Whether you are a frustrated parent, a professional in the field, or an individual on the spectrum, this session is for you. Are you struggling with, fascinated by, or just puzzled as to why individuals with autism spectrum disorders (ASD) have difficulty making eye contact, squint, are fascinated by lights, spinning objects, shadows or patterns, flap their hands, flick objects in front of their eyes, or look at objects sideways? Maybe it is because of undiagnosed vision problems.
For the past 25 years I have been fascinated by vision and its relationship to learning and behavior in individuals with special needs, especially autism. My training as a mental health professional did not satisfy me, so I had to turn to other disciplines for answers. I have combined my findings in the book, EnVISIONing a Bright Future: Interventions that Work for Children and Adults with Autism Spectrum Disorders, published in 2008 by the Optometric Extension Program (OEP). Here is a “look” at some of what I learned.
What Is Vision?
Vision is the learned, developmental process of giving meaning to what is seen. It is far more than 20/20 eyesight. It incorporates all the other senses, eventually becoming the dominant sense in typically developing children. Vision is conceptual and perceptual. It allows us to attend to, organize, understand and interact with the world around us. It develops hierarchically emerging from an integration of sensory input from the eyes, body and brain. Vision drives imagination and creativity, and even many types of intelligence.
Visual Not Eyesight is Deficient in Autism
Sadly, visual issues are often overlooked and misunderstood as simply symptoms of autism. In 1999, the National PTA passed a resolution stating that vision problems are often missed as significant factors in learning problems, and that academic deficiencies are often mistakenly attributed to behavior or motivation.
Why Vision Issues in Autism are Misunderstood
Controversy surrounds the role of vision because several different models “view” vision according to widely diverse training. The medical model represented by an MD or ophthalmologist defines vision in terms of eye health and structural pathology. A functional model of vision is represented by an optometrist or OD, whose training emphasizes that vision operates in relationship to the rest of the body and looks at the visual skills necessary for learning including visual perception. The educational model defines vision as acuity, and offers “vision” services for students with “low vision” or eyesight problems. School-based occupational therapists (OTs), special educators and school psychologists can all evaluate visual perception and write IEP goals to enhance visual perception as it relates to academic achievement.
Who Has Vision Issues?
Every child is unique. Just as all children with autism differ in many ways, so do the visual issues in those with autism. To identify and treat underlying visual issues requires a complete vision evaluation. In an ideal world, evaluating and treating an individual demonstrating behavioral or learning issues such as autism, should take all aspects of visual function, including eyesight, structural pathology, perception and eye health into account. Oh, what I would give for an ideal world!
What Causes Visual Issues in Autism?
Vision affects and is affected by both genetics and the environment. While it is difficult to separate nature from nurture, nearsightedness (myopia) and a turned eye (strabismus) are believed to run in families. Some contemporary societal practices that restrict babies and young children’s movements for safety reasons may also be responsible in part. Safety measures such as back sleeping (even when remediated by “tummy time”), car seats, backpacks, strollers, and baby exercisers can impede the emergence of important reflexes necessary for motor development. An increased early use of electronics, such as computers, TV and video games, that force visual focus at inappropriate distances and for extended periods of time, may also contribute in subtle ways.
The eye is one of the most nutritionally demanding organs of the body, and is often the first place where disease appears, such as in diabetes. It is profoundly affected by vitamin and mineral deficiencies, toxins, and the foods we eat and drink. In the late 1990s, Mary Megson, MD discovered that a deficiency of vitamins A and D played a role in regressive autism, and saw great progress when supplementing the diets of her patients with cod liver oil, an excellent source of the deficient vitamins. Known excitotoxins, such as MSG, aspartame and alcohol quickly affect vision. Many medications also have visual side effects, such as blurring, double vision or even blindness.
Central and Peripheral Vision
One of the most significant issues for individuals with autism is coordinating central and peripheral vision. Autistics tend to use one part of their vision, but not both simultaneously and efficiently. Without integration, the body is under stress. Some who are more “focal” may play with specks of dust, are obsessed with details or demonstrate savant abilities. Others are “ambient,” fascinated by contrast, lights, shadows and shiny objects. This visual rigidity can make them appear very inflexible behaviorally. Reflex integration is often part of the treatment plan to restore a balance between central and peripheral vision.
Essential Visual Skills
Vision includes the following:
- Acuity – Sharpness or clarity at both distance and reading distance
- Focusing – Ability to maintain clarity while changing distances
- Eye Tracking and Fixation – Ability to look at and accurately follow an object
- Binocular Vision or Fusion: Ability to use both eyes together efficiently
- Eye Teaming: Ability to aim, move and work the as a coordinated team.
- Convergence – Ability to move the eyes as a team toward the nose
- Visual Motor Integration: the ability to combine visual input with input for other senses and respond motorically
Vision’s Role in Language and Social Skills
Pragmatic language and social skill development, two areas that are of great concern to parents of children with autism, are the most complex outcomes of tactile-motor-visual integration. Efficient vision allows a child to focus on someone who greets him, give the obligatory hand-shake, hug or kiss, and then listen to what the person is saying, even if seeing double, giving those words meaning and responding, all in a matter of seconds!
What Schools can do to Assure Efficient Vision
Most school and pediatric “vision” screenings are inadequate. Screenings must evaluate binocular function, accommodation and convergence in addition to acuity. Teachers can probably pick out those children with visual dysfunction just by observing their reading and writing postures, head and eye movements. Any student in first grade or older who is still moving the head or body along with the eyes requires intervention.
Vision Activities for Everyone
Teachers from pre-school through the secondary grades can incorporate enjoyable activities that will help vision develop, solidify visual skills and consolidate vision for everyone.
• Visual Arousal Activities. For our youngest and lowest functioning children, activities that heighten use of vision in general are a good starting place. Balloons, bubbles, scarves and other items that move slowly work well.
• Chalkboard Activities. Standing up and writing with the whole body engaged developmentally precedes sitting down and using only the hand. We can help those with ASD develop stability of legs and trunk so they can later concentrate on eye-hand connection by allowing them to stand instead of sit.
• Lazy Eights. The figure eight lends itself to many activities to improve attention, eye movements, binocularity, crossing the midline and overall visual efficiency. The ultimate goal is to use eyes only, with head, trunk and body still.
- Visual Thinking. The ability to generate and use imagery is the culmination of “sensory integration.” Simple activities can enhance and improve visual thinking. In school it is important for reading comprehension, written language and understanding mathematics concepts. Many children with autism do not have that ability, and are attracted to video games, television and computers to fill the empty space in their minds’ eye. Far better than electronic images are those that come out of one’s own sensory experiences of moving through space.
As children get older, introduce parquetry blocks, starting with forming simple patterns and eventually making constructions from “my point of view.” Taking another’s point of view is an abstract concept that starts concretely and develops with practice. A wonderful book containing visual thinking activities is Thinking Goes to School by Furth and Wachs. I recommend it highly for teachers of all ages.
- Rhythm and Balance. Adding rhythm and balance to visual activities removes conscious thought from the visual component and helps vision solidify. Teachers, parents and therapists can make all the activities above more difficult by doing them to a metronome and/or while on a balance beam. Once an individual can throw and catch beanbags while walking six inches above the floor on a narrow beam, you can add a cognitive component to the activity, such as saying the alphabet backwards or doing simple arithmetic calculations.
Learning Objectives
Through the use of lecture and demonstration, you will learn how underlying, often undiagnosed problems with vision interfere with development. We will look at language, movement, social-emotional functioning, academics and more, and, in each area, examine the impact of vision. You will learn
• the differences between vision and eyesight.
• the role of vision in autistic symptoms and behavior
• how movement and vision interact in language, social-emotional development and academic achievement
• how to conduct a thorough vision screening
• activities to enhance vision in the classroom and in speech-language, occupational and physical therapy
• how to model good vision practices
• resources for learning more about vision and autism
Change Behavior by Changing Vision
Individuals with autism can learn to use their vision more efficiently. Once their visual skills improve, so will their language, behavior, and learning. You will discover new activities and programs you can use to maximize the potential of students of all ages. You will leave with creative ways to collaborate, advocate and improve function in kids with all levels of ability.
Whether you are a professional treating your first kids, or are a seasoned veteran in the field, you are sure to gain new ideas and resolve in this provocative workshop. Once you understand the components of the vision system, and how they affect all aspects of functioning, you will feel ready to face even the most challenging behaviors in your patients. Come prepared for new answers to your questions about the quirky nature of kids with ASD.
Patricia S. Lemer, M.Ed, NCC
Executive Director
Developmental Delay Resources (DDR)
Patricia Lemer is founder and Executive Director of Developmental Delay Resources. She is a licensed Counselor and was an advocate for over 30 years. She lectures internationally and is presently working in Kuwait. She is the author/editor of the book EnVISIONing a Bright Future, and serves on numerous advisory boards.
