Parent-Led Intervention Method to Increase Eye Contact Initiation in Young Children with Autism Spectrum Disorder

Background: Difficulties in eye contact are well recognised in children with autism spectrum disorder (ASD). Reduced interest towards another person’s face and eyes may contribute to the abnormalities in social development of children with ASD, in general. Therefore, it is important to motivate them towards other people’s eyes and faces as early as possible. Recent interventions for children with ASD have, indeed, focused on the development of early non-verbal social communication skills. Interestingly, some recent studies have shown that imitating the behaviour of children with ASD improves their gaze behaviour and social initiations. In addition, involvement of parents in interventions has been shown to reduce parental stress and improve parent-child interaction. However, only a few studies have investigated the efficacy of parent-led intervention methods for young children with ASD.

Objectives: The aim is to plan and test a parent-led intervention method targeted to increase eye contact initiation in young children with ASD. The suggested intervention method is intended as additional to the treatment as usual (TAU). It is predicted that children’s motivation towards faces will increase if initiation of eye contact is reinforced by trying to make it rewarding. It is further assumed that improvements in children’s social communication will reflect positively to the parent-child interaction and parents’ image of their child.

Methods: The suitability of the intervention method was first tested in a family with a 4-year-old boy with ASD. In an ongoing study, 20 newly diagnosed, 3 to 4 -year-old children with ASD are randomly divided into two groups. In the first group, parents are taught and encouraged to do daily eye contact exercises with their child in addition to TAU. The second group receives only TAU. The daily exercises include encouraging the child to use eye contact for requesting food and physical contact, and imitation of the child’s actions in a specific manner. This intervention will last for 5 months and the progress will be monitored through follow-up assessments and phone-calls. Baseline and outcome measures are based, among others, on observations of gaze behaviour during parent-child interaction and questionnaires tapping on parents’ experiences.

Results: The preliminary results from testing the method suggest that relatively simple exercises attached to predictable daily routines are suitable to be carried out in the daily lives of the families. Moreover, in the pilot family, imitation of the child’s actions seemed to increase his initiations towards the imitating parent.

Conclusions: Evidence-based, parent-led intervention methods for young children with ASD are needed. It is expected that this study will help to introduce new evidence-based methods for autism-focused intervention and provide guidelines for supporting gaze behaviour, and social skills in general, in children with ASD.