In the actual diagnostic criteria, however, "lack of eye contact" is part of a much larger collection of symptoms, including "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." In other words, a child who is conversing and using body language typically, but refuses to make eye contact, is unlikely to be exhibiting a symptom of autism. A child who is unable to make eye contact and also has a hard time using spoken language, pointing to objects, or otherwise communicating wants and needs, may indeed have symptoms of autism.
How do you know if a child's lack of eye contact is sufficient to warrant worry? There is no absolute answer to that question, but of course the amount of eye contact to expect will increase as your child gets older. Infants don't intentionally make eye contact, but they typically turn their heads and look at faces. Older children look up when they're spoken to, and generally look toward the speaker. Eye to eye contact per se will vary with individuals and with cultural norms: in some parts of the world, it's considered rude to look directly into the eyes, while in other parts of the world it's considered a sign of trustworthiness.
If you have concerns about your child's unresponsiveness and lack of eye contact, you can request an evaluation by a qualified doctor or practitioner (typically a developmental pediatrician or psychologist). They may administer any number of tests, but the Autism Psychodynamic Evaluation of Changes (APEC) scale is probably the most useful, as it includes specific measurements of expression of emotion in relationships, eye contact, body image, graphic productions, exploration of space and objects, time perception, and verbal language.
It is possible to teach most children with autism to make more eye-to-eye contact, and to modify or improve their body language and gesturing. On the other hand, many people on the autism spectrum report that eye-to-eye contact can be anxiety-producing or over-stimulating. What's more, therapy occasionally results in a child who, attempting to comply with the command "look me in the eye," winds up staring too directly into the eyes of conversational partners. Therapy, therefore, should focus on communication skills in general, rather than on enforced eye-to-eye gaze.
More about Testing for Autism Spectrum Disorders
- Who Should Diagnose Autism Spectrum Disorders?
- Best Intelligence Test for Children with Autism
- How Is the ADI-R Test Used to Help Make an Autism Diagnosis?
- Explore other symptoms of autism with the Autism Symptoms Checklist
- Learn about different Types of Autism
- Find out How Doctors Screen for and Diagnose Autism
G. Haag 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 Oct 19.
A. Senju. "Atypical eye contact in autism: models, mechanisms and development." Neurosci Biobehav Rev. 2009 Sep;33(8):1204-14.