Autism and Eye Contact
Question: Can a child who makes eye contact and who relates well with his parents be autistic? – Sarah in Hartsdale
Answer: That is a good question, as it is often confusing when a child has a delay in development but also has notable strengths. Eye contact in particular has received much attention, and the lack thereof often sets off autism alarms, while appropriate eye contact often provides a sense of comfort. I am going to attempt to answer this question comprehensively, urging you and parents and professionals to consider a child’s development fully, rather than focusing on one particular “red flag.” I also want to remind readers that my answer should not be used to diagnose but rather to inform.
It might be helpful to summarize the defining features of autism. Autism is diagnosed when there are delays in three main areas of functioning: social interaction, language used in social communication, and symbolic and imaginative play (which typically involves fixed interests and strict adherence to routines). These delays must be present before the age of three.
Eye contact and relatedness fall into the social interaction domain. Without a doubt, it is a good sign when a child makes eye contact and relates well with parents. If these abilities are present, it increases the opportunities for any child to learn about their environment, about interaction and communication, to model behaviors, and to expand his or her range of interests. It is a myth, however, that simply because a child makes eye contact, the child absolutely cannot be diagnosed with autism. In the past, many children who were in fact autistic were not diagnosed because they were able to make eye contact. This came at a disservice to themselves and their families because they could have been receiving much-needed treatment.
Over time it has become clear that autism diagnoses need to be based on multiple factors and how they relate to one another. There is a reason that this developmental diagnosis is conceptualized on a spectrum. Individual’s presentations vary widely. However it is also important to educate parents to look for signs in their own children, and eye contact is something parents can readily observe and easily recognize. So although it is a good red flag, it is also not a definitive indicator. There are other over-simplified messages about autism. For example, it is often thought that children on the autistic spectrum do not experience empathy. In fact many have the capacity for empathy but may have more difficulty expressing it appropriately.
If you are trying to understand a child’s development and determine if services would be useful, definitely seek out a psychological evaluation. Any parent or professional could benefit from understanding a child’s unique profile of development and ways that they can help to facilitate that development. Such an understanding is often more important than the diagnosis itself (although a diagnosis can be useful for attaining services through insurance).
Treatment for children on the autistic spectrum focuses on building healthy foundations for social, emotional, and intellectual capacities through interactions with people. Parent-child interactions are the focus initially as children learn to relate to others. If the child in question has the capability to relate well with parents, they are at a great starting point for developing further and relating to others.
Some children have autistic-like characteristics even though they may not fully meet the criteria for a diagnosis. For these children, I still suggest that parents and professionals who work with them learn some principles of the therapeutic model used to treat autism. One particularly effective approach is the Developmental, Individual-Difference, Relationship-based (DIR)/Floortime model. I like it because it builds on a child’s strengths and interests rather than focusing on isolated skills and behaviors. But different models can be effective for different individuals.
When thinking about whether or not treatment is necessary, I find it useful to compare it to an adult diagnosis. Treatment for depression often involves increasing time spent doing pleasurable activities and evaluating negative thoughts and restructuring those thoughts. Even a person who is feeling down but does not qualify for a diagnosis of depression could benefit from those same concepts.
The bottom line is that no single indicator will tell you for certain whether or not a child would qualify for a diagnosis of autism. If there are concerns, it never hurts to get a formal evaluation and learn about a child. Whether or not this child meets criteria for a diagnosis, the information about the child’s development will be informative and help to promote a healthy development.
Jaime earned her doctorate in Clinical Psychology from Yeshiva University. She currently works in a private practice in NYC doing psychotherapy and career counseling. In addition to providing general psychological services, Jaime has extensive experience working with individuals of all ages on the autism spectrum. She lives in Hartsdale. (Advice given in Ask Jaime is not intended to be a substitute for individual psychotherapy.)
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