A Thematic Analysis of First-Hand Reports of Face Recognition and Eye Contact in Adults with and without Autism Spectrum Disorder

Background: It is well-established that many individuals with autism spectrum disorder (ASD) exhibit difficulties with maintaining and integrating eye contact during social overtures. Anecdotal reports have alluded to experiences of sensory or emotional overload when individuals with ASD engage in mutual eye contact, as well as a general unawareness of why eye contact is “necessary”. However, it remains unclear what thematic relationships are present amongst a number of individuals on the spectrum, as well as what factors and motivations underlie this socially salient behaviour. Empirical theories also propose that reduced eye contact may lead to cascading effects in social cognition, including face recognition difficulties, a concept yet to be addressed in qualitative reports.

Objectives: We sought to understand how adults with and without ASD experience eye contact and situations involving face recognition to clarify the motivations and reasons guiding their social behaviours.

Methods: A thematic analysis was conducted on semi-structured interviews collected in a sample of high-functioning adults with ASD and age-, gender-, and IQ-matched neurotypical adults in relation to their feelings, beliefs, and experiences with face recognition and the engagement of eye contact.

Results: Whilst adults with ASD were more likely than neurotypical adults to report difficulties with face recognition, a relationship between attention to another person’s eyes and face recognition was not reported by either group. Most adults with ASD reported they were aware of social conventions surrounding eye contact, indicating an awareness that it helps establish connection, rapport, and social attention with another person. Many also indicated they can engage in eye contact when required by social demands but if offered a choice would prefer to allow their eyes to wander or look away from the person completely. Several adults with ASD also discussed using strategies which mimic eye contact to an observer (e.g., looking at the forehead, nasion, or nose). A few informants also reported that attending to the eyes results in perceptual or sensory overload and “too much information”, leading to tendencies to look to less visually distracting areas. Adults with ASD also reported difficulties in maintaining eye contact when in a pre-existing emotional state, especially increased states of anxiety or depression, and eye contact itself was also deemed to be emotionally and/or physiologically overwhelming, thereby making regulation more difficult. Finally, whilst both groups reported reduced eye contact when thinking or trying to collect their thoughts, adults with ASD exclusively reported increased cognitive load during interactions, particularly in relation to monitoring socially anxious thoughts and gaze duration. These findings will also be discussed in relation to gender differences and how reports coincide with quantitative measures of face recognition and attention to the eyes.

Conclusions: These first-hand reports confirm that whilst adults with ASD are able to engage in mutual eye contact to a degree, many experience perceptual, emotional, and/or cognitive overload, making continuous eye contact difficult or uncomfortable. These findings have important implications for understanding the motivations sub-serving gaze behaviours in ASD, and the need for individualized interventions targeted to the type of overload experienced.