Autism & Asperger's Syndrome Expert Forum
2 year old with poor eye contact
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2 year old with poor eye contact

Hi.  My 2-year-old has fairly poor eye contact.  She has been evaluated by the EI and has no delays.  Her language is slightly ahead.  It really depends on her mood, but she often doesn't look into my eyes when she's speaking to me.  And when I'm speaking to her, often she will look at my eyes for only a few seconds, then look at my mouth or look away.

She does not seem to have any obsessions or line up toys very much.  She is not overly precocious, and plays well with kids her age.  She's also fairly adaptable to a change in routine.  That said, she prefers her routine.

She can be quite demanding.  For example, when her dad or I walk in the door, she immediately wants us to take our coats and shoes off.  If we don't, she gets pretty agitated.  When I walk into her room to get her in the morning, I'm usually in a robe, and she shouts, "Shirt!  Pants!" at me.

Sometimes (depending on her mood), she takes awhile to respond to her name.  It's almost as if she at times has a hearing problem, but her hearing has been checked, and it's fine.  At times during her first 2 years, she has responded to her name well.

Sometimes she plays repetitively.  No hand-flapping or anything like that, but for instance, she will walk into a room, pick up a doll, put it down, walk to the door, and walk into the room again, repeating the process several times before moving on.

She is intensely "shy" around adults.  I was, too, so it's hard to tell if this is the "shyness gene" or something else.  Once she gets to know an adult, it's better, but there's always the initial burrying of the head in mommy's shoulder when any adult walks into the room.

My problem is that her pediatrician and no evaluator in the world would say she's on the spectrum.  

But if she's not regularly looking at faces and into eyes, how is my daughter going to learn about human expression and emotion?  I can't help but think there's something out there that would help her.

Please help.  :(
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As you recognize in your description, your child's behavior does not appear consistent with a diagnosis of autism. Nonetheless, I recommend that you continue to share any developmental concerns with your child's pediatrician. You seem to have two main concerns regarding your child's behavior. First, she is shy and does not consistently make eye contact. Recongizing this early will allow you to gently encourage social development. Here are some general suggestions (some of which you are already doing). (1) Give your child plenty of opportunitites for enjoyable social interaction (e.g., play groups, going to the park, interacting with relatives). (2) Try to arrange it so that she receives more attention when she is appropriately social than when she is shy. For example, minimize attention directed toward her when she is clinging to you and hiding her face from others and be sure to give her attention when she interacts with others. (3) Encourage her to make eye contact with you by requiring it under some conditions. You will be most successful with this when she is particularly motivated. For example, when she asks for a favorite snack, you could direct her to make eye contact when making that request.

Your other area of concern was her demands on the families routine. This behavior is fairly common for two year olds, but I think it is important to address. Often parents and their toddlers find themselves battling for control in the house. One developmental challenge for toddlers is learning which things are under their control and which are not. It is very easy for parents to give toddlers too much control because it avoids tantrums. But, ultimately, this pattern is often more disruptive to the family as toddler's demands become more pervasive or extreme. I recommend that you work with your family to decide which are appropriate choices for your toddler to make and which things are unreasonalbe. Then, try to be consistent. For example, it may be reasonable for your toddler to make a choice between 2 reasonable outfits to wear. But, she should learn that she has no control over your clothing.
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Lack of eye contact is common in autistic spectrum disorders (including aspergers).  My son's eye contact is variable.  I don't think he has a uncomfortable feeling whilst looking, I think it is down to not being able to multi-task from a sensory point of view.  So when he speaks to you he is concentrating so much on what he is trying to say that he doesn't look at you.  If I make him look at me whilst I am speaking, often he cannot tell me what I have said.
Appearing deaf, not responding to name etc is also down to sensory issues.  That also happens to me and I am not on the spectrum, but I do have sensory issues and central auditory processing disorder.  When my ears are effectively turned off, my husband has to repeat my name a number of times or even touch me to make my ears begin working again.  I have no idea why it happens.
Does she have other sensory issues eg. what is she like having her hair washed/brushed/cut - or nails cut - socks and shoes put on - do tags have to be removed from clothes - does she complain of smells or tastes/textures of food - is her balance and co-ordination okay.
Did she ever repeat what you said back to you or does she use words/phrases you say or from TV/DVDs.  Does she have an unusual tone of voice or put the emphasis on the wrong part of words.  Does she pronounce words correctly.
Doe she every answer a question with something totally unrelated to the question.  Does she understand pronouns such as I, me, you, she, him, her etc.
You say she plays okay with other children her age.  Keep an eye on that.  Can she initiate play and join in with what the other children are playing.  Does she play with them or alongside them.  Can she sustain play or does she join in for a short time and then wander off, or if the other children move somewhere else to play would she go with them or stay behind? - I know she's quite young for this, but in comparison to her peers.
Children on the spectrum also have a need for routine, to have their expectations met, some have rigid repetitive behaviours.  It is very variable.  My son rarely flaps - only if watching an exciting part of a DVD and then its over in 2 seconds.  He doesn't need routine or need things to be done in a certain way.  However he does need his timetable at school, and he resists leaving the house when at home unless I tell him what the schedule is eg. you can watch TV until this programme is finished and then we have to leave to go shopping.  He likes to wrap himself up in clothes eg. even in summer he likes his coat hood up and fully fastened.  So your daughter expecting the same thing to happen when you walk through the door, or expecting you to get dressed is a rigid way of thinking and you may see it move into other aspects of daily life.  This way of thinking can also affect learning because the child is learning 'chunks' of information rather than analysing things and putting pieces together.  Eg. with the clothes, instead of using her imagination and understanding that mum has just got up and is wearing her dressing gown, she thinks immediately that you need to be properly dressed.  That approach to learning can make it difficult for them to learn concepts.  Teaching is usually giving out bits of information for the children to put that together.  Children on the spectrum can tend to work the other way around ie. they need to see the finished product and then take it to pieces to see how it works.
And 'autism' can be very subtle and you need experienced professionals who are used to diagnosing this disorder to see your daughter.  I would recommend you go back to your paediatrician and ask to be referred to a team of professionals who have expertise in diagnosing autistic spectrum disorders.  Your daughter is 2 now.  It will take some months (usually) to be referred.  Usually it is the Speech and Language Therapist that assesses all aspects of receptive and expressive speech as well as auditory processing and working memory and social interaction skills.  Depending on their results they recommend other professionals see the child.  In my case that took a further 6 months waiting and on top of that 18 months of observations and assessments.  My son finally got a diagnosis of high functioning autism with sensory integration disorder (he has recently been diagnosed with Semantic Pragmatic Speech Disorder).  He may have dyslexia and dyscalculia.  Yet he was able to put the numbers 0-10 in order from the age of 1.  But he did that because many children on the spectrum are brilliant with visual memory and pattern construction.  So he could put them in order and tell you what each number was in the line, but couldn't identify any number out of the sequence.  He is assessed as high average intelligence.  We started to have concerns around 3+ years old because he hated nursery and wouldn't join in.  But I was fobbed off until he started school - then 6 months later they called me into school with their concerns.  With hindsight I wish I had pushed for an answer earlier because all professionals agree that the earlier you start interventions, therapies and supports the better the outcome.  And you need your daughter to have those supports (if she needs them) before she starts nursery/school otherwise it will be a very stressful and negative experience for her.
I recently moved him to a school that is a mixture of mainstream children and those on the spectrum.  All the teachers and TAs have experience and expertise in teaching children with these types of difficulties.  He has shown alot of improvement.  This morning he spelt three words correctly.  He is also starting to read rather than just memorise all the words in his reading book.  
So, some of the things you mention in your post I would recognise as being on the spectrum.  Whether or not she has enough of them in all the areas required to get a diagnosis you won't know unless she is assessed.  And she is 2.  There is alot that can be done to help her learn skills.  She sounds like she is probably high functioning.  You can google DSM IV autism to see what the diagnostic criteria is.
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Avatar_n_tn
Thank you so much for taking the time to reply.

She doesn't seem to have other sensory issues.  Smells, tags, textures, etc. don't bother her.  She is not a picky eater.  She is one of the most cautious human beings I have ever known, and is more apt to try a new food when she sees mommy eating it.

I did have her speech fully evaluated, and she was deemed slightly ahead.  The report did put her at the low end of normal for social interaction, but it was chalked up to shyness.

She does go to nursery school 2 days a week and enjoys it.  Her teachers think she's "slow to warm up," but they tell me she loves to observe other kids intensely at times.

Yes, she sustains play well for her age.  She will let me read her books for a half hour, play independently, etc.

The biggest things are the spotty eye contact and inconsistent response to her name.
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470168_tn?1237474845
If it is just the eye contact the inconsistent response to her name that seems to suggest an attention and focus thing ie. when she is engrossed in something she is unaware that her name is being said and she may not be able to make eye contact for the same reason.  It is a case of she is engrossed and she cannot turn her eyes to look at you, or is she not doing anything other than try to tell you something and she cannot make eye contact at the same time.
The other possibility is sensory issues, but you say she doesn't have them.  When you say she is cautious do you mean she is very careful regarding her balance and co-ordination?
If that is the only things I would just keep an eye on her.  You have had her evaluated.  If she starts to lose words, or doesn't develop her social interaction side, or becomes more rigid in her behaviours/expectations - or having real tantrums that seem an over reaction to the trigger then I would want her looked at again.
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Avatar_n_tn
Thank you so much for taking the time to respond.  I am already doing some of the things you suggested, but I wasn't sure if I was doing the right thing.  It's such a relief to know I'm going in the right direction.  I will discuss it again with her doctor in greater depth next time.  Thank you.
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Avatar_m_tn
Did they do a vision / eye exam? maybe she needs glasses if all else has been ruled out.
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Jason C Bourret, Ph.D., BCBA-DBlank
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