Here are a few examples of how eye contact may be focused on early in behavioral treatment. While I present the information in terms of programs that may be used in therapy, all of the examples reach a level (some quickly and some with practice) at which parents can also practice them at appropriate times throughout the day.

1) Gaining Attention
A child initially learns to request for toys in which he demonstrates interest. For example, bubbles may be placed on the fireplace mantel. When the child walks over to the fireplace and looks up at the bubbles, the instructor prompts him to say, “bubbles.” When he does, the instructor blows bubbles for him. Prompts are faded until he independently asks for bubbles.

Next, the instructor ignores the child the first time he requests for the bubbles. It is particularly important that the instructor does not look at the child when he asks for the bubbles. The child is taught to gain the instructors attention by repeating the request. The instructor initially prompts the child to repeat the request. When the child repeats the request, the instructor dramatically looks up at the child and says, “oh, bubbles!” and gets the bubbles. Prompts are faded until the child independently asks for bubbles a second time.

Next, the instructor continues to ignore the child (by both not responding to the request and also not looking at the child) even when he repeats the request. The child is taught to gain the instructors attention by tapping her on the shoulder. The child is initially prompted to tap the instructor on the shoulder. Prompting may occur with the use of a third person (i.e., when the child starts requesting, the instructors tells a parent she needs help with prompting) or the instructor may casually wander over to the child, without looking at them, when they start requesting for the bubbles, and get close enough to physically guide the child to tap her on the shoulder. When the child taps the instructor on the shoulder, the instructor dramatically looks up at the child and says, “oh…”. The child says, “bubbles” and the instructor gets the bubbles. Prompts are faded, including how close the instructor is to the child, so that the child independently walks over to the adult, taps them on the shoulder, and requests bubbles.

Finally, the child is taught to gain the instructor’s attention by looking in her eyes. As before, the instructor ignores the initial request. The instructor often will instead turn her back to the child. When the child comes over to tap her on the shoulder, the instructor prompts her through physical guidance to move around to the front of the instructor rather than tapping her on the back from behind. From this point, a shaping procedure is implemented so that the child is no longer reinforced for tapping the instructor on the shoulder, he must also attempt to gain the instructors eye contact by moving to the front of them and trying to look in her eyes.

2) Asking Where (and then referencing nonverbal cues)
Children may learn to ask “Where?” early in treatment. Incidental teaching may be used so that when a child requests a toy they cannot find (e.g., cars), they are told, “Ok, you can have it.” They are then prompted to ask, “Where cars?” and then shown where the cars are. Another format is called the “Where Game.” The child sits in a chair in the corner of the room or just outside the door and is told, “We’re going to play the Where Game. I’m going to hide the (train). What am I going to hide?” The child responds, “the train.” The instructor then says, “no peeking,” goes in the other room or covers the child with his baby blanket, and quickly hides the object. The instructor says, “Ok, you can look now” and gets the child. The child asks, “Where cars?” The instructor shows him where the cars are.

Once prompts are faded for the above game or once the child is asking “Where” via incidental teaching, rather than telling or showing the child where the object is, the instructor can use nonverbal cues to teach the child to focus on the instructors face for information.

The Where Game is played with four to six shoeboxes around the room. When the child asks, “Where cars?” the instructor says, “Let’s go see!” and leads the child to the first box. She places the child’s hand on the object, but shakes her head “no” (often while frowning) and does not allow the child to open the box. The instructor and child continue to the other boxes until they randomly come to the box that has the object in it. For that box, the instructor vigorously nods her head “yes” while smiling and the child uncovers the box to find the cars.

Prompts are faded so that the child can go to each box independently and then look back at the instructor to find out whether or not to open the box. This is a very gradual process with the instructor initially right next to the child and then only a few feet away so that they can immediately intervene if the child begins to demonstrate difficulty. Over time, instructors may also begin to only frown or smile without shaking their head as a cue for whether or not to open the box.

Another format that focuses specifically on eye contact is to respond to the question, “Where cars?” by saying, “It’s in that box” while looking at one specific box with two or three boxes widely separated (i.e., one on each side of the room and one in the middle of the room). Other nonverbal cues may initially be used (such as turning one’s head in the direction of the box, pointing to the box, and moving closer to the box…even staring within inches of the box). These cues are faded gradually so that the child must pay attention to where the instructor is looking to identify the correct box.

3) Reinforcers/play activities that include eye contact
A number of reinforcers can be utilized to not only increase language or play but simultaneously increase eye contact. For example, some young children find the game “peek-a-boo” reinforcing. Besides the typical version, one can also play peek-a-boo with a child by turning a small child’s table on its side, having the child hide behind the table, and then having the instructor pop their head over one of the three sides to see the child. When the child looks at the instructor, the instructor says “peek-a-boo!” Another activity is to give a child a flashlight while going in a tent (or under a table) that is covered with a blanket (to make it dark). The instructor pops her head in and the child shines the flashlight on the instructor. The instructor then says, “boo!” Finally, many physical reinforcers such as tickling or spinning a child around can include an element of anticipation. The instructor moves toward the child but then stops and waits until the child looks at the instructor to finish tickling or to pick the child up and spin them (or to continue spinning them).

Like ABA therapy in general, the initial eye contact program of the past has been refined as we have grown in our knowledge of both what to teach and how to teach children with autism. I’m open to any comments or questions.