Eye Contact in ADHD: Why Is It A Challenge?

Why is Eye Contact Important?

Eye contact plays a crucial role in human communication and interaction. It is an essential part of non-verbal communication, building trust, communicating intention and

There are five key reasons why eye contact is essential:

• 1. Eye contact conveys emotional connection and creates an opportunity for emotional bonding and intimacy. Direct gazing can increase activity in the amygdala, the part of the brain involved in processing facial cues and emotions [1].
• 2. Eye contact enhances social relationships and is a potent source of social information. Direct eye gaze signals the desire to approach and interact, triggering the perception of minds in others [2].
• 3. Eye contact is a sign of trustworthiness. People are more likely to believe a person looking straight at them, and this trust-building aspect of eye contact can nurture deeper connections [1].
• 4. Eye contact regulates social interactions. Eye gaze plays a significant role in conversations, facilitating turn yielding, preventing and repairing conversation breakdowns, and managing speech interruptions [3].
• 5. Eye contact increases self-awareness. Making eye contact can lead to heightened self-awareness, impacting the sense of agency and the perception of oneself as the origin of our actions [4, 5].
• 6. Eye contact conveys social status. It is also a culturally dependent tool, where making or avoiding eye contact can be a sign of societal status [6].

How Does Eye Contact Work?

Eye contact begins with the physical act of one person looking directly into another person's eyes. This act is registered in the brain, triggering a range of cognitive and emotional responses. The 'zone of eye contact' peaks between the two eyes and is often surprisingly narrower than the observer's eye region [7].

The 'eye contact effect' is a phenomenon where perceived eye contact modulates certain aspects of concurrent and/or immediately following cognitive processing. This effect is initially detected by a subcortical route, which then modulates the activation of the social brain as it processes the accompanying detailed sensory information [8].

Eye contact is also associated with perceiving another person's gaze direction. The eyes provide a powerful signal to the direction of another person's gaze, and this information is analyzed rapidly and automatically, triggering reflexive shifts in an observer's visual attention [9].

Eye contact can also influence how we perceive and interpret the intentions and emotions of others. Direct eye gaze is often associated with ascribing sophisticated humanlike minds to others, signalling the desire to approach and the likelihood of instigating social interaction [2].

In summary, eye contact works through a complex interplay of physiological detection, cognitive processing, and emotional response. It is a powerful tool in human communication, influencing how we perceive and interact with others.

Why is it difficult to make eye contact in ADHD?

Individuals with Attention Deficit Hyperactivity Disorder (ADHD) often struggle with making eye contact. This difficulty is linked to several factors related to the condition.

The primary reason is impaired facial expression perception and recognition in ADHD. This can affect their ability to discriminate between familiar and unfamiliar faces, which is crucial for successful social interactions [10].

ADHD can also negatively affect social skills. Individuals with ADHD can find it challenging to maintain focus during conversations, miss important social cues, or look uninterested. This can lead to difficulties building and maintaining relationships and poor eye contact [11].

Another factor is the presence of abnormalities in processing eye gaze in the brains of individuals with ADHD. These abnormalities can lead to difficulties in decoding eye gaze, which is a crucial aspect of nonverbal communication [12].

ADHD is also associated with attentional dysfunction, which can affect the ability to maintain gaze at a fixed location. This can result in poorer performance in tasks that require vigilant attention, such as maintaining eye contact in ADHD [13].

Furthermore, research has shown that children with ADHD symptoms tend to look longer at the eyes before reorienting, which may contribute to social impairments, as it disrupts the natural process of interpersonal eye movements [14].

Lastly, ADHD often occurs in individuals with Autism. In autism, individuals may unconsciously avoid eye contact, which could be an involuntary response to the condition [15]. This was demonstrated through eye-tracking of individuals with autism, who unconsciously avoided looking at the eye region of a presented facial picture, unlike the control group.

Tips for improving eye contact in ADHD

Working on eye contact and facilitating the development of social skills is extremely valuable in young children. Here are 5 tips to improve eye contact in ADHD children, which may also apply to improving eye contact in ADHD adults.

1. Lead by example: Practice good eye contact when talking to individuals with ADHD and do not be discouraged if this is not reciprocated.
2. Learn to communicate through non-verbal cues: Encourage the use of non-verbal cues that demonstrate listening. These include nodding, tilting the head, or making eye contact, helping children with ADHD better understand the importance of eye contact in social interactions [11].
3. Use reinforcement: Positive reinforcement is a traditional method of rewarding learning. Rewards could involve providing praise or rewards when the child makes and maintains eye contact. Rewards act to consciously and sub-consciously associate the behaviour with the reward, increasing the changes the behaviour will be repeated [16].
4. Try out role-play: Role-play activities can be a safe and effective way to practice social skills with children, including eye contact. For example, try acting out social scenarios and practising maintaining eye contact during these interactions [11].
5. Understand and Reflect on Social Interactions: Encourage the child to understand their strengths and challenges and reflect on their social interactions. This can help them to recognize situations where they need to improve their eye contact [2].
6. Cognitive Behavioural Therapy (CBT): CBT is a common technique used for psychiatric disorders that can help children reframe their behaviour. This can have beneficial effects beyond just improving eye contact in ADHD.

In conclusion, the difficulty in making eye contact in individuals with ADHD is a multifaceted issue involving impaired facial recognition, attentional dysfunction, abnormal eye-gaze processing, and possibly an unconscious avoidance of eye contact. Helping your child or an adult you know with ADHD to manage eye contact can effectively improve their social function.