Premature babies are at an increased risk for autism. One indicator for autism in infants is gaze aversion or a failure to maintain eye contact. But, a recent study shows that premature infants who avoid eye contact are less likely to demonstrate symptoms of autism at age 2 , according to research at Washington University School of Medicine in St. Louis. So, gaze aversion is not an increased risk for autism in these infants.
“Children with autism typically have challenges with social interaction and may avoid eye contact, but it turned out that children in this study who had characteristics of autism at age 2 were more likely to maintain eye contact and not avert their gazes in early infancy,” said first author Bobbi Pineda, PhD,
Because early intervention benefits children with autism, researchers are trying to develop a method of diagnosing the disorder in infancy. In this study, the researchers observed behavioral symptoms characteristic of autism in a particularly high-risk group of young children: those born prematurely. Observing early behaviors may give researchers and clinicians indicators to look for early in life so they can recommend timely diagnostic testing and interventions to improve a baby’s adaptive responses and outcome.
The researchers evaluated 62 premature infants hospitalized in the neonatal intensive care unit (NICU) at St. Louis Children’s Hospital. The infants were born at least 10 weeks before they reached full term and were evaluated close to the dates they were supposed to have been born.
The researchers focused on whether the infants made eye contact or averted their gazes; responded to objects or people around them; interacted socially; and calmed themselves when upset. They also looked at whether the babies exhibited a horizontal repetitive eye movement called nystagmus.
Of the 62 preemies, 58 were observed for visual cues; the others were asleep during visits from the researchers. Of those 58 babies, 41 averted their gazes, and 21 showed nystagmus. Nearly all the infants with nystagmus — 19 — also averted their gazes.
When researchers screened the babies in the study for autism at age 2, 13 — or 21 percent — screened positive. A positive finding indicates a child is at risk for autism and should receive diagnostic testing. The researchers were surprised to find that many of the babies who had averted their gazes and showed signs of autism as infants did not display warning signs of autism at age 2.
“Surprisingly, we found that the children who later screened positive for autism were more likely as infants to not avert their gazes during social interaction,” Pineda said. “They were more likely to sustain eye contact.”
Pineda speculated that premature infants in the NICU may avert their gazes as a coping mechanism to help them deal with the stress of an intense environment during a vulnerable period of development. So absence of gaze aversion, she said, could signal an inability to avoid stressors.
“This could explain why some infants behave differently in social interactions as babies than later, as children,” Pineda said. “Better understanding how autism traits emerge along the developmental pathway is an important area for future research.”
With nearly one in 68 children in the U.S. diagnosed with autism, according to the Centers for Disease Control and Prevention, Pineda and her colleagues hope the new study will motivate researchers to better define differences in development across the lifespan, including the neonatal period.
Screening tools for autism spectrum disorder don’t exist for infants, but research is needed to improve understanding of how autism traits emerge, she said. This would help pave the way for early interventions aimed at improving life skills and allowing those with autism to lead more productive lives.