Avoidance of Eye Contact: An Early Sign of Autism

 Early detection and treatment has been declared critical to autism, putting more emphasis on the early identification of the red flags of autism. Early identification of autistic behavior in the first 12 months of infancy enables on-time application of effective therapy, such as applied behavior analysis (ABA), which significantly helps in the treatment of autism. Parents must be educated about the suggestive symptoms of autism, since they are the first ones who can identify them.

Infants who avoid eye contact with their parents mostly end up with a diagnosis of autism. This sign falls under the “social skills” category of autism and is regarded as a red flag. Eye contact in infants can be observed as early as the age of six months, making it a very important source of the earliest possible indication of autism. As per the growth milestones set by pediatricians, most babies start to make eye contact at around three months of age. If an infant fails to make eye contact in the first six months, an immediate consultation with an expert is recommended.

Pediatricians can further evaluate the eye contact problem by observing and asking parents about the following infant behavior traits:

  • The baby tends not to look at parents.
  • The baby fails to recognize familiar faces.
  • The baby does not cry when parents leave them.
  • The baby does not show anxiety with strangers.
  • The baby tends to gaze out of the corner of the eye.
  • The baby has problem following objects visually.

A pediatrician’s evaluation of the eye contact problem, along with assessing the triad of impairment in autism, can help conclude a diagnosis of autism. The pediatrician can further assess his findings by employing the PDD Assessment Scale Grading and Scoring. According to the Child Neurology and Developmental Center’s PDD Assessment Scale, the severity of eye contact problem can be assessed as:

Observation: Poor eye contact, or staring from unusual angle

  • None: Perfectly normal never had such problem
  • Resolved: Eye contact is now perfectly normal, but was clearly abnormal previously.
  • Mild: Almost normal eye contact, but still shows subtle and unusual way of looking at others.  This may be present in children with PPD NOS, a disorder that starts with very poor eye contact that gradually improves over time.
  • Moderate: Eye contact may be present for extended period but is obviously abnormal. The child may gaze too long at one spot, appears “very shy,” or establishes eye contact by turning the eyes to the side.
  • Severe: Almost never capable of establishing eye contact. When eye contact is present, it is very short and clearly abnormal.

Although the eye contact problem is significantly related to autism, it should be used only as a potential risk indicator of rather than a source of firm diagnosis.

Significance of Eye Contact Problem

The eye contact problem tends to persist with growth and demands immediate attention to be properly addressed through procedures such as ABA and Discrete Trial Instruction/Training programs (DTT).

One major reason why children with autism are apprehensive about establishing eye contact is because they lack social ability to communicate. Some children with autism require immense concentration on the situation resulting in lack of eye contact. In most cases, children with autism establish a habit of proper eye contact but would soon lose concentration on the situation or on the person he is looking at. The severity of the problem suggests a consultation with a certified professional behaviorist and proper application of the result-oriented ABA or DTT procedures. Furthermore, it is important for parents not to force their child to have eye contact because it will only establish anxiety and frustration. The child has to develop eye contact behavior naturally through ABA, rather than by force. 


Child Neurology and Developmental Center, www.childbrain.com: PDD Assessment Scale Grading and Scoring, retrieved March 22, 2011 from http://www.childbrain.com/pddassess2.html

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