Eye contact in adopted children: attachment, FASD, or autism?

Charlotte (age 7) is struggling with eye contact. And therefore so are we. Is it an attachment issue, FASD, or even autism? How concerned should I be? And should I be starting the fight for yet another assessment? Where do I start to find out? What information is there about eye contact in adopted children? Here’s what I found out.

Eye Contact In Adopted Children: Attachment, FASD Or Autism


Not today, thank you

It’s hard to know what Charlotte wants at any given time, as she changes her mind a lot. Sometimes she demands that we look at her, other times she screams at us not to look at her. Sometimes she wants to look at us, other times she refuses to. On extreme days, our children even scream at us for looking in the car’s rear-view mirror while driving. Not because we are looking at them, just because we’re using it to drive safely! Argh.

Possible diagnoses

I’d like to find out what this problem is about so that I can respond appropriately. Is it primarily an attachment issue? Is it part of FASD? Could it even be a sign of autism? Without a diagnosis it’s hard to know where to start. Is the advice for dealing with eye contact within each of these diagnoses the same or different? I did a bit of research to find out.

(Disclaimer: I’m not a medical professional. What follows is based only on my own experience as a parent and a bit of Googling.)

Eye contact in attachment disorders

John Bowlby (Mr Attachment Theory himself) lists eye contact as one of the critical factors in healthy attachment. His view is summarised by Psychology Today:

‘If the caregiver is responsive to the child’s signals and interacts with sensitivity, a secure attachment will be formed, reinforcing the child’s own positive emotional states and teaching him or her to modulate negative states. Deprived of the mother’s gaze, the area of the brain that coordinates social communication, empathic attunement, emotional regulation, and stimulus appraisal (the establishment of value and meaning) will be faulty. Such children are likely to develop “insecure attachment” along with all sorts of subsequent losses in self-esteem and feelings of belonging.’

So for Charlotte, whose birth mum wasn’t able to provide this for her, attachment looks like a possible contender. She probably didn’t have consistent doses of eye contact in her first few months of life. As a consequence, it may just be too threatening for her now.

Side note: though we were taught as prospective adopters that attachment theory is basically gospel truth, I am increasingly hearing of respected professionals calling it into question. I’m hoping to cover that in a future post.

Eye contact in FASD

It was harder than I expected to find good information about eye contact in FASD. One helpful resource is produced by psychology students at McMasters University in Hamilton, Ontario. They have a blog, ‘Live and Learn with FASD‘. There’s also an associated YouTube channel on which they have a series of videos for young people with FASD to help them improve their eye contact. They say:

‘It has been shown that some children with FASD experience problems with maintaining eye contact, and will typically look elsewhere on someone’s face when they speak. Their amygdalas, which play a role in processing emotions in the brain, tend to be less dense than in children without FASD. … While individuals [with FASD] tend to look at the centre of a picture of a face that is not moving, when a person’s face who is talking appears they tend to look at the mouth instead. This is because when the mouth is not moving, the eyes are more of a stimulus than the mouth in general, but when the mouth is moving, the mouth is a more important stimulus for the proposed pathway along which the information is processed’.

Eye contact in autism

Eye contact is well-known as a symptom of autism. An article from the charity Autism Speaks, ‘Why is it so hard for someone with autism to make eye contact?’ explains:

‘The act of making eye contact is extremely stressful for some people affected by autism. There are many books and articles written by adults with autism who describe the terrible stress they felt when well-meaning parents and teachers tried to force them to make eye contact during conversations. In many cases, they describe being further distracted and unable to focus on the conversation because of this insistence.’

This does sort of sound like Charlotte at the times she screams ‘STOP LOOKING AT ME!’ She has a few other behaviours that I’ve seen described as autistic traits, too. She loves pretending to be a dog, she likes lining things up, and she has sensory issues, especially around food, which can lead to massive meltdowns. Tomato on her plate? Salad leaves? She’ll scream, push the plate away, and either hide under the table or leave the room, slamming the door behind her and shouting. However, there is also a lot of overlap between FASD and autism, which leads to the question…

Which is it?

This helpful printable chart summarising the overlapping behavioural characteristics in FASD and other diagnoses indicated that FASD and autism are both possibilities. (I took this to our GP and it was a really useful tool to discuss it.) As Charlotte’s behaviour ticks all the boxes for FASD, I think it highly likely that she has it. Autism, though? Though I occasionally wonder about it when she exhibits certain behaviours, I don’t think so. This chart from MOFAS (below) is helpful in explaining the differences.

Differences Between Fetal Alcohol Spectrum Disorders and Autism

Source: Dan Dubovsky MSW SAMHSA, FASD Center for Excellence

FASD Autism
Occurs as often in males as in females Occurs in males 4 times as often as in females
Able to relate to others Difficult or impossible to relate to others in a meaningful way
Restricted patterns are not commonly seen Restricted patterns of behavior, interests, and activities as a core area
Verbal communication may be slow to develop but is not commonly significantly impaired Difficulty in verbal and non-verbal communication
Difficulties begin at birth Difficulties may begin after a period of normal growth
Difficulty in verbal receptive language; expressive language is more intact as the person ages Difficulty in both expressive and receptive language
Spoken language is typical Some do not develop spoken language
Spontaneously talkative Robotic, formal speech
Echolalia not common Echolalia-repeating words or phrases
Stereotyped movements not seen Stereotyped movements
Ritualistic behaviors not commonly seen Ritualistic behaviors
Repetitive body movements not seen; may have fine and gross motor coordination and/or balance problems Repetitive body movements e.g., hand flapping, and/or abnormal posture e.g., toe walking
Social and outgoing Remaining aloof; preferring to be alone
Difficulty with change and transitions Inflexibility related to routines and rituals
Can share enjoyment and laughter Lack of spontaneous sharing of enjoyment
Can express a range of emotion Restricted in emotional expression
Funny; good sense of humor Difficulty expressing humor
Microcephaly more common Macrocephaly more common
Considered a medical disorder in the ICD.  Not in the DSM-IV Considered a mental disorder in the DSM-IV

I’ve added colour to indicate where Charlotte’s behaviours fall definitively on one side – and that is mainly on the FASD side. She does have some language issues, such as becoming non-verbal at times of stress, using a made-up language and babble, and often preferring to communicate through grunts. (Some might say that sounds like a typical teenager.) But in other areas her social skills are generally OK. Yes, her level of empathy is a bit lower than I’d like. But she certainly prefers to play with others rather than alone, and she is very, very talkative. She also has a fully-functioning GSOH. Hmmm.

Conclusion

Problems with eye contact in adopted children are not desperately unusual. People have discussed the topic in a couple of threads on the Adoption UK forums, for example. It could ‘just’ be a consequence of early neglect. I’m aware that neglect in the first 18 months of a child’s life has a massive impact. (This was the age at which Charlotte was taken into care.) But my gut feeling is that it’s more than that. This is partly because I have Charlotte’s sister Joanna to compare her to.

Joanna was in the same birth family for even longer (nearly 3 years). Eye contact is occasionally an issue for her, but not to the same extent, and with Joanna it is almost always shame-related. Charlotte’s seems to be fuelled by something else: I get the sense it comes from overwhelm of some kind.

Meanwhile, we’re pressing on with trying to obtain an FASD diagnosis, and I’ll ask these questions when I’m finally face-to-face with someone who knows about this stuff. And as I find out more, I’ll update this post. If you have other sources of information on this topic, please leave them in the comments.

Further reading

I recommend these two books about FASD, both of which contain very practical advice and strategies, including a bit about eye contact.

You might also like to visit:


Have you experienced eye contact issues in your child? What are your thoughts? Please let me know in the comments.


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