Why are eye contact, pointing, and pretend play included in autism spectrum disorder screenings?

Eye contact, pointing, and pretend play are included in autism spectrum disorder (ASD) screenings because they are key indicators of the core deficits associated with the condition: atypical social interaction and communication difficulties.12

These behaviors are considered foundational milestones in early social development. Their absence or impairment serves as a clinical marker for the following reasons:

• Eye Contact: Poor eye contact during interactions is a hallmark of the social communication challenges seen in individuals with ASD, reflecting a reduced range of social engagement.1
• Pointing: This is a form of joint attention and a critical nonverbal gesture. Diminished use of such gestures is categorized under communication difficulties, which are central to the diagnostic criteria for ASD.1
• Pretend Play: A lack of appropriate developmental or imaginative play is a recognized sign of communication and social impairment, as it reflects differences in how children engage with their environment and peers.1

Screening for these specific markers helps identify the neurobiological conditions characterized by these deficits, allowing for earlier support and intervention.123