Increased Eye Contact during Conversation Versus Play in Children and Adolescents with ASD

Background: Atypical eye contact is a diagnostic hallmark of Autism Spectrum Disorder (ASD). Individuals with ASD typically make less eye contact overall than those who are typically developing (TD). Research on TD children suggests eye contact is limited during free-play interactions highlighting the importance of context for eliciting eye contact (Arnold et al., 2000). To date, there is limited research comparing the amount of eye contact across different contexts in ASD, which may be important for interpreting social communication behavior in a clinical setting.  

Objectives: To determine if the amount of eye contact differs during distinct aspects of social interactions, specifically interactive play compared to conversations. We hypothesized that the amount of eye contact with an examiner would be less during play than during conversation segments in ASD.

Methods: 26 children and adolescents with ASD (M = 8.5 years, 5-17 years) completed the Brief Observation of Social Communication Change (BOSCC) assessment. The BOSCC is a 12-minute clinician-subject interaction that consists of two 5-minute play segments with a standardized set of toys, separated by a 2-minute conversation segment. The BOSCC was recorded via Pivothead Kudo glasses that are worn by an examiner. They contain an outward facing camera and readily capture the child’s face and shifts in eye gaze to the examiner. The duration of eye contact was manually coded using ELAN, a video annotation software, to capture eye contact duration by the millisecond in both play and conversation. Proportions of eye contact with the examiner were calculated by dividing the duration of eye contact with the examiner by the total time for the play segment versus the conversation. A subset of 8 individuals had a second BOSCC session four weeks after the first session. Repeated Measures ANOVAs determined 1) differences in the duration of eye contact during play versus conversation; 2) stability across time in the duration of eye contact in participants who had two time points and 3) the impact of age, cognitive abilities (VIQ, NVIQ) and autism symptom severity (ADOS CSS) on eye contact duration in the two segments.

Results: The duration of eye contact was significantly greater during conversation as compared to play (p < 0.001, Mean Play = .05, Mean Conversation = .28). There was no significant interaction with age, severity of autism symptoms, NVIQ, or VIQ.  Similarly, children made more eye contact during conversation versus play across two time points (p < 0.001) with no significant difference between the two time points, highlighting the stability of the findings.

Conclusions: School-aged children with ASD make less eye contact during play with an examiner than during conversation, independent of age, autism symptom severity, or cognitive abilities. In the absence of any distracting toys or materials, children made more eye contact, highlighting the importance of considering context and the environment when measuring different forms of social communication. The finding that the amount of eye contact was contingent upon environmental demands that are commonly used in clinical settings has important implications for studies that examine behavior changes during intervention.