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Posted on 08-07-2013

Originally posted on June 11th, 2012

How is vision related to autism?

Children on the autism spectrum are very likely to have delays in visual development.  This fact has not substantially penetrated mainstream public awareness.  Perhaps more unfortunate, it remains ignored by most healthcare professionals.  The development of the visual process goes hand in glove with overall development.  Behavioral optometrists understand that visual development is fundamental to overall development.

Visual development is not even on the radar of most eye care professionals.  Visual development is also poorly understood by the vast majority of medical doctors including pediatricians, pediatric ophthalmologists, child psychologists and psychiatrists.  Many of these doctors are relied upon by parents seeking care for their children on the autism spectrum and while all of them provide critical services to these families, they are missing an important piece of the puzzle by ignoring the visual process.  Most doctors do not understand the visual needs and challenges of children on the autism spectrum.  Behavioral optometrists are trained to assess and treat visual development issues in people of all ages.  Many behavioral optometrists have extensive experience working with children on the autism spectrum using lenses and vision therapy.

The numbers and percentages of children on the autism spectrum are growing.  The autism spectrum includes a diverse population including those with unspecified developmental delays and people with a number of conditions including attention deficit, Aspergers, and of course those with more significant autistic profiles who demonstrate little inclination or ability to interact emotionally or socially at the level we typically expect.  Children across the entire autism spectrum are commonly found to have delays in visual development.  Many of these children respond well to vision therapy and developmental lenses.

Behavioral optometrists use lenses and vision therapy to help children on the autism spectrum maximize their potential to use the visual process and improve their chances to develop a broad range of skills that require the continued development of the visual process.  It is interesting that other professionals are beginning to recognize the connections between visual development, visual abilities and the early diagnosis of autism.  It is unfortunate though that most of these professionals remain unaware of what behavioral optometry has been offering developmentally delayed children for over sixty years.

artwork by Zachary Osmun

Vision means nothing more than 20/20 to most people – and to most doctors.  Perhaps you are wondering what optometry has to offer children on the autism spectrum.  There are of course many variations in behavior across the autism spectrum.  From savant to stimming, just like the rest of us, no two children on the spectrum are exactly alike.  One thing that is very common across the spectrum is it is almost a certainty that a child on the autism spectrum has visual development issues.  Some of the outward signs we see are difficulty initiating or maintaining eye contact, poor tracking and scanning skills, below expected coordination and balance, bumping into things and poor focusing and eye teaming abilities.

It is also important to know that visual development and general development are intimately linked.

Many of these visual issues go unnoticed, are written off as unfortunate but unfixable or are simply ignored by most eye care professionals. It is necessary to seek out the right doctor who can adequately assess and help you understand your child’s visual status.  Behavioral optometrists are well versed in observing, evaluating, diagnosing and providing treatment for visual issues in children on the autism spectrum.

Why don’t all eye care professionals analyze, diagnose and treat the kinds of visual problems faced by children on the autism spectrum?

Behavioral optometrists specialize in helping people with a wide range of visual problems in addition to those already mentioned.  These problems are not typically structural in nature, but more functional and developmental in nature (that is, neurological in nature).  Essentially the brain has not established the necessary wiring to enable the visual process to operate at full capacity.  The good news here is that functional and developmental visual deficiencies are usually treatable by methods commonly employed by behavioral optometrists.  Behavioral optometry treats visual problems with vision therapy and the therapeutic use of lenses – all very safe and non-invasive.  Behavioral optometrists do not use drugs or surgery to treat these functional/developmental conditions.

Vision therapy and therapeutic lenses help create the proper conditions to stimulate the brain to establish new and better connections, which leads to new behavior patterns. All learning involves the brain making new connections.  Behavioral optometrists are trained to treat these visual deficits, which are almost always responsive to vision therapy and lenses.  Sometimes these responses are dramatic, sometimes less so.

Here’s an example of the former, received the morning after 9 year old  Jordan got his new glasses:

Hi Dr. Gallop,

The glasses seem to be working very well for Jordan. It’s like he sees the world with a new set of eyes. He’s very calm and doesn’t seem to be seeking as much sensory input as he usually does like walking into things, touching everything, etc. You can really see the difference it has made in just one day.

Thanks,

Lauren

As I said, they’re not all like this, but this kind of change sure makes me feel like I’m doing something worthwhile.  The changes we hope to see usually take longer than one day, but every so often this kind of thing does happen.

The standard eye exam usually consists of examining the physical structure of the eyes and an assessment of the person’s ability to distinguish letters or pictures on a wall across the room.  Behavioral optometrists assess much more than eyesight and eye health.  That’s one reason I describe my first interaction with someone as a visual evaluation not an eye exam.

It’s not uncommon for someone with developmental visual problems to have 20/20 eyesight.  The parents are then told in no uncertain terms that their child has no vision problem.  This is like telling someone they must obviously be a great painter because they can manage to write their name legibly.  Most of the young people I work with can see clearly at all distances and many, if not most, of them have fairly high IQs, yet they struggle with things like reading, copying from the board, catching a ball or being generally clumsy among others.  This begins to get at the difference between good eyesight and competent use of the visual process.

I am purposely using the phrase ‘visual process’ rather than simply saying vision because for most doctors and the entire public, the term vision is usually equated with eyesight.  When someone says or is told they have good ‘vision’ it almost always means they can see 20/20, which means nothing more than being able to discern a symbol or object 1/3” in size from a distance of twenty feet.  That’s it.  As you will see next time, we are dealing with much, much more than that.

Next time: The Visual Process, Movement, Development and the Autism Spectrum

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