Teaching Eye Contact to Children with Autism: A Conceptual Analysis and Single Case Study
Carbone, Vincent J., O'Brien, Leigh, Sweeney-Kerwin, Emily J., Albert, Kristin M., Education & Treatment of Children
Eye contact occurs very early in development and serves many functions for the young child. It has been implicated in the development of social, cognitive, and language skills. A substantial number of children with autism fail to develop this important skill and therefore experimenters with both developmental and behavior analytic perspectives have researched methods to teach eye contact. However, only a few researchers have recently attempted to condition the response of the communication partner as a reinforcer for social behavior and thereby arrange the conditions under which typical children develop social responses. The purpose of this case study was to extend the analysis of typical development of social skills to the teaching of eye contact as a language pragmatic skill to a child with autism. Data from a single case study of a child with autism are provided.
KEYWORDS: Eye Contact, Social Skills, Mands, Extinction, Autism, Motivating Operations
It has been suggested that eye contact, sometimes referred to as (eye) gaze behavior or eye-to-face gaze (Mirenda, Donnellan, & Yoder, 1983) serves an important social function for young children even before vocal responding begins to develop (Stern, 1985). In early development, eye contact serves to regulate face-to-face social interactions (Lee, Eskritt, Symons, & Muir, 1998; Leekam, Baron-Cohen, Perrett, Milders, & Brown, 1997) and contribute communicatively to social interactions (Tiegerman & Primavera, 1984). Later, eye contact responses coordinate the visual attention between another individual and an object of interest (Arnold, Semple, Beale, & Fletcher-Flinn, 2000) and have been found to be an influencing variable in language acquisition (Podrouzek & Furrow, 1988).
Deficits in various nonverbal social-communicative behaviors, particularly in dyadic (i.e., eye-to-face) and triadic eye gaze (i.e., joint attention directed at a third party or object) are commonly identified as the earliest indicators and most noticeable deficits of developmental delays and of Autism Spectrum Disorder in particular (Baron-Cohen, Allen, & Gillberg, 1992; Mirenda et al., 1983; Wimpory, Hobson, Williams, & Nash, 2000; Woods & Wetherby, 2003). Because of the various social functions eye contact may serve, failure to emit this important behavior may have significant implications for children with autism. In addition, there are possible educational concerns associated with poor eye contact. Specifically, previous research has suggested that the diversity of prelinguistic pragmatic skills exhibited (e.g., eye contact, joint attention) is predictive of the rate of subsequent vocabulary acquisition (Kleinke, 1986) and it has also been suggested that poor eye contact may adversely affect the educational gains of children with autism due to the relationship between eye contact and attending to the teacher and instructional demands (Greer & Ross, 2007; Lovaas, 1977).
Given the potential negative outcomes correlated with deficits in eye contact, the development of eye contact responses in children with autism has drawn the attention of many researchers. Theories related to cognition, affect, social meaning, and theory of mind have been offered to account for the development of eye contact and for the characteristic deficit in children with autism (Baron-Cohen, 1988; Burgoon, Coker, & Coker, 1986). In addition, the effects of various behavior analytic principles and procedures on eye contact responses have been investigated.
Early behavior analytic investigations targeted eye contact responses to achieve instructional attention prior to beginning academic programs using vocal and physical prompts (Foxx, 1977; Greer & Ross, 2007; Helgeson, Fantuzzo, Smith, & Barr, 1989; Lovaas, 1977; Lovaas, 1981; Mirenda et al., 1983). The premise of these interventions was that if children with autism failed to orient toward the instructor, they would also fail to respond and learn (Foxx, 1977; Helgeson et al. …