Adults sustain eye contact out of courtesy, as well as to send out information. We want to know whether we are sharing the same feeling, if people are paying attention to us, or the same things as we are. Children with ASD have difficulties comprehending non- verbal communications, and take no notice of the thoughts and feelings of others. Objects that they are interested in, like posters on the wall or spinning fans etc., easily distract children. Children will be less motivated to look at you when there is so much distraction around them. In time, the child would equate eye contact with boredom.
We must teach children the purpose of eye contact to effectively improve their behavior. We should provide reinforcement when a child initiates eye contact to increase the frequency of desirable behavior. We could also try teaching through play to minimize avoidance behavior. It is essential to remove distractors in the beginning phases to promote attention.
- Exercise 1: Teach the child that “You can get what you want quicker when you check if people are paying attention on you.”
While playing his favorite game (e.g. tickle, sing songs, etc.), pause when he is expecting you to continue. Verbally praise him (e.g. you’re looking at me! Let’s play!), and resume the game as a reinforcement when he initiates eye contact. Each segment should consist of at least 4 trials.
Tip：In beginning stages, be at eye level with the child to promote success. Return to a natural height and gradually adjust our demand once he gets a grasp of it.
- Exercise 2: Teach the child that “You can get what you want more effectively when you check if people are responding”
Hold your child’s favorite snack or toy, with your back facing them. Turn around to face him once he taps on your shoulder or verbally request for it. If the child is looking at you, verbally praise him and reinforce the behavior with the desired snack/ toy. Let your child understand that good behavior (i.e. looking) will lead to positive consequences. If he fails to look within 3 seconds, indicate that he missed out on the reinforcement by returning to your original position.
Tip：In beginning stages, be at eye level with the child to promote success, and return to a natural height once he gets a grasp of it. Adjust the speed we turn to face him to lengthen the duration he has to sustain his eye contact. - Exercise 3: Teach the child that “You can obtain information when you are following people’s gaze”
Line 5 or more small cups in a row, at least 10cm apart, and turn them over. Place your child’s favorite snack in one of them. Tell him “your snack is here”, gaze at the designated cup and instruct your child to flip it over. If the child gets it right on his first attempt, it means that he is paying attention to your gaze and can consume the snack right away. If he fails, remove the snack, indicating that he missed out on it, and try again.
Tip：In beginning phases, gaze at the cup for a longer period. When the child is getting fluent with the practice, increase difficulty by glancing at the target and reduce verbal instructions, so the child can be accustomed to follow people’s gaze on their own.
Information provided by Autism Partnership
Autism Partnership (AP) is one of the most established Applied Behavior Analysis (ABA) service providers for Autism Spectrum Disorders (ASD) in the world. Formed in 1994 in the United States, AP is run by professional clinicians and specializes in providing one-on-one therapy, group interventions and overseas consultation for children with ASD and their families.
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[:zh]對自閉症小朋友的家長而言，每次讓小朋友給別人打招呼都是一個考驗。很多家長都留意到小朋友雖然沒有視覺問題，但就總不能望着別人打招呼，每每需要提醒才望，一不提醒眼睛就亂望；質素也未如理想，往往只望半秒就不能持續了。家長大多會用不同方法嘗試引小朋友望着自己或別人，如：用手遮擋小朋友兩側的視線、不斷提示「望住我、望住我眼睛、眼睛在哪兒？」、拿起小朋友的手指猛指着自己眼睛等，但這些都不是常常湊效。
一般人會跟別人有持續的眼神接觸除了因為表達禮貌外，更大的原因是希望接收眼睛發放出來很多有用的資訊，如別人是否有留意自己，大家有否看着同一樣事物，有否和自己分享一樣的情感等。自閉症小朋友一般較難明白這些比較抽象的非語言溝通，大部分也不太在意其他人的想法和情感，致他們會主動跟別人有眼神接觸的動力較低。自閉症小朋友容易被感興趣的事物吸引，如牆上充滿ABC或數字的海報、轉動的風扇等，這通通都吸引了他的視線，他會好好望着你的機會一定大減。再者，小朋友在日常生活中不斷聽到「望住我、望住媽媽」等說話，久而久之＂眼神接觸＂和＂不好玩的任務＂成了掛鉤。為了逃避不好玩的任務，小朋友就更加不望別人了。
要有效改善眼神接觸，應着重於教導小朋友真正明白眼神接觸的意義，並在其主動嘗試有眼神接觸時，讓其得到相關的強化物，讓他下次會主動望人的行為會持續增加。利用一些好玩的小遊戲作為訓練，可減少小朋友想逃避的行為。在訓練初期，要先拿走令小朋友容易分心的事物，使你不需要太費力就得到小朋友最大的專注。
- 練習一：教導小朋友明白望人就知道別人是否也留心你，可以讓你更快得到想要的東西
和小朋友玩一些他十分喜愛的互動小遊戲，如抓癢、飛、按摩或唱歌等。在他最開心、最期待的一刻停下來，等候數秒，就在小朋友主動跟你有眼神接觸的一瞬間，立刻繼續遊戲作為強化物，再加上口頭奬勵他「你望著媽媽，很好，我們一起玩吧」一首兒歌可讓你們有至少有4次的練習哦。
小貼士：訓練初期，或要刻意保持面對面的姿勢，雙方眼睛成同一水平，讓小朋友比較容易成功。待小朋友逐漸掌握，就可回復比較自然的姿勢。亦應慢慢增強難度，如初期只需望1秒就立刻繼續遊戲，掌握後就需要望3秒才繼續，如此類推把時間拉長。
- 練習二：教導小朋友明白望人會知道別人是否有回應你，可更有效得到想要的東西
手執着小朋友非常喜歡的玩具（或食物），坐在會轉的椅子上，背向小朋友，當他搭你膊頭示意想拿或口頭提出要求時，立刻轉身並望着小朋友。若他當刻已望着你，就可給他想要的作為強化物，再加上口頭奬勵讓他明白是＂眼神接觸＂的好行為為他帶來奬勵；若小朋友3秒內都沒有主動看着你，可轉身返回原地，代表因為他沒有望所以失去了奬勵的機會了。
小貼士：可從雙方眼睛在同一水平開始，慢慢就變成了小朋友站着、家長也站着的一低一高水平。到小朋友大致掌握技巧時，可將轉身速度放慢，拉長他需要持續眼神接觸的時間。 - 練習三：教導小朋友注視大家共同注視的事物，以得到所需資訊
預備五個以上的小杯（或小盒子），把全部杯翻轉及一字排開，每個杯中間至少有10 cm的距離，將小朋友喜歡的小玩具或零食放入其中一個杯內。遊戲開始前，先給小朋友一些提示如「我把零食放在＂這裏＂了」同時眼睛望着藏着小玩具的杯，及指令他可把杯拿開；如小朋友第一次就拿對了，就可以讓他立刻吃掉小零食，因這反映了他剛真的有留意你眼睛；如小朋友拿錯或在估，就應拿掉他的小零食，代表因他沒有望而錯失了機會。
小貼士：訓練初期，看著杯的時間要較長，隨著小朋友越來越掌握技巧，可増加難度至只瞄杯一眼，也把事前的提示漸漸刪去，訓練小朋友要常常自己主動留意別人的眼神。
資訊由Autism Partnership提供
Autism Partnership （AP）於1994年在美國成立，是全球最具規模為自閉症患者提供『應用行為分析』(ABA) 治療的專業機構。AP是由多位專業臨床心理學家、應用行為分析治療顧問及治療師管理，為患有自閉症譜系障礙（ASD）的兒童及其家庭提供一對一治療、行為干預小組訓練及海外諮詢服務。
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