autism Speaks Autism Care Network site at Children’s Hospital of Philadelphia, where Mrs. Tomkinson and Dr. Miller also practice.

Why is it so difficult for our son (12 years old and on the spectrum) to make eye contact. What can we do – and what shouldn’t we do – to encourage this important social skill?

Thank you so much for your question. It’s one shared by a great many people – particularly those on the autism spectrum and those who care about them.

Using eye contact is an important nonverbal communication behavior that most of us use automatically in social interactions. However, as you describe, making eye contact with others can be very challenging for some people with autism – adults as well as children.

The answer to your question is difficult because research and clinical experience produces a mixed message as to how much emphasis we should place on teaching and reinforcing this skill. 

On the one hand, we know that eye contact helps people communicate their interest and attention to a conversation partner. It’s also important for communicating interest in having a social interaction with someone. Often times, we need to maintain eye contact in order to pick up and respond to important social cues from other people. And of course, a failure to make eye contact can be misconstrued by others as disinterest or inattention.

Why autistic people struggle with eye contact

The act of making eye contact is extremely stressful for some people affected by autism. There are many books and articles written by adults with autism who describe the terrible stress they felt when well-meaning parents and teachers tried to force them to make eye contact during conversations. In many cases, they describe being further distracted and unable to focus on the conversation because of this insistence.

We’ve also learned from these wonderful individuals that – when others give them leeway to communicate in a more-comfortable manner (without eye contact) – they can engage in conversations and participate in school, work, and social interactions just fine.

Should we force eye contact?

So should we insist on eye contact with those who find it uncomfortable? As with many complex questions, the best answer is probably “it depends.”

First and foremost, we encourage you to begin by exploring what the issue means for your son. How does making eye contact affect your son? Does it help him pay attention to the conversation or make it more difficult? 

It may be that eye contact is so stressful for your son that he pays less attention when you ask for it. In this case, it’s appropriate to look for alternative ways for your son to indicate to others that he is interested and paying attention to them.

For example, you might explain the importance of indicating his interest in some nonverbal way and then offer some of these options:

• Suggest that your son show his interest by fully facing the person and staying within a conversational distance. This includes working on any tendency to wander away in the middle of a conversation.
• Help your son learn some socially appropriate comments that he can use to indicate his attention. For example: saying “yes” or “okay” or even “hmm-hmm.” It’s important to help him understand that these little comments should come when the other person pauses – not while they are speaking. The two of you can practice the timing together.
• Your son might even tell someone “I am paying attention even though I’m not looking at you.”

How to develop eye contact

We’ve seen that making eye contact clearly improves attentiveness for many children who have autism. If you notice that your son doesn’t pay attention unless he’s making eye contact, then encouraging this skill may be important for his success and independence in life.

Below are some general strategies you can practice while encouraging eye contact with sensitivity. We caution that these strategies can’t replace an individualized therapy program under the guidance of a qualified professional. Behavioral therapists use a variety of approaches to encourage and increase eye contact. These can include reinforcing natural and spontaneous occurrences of eye contact and increasing the duration of eye contact during conversation.

When introducing a new skill, it’s important to teach it in small steps, while slowly advancing your expectations as your son progresses. We recommend practicing in casual and private situations with few other demands on his attention.

Also keep in mind, that in some situations, there are more-important priorities than eye contact. For instance, most of us tend to break off eye contact when we’re trying to remember something.

Eliciting a glance

The first step toward eliciting eye contact could be to pause before responding to your son. So if he asks a question or asks for something, pause before responding or offering it to him. This may be enough to get him to glance in your direction to see whether you heard him. When he does, respond immediately and praise him for making eye contact.

This can be as simple as saying, “I like how you’re looking at me” or simply “Nice looking.”

Next you want to build up the length of his eye contact. Ask him to maintain eye contact with you and wait a few moments before giving him what he wants. During this pause, you might tell him how his making eye contact encourages you to respond to his requests.

Building on interests

Special interests can be another way to encourage eye contact. Does your son just love to talk about a particular show or a special collection he has? Is he more likely to look up at you when you engage him on these subjects? This is a wonderful way to encourage him.

Visual supports

Of course, it may be that your son doesn’t make enough eye contact for you to be able to reinforce it on a regular basis. In that case, you might try some strategies to “catch his eye.” This can be as obvious as us using a visual support or touching the corner of your eye with a motion that starts within his range of sight and then reinforcing.

Research – and our clinical experience – suggest that many children with autism respond better to visual cues than to spoken directions. Visual supports can be particularly useful in reinforcing expectations. In this case, you might use a picture of eye or the word “look” written on a cue card. Eventually, you’ll want to do away with these prompts. They are teaching tools.

For more information and examples on using visual supports, see the Autism Speaks ATN/AIR-P tool kit “Visual Supports and Autism Spectrum Disorder.” Follow the link for free download.

Behavioral therapy and social-skills groups

If your son is already seeing a behavioral therapist, eye contact and attentiveness are wonderful skills for them to work on together. A behavior analyst or educator can work with you and your son on personalized recommendations. This will likely include a range of behavioral strategies that can help increase eye contact within your son’s natural environments of home, school and play. For more information download the Autism Speaks Introduction to Behavioral Health Treatments Tool Kit and A Parent’s Guide to Applied Behavior Analysis.

The therapist may begin by completing a behavior assessment of your son. Ideally, the therapist will observe how your son interacts with others in a variety of real-life settings. For instance, the therapist will want to observe your son in several settings with varying demands and collect information on how often he directs eye contact and when he might avoid gaze. If this is not possible, he or she may ask you to describe these situations.

Based on these observations, the therapist will work with you to develop a plan to increase eye contact in specific situations.

Along these lines, your school district may have a social skills coaching group. Or a school counselor may know of one in your community.

These strategies should serve as a springboard for additional behavioral supports that enlist the help of professionals. As we describe above, we want to encourage you to take advantage of autism specialists and resources in your area.

We hope these strategies and suggestions prove helpful. 

Editor’s note: The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.