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Concerned About Unconventional Mental Health Interventions?

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

Tuesday, December 11, 2018

Eye Contact and Autism: Questions About a Baby

Over the years, I’ve posted on this blog several comments about whether it’s possible to identify autism in young infants. It’s clear that nobody can do this with babies less than a year old—and it’s especially unlikely that it’s possible in the first 6 months. There have been many queries and comments on this topic, so many that pages have been filled and it has not been possible to post any more, even though I’ve started a new page from scratch several times.

Today I’m going to start again because of a query I received in my email. I think other people may be interested in reading this mother’s questions and my comments, and I hope readers will respond to her if they have something helpful to say about the points that are worrying her.

The mother writes:

I would love to pick your brain about my 5 month old baby who seemed to be developing socially normally up until he turned 3 months. After that his eye contact has gradually decreased and he seems to be getting more and more interested in the world around him. 

My comment: Your baby is still in the process of developing vision and becoming able to use his eyes in coordination. He can also see clearly at greater distances than he did earlier. It’s not surprising that he is interested in all those things to look at that used to be just part of a blurry cloud behind the nearer things that he could see well.

His cooing back to me has also declined though he will occassionally coo to himself or make a couple of sounds to me when he first sees me. He also sometimes says ma. Yesterday and today he also copied me when I said uh oh after he dropped his toy. He also growls in frustration and will look at me angrily as if in plea to pick him up or to stop reading. He understands "up" and "milk" as he'll prepare his body in response. 

My comment: Cooing is an early form of vocalization that helps babies move toward speech. Your baby sounds as if he is beginning the next stage, syllabic babbling, where he creates syllables with a consonant and vowel. Some of these sound like words (“mama”) but the baby does not really connect them with things or people and is just as likely to say “ma” to the cat as to you. What’s really a sign of good development is that you and he are beginning to communicate with sounds and he has already imitated you once. There’s nothing autistic about that. This baby pays attention to people and thinks they are interesting/

He does follow people around the room with his eyes and seems to like looking at people when they are not looking at him. He never looks at me when I hold him. When we move him playfully up in the air he might look for a split second. 

My comment: People looking at him are probably not walking around, and someone walking around provides a lot of interesting things to look at. I doubt that he’s avoiding looking at faces, just choosing to look at more complicated moving things. Babies don’t really gaze into their mother’s face at length, the way sentimental advertising photos seem to show, at this age, although later he will probably look at you while exploring your face with his hands, for instance sticking his fingers up your nose—a scene the ads never show!

He sometimes giggles, occassionally has a laugh and he usually smiles back at me when he first sees me. However I just feel that I am working hard to engage with him. I need to be very animated and fun to get him to look at me for more than a second. Even playing/tickling his feet and toes isnt getting much of a response these days. He will look at me the longest when I am singing and dancing. His attention for books is ok though it used to be better.

My comment: It can feel like a lot of work to engage a baby this young, especially if you are feeling anxious and not having so much fun yourself. Do you think you are looking a bit blank or worried or sad? Babies do tend to look away from that kind of expression. But also, not every baby reacts easily or actively—some don’t show very much whether they are interested in something, and those are just personality differences, not developmental problems at work. As for his attention to books, I  would be surprised if he has actually been paying attention to them at all rather than just listening to your voice and noticing colors and movement. I know everybody is told nowadays to make their baby literate from birth by reading aloud, but in fact talking and social play are the things that babies respond to most, and involving books at an early age is mainly useful to make connections between books and pleasant social times. (Although parents who don’t feel comfortable talking to a baby may find reading aloud to be easier.)  

His motor skills are good and his attention for his toys are great. He does tend to look at the ceilings light fixture and window blinds a lot which worries me.

My comment: He does need to figure out which are the background things that don’t move by themselves and which are the moving things, but in addition these large shapes are interesting to him although not to you. He has a lot to learn about the visual world and concepts like “in front of” and “behind” that seem obvious to adults but did have to be learned even for us.

If it was up to him he would be walked around for the whole day looking at the world. Though at the same time he has never shown separation anxiety. 

My comment: Of course it’s more interesting to move around and see things than just to stay in one place, and he can’t do it by himself, so he would like you to help him do it. (This doesn’t mean you have to!) As for separation anxiety, I would be astonished if he had shown any at his age! At least two or three months will pass before he comes to that point in development, maybe even longer than that.

I am very anxious about him having autism. I'm an OT working with kids on the spectrum and I have been anxious about autism since I was pregnant. I have started seeing a psychologist.  

My comment: I’m glad to hear that you are getting some treatment. I am thinking that even though almost all parents of young infants worry a lot about possible problems, your fears strike me as part of a perinatal mood disorder in which anxiety and sadness make you interpret normal behavior as frightening symptoms. Such disorders can be present at milder or more severe levels, but they can be treated, and for your own sake as well as your baby’s and your husband’s it is best to get help for them.


By the way, I sometimes think that women in the helping professions may have extra difficulties along these lines. They are used to focusing on developmental problems rather than thinking in terms of the many variations of normal development. In a most unfortunate case in South Dakota recently, a psychologist engineered an intentional car crash that fortunately did not succeed in killing her and her 6-month-old baby. Under the influence of a mood disorder, she had convinced herself that her baby had reactive attachment disorder, which would be impossible at that age. I am not suggesting that the mother whose questions are above is in anything like that position, but her unhappy focus on what might be wrong may be worsened by her knowledge of what can go wrong—and she may have seen children with real problems a lot more often than normally developing children.

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