Lack of Eye Contact in Autism

Lack of eye contact is often seen in children with autism and is assumed by many to be diagnostic of autism. But the simple fact is that not all people with autism avoid eye contact, and not all people who avoid eye contact have autism.

The lack of eye contact is due to a condition known as alexithymia, a term used to describe trouble feeling emotions. Current research suggests that only around 50% of people with autism have alexithymia and that one in 10 people in the general population have it as well.

While alexithymia is more common in people with autism, it can also occur with major depression, schizophrenia, post-traumatic stress disorder (PTSD), stroke, Alzheimer's disease, and many other psychological or neurocognitive disorders.

This article discusses how eye contact factors into an autism diagnosis. It explains how eye contact is different in many autistic people and the reasons why an autistic person may avoid eye contact.

Diagnosing Autism By Eye Contact

Lack of eye contact is one of many criteria used by medical providers to diagnose autism. Since there are no physical tests for autism, a diagnosis is based on a review of behaviors and traits.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, one symptom of autism is the impaired use of nonverbal language such as eye-to-eye gaze, facial expression, and body posture.

Other criteria used for diagnosing autism include an inability to develop, maintain, or understand relationships, often seen by others as apathy or disinterest. A lack of eye contact further amplifies this perception.

While a lack of eye contact may be a feature of autism, it is not "diagnostic" of autism. A person can have autism with no signs of alexithymia—and look you straight in the eye.

Eye Contact In Autism

Research shows autistic individuals respond to eye contact differently than their non-autistic counterparts.

Scientists at Yale University used brain scans to compare reactions to eye contact among autistic people and non-autistic people. The study found eye contact prompted activity in different regions of the brain in each group.  

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

According to the study authors, these findings may indicate that autistic children:

• Don't experience 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 a 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 autistic adults often experience physical discomfort when making eye contact. Negative physical symptoms associated with eye contact in autistic people include: 

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

The study also found that many autistic people find eye contact invasive, distracting, and confusing. Some reported eye contact should be reserved for intimate relationships and trusted people.

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

Forcing an autistic person to maintain eye contact can actually take away from their focus.

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 mean a child is autistic. A child can avoid eye contact because they:

• Are fearful of or dislike the person who is attempting to make eye contact
• Are hard of hearing or deaf and are 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 cultures of color)

When To Seek an Autism Evaluation

The lack of eye contact on its own does not mean a person is autistic. 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 the ability to hear
• Developmental delays in social communication milestones
• Common autistic behaviors such as repetitive, self-stimulatory activity, little or intense interest in imaginative play, or non-conventional use of toys

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

Summary

A person who avoids eye contact is not necessarily autistic, but avoiding eye contact is a quality many autistic people have. Autistic people may not understand the importance neurotypical people place on eye contact or find the experience of making eye contact uncomfortable.

With that said, avoiding eye contact is not diagnostic of autism. Rather, it is a symptom of alexithymia, a condition characterized by an inability to feel emotions that only affects 50% of people with autism. There are many other psychological and neurological reasons for alexithymia; autism is just one of them.