Vision Therapy and the Autistic Child

By Audrey Adams

I am the parent of an autistic child.

Too often, visual problems which would have been detected early in non-disabled children go undiagnosed and untreated for children with disabilities, perhaps because the visual examination would be difficult, or the child is not able to verbalize a problem, or the school’s test showed “normal” 20/20 eyesight. Whatever the reason, all school aged children, including children with disabilities, should have a full visual examination.

The eye charts used by schools only measure clearness and sharpness of eyesight at a distance of 20 feet using a stationary target. However, these charts do not test for eye tracking, aim, teaming, depth perception or visual perceptual skills. In other words, a chart test will not measure the ability to see adequately at 20 inches (affects reading writing, math, etc.) visual efficiency in following an object or landscape in motion (affects all sports, PE, ball games, riding bicycle, etc.) or the ability to accurately judge distances and depth (affects balance, large motor coordination, perception of environment, etc).

If a child with autism/PDD is unable to read is uncooperative with close tasks, has illegible handwriting, or is disruptive in class, too often we assume these are “autistic” behaviors that must be modified behaviorally or taught with numerous repetitions. When these same characteristics are present in non-disabled children, most primary grade teachers would ask if the child has had a complete visual examination. My son’s first, second, and third grade teacher all did and I regrettably ignored them until the fourth grade. Though he read and was disruptive, these regular education teachers all saw signs of possible vision problems: eye contact avoidance, blackboard visual avoidance, poor and uneven handwriting, inability to listen and look simultaneously, over use of peripheral vision, a stiff-legged walk and poking at the sides of his eyes.

Because some sensory dysfunction is present in all individuals with autism, and because vision problems are more common in individuals with sensory impairments, it would benefit parents of children with autism greatly to become more knowledgeable about vision impairments and possible remedies. Occupational therapists should also be interested in learning more about eye exercises and the improvement in motor skills when the “eye” is the culprit in “eye-hand” coordination difficulties.

My son, Kyle, had throwing and catching a ball on his IEP for about 6 years, because we knew improving coordination and reciprocal play was important. After all the time, he still was not able to catch even a beach ball. it simply bounced off his stomach and then he moved his arms, sometimes, but too late. A vision examination two years ago revealed that Kyle had, among other things, significant convergence problems and could not focus on a fast moving object. His eyes were working independently, rather than together, so that he saw two pictures instead of one. In other words, he never accurately saw the ball as it moved, he only saw it after it stopped. Once the ball was still, he willingly retrieved it and brought it to you. We began doing the prescribed eye exercises at home for about 10 minutes a day; it seemed more like play than work. After three weeks, Kyle was catching tennis balls!

In addition to enabling Kyle to see moving objects, vision therapy has improved his reading efficiency and comfort, increased his depth perception and improved horizontal and vertical tracking (imperative for math and reading music.) these exercises also decreased Kyle’s overuse of peripheral vision, reduced his gaze (and task) avoidance, and decrease eye poking and other physical signs of visual strain. Kyle also wears glasses with prisms lenses to slightly tilt his visual field upward, which helps him to look forward rather than down, as he tends to.

The bad news is that a lot of Kyle’s early years were wasted (for example, as a human target, rather than a participant in ball games) because parents, educators and pediatricians alike were unaware of the limits of his vision. We accepted, and even ignored, many of Kyle’s behavioral differences because those characteristics are known to be associated with autism. The good news is that many of this vision problems are correctable with methods that have been in use for over 40 years in the field of optometry. In fact, vision therapy has been around so long that it even appears in encyclopedias written in 1960. Unfortunately, it seems almost unknown to those searching for answers for autism. Vision therapy does not cure autism, but it can significantly improve academic performance, personal comfort and security and participation in more typical, age-appropriate activities. in other words, enhance a person’s quality of life.

When making an appointment for a vision examination, go straight to a developmental optometrists, not an ophthalmologist. While most optometrists do not offer therapy services, one with a developmental background is able to diagnose correctable vision problems and give a referral for therapy. Don’t assume that your child can’t be tested; a really good eye doctor can tell you a lot about the vision performance of even non-verbal individuals. If the optometrists tells you that your child is untestable, find one that is willing to try.

A word of caution here is prudent: If you are told that your child needs surgery to correct vision problems you MUST get a second (or even a third) opinion. A friend of mine has a non-disabled son who has had a “lazy eye” since he was a toddler. Over a period of several years, three different ophthalmologists told her that her son would need surgery to correct it. In the 4th grade his reading and other close work was suffering, prompting her to take him to yet another eye doctor, but this time to an optometrist. The optometrists told my friend, “DO NOT DO ANY SURGERY!” The surgery proposed corrects muscle problems; this is not a muscle problem, it’s a brain problem. It is correctable with eye exercises your son can do at home.” He referred them to a developmental optometrists for therapy. Four months of eye exercises corrected her son’s vision problem. Reading, math, and sports are now much easier and enjoyable. A happier 10 year old, he exclaimed after one month of therapy, ” Hey, Mom, the words don’t jump all over the page anymore!” Interestingly , my friend had previously asked her son if he saw words moving, and he had replied, “No.” He didn’t know that what he saw was different than everyone else and was apparently expecting a larger movement, compared to what he typically saw.

Do you know the difference between an optometrists and an ophthalmologist? They are both “real” eye doctors. Their education differs in that ophthalmologists are trained in surgery. Optometrists are licensed to diagnose conditions that require surgery and ocular pathology but cannot operate. Some optometrists have additional training and certification in developmental optometry and prescribe and/or direct vision therapy programs, usually performed by a therapist. While most insurance companies will readily cover doctor visits, glasses and surgery, they do not always cover therapy. Is it any surprise that, generally, ophthalmologists are not interested in prescribing or learning about vision therapy?

My son is eleven and several questions continue to nag me. How many of the behavioral characteristics listed as diagnostic criteria for autism/PDD are symptoms of severe vision dysfunctions? Auditory dysfunctions? Tactile and vestibular dysfunctions? If my son could have seen, heard and felt as typical children do as a toddler, would he have had those characteristics that label him autistic? How much more could Kyle have learned in those formative years if we had addressed his sensory problems first?

If I could turn back the clock, I would do all sensory therapies FIRST and THEN behavioral therapies and interventions. I have done it backwards, not only wasting critical developmental years, but also not allowing Kyle to receive the full benefit of his behavioral therapies and educational instruction. He has spent his life trying to cope with and diminish his discomfort of sound and touch. He has worked diligently to make sense of what he sees that is not real, what he doesn’t see that others do, and even trying to shut off his vision so that he may hear us better. All the while those of us with sensory systems intact say that he’s in his own world. and he is, literally. Only HE can see, hear and feel his world as he does, but he did not ask it to be so.