Parent-Led Training for Motivating Eye Contact in Young, Low-Functioning Children with Autism

Background: Difficulties in the use of eye contact are widely reported in children with autism spectrum disorder (ASD). Following this, it may be important to motivate them to look towards other people’s eyes and faces as early as possible to reduce further abnormalities in social development. Involving parents in interventions of early social communication skills has been shown to reduce autistic behaviour and improve parent-child interaction.

Objectives: The aim of the study was to pilot a parent-led training method targeted to improve eye contact in young children with ASD. The planned training method was in addition to treatment as usual (TAU) which also includes eye contact encouragement but not as systematically and explicitly as in this training method. It was predicted that children’s motivation towards faces would increase if eye contact is reinforced by trying to make it rewarding. It was further assumed that children's interaction with their parents would improve.

Methods: Twenty young (age range: 2.5-5.5 years of age) and low-functioning children with severe ASD were randomly divided into an intervention group (N=10) and a control group (N=10). The parents of the intervention group were taught to do three kinds of daily activities with their child for 4 months. The activities included encouraging the child to use eye contact for requesting food, toys or physical play activity, and imitating the child’s actions in a specific manner. The training was based on combining behavioural and developmental principles of early intervention. Baseline and outcome measures included observations, questionnaires and psychophysiological measures. There were short-term measurements 4-6 months and long-term measurements two years after the baseline measurements in both groups. Orientations toward the parent’s face (indicative of eye contact) and the state of engagement were analysed from play sessions with the parent in the laboratory and at home. The number of eye contacts was analysed in addition to the information as to whether the eye contact was an overture or a response, and whether it was linked to other forms of social communication.

Results: The laboratory observation analyses showed that in the intervention group eye contacts, especially responsive eye contacts, increased in the short-term outcome (Z = 2,61; p = 0.009). Eye contact was also connected more often to other forms of social communication (e.g., gestures and facial expressions) in the intervention group (Z = -2,51; p = 0.012). The increase of eye contacts was not significant in the control group. Preliminary analysis of the long-term follow up indicated that these findings remained stable. The significant improvement of the joint engagement (Z = -2,19; p = 0.028) was evident only after the long-term follow-up and was shown in the intervention group only (Fig.1).

Conclusions: It seems beneficial to encourage eye contact initiation in young, low-functioning children with ASD. The parent-led eye contact focused training did not only increase the use of eye contact but, importantly, also the state of engagement seemed to improve in the long run.