Have you looked directly into someone’s eyes today when you spoke with them? Did it help you understand them? Or connect with them? Or did it make you feel uncomfortable? And (perhaps more interestingly) have you consciously thought about using this eye contact or have you just done so automatically?
As health and educational professionals, we may spend a little more time thinking about eye contact (usually in relation to young people we are working with) than others in the general population, but even for us, it is a concept which doesn’t occupy much of our thinking. Most of us use appropriate eye contact without much thought and it also may be very far down the list of topics we discuss with our clients, given the other significant needs they present to us with. However, eye contact may actually be an extremely important part of maintaining connected relationships with others and something worth thinking about more often.
On the other hand, some children we work with, such as children presenting with autism or anxiety/challenging behaviours/ADHD, may have more difficulties than others with looking at people’s faces and/or making eye contact and for some of these children, working on increasing eye contact may be unnecessarily distressing and may not result in any meaningful gains.
Therefore, it is important to consider the potential benefits and risks of talking about eye contact when working with children and their families on a case-by-case basis. Here are some of the factors to consider.
The potential benefits of eye contact:
Most babies are interested in their mothers’ faces within hours or days of being born. From just 2 days of age typically developing infants prefer looking at people who are looking at them. Babies also consciously turn their heads to make eye contact with others by 6-12 weeks of age and the amount of deliberate eye contact increases throughout childhood and adolescence.
Furthermore, some research with children and young people (with some exceptions – see below) suggests more eye contact seems to lead to (or at least be linked with) more positive outcomes. For example, studies have found that babies and toddlers under the age of 2 who make more eye contact have better language development. As they get older, children who make eye contact with adults when they are given instructions are more likely to follow those instructions. Other studies have found that when children make eye contact with people, they are less anxious about talking with them.
The potential benefits of eye contact in adults have been studied more extensively. For instance, experimental studies have found when we make eye contact with other people, we are more likely to be able to do the following: accurately identify how people are feeling, accurately identify our own emotional responses, manage our anger and frustration with people and to remember their faces.
Other research has found that when people make eye contact with us, we are more likely to consider them to be sincere and less likely to feel rejected or hurt by them.
However, as always, this research has its limitations. Many of these studies have been done in laboratory settings using static images and videos without any social contexts. Perhaps once this social contextual information is added, eye-contact is less important for communication than it has been found to be in laboratory settings.
In addition, much (not all) of the research above is correlational. It may be that some other factor (e.g., positive mental health) leads to both increased eye contact and increased positive outcomes, rather than eye contact being the driver of the positive outcomes.
Is more eye contact always linked to positive outcomes?
It is also important to note that even looking at the studies – eye contact has not always come out as a positive force. For instance, some cognitive processing studies have suggested people are less able to do difficult thinking tasks when they are looking in someone’s eyes. One study even found that teaching children to break eye contact while they were trying to solve a problem helped them do better at that problem.
Another study found that if someone is getting negative feedback from someone they don’t know well, if someone is afraid or angry, eye contact can make them feel worse. Also, long, unbroken eye contact (i.e., “staring”) is commonly found to increase people’s discomfort in most situations.
Finally, much of the research conducted into eye-contact has been done in Anglosaxon-European cultures. People from other cultural backgrounds may view longer and more intense eye contact less positively.
Understanding children and young people who find eye contact difficult:
Many of the young people we see find eye contact more difficult than their peers. For example, it is well established concept that children with ASD find making eye contact more difficult than others (included in the list of potential diagnostic criteria). Some studies have backed this up – for example one study found that children ultimately diagnosed with autism had less eye contact than neurotypical children from the time they were 2-6 months of age. Other studies found this reduced eye contact in these infants often continued throughout childhood and adolescence (and adulthood). Other studies with middle primary children and adolescents found that some children/teens with autistic traits not only avoided eye contact but found it overwhelming and distressing – and had higher “brain activation” in certain regions compared to young people without these traits.
It is worth noting however several studies did not find any differences in eye contact patterns between people diagnosed with autism and those without. It may be that only people with higher levels of severity of autism have different eye contact patterns than those without autism.
Some children/young people with other psychological conditions may also find eye contact difficult. For example, several studies have found that children who have a diagnosis of an anxiety disorder also have more difficulties with eye contact – feeling more anxious when asked to give eye contact AND when others make eye contact with them compared to their less anxious peers.
Children with ADHD and challenging behaviours also have more difficulties maintaining eye contact with others. Some studies have found less eye contact between these children and their parents and some between themselves and their peers.
In addition, some research suggests some children may become more distressed or overwhelmed if they feel they must use eye contact (“masking”) and may also start to change their behaviour to “fit in” with others, hide their discomfort, which can intensity emotional distress.
Should we try to help children increase their eye contact with others?
There have also been interventions to increase eye contact in various groups (e.g., in children with autism) which have successfully increased eye contact– and led to positive outcomes for these children.
However, some writers claim that these interventions are also potentially damaging, and the positive outcomes may hide additional distress.
Therefore, I think we need to weigh up interventions on a case by case basis.
Yes, some children’s lack of eye contact may lead to longer term social difficulties and increased mental health concerns and some children may benefit significantly from us working with them on increasing eye contact. However, for some children it may be unnecessary, distressing and not lead to meaningful gains.
Perhaps a balanced approach is – first – never “force” children and young people to use eye contact, or suggest that eye contact is absolutely essential for relationships or connections nor make young people feel they are in some way deficient for not using it. But perhaps we should let children and young people know that eye contact can – for many people – be a very helpful skill and to support them gradually increase eye contact at a rate which is consistent with their own values and wishes.
Here are some ideas for how we might do this.
1. Provide information and invite them to decide whether this is a skill they would like to build:
It can be useful to explain to children, young people and their families that there are many benefits of eye contact. We might say something like:
Looking at people’s eyes or faces (see my next point) can be helpful. Scientists have found it can sometimes help us feel braver and more confident with people, know what people want and are thinking and can help us get closer to them. It can help us know what to do and say in tricky situations and help us have better friendships. You don’t have to do this all the time, but it can be a helpful thing to do sometimes. But some children/young people don’t think it is important for them. What do you think? Would you like to talk with me about learning to do this a bit more often?
2. Acknowledge that it can be hard (while providing hope):
We should acknowledge to young people and their families that some people find this harder than others. For example, we might say something like.
Some people find it harder to look at faces than others. Some people find it makes them feel uncomfortable or anxious. Some people find it hard because it is hard for them to keep still. Some people find it hard because they have trouble remembering. Some people find it hard because they don’t find faces as interesting as other people do.
If you are someone who finds it hard to look at faces when you are talking with them, this is not your fault, it’s just the way your brain is. But if you would like to work on this, I can try to help you. Many people slowly over time do feel better about doing this, and get better at it.
3. Be flexible:
Recent research suggests that looking at people’s faces rather than directly into people’s eyes – may be easier for some young people and yet still achieve all the benefits associated with more direct eye contact.
This means it may be more effective to teach young people who struggle with eye contact to look at faces – mouths, foreheads, noses for instance – rather than directly into eyes.
We should also remember that we don’t need to ask young people to look at faces/eyes for a particularly long period of time, nor do we need to suggest they should eye contact in all situations (as outlined above, eye contact can actually be counter-productive in some situations – e.g., for solving problems) and or to use extended eye contact (i.e., “staring”). We might explain this to young people by saying something like:
– It’s okay to look at noses, mouths, or foreheads instead of eyes if that is easier for you.
– We don’t have to look at people’s faces all the time or for a long time. It is okay to just look at people at the beginning and the end of when they are talking or when we are talking.
– It is perfectly okay to look away from people’s faces when we are trying to think or concentrate hard.
4. Have adults “show rather than just tell” children and young people about eye contact:
As always, children and teens learn a great deal from watching what adults do, not just from what we tell them to do! This means as professionals we should be vigilant about using appropriate eye contact with the children we work with. This of course does not mean providing so much eye contact that young people feel uncomfortable (I’m sure you have found like I have that sometimes it is therapeutically best to turn our gaze away when working with some young people).
However, providing our own appropriate level of eye contact with children– and encouraging parents/caregivers to do the same at home (especially when they are providing instructions or listening to their child talk) – is an important way of teaching young people that eye contact can be helpful, and also that it isn’t required all of the time – and that’s okay too.
5. Increasing motivation and decreasing distress for eye contact:
We want to support parents/caregivers to not to constantly “nag” children about this issue – as we know, distressed and unmotivated children or teens are unlikely to change or learn this skill effectively in the long term.
Instead, we might support families to use activities which increase children’s motivation and decrease their distress, for example:
– For younger children we can “gamify” providing eye contact – e.g., peek a boo, or charades, or using silly glasses, eye contact “who laughs first”, using only eye contact to find an object
– For younger children, using neutral or positive imagery – rainbow or laser eyes (imagining a laser or a rainbow joining eyes to faces) to talk about eye contact
– For older children/teens, continuing to calmly provide factual information about the benefits of eye contact (i.e., that outline above)
– Helping children/teens to gradually “build up” eye contact – i.e., encouraging eye contact in easier situations (i.e., with people with and situations in which they feel comfortable) and then gradually in more challenging ones
– Using a “track chart” for children/young people (of varying ages) to self-monitor their progress in remembering to use appropriate eye contact
– Teaching parents to try to “earn” eye contact rather than just demand it, for example asking them to say… “I have something I want to tell you (then waiting); would you like to hear it?” rather “Look at me!”
6. Helping children to remember to use eye contact:
Sometimes young people do not find eye contact distressing, but simply “forget” to use it.
In this case, rather than increasing comfort/decreasing anxiety, it may be more important to work with them to find strategies to remember to do this. Young people need strategies they can use themselves, rather than relying on “verbal reminders” from mum/dad/adults. The following strategies may be helpful, depending on the age and the child/young person:
– Using stickers (picture of an eye) in various places
– Setting up “secret codes” parents can say to children when out to help remember
– Having children set an alarm on their phone/watch
– Asking young people to put a note in their pencil case/locker/computer cases
These types of strategies usually only work in the short term, and are not well tolerated for long. However sometimes a short “burst” of these strategies over a few weeks can be enough to still increase the frequency of the behaviour even after they stop being as effective as they were when implemented.
All the best with considering this work with young people. Providing that we do it respectfully – and only when and if it does fit with a family’s values – this is one of those “smaller” interventions which can potentially significantly assist young people to create better relationships with their peers, families and other people in their life.