Expert: Jene Aviram - 4/15/2009

Question
QUESTION: Hi Jene,

I've read some of your posts and thought I would reach out to you about our daughter. At her 9mth old appt, I mentioned to our pediatrician that she seemed a bit "different" from our other children when they were her age. I had become increasingly aware that she was lacking eye contact. I had no clue what this could mean at the time, but our pediatrician spent some time with her and did conclude that she seemed to be more "object" oriented vs. people oriented. She referred us to early intervention and we have just been through the screening and started her in a play group.  Fortunately, as she approaches her 1 yr birthday soon, she seems to be doing exceptionally well in every area except eye contact.  You can go to great lengths to attempt to get her to look at you, such as her favorite toy on your head and calling her name, and she will look past you.  She will even jump into the arms of a complete stranger, not looking at them, and only utilizing them as a "means" to get to something she wants, such as a different toy. From reading your posts,what we know about her is that she does not seem to have the more severe symptoms/signs of possible autism.  What ideas do you have that can help us to develop her eye contact with people?  Additionally, she seems to have an excessive "mouthing" of objects far beyond what I experienced with our other children.  Should this in itself be a concern?  

Thanks for your input!

ANSWER: Hi,

Firstly let me say that you are doing all the right things.  There are not many people who get an evaluation so early for their child.  You are really on the ball and your daughter will benefit greatly from your proactive approach.

Eye contact is a difficult thing.  If you and I are having a conversation you look at my eyes because they tell you things.  You want to see my expressions.  As you tell me something you look for my interest.  Am I curious?  Am I bored?  Am I shocked?  We constantly seek out and receive information from other peoples eyes.  People who don't make eye contact are often not receiving information therefore they don't seek it out.  The next time you are having a conversation with your husband, try staring for the entire time at the wall behind his head.  I bet it would be really hard for you to do because it's not giving you any feedback.  

I don't know the results of your daughter's evaluation but I'm assuming that she does not receive information from people's eyes.  We therefore have to be very patient in teaching her how to read that info.

Your daughter is very young and I would suggest playing some games with her at this stage.  Does she like peek-a-boo?  This is a great game to get some eye contact.  I would also try and play some simple interactive games together that involve looking at each other before the next step takes place.  You can be creative and make these games up.  Do you have stairs in your house?  One example would be for you to sit on the top of the stairs together with a big bag of lightweight balls.  You have control of the balls.  The object of the game is to let her throw the balls down the stairs when she sees you nod your head that it's OK.  If you shake your head no, then it's not time to do that yet.  Make your expressions as dramatic as possible, particularly with your eyes.  When you are shaking your head no, scrunch up your eyes and your brows.  When you are nodding yes, look absolutely delighted.  Use NO LANGUAGE in this game.  You want her to rely on non-verbal cues.  

Hold one ball in your hand as if you're giving it to her.  When she reaches for it, shake your head no.  If she doesn't look at you, keep a firm grip on it.  Shake your head no again.  If she still doesn't look up at you, literally swing your head from side to side to try and attract her attention.  If all else fails, grunt to get her attention.  The minute she looks up at you, nod in a delighted "Yes" and throw it down the stairs.  Don't get despondent.  Rome wasn't built in a day.  Play this repeatedly and you will see that she'll start responding and probably love it.  Use this philosophy with other games.  Get a mailing tube and sit together at a child's table.  Angle the tube to the floor.  With the same philosophy, let her put the cars down the tube so she can seem them fly out the other side.  Do you have bean bags or lots of pillows?  Kneel down and hold her hands.  Shake your head from side to side.  When you nod your head, fall down on the pillows together while you shout "We're Falling!"  Once again, try and use no directive language in these games so that your daughter must seek out your expressions.  You're catching her at a perfect age and consistency is key.  You will find these games will help a lot as she learns that she must look up at you for direction and information.

Regarding the mouthing of objects, this can usually be helped with OT.  I'm not sure if you were granted this service.  She is still young and might be a little delayed in having mouthing of objects fade.  Since she is not actually eating things like soil, crayons, etc it certainly doesn't sound like something to be overly concerned about.  The chances are that it will stop in due time.  Simply redirect the objects out of her mouth and use your same shaking of the head with dramatic expressions.

I hope this answer has been of some help and I wish you great success.  I can see that you are going to be a great advocate for your daughter.

Jene Aviram
http://www.nlconcepts.com

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for the reply and the great suggestions! We will start implementing them right away.  Ironically, yesterday after I had sent this Early Intervention called me to arrange for an OT to come out and work with her regarding the excessive mouthing.  Again, she is very young--but with this and lack of eye contact, it's a true struggle to try to balance it.

She goes tomorrow for our first appt with a developmental Pediatric Specialist.  While again, we know she isn't extreme-we have noted the "unusual" and want to be as proactive as possible.  While we are not looking for a diagnosis as she is so young, I have found it to be VERY frustrating how we are receiving lots of referrals-such as OT,etc..---but no one is really taking the time to elaborate when we ask questions about her lack of eye contact,etc..  Hopefully we will get some elaboration when we go tomorrow.  Thanks again for your time!

Answer
You're very welcome.  Yes - it is EXTREMELY frustrating when you can't get answers and you feel like you're being bounced around from one person to the next.  I wish you the best of luck for tomorrow.  Write all your questions down before you go.  That way you won't forget them if you get lost in the moment.

Jene Aviram
http://www.nlconcepts.com