Parents with children on the spectrum often speak about their kids’ difficulty recognizing faces, even those of friends and relatives. Face blindness, or prosopagnosia, means a person cannot recognize that they’ve seen a face before; this condition, found in many on the spectrum, may have serious psychosocial consequences.
What do you see when you look at someone’s face? Where do you look first? Where do your eyes linger? Even though we look at the faces of others many times in a single day, it may be hard to answer such questions.
Most people look at, and recognize, faces effortlessly. Facial recognition seems trivial, until the possibility of not recognizing loved ones is contemplated. Facial recognition is an intricate, integral part of social communication; for autistic individuals already facing difficulty in social communication this may be especially relevant and taxing.
Face blindness or prosopagnosia
This condition is not about memory. It’s not about forgetting someone and encountering an awkward social encounter. It’s a serious mental condition where the ability to recognize faces is impaired or never adequately developed. There are two types of prosopagnosia:
- Developmental prosopagnosia: (sometimes referred to as congenital prosopagnosia) is a lifelong, neurodevelopmental condition which is not associated with brain injury or intellectual deficits. It runs in families (Duchaine et al., 2007), manifests in childhood, and often occurs alongside conditions like autism
- Acquired prosopagnosia: this condition occurs when poor face recognition is the result of brain damage, most commonly after a stroke, brain disease or injury, illness or tumor
Acquired prosopagnosia became a subject of interest when a report (Bodamer, 1947) described deficits in face recognition of wounded soldiers. Face blindness is often linked to the brain’s right fusiform face area (FFA), but a study (Cohen et al., 2019) suggests no single area is always affected in face blindness. Rather, prosopagnosia may involve an entire network, where impairment in communication between components or different brain regions may contribute to the deficit in face recognition.
Findings from the study, published in the journal Brain, led the first author Cohen (2019) to suggest that face recognition involves two distinct brain networks. The author is not sure whether face blindness is caused by a disruption in both networks, or whether the condition occurs because of an imbalance between the two networks.
For those who realize their skill of recognizing faces is compromised after brain damage, the loss of this skill must be deeply troubling. But would a child with developed face blindness or congenital prosopagnosia be aware of their deficit and its severity in recognizing faces? As it runs in families, and the child may never experience typical face recognition, would they be aware of any difference or impairment? Probably, at least according to a study (Dalrymple et al., 2014) aptly titled: “A room full of strangers every day”: The psychosocial impact of developmental prosopagnosia on children and their families.
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Dalrymple et al. (2014) concluded that children are mostly aware of their difficulties with face recognition, they use many different coping strategies as compensation for the condition, and face blindness may have significant social implications for some children. Do these conclusions apply to children with face blindness who are also on the autism spectrum? More research may be needed to establish how autistic kids with atypical facial recognition feel about the condition.
The face blindness, autism link
The results from a recent study (Minio-Paluello et al., 2020) revealed prosopagnosia potentially occurs in more than 36% of autistic adults without intellectual disability, compared to around 2% in the general population. Another study (Lynn et al., 2018) found connectivity between the fusiform face area (FFA) of the brain and the left frontal cortex was reduced in those with autism, relative to the typically developing individuals.
The study concluded by stating underconnectivity and abnormal development of functional connectivity may bring about an inferior face-processing network, in the context of escalating cognitive impairments in autism spectrum disorders (ASD).
Research suggests neural networks involved in the visual processing of faces may be one of the most crucial neural substrates affected in ASD (Pereira et al., 2019). This study also mentions real-time functional magnetic resonance imaging as a potential tool to study the visual processing network in ASD. Persistent differences in facial processing neural networks were found between typically developing individuals and those on the spectrum (Pereira et al, 2019).
Information based on brain MRI data, particularly functional MRI based neurofeedback, could be used to study visual processing networks in ASD, giving clues to exactly how those on the spectrum recognize faces. Parents with kids on the spectrum may wonder if there is anything they can do to help accommodate atypical face processing, if the condition is present in their child.
Autistic kids, eye contact and poor face processing abilities
Children on the spectrum often find eye contact uncomfortable. Research (Neumann, 2006) discussing mouth fixation offered a possible explanation, which includes abnormal, top-down strategy for allocating visual attention by autistic individuals. The “eye avoidance” hypothesis of autism face processing (Tanaka & Sung, 2016) may be a plausible explanation of atypical face recognition where those on the spectrum avoid looking at the eye region of the face because it is perceived as socially threatening.
Parents with kids on the spectrum often speak about the unfairness of their children being perceived as “rude” in social contexts, especially when there is little understanding of autism and communication deficits. Raising awareness of face blindness could be helpful in educating society; a child on the spectrum may be overwhelmed and insecure in social contexts where it takes considerable effort to recognize a face, a task their peers execute effortlessly.
Finding eye contact challenging, the child may look at other facial features (often the mouth), or they may look at clothing or other contextual clues to work out who the person is. Kids with face blindness may feel especially intimidated when encountering someone they are familiar with in a new or different environment. My own children seem surprised when they see their teachers in a supermarket; familiar contexts or environments do facilitate face recognition even for neurotypical children.
When face recognition is impaired, social interactions may be strained from the get-go. If autism is associated with face blindness, it is appropriate for researchers to examine whether poor face recognition contributes to social communication deficits, a core autism characteristic. For parents, an awkward social interaction where memory fails and you just can’t place the person, should shed some light on the experience. Could anyone interact in a socially appropriate way with raging doubts about who they’re actually communicating with?
Addressing face processing
Cleary autistic children with face processing deficits would benefit from early intervention—if face recognition is improved it could facilitate improved social communication. We need more research to identify the underlying mechanisms of face recognition and how this is impaired specifically in those on the spectrum.
Until recently clinicians did not seem overly optimistic about a cure for face blindness, probably because the condition seemed almost resistant to treatment. Reviewing successes and failures over the last 50 years of research, a study (Degutis et al., 2014) found compensatory training showed some effectiveness in children with developed face blindness. In adults with congenital prosopagnosia, remedial-training and administering oxytocin demonstrated improvements. Other approaches like transcranial magnetic stimulation are also under investigation as possible intervention for face blindness in those on the spectrum.
A recent study (Bate et al., 2020) may change the pessimism about treatment for face blindness. The study describes the first remedial face training program appropriate for children. The program, using a modified version of the popular game Guess Who?, led to improvements in face memory—gains which were maintained when evaluated at a one month follow up session.
Accommodate, compensate, educate
With more research and better intervention approaches, atypical facial recognition could be addressed in children on the spectrum. For parents, advocating for their kids becomes even more important when autism is comorbid with a condition like face blindness. Many of the studies above mention the importance of informing relevant people (in the child’s life) about the condition. Teachers, caregivers, and peers need to be educated and informed to help autistic children with face blindness.
A teacher introducing themselves in a supermarket when they’ve been in the child’s life for a while may seem strange, but it could set the stage for a much easier and more comfortable social interaction. Doing things differently to accommodate different minds should not be regarded as an inconvenience. Rather, changing the way we do things, to accommodate neurodivergent individuals could embolden them to add a fresh perspective, new ideas, and boundless ways of thinking. A win-win for a world increasingly stumped by novel problems.
Bate, S., Adams, A., & Bennetts, R. J. (2020). Guess who? Facial identity discrimination training improves face memory in typically developing children. Journal of Experimental Psychology: General, 149(5), 901–913. https://doi.org/10.1037/xge0000689
BODAMER J. (1947). Die Prosop-Agnosie; die Agnosie des Physiognomieerkennens [Prosop’s agnosia; the agnosia of cognition]. Archiv fur Psychiatrie und Nervenkrankheiten, vereinigt mit Zeitschrift fur die gesamte Neurologie und Psychiatrie, 118(1-2), 6–53. https://doi.org/10.1007/BF00352849.
Cohen, A. L., Soussand, L., Corrow, S. L., Martinaud, O., Barton, J., & Fox, M. D. (2019). Looking beyond the face area: lesion network mapping of prosopagnosia. Brain : a journal of neurology, 142(12), 3975–3990. https://doi.org/10.1093/brain/awz332.
Dalrymple, K. A., Fletcher, K., Corrow, S., das Nair, R., Barton, J. J., Yonas, A., & Duchaine, B. (2014). “A room full of strangers every day”: the psychosocial impact of developmental prosopagnosia on children and their families. Journal of psychosomatic research, 77(2), 144–150. https://doi.org/10.1016/j.jpsychores.2014.06.001.
DeGutis, J. M., Chiu, C., Grosso, M. E., & Cohan, S. (2014). Face processing improvements in prosopagnosia: successes and failures over the last 50 years. Frontiers in human neuroscience, 8, 561. https://doi.org/10.3389/fnhum.2014.00561
Duchaine, B., Germine, L., & Nakayama, K. (2007). Family resemblance: ten family members with prosopagnosia and within-class object agnosia. Cognitive neuropsychology, 24(4), 419–430. https://doi.org/10.1080/02643290701380491.
Lynn, A. C., Padmanabhan, A., Simmonds, D., Foran, W., Hallquist, M. N., Luna, B., & O’Hearn, K. (2018). Functional connectivity differences in autism during face and car recognition: underconnectivity and atypical age-related changes. Developmental science, 21(1), 10.1111/desc.12508. https://doi.org/10.1111/desc.12508.
Minio-Paluello, I., Porciello, G., Pascual-Leone, A., & Baron-Cohen, S. (2020). Face individual identity recognition: a potential endophenotype in autism. Molecular autism, 11(1), 81. https://doi.org/10.1186/s13229-020-00371-0.
Neumann, D., Spezio, M. L., Piven, J., & Adolphs, R. (2006). Looking you in the mouth: abnormal gaze in autism resulting from impaired top-down modulation of visual attention. Social cognitive and affective neuroscience, 1(3), 194–202. https://doi.org/10.1093/scan/nsl030.
Pereira, J. A., Sepulveda, P., Rana, M., Montalba, C., Tejos, C., Torres, R., Sitaram, R., & Ruiz, S. (2019). Self-Regulation of the Fusiform Face Area in Autism Spectrum: A Feasibility Study With Real-Time fMRI Neurofeedback. Frontiers in human neuroscience, 13, 446. https://doi.org/10.3389/fnhum.2019.00446.
Tanaka, J. W., & Sung, A. (2016). The “Eye Avoidance” Hypothesis of Autism Face Processing. Journal of autism and developmental disorders, 46(5), 1538–1552. https://doi.org/10.1007/s10803-013-1976-7.