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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, May 13, 2014

Eye Contact, Ear Contact, and Autism

Of all the topics I’ve ever dealt with on this blog, the one that has continued to attract the most attention is children’s eye contact. Hundreds of people daily read blog posts on this topic, and when I look at the questions that are asked and bring readers to this site, the great majority of them are about eye contact. People know that unusual use of the gaze is characteristic of autism and become concerned when a child does not look at the adult’s eyes in the way they might expect.  

Unfortunately, that justified concern is all too often coupled with unrealistic expectations about the development of eye movements and eye signals as part of communication. Some young parents become very anxious when a baby of a few weeks old does not readily gaze at someone’s face, or even when a nursing baby closes the eyes while sucking. It seems that people expect very young babies to use the eyes in almost the same way that adults do, rather than understanding that communication with the eyes--  and even vision itself—are not completely developed at birth. It seems to be forgotten, too, that human beings have communicative modes other than eye contact, and that failure to develop speech is an outstanding characteristic of autism.

It is not possible to diagnose autism from a baby’s use of gaze at a few months of age. but could it be possible to see the beginnings of other features of autism at that early stage? Babies don’t talk, of course, but might there be something about their sounds and their responses to others’ sounds that could predict development along atypical lines? A group of French investigators, Julie Brisson and her colleagues, looked at 13 babies who were later diagnosed as autistic (LDA) and 13 others who were typical in their development (TD). All the babies’ families had taken home movies that recorded the sounds made by the babies and their mothers in the first six months of life. (Of course they did not know at the time which babies would develop in which way; the investigators asked for the movies taken earlier, after the children had been diagnosed with or without autism.)

An interesting part of this study was the examination of the mothers’ speech to the babies, as well as of the babies’ own sounds. No matter what language a person speaks, he or she talks to babies differently than to adults. The type of speech used with babies is sometimes called “motherese”, but is also referred to as infant-directed talk (IDT) to differentiate it from adult-directed talk (ADT). IDT uses a higher pitch and more intonation or change in pitch, as well as repeating phrases or words more frequently than in ADT. Babies are typically very interested in IDT and will pay attention to someone speaking in that way, even though they will ignore the same person speaking ADT. It seems to be the case that adults are “taught” to use IDT to some extent by the responses they get from interested babies. If a baby was not interested in IDT (as might be the case for a baby developing along an autistic pathway), he or she might not reward an adult by attentiveness, so the adult might quite unconsciously not use IDT so much.

As babies develop through the first months of life, they are already beginning to change the sounds they make toward a more speech-like pattern. Because autistic children often speak late or have trouble developing speech in other ways, it’s possible that the LDA babies already showed unusual sound production patterns before they were six months old.

Brisson and her colleagues found that even in the first six months the sounds made by LDA babies were more monotonous and less complex in their sound patterns than those made by TD babies, although they were similar in pitch and duration. The mothers’ speech to the LDA babies used shorter utterances than speech to the TD babies, which might have been because when the babies failed to respond to talking, the mothers tried following up with a shorter message (like the baby’s name). But with little feedback or reinforcement of their efforts, the mothers may have become less likely to talk to the LDA babies.

Could we say, then, that the mothers somehow caused the infants’ autism by failing to talk to them enough? This is not likely to be an accurate conclusion, because there seems to have been a pre-existing characteristic of the baby that discouraged the mother from talking, or at least failed to encourage her as more typically happens. In either typical or autistic development, the development of communication is transactional--  each of the pair affects the other, and the way they do so changes over time. However (and this is my speculation, not Brisson’s), it’s an interesting question whether the LDA babies might have developed more typically if the mothers’ speech to them had been “artificially” increased by training, rather than by the usual rewarding baby responses. In a 2012 article in Science, Beaudet speculated about the possibility that the genetic factors in autism may make LDA babies need different nutrients than those appropriate for TD babies, and if they received an appropriate diet the LDA babies might develop more typically. Beaudet’s idea has not been supported by much evidence so far, but it is an intriguing one—and it does suggest the idea that there could be a parallel in terms of a “speech diet” designed for LDA babies.

Let me just emphasize that this discussion is by no means intended to blame mothers of autistic children. Transactional processes being what they are, a mother’s speech behavior is as much shaped by her baby’s responses as the baby’s sound production is shaped by the mother. It’s possible that LDA babies don’t have the ability to “teach” their mothers how to talk to them as TD babies do. Talking IDT is not something that’s easy to do voluntarily--  just for fun, try to talk to another adult or an older child as if you were talking to a baby. But if it turned out to be a good idea to help mothers of LDA babies do more of this (which we can’t really tell from this small study), we could certainly find ways to encourage them.

ADDENDUM: I forgot to give the citation for the Brisson article. It is Brisson, J. et al (2014). Acoustic analysis of oral productions of infants later diagnosed with autism and their mothers. Infant Mental Health Journal, 35, 285-295.


  1. Dear Doctor,

    I am mother of 23 month old boy. We live away from family, it was me and my son all time in small house. So i allowed him to watch TV when i am working (without knowledge that i shouldnt let him watch). He has not played with any kids of intracted with people. As his father was a late talker, he said he too will talk late... So i didnt worry much now i started worrying as he couldnt realize that we are talking to him and calling him. Now we moved inside city and he love to run outside, watch cars and bus a lot. he can understand little of my talking not fully. He like to see me in eyes only when i sing his favourite song with actions. Now i almost stopped him from watching TV. Please help to recover my baby from my mistake Doctor. I am spending almost most of my time with him, but he not caring to listen or understand me... how to overcome this issue Doctor. I know he is a very bright Kid for sure Doctor.

    1. I am wondering where you live. Do you have access to any early intervention services? If you don't know whether you do, your pediatrician could probably tell you. If you could get some early intervention help, it would be much easier for you to help your little boy.

      Have you had his hearing tested? If he has any hearing impairment, that would be a reason for his language delay. Even if he has only had some ear infections, he may not have been hearing everything around him. You need to make sure that he can hear well.

      Does he communicate in other ways? Will he point to something that's interesting or that he wants? Does he try to get you to look at what he wants you to see-- for example, by putting something close to your face? If he does those things, those are good signs that he should be able to start talking and understanding soon. If he doesn't do them, he may still improve a good deal.

      I would suggest that you let him see as little TV as possible. You should not have the TV on even in the background when you talk or sing to him. Try to talk as much as possible about things he is interested in and that he can see or touch at the same time. If he points at things, talk about them. If he makes any sounds, say the word he seems to be trying to say. Act enthusiastic and excited when you talk to him. Get some simple books and read to him EVEN IF HE DOES NOT SEEM INTERESTED.

      But I think it would be a big help if you can get someone to evaluate him and provide early intervention services, if that's possible where you live.

      Please let me know what happens.

    2. Dear Doctor,

      Sorry i have posted my reply but i dont know i went missing.... I was waiting for your reply.... So sorry for that...........

      We live in south Korea now.... as we dosent know the language, no pediatrician for him. we got put vaccin and come back Dr....

      I have not tested his hearing... no ear infection for him, but once around 8 months he had fever and after thta for 2 months, he was pulling his ears, my husband told its just a mannerism and so i left it after than he never do it Doctor.

      He bring things to me for opening box, pencil, or if any rice spill after his lunch time, he come place it in my hand and he run for play, after reading ur post i let him watch rhymes for 30 mins per day and he trying to imitate actions and babbling showing actions on his own while playing, but not looking at me Doctor. He always point his pointing finger but own his own saying something. Recently he imitated two animals sounds (ka ka and seal sound), he hide behind me and watch his father like hide and seek recently, he bring the baloon and ask to play with it, he bring ropw and ask to pull (all in action)

      He like turning pages and watching books, but on his own, he dont listen when i say something Doctor. He thinks as if i am talking to somebody.

      Traveling to India on 25 of this month, see i can do evaluate him and make him play with kids Doctor.

    3. I'm sorry-- I thought I had replied to everything you sent.

      Of course, because I can't see your son I can't really tell, but he sounds to me as if his difficulty may be with hearing or some specific language problem. He seems to be very social and he communicates to you and wants to play together. It's possible that when he was pulling his ears he did have a painful ear infection and there may be some lingering effects from that. It certainly does not sound to me as if he is autistic.

      If you can get a full evaluation in India that will be a big help to you. Good luck to your family!

    4. Dear Doctor,

      I too dont understand why he not calling me "amma", though i teach him many times Doctor..... But he trying to tell few words (like not exactly), sometimes seeing my mouth when i sing, he is humming rhymes Doctor..... Once back to India do an ear test first Doctor.... Is it possible to have ear infection with out any liquid coming out of ear Doctor???? MAy be i cant wait to do his ear checking, thanks a lot Doctor.

      As you said he dosent sounds autistic, gives me a great relief for now Docotr. Once again thank you so much......

      I will keep you posted Doctor.

    5. You can certainly have an ear infection without any liquid draining. The infection is usually inside, between the eardrum and the inner ear, and unless the eardrum breaks, there will be no drainage that you can see.

      There are also many other reasons why there might be hearing impairment. Any of those problems might make it so difficult for him to hear that he does not really know what you are trying to teach him.

      Good luck, and please let me know what you find out.

    6. Dear Doctor,

      We are in chennai now.
      Done ear test and everything normal Doctor.

      Pediatrician here told, he found 3 issues interacting with my kid and said 1. he is not afraid of strangers. 2. he is not bothering whether we are talking to him or not, he is on his own. 3. he is keep on babbling on his own.
      so he asked to put him in playschool for a month and see, whether he is improving, otherwise we will take him for assessment.
      So i put him in playschool Doctor. taking him to park where lot of kids shouting and playing in evening time....

      Waiting for Good result Doctor.

    7. This playschool sounds like a very good idea and I hope you see some improvement very soon.