Autistic Look Away Due to Stress, Not From Indifference

Related articles

Some Boston-based researchers are challenging the widely-held belief that those on the autism spectrum choose not to make eye contact largely due to indifference for the other party. Instead, they believe the behavior is not a product of conscious decision making – but instead it's based on an involuntary neurological reaction taking place.

By probing the brain's inner-workings using functional magnetic resonance imaging (fMRI), investigators at Massachusetts General Hospital determined that when those with autism spectrum disorder (ASD) are face to face with others, they tend to look away because by not doing so produces stress and physical discomfort. 

"The findings demonstrate that, contrary to what has been thought, the apparent lack of interpersonal interest among people with autism is not due to a lack of concern," says study author Nouchine Hadjikhani, MD, PhD, director of neurolimbic research at Mass General's Martinos Center for Biiomedical Imaging. "Rather, our results show that this behavior is a way to decrease an unpleasant excessive arousal stemming from overactivation in a particular part of the brain."

The area of the brain responsible for emotion perception and facial recognition is known as the subcortical system. This study sought to learn about what happens when people with autism were asked to "constrain their gaze" into the eye-region of another party.

Initially, the study included 25 participants with ASD and 25 more that constituted the control group. Of those with ASD, two were excluded because their behavior prevented them from taking part adequately. Of those in the control group, who the authors noted had "no history of psychiatric or neurological disorders," five were excluded for the same reason(s) as those with ASD.

When the participants with ASD viewed faces with a range of emotions – especially true with fearful faces, but also true when viewing happy, angry and neutral faces – overactivation was measured in the "subcortical circuitry," which produced discomfort. 

"Our data demonstrate that constraining individuals with ASD to look into the eyes of dynamic faces expressing different emotions results in aberrant activation of the subcortical pathway, such that higher activation was found generally in the ASD group," the authors wrote in their study, published this month in the journal Scientific Reports. The data, they continued, "is the most direct evidence of the mechanisms by which direct eye-contact may be experienced as stressful in autism."

For additional details of how the study was conducted, here's the paper entitled, "Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism."

These findings by Dr. Hadjikhani's team, which is seeking to conduct follow-up research, might turn out to be useful to behavioral therapists. That's because not knowing the physical discomfort being created, some may be inclined to force their patients to make contact as part of their therapy.