autism no eye contact

Autism Tips for Emergency Responders: No Eye Contact

autism no eye contact

image courtesy of freedigitalphotos.net

I read an awesome article on TheMighty.com that asked 16 different people on the autism spectrum to describe why making eye contact can be difficult for them. Any insights like this help me be a better parent to my autistic teens and a better educator for emergency responders.

Lack of eye contact may be considered rude or antisocial to those who don’t understand it. However, in an emergency situation that involves first responders, it can be misconstrued as evidence of guilt, non-compliance, or even altered mental status, all of which can put an emergency responder on the defensive and potentially lead to a call going downhill fast.

The Mighty asked their readers with autism who find eye contact difficult to share a description of what it’s like for them. I think some of these quotes are really helpful for emergency responders to be able to understand and identify what’s really going on when someone with autism cannot look at them. The full article can be found here, but some of my favorite descriptions are:

“It’s abstract to me and can be draining. Looking at someone else in the eye means I am taking in everything about them as a person, and I become overloaded. It can disrupt any thought or speaking process I have going on and zaps my energy quickly.” — Laura Spoerl

“To me, eye contact feels like I’m being stared at, like I’m being scrutinized and judged. It makes me uncomfortable because I feel like I’m under immense pressure, and the tension builds and builds until finally I have to look away. It feels almost confrontational, which causes me a lot of anxiety.”— Emma Wozny

“It can feel like you’re standing there naked. It’s very difficult to form a coherent thought with all of this going on in your head. ” — Megan Klein

“When I make eye contact, the world around me blocks out. I can only process the immense pain and discomfort that comes to my brain. This pain goes if I look away.” — Lucy Clapham

“For me it can be a physical pain; it feels like burning with too many emotions, and I just can’t take it in all at once.” — Rosie Howard

“There’s plenty enough for us to concentrate on mid-conversation without the demand to do something which, quite frankly, feels very unnatural to many of us. You can have my eye contact, or you can have my concentration. Choose whichever one you value more.”– Chris Bonnello, from Autistic Not Weird

“Eye contact is hard for me because I am easily overwhelmed by lots of different input. When I am trying to listen, follow, or contribute to a conversation or just manage all my different sensitivities, it is easiest, most comfortable and least painful for me to not make eye contact. I listen and focus better when I am not making eye contact.” — Erin McKinney

My co-trainer at Spirit of Autism, Austin Harris, told me what it’s like for him, and how he’s learned to manage it:

“Eye contact is difficult for me because it makes me very nervous when I’m being looked at directly. It makes me feel uncomfortable in an unexplainable way. One tool I use to combat this is quick contact by looking at multiple people and objects. This works especially well for public speaking and teaching where you need to talk to the group instead of one person. What I do is I make brief contact every so often with different individuals so I am not focusing on just one person’s eyes.”

My daughter shared this with me about her experience:

“If I’m coming up on a person about to pass me, I drop my gaze immediately. If I happen to accidentally lock eyes with them, I feel a tinge of panic. What are they thinking? Are they thinking about me at all? Did I rub them the wrong way? I’d rather be invisible to them, and chances are likely that they thought nothing of it, but I remember it.

There’s something very uncomfortable about looking directly into somebody’s eyes while they’re staring at you. I don’t know what’s going on and I’m trying to evaluate the situation. And how long are you supposed to keep eye contact, anyway? If it’s too short, it may come across as dismissive; if it’s too long, it’s way too awkward. It’s a lot of processing and confusion that goes on underneath the surface in a matter of seconds, and when there are responses and replies expected of you on top of that, it gets to be overwhelming sometimes.”

I think the biggest takeaways for emergency responders when it comes to lack of eye contact are:

  1. If someone with autism isn’t looking at you directly it does not mean they aren’t listening.
  2. It can be physically painful for an autistic person to maintain eye contact with you.
  3. A person with autism may need to avoid eye contact in order to process and focus on what you’re saying to them.

Rather than demanding that someone look at you when you are speaking, it may be helpful to simply ask a person that’s not keeping eye contact with you if they are listening, if they understand you, if they can repeat back what you just said, or even if they’d prefer to communicate by writing.

Why Emergency Responder Education Part II – Behaviors

Yesterday I participated in a beautiful 9/11 memorial service and emergency preparedness festival. I am still brought to tears when the events of that horrific day are described by anyone, especially those who serve in public safety. I am honored to be a part of a huge calling to encourage citizens to get involved and help their families, neighbors, and community be prepared for disasters of all kinds. To learn more about how you can be involved in your community, go to the Citizen Corps website.

Common behaviors of children with Autism and how to handle them

As promised, here is part two of why I am passionate about training and educating Emergency Responders about Autism. Here is a snapshot of behaviors that are highly likely to be misinterpreted by police officers, EMTs, or firefighters responding to an emergency call:

Self-stimulatory (stimming)

  • Hand flapping
  • Finger play
  • Head tapping
  • Spinning
  • Transfixing on spinning or moving objects

Unless the child is injuring himself or others, self-stimulatory behaviors should not be stopped. This is a comfort for the child.

Self-injurious

  • Head banging
  • Biting self
  • Scratching
  • Eye gouging

This behavior should be stopped immediately.

Aggressive behavior is not intentional - handle with care

  • Head butting
  • Biting
  • Punching
  • Crashing into or pushing others

Aggressive behavior is usually caused by over-stimulation, sensory-seeking, fear, pain, surprise, or lack of communication.  Remember this child does not mean to hurt you. Restrain if needed, as calmly and controlled as possible.

Insensitivity to pain

  • May be unaware of pain
  • May under-react: major physical trauma may go unnoticed
  • May over-react: minor scrapes and cuts could be perceived as major

Check thoroughly for injuries; do not rely on communication or reaction from the child.

Aversion to touch

  • Light touches (hand on shoulder, back rubbing) may be painful

Although they may crave deep compression and tight squeezes, light touch is often over-magnified and can cause pain and discomfort. Do not approach the child from behind if possible; children with Autism do not like surprises.

Avoiding eye contact

  • May look at you through peripheral glance
  • May look at you through an object or spread fingers

Do not mistake lack of eye contact for suspicion of guilt, avoidance, lack of respect, or belligerence.  Try to get eye contact if you can, but do not force it.

Lack of response

  • May only respond to visual cues

Emergency responders should consider carrying sets of visual communication cards, or familiarizing themselves with basic sign language.

Repetitive motion

  • May repeatedly fidget with an item
  • May fixate on spinning or lighted objects
  • May appear to be in a trance

Do not mistake for drug use, mental illness, or lack of respect for authority.

Extreme hyperactivity or inactivity

  • Prone to running or bolting away suddenly

    Children with Autism are prone to running away - especially if frightened or confused

  • May rapidly pace back and forth
  • May appear out of control (like the Tasmanian Devil!)
  • May go limp at touch or fold into self

Redirection is the best way to diffuse hyperactivity or passivity. Try asking what the child’s favorite show, game, or movie is.  Asking mathematical questions or giving the child a “job” to will reel in their focus.

Inappropriate emotional response

  • May laugh or cry for no reason
  • May laugh at a very serious situation, or in response to feeling or causing pain
  • May show extreme distress over minor incidents

This is very hard for us to understand. Laughter in response to a serious question or accusation does not imply guilt or disrespect. It is simply a defense mechanism for the child.

Echoing speech or movement

  • May repeat everything you say
  • May mimic your tone and gestures
  • May speak in robotic tone

Do not mistake this for “being a wise guy”, or lack of respect.

Non-verbal and non-responsive to verbal cues

  • Limited or no speech
  • May appear deaf
  • May communicate with sign language, by pointing, or using picture cards

Do not mistake for lack of interest or ignorance. Try to use common gestures to get through to the child. Be patient!

Attachment

  • May hold unusual items
  • May be extremely agitated or distressed if item cannot be located

While seeming unimportant or silly to us, comfort items are critically important to children with Autism. It may be a rock, a paper clip, fabric, shoelace, or anything. Do not take away the item from the child. Try to find the item if the child loses it.

Need for routine and order

  • Obsessed about routines
  • Literal about things like time and location (“It’s not 8:30, it’s 8:28!”)
  • May repeatedly seek places or activities from the child’s normal routine

Children with Autism look to bring order to a world that’s out of order to them. Noise, lights, smells, and other sensory challenges are coming at them all the time. This is their norm.

Oblivious to others’ emotions

  • Typically do not understand facial expressions
  • Will not understand sarcasm, idioms, exaggerations, or jokes
  • May not understand they are a victim of a crime
  • May be hard to diffuse situation with normal socialization techniques (e.g., “How would YOU feel if…”)

Don’t assume that these children “should know better”, or that a simple unapproving look will get through to them. They rarely know what they did wrong and need it explained in a way they understand.

Children may respond to loud or confusing noises by screaming to drown it out

Inappropriate response to noise

  • Hyper sensitive: May cover ears with hands or try to break object that is causing discomfort
  • Hypo sensitive: May appear deaf or not respond to verbal commands

Each child on the Spectrum presents different variations of sensory issues – no two are alike! They can even be hyper and hypo sensitive to the same thing!

No fear of danger

  • May run into traffic
  • May bolt suddenly into the street or a hazardous environment
  • May willingly go with strangers
  • Will not recognize dangerous situations
  • May not understand fire, heat, sharp objects, or other hazardous items

While often possessing extraordinary academic abilities, many children with Autism do not recognize danger, exhibit no fear, are prone to wandering, and miss basic cause and effect concepts (“If I touch this, I will get burned”). Never leave unsupervised at the scene of an accident, fire, disaster, or crime.