Eye Contact and Adults with Autism Spectrum Disorder

Autism, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), is primarily a social disorder. Of the many social skills deficits common to people with Autism Spectrum Disorder (ASD), one of the most common, and disconcerting, is difficulty making appropriate eye contact. The following article will discuss the importance of eye contact, why eye contact might be difficult for adults with ASD, and some possible treatments and interventions.

Importance of Eye Contact

Have you ever wished someone you were taking to wasn’t wearing sunglasses? Spoken words are only one element of a conversation. The non-verbal aspects, especially eye contact, are equally important. For neuro-typical adults, eye contact is so inherent, they are able to follow complex and unspoken rules unconsciously and automatically, noticing the importance of eye contact only when their conversational partner isn’t playing along.

Eye contact should vary depending on the number of listeners and intentions of the speaker:

• Talking to a group: To keep everyone engaged, make brief eye contact with every member of the group
• Talking to an individual: Make regular eye contact, but not so constant so that you are staring at them
• Listening to someone: Make more consistent eye contact than when you are the speaker, but still don’t stare intensely
• Arguing: Holding the gaze shows strength
• Flirting: Holding eye contact a little longer than usual combined with dilated pupils indicates romantic interest

If you don’t follow these rules, you are likely to make people uncomfortable. For example, in western cultures, and throughout much of the animal kingdom, direct and unwavering eye contact is perceived as threatening and aggressive. Too much eye contact in a flirtatious situation will almost definitely not lead to a date.

On the other hand, if the person you’re talking to isn’t making eye contact, they are likely perceived as:

• Not listening or not caring
• Lying, deceiving, or hiding something

Therefore, for example, too little eye contact on a job interview is not likely to leave the interviewer with a good impression.

Why is Eye Contact Challenging for Individuals with ASD?

Often one of the first symptoms of autism recognized in children is a lack of eye contact. This is classified as an impairment in social interaction, and grouped with other non-verbal behaviors such as facial expression, body posture, and gestures to regulate social interaction.

To specifically understand the deficit in eye contact, however, it is important to know that looking at faces is mentally demanding. In a recent study, researchers found that simply looking away from a questioner’s face can help adults answer challenging arithmetic and verbal-reasoning questions. Without the distraction of complex visual input (i.e., a human face), more energy can be devoted to processing other mentally demanding input.

Human faces are very stimulating and require a lot of mental processing. For someone with autism, who is already likely a highly visual person, looking directly at a face may cause sensory overload. John Elder Robinson, author of Look Me in the Eye: My Life with Asperger’s, wrote about the frustration of constantly being told he needed to make eye contact, an act that is very uncomfortable for him. Robison didn’t know why his parents and teachers were so irritated with him; he didn’t even know what “look me in the eye” meant. Adults perceived him as no good, a criminal, shifty or evasive, even a sociopath. Robinson explained that he finds visual input distracting. For him, speaking or listening when watching something nearly impossible; he is better able to concentrate when he looks somewhere neutral, like the ground or off into the distance.

Treatments and Interventions

Therapies for improving eye contact in adults do exist, mainly in the context of improving social skills in general. There are three primary avenues for addressing eye contact in adults with ASD: direct instruction and training, natural environment training, and promoting acceptance and understanding.

Training

Behavioral Therapy

Behavioral Therapy (e.g., Discrete Trial Training) provides positive reinforcement immediately following an action (i.e., making eye contact) to increase the frequency of the action. This kind of therapy is most often done with young children. While behavioral therapy can be effective, a criticism of this approach is that the eye contact may become forced or robotic, and therefore equally as inappropriate as making no eye contact at all.

Providing Rules

Adults with ASD may benefit from learning rules to follow during a conversation. The rules should be as specific and concrete as possible. Some examples are:

• Break eye contact approximately every 5 seconds
• When you break eye contact, look up or to the side
• The Triangle: When listening to someone, look at their right eye for 5 seconds, their left eye for 5 seconds, their mouth for five seconds, and repeat

Natural Environment

Social Skills Groups and Activities

Social skills groups for adults are far rarer than social skills groups for children, but the few that have been formed have shown some success. For example, after a 12-week group for adolescents and young adults with autism, improvements were found in areas such as initiating and maintaining conversations and understanding and expressing emotions.

AHEADD

Achieving Higher Education with Autism and other Developmental Disabilities (AHEADD) is a program that provides on-site supports to college students. In addition to other academic supports, AHEADD assists its students by providing communication and social skills support and development. With the help of trained staff and a peer mentor, a student with ASD can practice social skills, including eye contact, in a natural environment.

Acceptance and Understanding

Making eye contact is not likely to ever be natural and easy for someone with ASD. The best route may be for the individual to advocate for acceptance and understanding. Is eye contact really necessary to get the job done? Is it more important to be looked in the eye or listened to? Isn’t it kind of a strange habit, anyway, to stare at someone’s eyeballs when you speak to them? Individuals with ASD state that their most successful social and work experiences are those in which there is a tolerance of differences and those around them are patient and caring.