The natural inclination to make eye contact with another person is sometimes disrupted in children and adolescents. The observant clinician can use the nature of the eye contact disruption as a help in clarifying the underlying diagnosis that is likely responsible for the referral. There are 4 possible reasons for disruptions in eye contact.
The first and least common is due to paranoia that is usually associated with a psychotic condition. In this instance the avoidance of eye contact is active and it represents an attempt to prevent the clinician from seeing the distrust, fear, and anger that lurks behind the eyes of the person as his or her mind tries to protect itself from agitating interpersonal contact. Eye contact that is made will likely feel like a brief intense stare and the person will then quickly look away or become increasingly agitated and need to withdraw either physically or emotionally. The history of such a person who is referred will typically include substantial problems with peers and parents and there are likely to be vegetative disturbances. A history of hallucinations, nightmares, poor hygiene and declining school performance are quite possible.
The second reason for disruption in eye contact is with Autistic Spectrum Disorder. In that condition, the person does not make smooth natural eye contact during the course of the interaction because there is a basic lack of the natural inclination to make eye contact. The person is not necessarily avoiding contact, but is rather living in a state in which eye contact does not occur as a natural extension of human interaction. In fact the most basic disruption in ASD is the naturalness of the human interaction, so it is not surprising that one of the basic means of fostering increased human relatedness would be disrupted. The person can be briefly oriented to making eye contact, but the contact will feel somewhat contrived and will easily revert to its disconnected status.
The third reason for disruption of eye contact is quite common and is the active avoidance by the oppositional child who carries an angry attitude and uses eye contact avoidance as a way of displaying their limited willingness to participate in the interview process. The eye contact is yet another manifestation of the child’s angry oppositionality.
The fourth reason for disruption is probably the most common and represents exaggerated interpersonal anxiety. This is the overly anxious, inhibited, shy child with a soft voice who can barely look up and seems like he or she is trying to shrink and hide.
Eye contact between humans is a basic and natural means of engaging in interpersonal connections. The astute professional can use disruptions in eye contact as part of the diagnostic data base that helps determine the nature of the underlying disturbance.