Report from Sensory Integration Quarterly

Reprinted from Summer 1996 Issue with Permission

Letter from Mrs. Roxane Barricklow of West Harrison, IN, describing the positive response of her autistic son, Jimmy, to vision therapy:

Our family began vision therapy in April, 1994. It was recommended to us by our son’s speech therapist and audiologist, along with other therapies. At that time our son was receiving many other therapies to help him deal with autism, including allergy medications, music therapy, auditory training (three times), speech therapy, sensory integration therapy, craniosacral therapy, and the medications Naltrexone, Trilafon, vitamin C, and a multivitamin. All of these therapies helped him in their own way, and doing them all frequently helped even more. We were leery of adding a new therapy that we did not understand, but followed the advice of a valued and trusted therapist. Our first visit was an eye-opener. We did nor believe that our 12 year old son would tolerate wearing the glasses because he is very touch sensitive. As soon as his eye exam was over and the doctor told Jimmy to pick himself out a pair of glasses, he did it! He tried glasses on and even looked in the mirror to see how he looked in them!

When the glasses came in we picked them up right away. Jimmy wore them out the door with no problem. On the way home we stopped at the park to walk on a trail. This was always a gambit because Jimmy had a strong fear of all animals, and if someone was walking their dog Jimmy would jump up on our backs to safety until the dog was gone out of sight. On this day a very large and mean looking dog passed us on the trail and Jimmy was not afraid. He simply looked at the dog as if, “Huh! So that is what a dog looks like. No big deal.” He had only had his glasses for thirty minutes and already our lives were changed.

For the first few weeks he only wore his glasses for two to three hours per day and we did nor push the issue, since we wanted him to want to wear them. By the end of the third month he was wearing them 90% of the day. Ten months later he has them on when he comes down to breakfast and they are still on when he falls asleep at night.

The changes made in our home life were gradual but steady. Before vision therapy he spent long periods of time staring trance-like into space, even as he walked. Jimmy immediately began visually investigating his environment. He is now investigating his therapists’ offices as though seeing them for the first time. He plays with his toys more appropriately instead of tapping them or making rows of them.

At age 13 Jimmy can now tie his own shoes. He is able to do this now because he has learned to “look” at what he is doing. He always puts his clothes on by himself, front-ways, and is very proud of this accomplishment. Before, dressing was hit-or-miss, with clothes put on backwards, or shoes on the wrong fret. Jimmy cares about his appearance now. After his shower he wants his hair blow-dried and styled, and wants to be told he looks handsome. He now washes himself and shampoos his own hair; drying himself when he is done. I believe this is because he now “looks” at what he is doing, something he could not seem to do before vision therapy.

All of his other therapies have benefited from vision therapy as well His progress in speech therapy has sky rocketed! He was basically non-verbal a year ago, and now uses speech to communicate. He makes eye contact while communicating with no trouble — before now, eye contact was fleeting.

School is as different as night from day since vision therapy began. Jimmy has a longer attention span, follows instructions better, listens more closely and can sir for longer periods of time. Last year his time was spent doing sheltered workshop jobs, daily living skills, and he had lots of free time.

This year he has three or four five-minute breaks during his morning, with the rest filled with learning activities.

His classes are in the high school building this year and Jimmy has noticed that the kids there look and act different than the elementary kids did. Hr is trying very hard to be like the older kids. Socially, he is much happier. He wants to be in our company at home, instead of shut in his bedroom. He used to cry when told we were going out, but Jimmy loves outings in the community now, asking to go places every day. He wants to be a part of the world now. In stores, he pushes the shopping cart. If told he can pick a snack, he takes time and scans the shelves looking for what he likes, instead of blindly grabbing the first item. Stores used to give him panic attacks which sent him running for the nearest exit.

Our life together has definitely changed! Our son is still autistic, and in need of years more of his therapies, bur he now makes steady progress and is happy and proud of himself. He likes himself and wants to be an active part of his family, community and world.v

Answers to Questions about Vision Therapy:

Dr. Stanley A. Appelbaum, OD, FCOVD is a member of the Board of Directors of SII, and has been a developmental and behavioral optometrist in the Washington D.C. area for 22 yeares. Dr. Appelbaum’s wife, Barbara S. Bassen, OTR/L,BCP is an Occupational Therapist trained and certified in using Sensory Integrative theory and therapy. She has added to Dr. Appelbaum’s understanding about children with sensory integrative needs.

Dr. Appelbaum, what is developmental, or behavioral optometry?

Developmental, or behavioral optometry is a specialty within the field of optometry. We have a certifying organization called the College of Optometrists in Vision Development (COVD). This organization certifies specialists in vision therapy development. A number of books have been written about it (vision therapy). It looks at how an individual processes visual information. A routine eye exam looks at eye sight and health — a behavioral optometrist looks at those things, but also how the individual processes information: whether or nor the eyes work together as a team, focusing problems, eye movement problems, or whether there is a problem integrating vision with other sensory modalities. Vision therapy is not new. It started in the early 1920’s. Our “Jean Ayres figures” are Dr. A.M. Skeffington and the late Dr. Jerry Getman, (who worked with Dr. Ayres). Dr. Getman’s book, “How to Develop Your Child’s Intelligence,” can be purchased from the Optometric Extension program Foundation, in Santa Ana, CA. The PAVE group can help you find the book in your area.

Is there a basic pattern that vision therapists use when they prescribe vision therapy for chldren? If I were to have therapy at your center in Maryland, then go to a vision therapist here in my town, would your basic approaches be the same?

If you go to an optometrist who is a Fellow of the College of Optometrists in Vision Development it is like going to a SIPT-certified OT. They would have similar training. But there is not one program for vision therapy. Instead, there are many different diagnoses – oculomotor problems, strabismus, amblyopia – many kinds of programs. Each patient receives a treatment strategy designed for her/him, to help them gain their own oculomotor control.

In your optometric pracice (or anyone else’s) approximately what percentage of the clients you see need vision therapy?

In a general practice, of family vision care, it turns out that about 20% of all of the patients seen have vision problems that can’t be solved by any therapy other than vision therapy. In my practice here in Bethesda, I get a high number of referrals from other professionals who have already identified the patient as having a vision problems, so my percentages are higher.

What should we look for when choosing a vision therapist?

When choosing an eye doctor it’s est to get someone who is Board Certified in Vision Therapy. The initials FCOVD (Fellow of the College of Optometrists in Vision Development) will follow her or his name. Also, you want to be sure that, during the exam, the doctor makes a series of near-point tests. No eye drops can be used for that procedure. There is a list from the COVD of those people who have passed oral and written exams demonstrating competence in vision therapy. (1-800-PAVE-988 is a national group of parents, Parents Active in Vision Education, who staff this number, and will give you a list of developmental or behavioral optometrists in your area, as well as information about symptoms).