Deliberate And Self-Conscious Adaption Of Eye Contact By Autistic Adults

Eye contact can be challenging for autistic individuals due to sensory processing differences, cognitive overload, and social anxiety.

Many autistic people report that maintaining eye contact feels uncomfortable, overwhelming, or even painful.

It can interfere with their ability to process verbal information or formulate responses during conversations.

For some, eye contact may feel too intimate or intense. These challenges often lead to conscious efforts to manage eye contact, which can be mentally exhausting and increase social anxiety in various situations.

Garvey, A., Ryan, C., & Murphy, M. (2024). Deliberate and Self-Conscious Adaptation of Eye-Contact by Autistic Adults. Journal of Autism and Developmental Disorders, 1-12. https://doi.org/10.1007/s10803-024-06296-4

Key Points

1. The primary methods of exploring autistic adults’ experiences of eye contact include semi-structured interviews and Interpretative Phenomenological Analysis (IPA).
2. Factors like cognitive processing difficulties, familiarity with conversation partners, and social expectations significantly affect autistic individuals’ experiences and strategies related to eye contact.
3. This research has certain limitations such as a small sample size and potential language difficulties in articulating experiences.
4. Understanding autistic individuals’ experiences of eye contact is universally relevant for improving social interactions, support services, and overall quality of life for those on the autism spectrum.

Rationale

Eye gaze is widely recognized as a powerful tool for social interaction, serving multiple functions in social processes (Hietanen, 2018).

However, atypical eye gaze is a characteristic hallmark of Autism Spectrum Disorder (ASD) (Madipakkam et al., 2017).

While experimental research has contributed significantly to our knowledge of eye gaze in autism, there is a lack of research exploring how autistic individuals describe and understand the phenomenological experience of eye gaze and eye contact.

Previous research has identified differences in social attention as key features of ASD, with eye-tracking studies showing reduced fixation on others’ eyes and social stimuli from infancy (Chawarska et al., 2013; Jones & Klin, 2013) to adulthood (Moore et al., 2012).

However, the underlying cause of atypical eye contact in ASD remains unclear, with various models proposing different explanations (Moriuchi et al., 2017; Trevisan et al., 2017).

The next step in understanding this phenomenon is to explore the subjective experiences of autistic adults regarding eye contact, including their awareness, motivations, and strategies.

This qualitative approach can provide valuable insights into the real-world challenges and adaptations related to eye contact in ASD, informing psychological supports and interventions.

Method

The study employed a qualitative design using Interpretative Phenomenological Analysis (IPA) and semi-structured interviews.

IPA was chosen for its focus on specific phenomena and its ability to provide detailed analysis of individual experiences (Pietkiewicz & Smith, 2014).

The method involves a double hermeneutic process, where the researcher interprets the participants’ interpretations of their experiences.

Participants were recruited from an ASD support service in Ireland.

They were invited to keep a diary of their eye contact experiences for one week before the scheduled interview.

Due to COVID-19 restrictions, interviews were conducted online using live video.

The interview schedule covered topics such as eye contact experiences growing up and in the family, social skills training, strategies for making eye contact, and the experience of eye contact itself.

Adaptations for autistic participants included piloting the interview schedule and providing an outline of topics prior to the interview.

Data analysis followed the seven sequential steps recommended by Smith et al. (2021), including reading and re-reading transcripts, making exploratory notes, generating experiential statements, searching for connections, and developing personal and group experiential themes.

Sample

Nine participants with an ASD diagnosis were interviewed.

Participants ranged in age from 20 to 56 years, and seven were male.

All participants had no intellectual disability.

Their diagnoses were verified through the support services they accessed, and participants confirmed their ASD diagnosis in the consent form.

Results

The analysis revealed three interrelated Group Experiential Themes (GETs), each with subthemes:

Theme 1: Eye-contact: Awareness and Motivation

Subtheme 1: Levels of Conscious Awareness

Participants reported varying levels of conscious awareness of their atypical eye contact. Many became aware through feedback or increased self-awareness over time.

“I might not be looking directly in their eyes. But I don’t realise that. I think, if I’m looking at the person, I’m kind of looking up and down, or it’s hard, so I think my dad will always notice it.” (Maria)

Another participant, Shane, described increased awareness following his ASD diagnosis:

“She just took out the form of traits, and what not, of Asperger’s and I thought ‘That sounds like that makes sense’ [laugh]. And I guess that it wasn’t until that that I thought ‘Hold on, eye-contact!'” (Shane)

Subtheme 2: Motivation to Make Eye-Contact in the Context of Autistic Identity

Motivations to make eye contact were influenced by perceptions of autism and societal expectations.

Some participants were intrinsically motivated to connect with others, while others were extrinsically motivated to avoid negative social outcomes.

“It’s kind of like doing exercise, you never really want to do it but when you actually do it you feel better after doing it.” (Ryan)

Conversely, John perceived eye contact differently:

“For the benefit of neurotypicals… it doesn’t necessarily mean anything if autistic people are not making eye contact.” (John)

Theme 2: Phenomenology of Eye-Contact

Subtheme 1: ‘Eye-Contact is Part of Thinking’: Processing Difficulties

Participants described cognitive processing difficulties during eye contact, including challenges with multitasking and processing information from multiple sensory modalities.

“I might look at someone in the eyes for a few seconds but be able to say absolutely nothing, but then when I look away I can say it.” (Shane)

Maria elaborated on the cognitive demands:

“Being so focused on the other person takes a lot of effort. It’s kind of- to just stay in conversation and not drift off into your own thoughts. Particularly when you are in conversation; you kind of think of something you want to say- it’s trying to focus on the person, and what they’re saying, and maintain dialogue and be present, I think is something hard.” (Maria)

Subtheme 2: Familiar Others Mediating Affective Arousal and Eye-Contact

Participants reported differences in experiences with familiar versus unfamiliar people. Eye contact with familiar others was often perceived as easier and less stressful.

“I find…the more you know a person the easier it is to do eye-contact with them.” (Ryan)

Lauren described her experience with unfamiliar others:

“I’d be looking at them, and then when they look at me it’s like a reflex to just look away. Like I wouldn’t continue looking at them.” (Lauren)

Theme 3: Strategies to Make Eye-Contact

Participants employed various strategies to manage eye contact, including compensatory behaviors and conscious efforts to adapt.

“I say in my core sentence whatever I have to say and then for a brief second, I slightly look them in the eye or I totally do. And that’s not comfortable either but at least I’ve said what I needed to say.” (Shane)

Some participants described their attempts to avoid “staring”:

“You just sort of look away because you don’t want to be seen as staring.” (Maria)

Others, like Ryan, reported adaptation over time:

“Before when I tried to make eye-contact I could do it almost too hard in a sense. But I can do it more, I can do it better now like. At first I was being kind of surgical with practicing it. Now it comes a bit more naturally to me.” (Ryan)

Insight and Depth

This study provides valuable insights into the subjective experiences of autistic adults regarding eye contact, an area that has been predominantly studied through experimental methods.

The findings highlight the complex interplay between cognitive processing, social expectations, and individual adaptations in managing eye contact.

The research reveals that for many autistic individuals, eye contact is a conscious and effortful process, rather than an automatic social behavior.

This challenges assumptions about the nature of social deficits in autism and suggests that interventions focused solely on increasing eye contact may not address the underlying cognitive and sensory processing differences.

The study also sheds light on the potential emotional and cognitive costs of masking or camouflaging atypical eye contact, which has implications for understanding mental health and well-being in autistic adults.

Strengths

This study had several methodological strengths, including:

1. The study employed a rigorous qualitative methodology (IPA) that allowed for in-depth exploration of individual experiences.
2. The research included the voice of autistic individuals, providing valuable first-hand accounts of eye contact experiences.
3. The study considered both the phenomenological experience of eye contact and the strategies employed by autistic adults, offering a comprehensive view of the topic.
4. The researchers employed adaptations to make the interview process more accessible for autistic participants.
5. The analysis process included measures to ensure credibility and trustworthiness, such as coding audits and reflexive practices.

Limitations

This study also had several methodological limitations, including:

1. The small sample size (9 participants) limits the generalizability of the findings, although this is typical for IPA studies.
2. The sample only included autistic adults without intellectual disability, excluding experiences of those with co-occurring intellectual disabilities.
3. The online interview format, necessitated by COVID-19 restrictions, may have affected the researcher’s ability to observe participants’ eye contact behaviors directly.
4. Some participants demonstrated limited capacity to introspect on their thoughts and feelings, which may have affected the depth of data collected.
5. The study was conducted in Ireland, potentially limiting its cultural applicability to other regions.

Implications

The results of this study have significant implications for understanding and supporting autistic individuals:

1. Clinical practice: The findings suggest that interventions focused solely on increasing eye contact may be insufficient. Instead, clinicians should consider the cognitive and sensory processing challenges associated with eye contact and develop strategies that address these underlying issues.
2. Social understanding: The research highlights the need for increased awareness among non-autistic individuals about the challenges and experiences of eye contact for autistic people. This could lead to more inclusive social environments and reduced pressure to conform to neurotypical social norms.
3. Self-advocacy: The study provides autistic individuals with language and concepts to describe their experiences, potentially empowering them to advocate for their needs in social and professional settings.
4. Educational settings: Educators and support staff could use these insights to develop more effective strategies for supporting autistic students in social interactions.
5. Employment: The findings have implications for workplace accommodations and training programs for autistic employees, particularly in roles that require frequent social interaction.
6. Research directions: The study opens up new avenues for research, including exploring the experiences of autistic individuals with intellectual disabilities, investigating cultural variations in eye contact experiences, and developing and evaluating interventions based on these phenomenological insights.

Conclusion

This study makes an important contribution to understanding the experience of eye contact differences from the perspective of autistic adults themselves.

It highlights the phenomenology of eye contact as potentially aversive and the social pressure to engage in it, while exploring factors influencing effective eye contact.

The research underscores the complexity of social interactions for autistic individuals and the need for a more nuanced understanding of social differences in autism.

It challenges simplistic interventions focused solely on increasing eye contact and suggests the need for approaches that consider the cognitive, sensory, and emotional experiences of autistic individuals.

Future research should expand on these findings by including more diverse samples, exploring cultural variations, and investigating the long-term impacts of eye contact strategies on mental health and social outcomes.

Additionally, the development and evaluation of interventions that address the underlying processing difficulties associated with eye contact could significantly improve support for autistic individuals.

In conclusion, this study emphasizes the importance of listening to autistic voices in autism research and practice.

By understanding the lived experiences of autistic individuals, we can move towards more effective, ethical, and empathetic approaches to supporting neurodiversity in our society.

References

Primary reference

Garvey, A., Ryan, C., & Murphy, M. (2024). Deliberate and Self-Conscious Adaptation of Eye-Contact by Autistic Adults. Journal of Autism and Developmental Disorders, 1-12. https://doi.org/10.1007/s10803-024-06296-4

Other references

Chawarska, K., Macari, S., & Shic, F. (2013). Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders. Biological psychiatry, 74(3), 195-203. https://doi.org/10.1016/j.biopsych.2012.11.022

Hietanen, J. K. (2018). Affective eye contact: An integrative review. Frontiers in psychology, 9, 1587. https://doi.org/10.3389/fpsyg.2018.01587

Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism. Nature, 504(7480), 427-431. https://doi.org/10.1038/nature12715

Madipakkam, A. R., Rothkirch, M., Dziobek, I., & Sterzer, P. (2017). Unconscious avoidance of eye contact in autism spectrum disorder. Scientific reports, 7(1), 13378. https://doi.org/10.1038/s41598-017-13945-5

Moore, D. J., Heavey, L., & Reidy, J. (2012). Attentional processing of faces in ASD: A dot-probe study. Journal of autism and developmental disorders, 42, 2038-2045. https://doi.org/10.1007/s10803-012-1449-4

Moriuchi, J. M., Klin, A., & Jones, W. (2017). Mechanisms of diminished attention to eyes in autism. American Journal of Psychiatry, 174(1), 26-35. https://doi.org/10.1176/appi.ajp.2016.15091222

Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological journal, 20(1), 7-14.

Smith, J. A., Flowers, P., & Larkin, M. (2021). Interpretative phenomenological analysis: Theory, method and research (2nd ed.). SAGE.

Trevisan, D. A., Roberts, N., Lin, C., & Birmingham, E. (2017). How do adults and teens with self-declared Autism Spectrum Disorder experience eye contact? A qualitative analysis of first-hand accounts. PloS one, 12(11), e0188446. https://doi.org/10.1371/journal.pone.0188446

Keep learning

Suggested Socratic questions for a college class to discuss this paper:

1. How might the findings of this study challenge or support existing theories about social cognition in autism?
2. In what ways could the experiences described by participants inform the development of more effective social skills interventions for autistic individuals?
3. How might the conscious effort required for eye contact, as described by participants, impact other aspects of social interaction or daily functioning for autistic individuals?
4. What ethical considerations arise when designing interventions aimed at changing autistic individuals’ eye contact behaviors?
5. How might the experiences of eye contact differ for autistic individuals from different cultural backgrounds, and why is this important to consider?
6. In what ways could the strategies developed by autistic adults to manage eye contact be viewed as strengths rather than deficits?
7. How might the findings of this study inform workplace accommodations or educational support for autistic individuals?
8. What are the potential long-term psychological impacts of constantly managing eye contact for autistic individuals, and how might this inform mental health support?
9. How does this qualitative research complement quantitative studies on eye gaze in autism, and what unique insights does it offer?
10. In what ways might non-autistic individuals adapt their own behaviors or expectations to create more inclusive social environments based on these findings?