Looking at me anxiety: Facial gaze and anxiety in Autism

Donna Milne

Research output: ThesisDoctoral Thesis

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Autism traits have been linked to higher levels of anxiety; however, no research has examined the relationship between eye contact and anxiety in an autistic population. The current research explores the relationship between eye contact and anxiety in an autistic adult population. It adopted a sequential mixed methods design with three stages: (1) a systematic literature review of autistic adult research on eye contact and anxiety; (2) a qualitative study that investigated autistic individuals’ experiences of eye contact and anxiety; and (3) a quantitative stage evaluating anxiety, alexithymia, and personality relationships and producing a model for predicting anxiety in autistic adults.
Stage 1
The systematic literature review reported 10 studies involving facial gaze behaviour and anxiety in autistic adults. No study was found reporting the level of anxiety on eye contact in autistic adults. The review revealed a paucity of studies, and those found used various paradigms, measurement types, and afforded differing outcomes. Gaze behaviour was found to be similar between autistic and non-autistic groups in some studies, yet dissimilar in others. And when cognitive load was increased gaze behaviour differences were reported.
Stage 2
The qualitative stage used a grounded theory epistemology, employing semi-structured interviews with 15 autistic adults and 7 supporters. This explored how autistic adults and their supporters communicated their lived experience of eye contact and anxiety. Key findings were accounts of feelings of anxiety when using eye contact for some, whereas others reported no specific feelings. Participants described methods of simulating eye contact behaviour, such as looking at a social partner’s nose or using sunglasses. Feelings of general anxiety were expressed by all participants, a highlighted cause being social situations.
Stage 3
The quantitative stage used an online data collection method with community-sampled participants diagnosed with autism (n = 133), broadly representative of the Australian autistic population, and a concurrently collected non-autistic control (n = 129). The aim of this study was to measure levels of general anxiety, stress, social anxiety, gaze anxiety, alexithymia, and personality traits, to report relationships between the measures and, further, to formulate a predictive model of anxiety in autism. In the autistic cohort, higher levels of anxiety and stress measured by the DASS-21, social anxiety measured by the LSAS SR, gaze anxiety measured by the GARS, and alexithymia measured by the TAS-20 were found. A prospective model was produced that used gaze anxiety, alexithymia, and extraversion to predict anxiety in autism. This model found that as gaze anxiety, alexithymia, and extraversion increase, so does anxiety measured by the DASS-21, which explained 45% of the variance in anxiety levels in the autistic sample.
The unique research findings provide an understanding of the complexity of anxiety in autistic adults and that gaze anxiety, alexithymia, and extraversion interact to increase anxiety. These findings will aid in the development of autism-specific interventions for anxiety, a high prevalence of which has previously been reported, and guide future research.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Charles Sturt University
  • Saliba, Anthony, Principal Supervisor
  • Sugden, Nicole, Co-Supervisor
Place of PublicationAustralia
Publication statusPublished - 2023


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