If you do a Google search for keywords ‘eye contact’ + ‘autism’, the top search results all suggest ways to increase eye contact for Autistic people. Is this the best way, especially in occupational therapy? It appears to be no because the Autism community largely disagrees with this practice and approach. This article describes alternatives and why a different neurodiverse approach should be used to promote client-centered practice in early intervention for Autistic toddlers.

“Eye contact is often perceived as incredibly painful or uncomfortable for autistic people. Many autistic people report that they cannot listen to a conversation if they are required to make eye contact. So why do we require it? It is similar to the whole-body listening idea. You can be listening while looking out the window, or you can be listening while moving around. Sometimes, we think we should require something, but we do not think about why we need that.”

In the world of toddlerhood, communication is a vibrant and evolving process. For toddlers on the autism spectrum, the expectations surrounding eye contact can present unique challenges. This exploration seeks to understand the discomfort associated with eye contact in these young individuals and advocates for a reevaluation of traditional occupational therapy interventions. Emphasizing a gentle, client-centered approach, we aim to foster effective and comfortable communication for toddlers navigating their developmental journey.

The Challenge of Eye Contact

Toddlers on the autism spectrum may find eye contact uncomfortable or overwhelming. Traditional approaches to occupational therapy often focus on teaching eye contact as a social skill. However, a gentle, client-centered approach recognizes that each toddler is unique. Occupational therapists can collaborate with both the toddler and their caregivers to identify alternative ways of expressing engagement, such as using gestures, pointing, or other non-verbal cues.

Multiple Ways of Paying Attention

Just like adults, toddlers can engage in active listening through various means. A gentle, client-centered occupational therapist might encourage activities that allow toddlers to express themselves without the pressure of sustained eye contact. This could involve incorporating movement, interactive play, or using favorite toys as communicative tools, fostering a more natural and toddler-friendly approach to communication skills. In recognizing the diverse ways toddlers engage in active listening, a gentle and client-centered occupational therapist takes a holistic approach to communication skills. Understanding that sustained eye contact may be challenging for toddlers on the autism spectrum, the therapist seeks to create an environment that accommodates their developmental needs and preferences. Instead of relying solely on visual cues, the therapist introduces a range of sensory-rich activities that align with the toddler’s natural inclination for movement and play. Through interactive play sessions, toddlers are encouraged to express themselves using their bodies, engage in expressive movements, or utilize their favorite toys as communicative tools. This multifaceted approach not only acknowledges the toddler’s unique mode of communication but also fosters a more organic and comfortable atmosphere for them to navigate and understand the intricacies of interpersonal interactions. By incorporating movement, play, and familiar toys into the therapeutic process, the therapist respects the individuality of each toddler, allowing them to actively participate in communication without the undue pressure of conforming to conventional expectations. This client-centered approach not only supports the toddler’s developmental journey but also promotes a positive and enjoyable experience that enhances their overall communication skills.

Exploring Alternative Social Cues

Occupational therapy interventions for toddlers can actively explore alternative social cues in a playful manner. Instead of fixating on eye contact, therapists might focus on building the toddler’s understanding of facial expressions, body language, and simple gestures. Through interactive games and activities, toddlers can learn to communicate effectively while enjoying the process, aligning with their developmental stage and preferences.

Asking the Question: Why?

In a client-centered approach, occupational therapists working with toddlers actively involve caregivers in open dialogue. Understanding the comfort levels and preferences of both the toddler and their caregivers is crucial. Together, they question the societal norms surrounding eye contact and assess its relevance for effective communication in the context of the toddler’s unique developmental journey.

Occupational Therapy Ideas: Beyond Eye Contact

Gentle occupational therapy interventions for toddlers extend beyond the conventional focus on eye contact. For instance, a therapist might encourage the use of simple communication boards with pictures or symbols that toddlers can point to when expressing their needs or feelings. This client-centered approach respects the toddler’s individual communication style and promotes early and effective communication.

Creating Comfort Zones

A crucial aspect of a gentle, client-centered approach involves creating comfortable environments for therapy sessions. Occupational therapists can work closely with caregivers to identify sensory preferences, favorite toys, or comforting items that can be incorporated into therapy. By creating familiar and supportive spaces, toddlers can feel more at ease and receptive to communication activities.

Welcoming Non-verbal Interaction

Toddlers who get gentle occupational therapy enthusiastically embrace nonverbal communication. Including play-based activities that promote imitating, gestures, and other non-verbal clues may be one way to do this. Therapists recognize the toddler’s developmental period and lay a solid foundation for future communication development by embracing these alternate forms of communication.

Expanding Perspectives

Expanding perspectives from rigid expectations to a gentle, client-centered approach is essential in occupational therapy for toddlers. Therapists can actively involve caregivers in the decision-making process, encouraging open communication about the toddler’s preferences and comfort levels. By embracing alternative modes of expression that align with the toddler’s developmental stage, occupational therapists foster a positive and encouraging therapeutic environment.

Further Analysis: Taking Toddler Views into Account

By using interactive play and observation, occupational therapists can explore the unique viewpoints of toddlers within a client-centered framework. Therapists can learn a great deal about each toddler’s unique developmental path by participating in activities that reflect their interests and preferences. Therapists can interpret communication signs, sensory preferences, or potential stressors by closely observing the toddler’s play behaviors, reactions, and engagement patterns. As therapists tune into the toddler’s reality and adjust interventions accordingly, interactive play becomes a medium for mutual understanding. As therapists get to know children on their terms, this private investigation serves as the foundation for developing trust and cooperation. By recognizing and integrating the toddler’s interests into therapy sessions, therapists not only enhance their understanding of the child’s unique needs but also create an environment that resonates with the toddler’s comfort and joy. This client-centered approach not only facilitates effective therapy but also establishes a solid foundation for a therapeutic alliance based on mutual trust and collaboration between the therapist and the toddler.

Conclusion

Communication for toddlers on the autism spectrum is a dynamic and evolving process. Gentle, client-centered occupational therapy interventions, with a focus on personalized strategies and embracing alternatives, can create a supportive and encouraging environment. By respecting the unique needs and preferences of each toddler, therapists can foster effective and comfortable communication, nurturing the toddlers as they navigate their early developmental stages.

Submitted by:
Anum Anwer Baig
Occupational Therapist, CCD