Blickkontakt bei erwachsenen Patienten mit einem Asperger-Syndrom

Zusammenfassung

Einleitung: Es ist unklar, ob Menschen mit einer Autismus-Spektrum-Störung den direkten Blickkontakt selten suchen, da sie ihm keine Bedeutung beimessen, oder ihn aktiv meiden. Ziel der vorliegenden Untersuchung war, durch Befragung erwachsener Patienten mit einem Asperger-Syndrom ein besseres Verständnis für ihre Sichtweise des Blickkontakts zu erhalten.

Methode: 63 erwachsene Patienten mit einem Asperger-Syndrom (28 weiblich, 35 männlich; 21 – 62 Jahre) wurden mit einem standardisierten Fragebogen zu ihrem Anwenden und Empfinden des Blickkontakts befragt.

Ergebnis: 87 % der untersuchten Patienten gaben an, den direkten Blickkontakt als unangenehm zu empfinden. Meist bewerten sie ihn als anstrengend und ablenkend. Er wird überwiegend aktiv gemieden.

Diskussion: Mit dem Wissen um die Abneigung gegenüber dem direkten Blickkontakt bei Menschen mit einem Autismus wäre ein stärkeres Verständnis und Akzeptanz in der nicht-autistischen Gesellschaft für diese Problematik wünschenswert.

Abstract

Introduction: It is unclear if individuals with autism spectrum disorders rarely hold direct eye contact because eyes are unimportant for them, or if it is actively avoided. The aim of the current investigation was to gain a better understanding for their views on direct eye contact by exploring adult patients with Asperger syndrome.

Method: 63 adult patients with Asperger syndrome (28 females, 35 males, 21 – 62 years old) were explored about using and sensing direct eye contact by means of a standardised questionnaire.

Result: 87 % of investigated patients depict direct eye contact as being disagreeable. They describe it as arduous and distracting. Therefore they mostly actively avoid direct eye contact.

Discussion: The here gained knowledge about aversion towards direct eye contact in individuals with autism should lead to a stronger understanding and acceptance of this problem in the non-autistic population.

Schlüsselwörter

Asperger-Syndrom - Autismus - erwachsen - Blickkontakt - Vermeiden

Key words

Asperger syndrome - autism - adult - eye contact - avoidance

• Literatur

• 1 WHO. Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F), diagnostische Kriterien für Forschung und Praxis. Bern: Verlag Hans Huber; 2011
• 2 Buitelaar JK. Attachment and social withdrawal in autism: hypotheses and findings. Behaviour 1995; 132: 319-350
• 3 Sawyer AC, Williamson P, Young RL. Can gaze avoidance explain why individuals with Asperger’s syndrome can’t recognise emotions from facial expressions?. J Autism Dev Disord 2012; 42: 606-618
• 4 van Engeland H, Bodnar FA, Bolhuis G. Some qualitative aspects of the social behaviour of autistic children: an ethological approach. J Child Psychol Psychiatry 1985; 26: 879-893
• 5 Adrien JL, Faure M, Perrot A et al. Autism and family home movies: preliminary findings. J Autism Dev Disord 1991; 21: 43-49
• 6 Hobson RP, Lee A. Hello and goodbye: a study of social engagement in autism. J Autism Dev Disord 1998; 28: 117-127
• 7 Wiklund M. Gaze behavior of pre-adolescent children afflicted with Asperger syndrome. Commun Med 2012; 9: 173-186
• 8 Tottenham N, Hertzig ME, Gillespie-Lynch K et al. Elevated amygdala response to faces and gaze aversion in autism spectrum disorder. Soc Cogn Affect Neurosci 2014; 9: 106-117
• 9 Jones W, Klin A. Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature 2013; 504: 427-431
• 10 Yi L, Fan Y, Quinn PC et al. Abnormality in face scanning by children with autism spectrum disorder is limited to the eye region: evidence from multi-method analyses of eye tracking data. J Vis 2013; 13
• 11 Richer J, Richards B. Reacting to autistic children: the danger of trying too hard. Br J Psychiatry 1975; 127: 526-529
• 12 Richer JM, Coss RG. Gaze aversion in autistic and normal children. Acta Psychiatr Scand 1976; 53: 193-210
• 13 Kliemann D, Dziobek I, Hatri A et al. Atypical reflexive gaze patterns on emotional faces in autism spectrum disorders. J Neurosci 2010; 30: 12281-12287
• 14 Kylliainen A, Hietanen JK. Skin conductance responses to another person’s gaze in children with autism. J Autism Dev Disord 2006; 36: 517-525
• 15 Kaartinen M, Puura K, Makela T et al. Autonomic arousal to direct gaze correlates with social impairments among children with ASD. J Autism Dev Disord 2012; 42: 1917-1927
• 16 Kliemann D, Dziobek I, Hatri A et al. The role of the amygdala in atypical gaze on emotional faces in autism spectrum disorders. J Neurosci 2012; 32: 9469-9476
• 17 Kylliainen A, Wallace S, Coutanche MN et al. Affective-motivational brain responses to direct gaze in children with autism spectrum disorder. J Child Psychol Psychiatry 2012; 53: 790-797
• 18 Mundy P, Sullivan L, Mastergeorge AM. A parallel and distributed-processing model of joint attention, social cognition and autism. Autism Res 2009; 2: 2-21
• 19 Chevallier C, Kohls G, Troiani V et al. The social motivation theory of autism. Trends Cogn Sci 2012; 16: 231-239
• 20 Schilbach L, Wilms M, Eickhoff SB et al. Minds made for sharing: initiating joint attention recruits reward-related neurocircuitry. J Cogn Neurosci 2010; 22: 2702-2715
• 21 Schilbach L, Timmermans B, Reddy V et al. Toward a second-person neuroscience. Behav Brain Sci 2013; 36: 393-414
• 22 Bockler A, Timmermans B, Sebanz N et al. Effects of observing eye contact on gaze following in high-functioning autism. J Autism Dev Disord 2014; 44: 1651-1658
• 23 Schilbach L, Eickhoff SB, Cieslik E et al. Eyes on me: an fMRI study of the effects of social gaze on action control. Soc Cogn Affect Neurosci 2011; 6: 393-403
• 24 Schilbach L, Eickhoff SB, Cieslik EC et al. Shall we do this together? Social gaze influences action control in a comparison group, but not in individuals with high-functioning autism. Autism 2012; 16: 151-162
• 25 Pfeiffer UJ, Vogeley K, Schilbach L. From gaze cueing to dual eye-tracking: novel approaches to investigate the neural correlates of gaze in social interaction. Neurosci Biobehav Rev 2013; 37: 2516-2528
• 26 Senju A, Johnson MH. Atypical eye contact in autism: models, mechanisms and development. Neurosci Biobehav Rev 2009; 33: 1204-1214
• 27 Dziobek I, Bahnemann M, Convit A et al. The role of the fusiform-amygdala system in the pathophysiology of autism. Arch Gen Psychiatry 2010; 67: 397-405
• 28 Pierce K, Muller RA, Ambrose J et al. Face processing occurs outside the fusiform ‘face area’ in autism: evidence from functional MRI. Brain 2001; 124: 2059-2073
• 29 Baron-Cohen S, Wheelwright S, Skinner R et al. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord 2001; 31: 5-17
• 30 Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord 2004; 34: 163-175
• 31 Johnson MH. Subcortical face processing. Nat Rev Neurosci 2005; 6: 766-774
• 32 Adolphs R. The social brain: neural basis of social knowledge. Annu Rev Psychol 2009; 60: 693-716
• 33 Baron-Cohen S, Ring HA, Wheelwright S et al. Social intelligence in the normal and autistic brain: an fMRI study. Eur J Neurosci 1999; 11: 1891-1898
• 34 Emery NJ. The eyes have it: the neuroethology, function and evolution of social gaze. Neurosci Biobehav Rev 2000; 24: 581-604
• 35 Kleinhans NM, Richards T, Sterling L et al. Abnormal functional connectivity in autism spectrum disorders during face processing. Brain 2008; 131: 1000-1012
• 36 Kuzmanovic B, Bente G, von Cramon DY et al. Imaging first impressions: distinct neural processing of verbal and nonverbal social information. Neuroimage 2012; 60: 179-188