Eye contact discomfort does not explain slower emotion recognition in autistic individuals

Recent findings published in the journal Emotion suggest that the discomfort associated with making eye contact is not exclusive to individuals with a clinical autism diagnosis but scales with autistic traits found in the general population. The research team discovered that while this social unease is common among those with higher levels of autistic traits, it does not appear to be the direct cause of difficulties in recognizing facial expressions.

The concept of autism has evolved significantly in recent years. Mental health professionals and researchers increasingly view the condition not as a binary category but as a spectrum of traits that exist throughout the general public. This perspective implies that the distinction between a person with an autism diagnosis and a neurotypical person is often a matter of degree rather than a difference in kind.

Features associated with autism, such as sensory sensitivities or preferences for repetitive behaviors, can be present in anyone to varying extents. One of the most recognizable features associated with autism is a reduction in mutual gaze during social interactions. Autistic individuals frequently report that meeting another person’s eyes causes intense sensory or emotional overarousal.

Despite these self-reports, the scientific community has not fully determined why this avoidance occurs or how it impacts social cognition. Previous theories posited that avoiding eye contact limits the visual information a person receives. If a person does not look at the eyes, they might miss subtle cues required to identify emotions such as fear or happiness.

To investigate this, a team of researchers led by Nouchine Hadjikhani of Harvard University and the University of Gothenburg designed a study to disentangle these factors. The study included co-authors Jakob Åsberg Johnels, Martyna Galazka, and Sara Landberg. Their primary goal was to examine how eye gaze discomfort relates to autistic traits, distinct from a formal diagnosis.

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They also sought to understand the role of other conditions that often co-occur with autism. One such condition is alexithymia, which is characterized by a difficulty in identifying and describing one’s own emotions. Another is prosopagnosia, often called “face blindness,” which involves an impairment in recognizing facial identity.

The researchers recruited 187 adults from English-speaking countries through an online platform. This method allowed them to access a diverse sample of the general public rather than relying solely on clinical patients. The participants completed a series of standardized questionnaires to measure their levels of autistic traits, alexithymia, and face recognition abilities.

To assess sensory experiences, the group answered questions about their sensitivity to stimuli like noise, light, and touch. The study also utilized a specific “Eye Contact Questionnaire.” This tool asked participants directly if they found eye contact unpleasant and, if so, what strategies they used to manage that feeling.

In addition to the self-reports, the participants completed an objective performance test called the Emotion Labeling Task. On a computer screen, they viewed faces that had been digitally morphed to display emotions at only 40 percent intensity. This low intensity was chosen to make the task sufficiently challenging for a general adult audience.

Participants had to match the emotion shown on the screen—such as fear, anger, or happiness—to one of four label options. The researchers measured both the accuracy of the answers and the reaction time. This setup allowed the team to determine if people with high levels of specific traits were slower or less accurate at reading faces.

The data revealed clear associations between personality traits and social comfort. Participants who scored higher on the scale for autistic traits were more likely to report finding eye contact unpleasant. This supports the idea that social gaze aversion is a continuous trait in the population.

The study also identified an independent link between alexithymia and eye gaze discomfort. Individuals who struggle to understand their own internal emotional states also tend to find mutual gaze difficult. While these two traits often overlap, the statistical analysis showed that alexithymia predicts discomfort on its own.

A particularly revealing finding emerged regarding the coping strategies participants employed. The researchers asked individuals how they handled the discomfort of looking someone in the eye. The responses indicated that people with high autistic traits tend to look at other parts of the face, such as the mouth or nose.

In contrast, those with high levels of alexithymia were more likely to look away from the face entirely. They might look at the floor or in another direction. This suggests that while the symptom of gaze avoidance looks similar from the outside, the internal mechanism or coping strategy differs depending on the underlying trait.

When analyzing the performance on the Emotion Labeling Task, the researchers found no statistically significant difference in accuracy based on autistic traits. Participants with higher levels of these traits were just as capable of correctly identifying the emotions as their peers. This contrasts with some previous literature that found deficits in emotion recognition accuracy.

However, the results did show a difference in processing speed. Participants with higher levels of autistic traits took longer to identify the emotions. Similarly, those with higher levels of prosopagnosia, or difficulty recognizing identities, also demonstrated slower reaction times.

The researchers then performed a mediation analysis to see if the eye gaze discomfort explained this slower processing. The hypothesis was that discomfort might cause people to look away or avoid the eyes, which would then slow down their ability to read the emotion. The data did not support this hypothesis.

Eye gaze discomfort was not a statistically significant predictor of the reaction time on the emotion task. This implies that the discomfort one feels about eye contact and the cognitive speed of recognizing an emotion are likely separate issues. The slower processing speed associated with autistic traits seems to stem from a different cognitive mechanism than the emotional or sensory aversion to gaze.

The study also explored sensory sensitivity. The researchers hypothesized that general sensory over-responsiveness might drive the discomfort with eye contact. However, the analysis did not find a strong link between general sensory sensitivity scores and the specific report of eye gaze discomfort.

These findings suggest that the difficulty autistic individuals face with emotion recognition may be more about processing efficiency than a lack of visual input due to avoidance. It challenges the assumption that simply training individuals to make more eye contact would automatically improve their ability to read emotions.

There are limitations to this research that must be considered. The data was collected entirely online. While this allows for a large sample, it prevents the researchers from controlling the environment in which participants took the tests. Factors such as screen size, lighting, or distractions at home could influence reaction times.

The sample was also relatively highly educated. A majority of the participants had completed a university degree. This demographic skew might mean the results do not perfectly represent the broader global population. Additionally, the autistic traits in this sample were slightly higher than average, which may reflect a self-selection bias in who chooses to participate in online psychological studies.

The measurement of eye gaze discomfort relied on a binary “yes or no” question followed by strategy selection. This simple metric may not capture the full complexity or intensity of the experience. Future research would benefit from using more granular scales to measure the degree of discomfort.

The researchers note that this study focused on traits rather than diagnostic categories. This approach is beneficial for understanding the continuum of human behavior. However, it means the results might not fully apply to individuals with profound autism who experience high functional impairment.

Future investigations could expand on the distinct coping strategies identified here. Understanding why individuals with alexithymia look away completely, while those with autistic traits look at other facial features, could inform better support strategies. It suggests that interventions should be tailored to the specific underlying profile of the individual.

The study also raises questions about the role of social anxiety. While the team controlled for several factors, they did not specifically measure current anxiety levels. It is possible that general social anxiety plays a role in the strategies people use to avoid eye contact.

The study, “Eye Gaze Discomfort: Associations With Autistic Traits, Alexithymia, Face Recognition, and Emotion Recognition,” was authored by Sara Landberg, Jakob Åsberg Johnels, Martyna Galazka, and Nouchine Hadjikhani.