Many of the behavioral characteristics of those falling within the autism spectrum involve the visual system. Poor eye contact, staring at lights or spinning objects, looking askance, side viewing and general difficulties attending are often symptoms of visual dysfunction. Thus, any individual with a diagnosis of autism, PDD, learning disability, speech-language delay, sensory integration dysfunction, Asperger syndrome, non-verbal learning disability or with psychological problems should most certainly undergo a thorough examination by a developmental optometrist.

The earlier families of children with autism undergo a visual examination and begin visual intervention, the faster the improvement and the longer lasting the gains and overall chances for success. The American Optometric Association (AOA) recommends that all children undergo visual exams by six months of age. If parents complied with this guideline, optometrists would certainly note many visual problems in these young, yet undiagnosed children. For those with autism spectrum diagnoses, an immediate developmental exam is essential. After age four, a child may make adaptations which further embed the visual problems. For example, an eye turn out becomes an eye turn in or a suppression becomes firmly established by a large angle head turn or tilt.

Children with autism spectrum disorders (ASD) have motor, sensory, language and social-emotional delays that affect visual processing. Likewise visual problems affect cognitive, speech-language, social-emotional and perceptual development. Specifically, delays in oculomotor function, focusing, and binocular abilities can affect gross and fine motor abilities and language acquisition. Sensory problems result when vision does not coordinate with the vestibular and proprioceptive systems properly, or if there is poor synchronization between the central and peripheral visual systems. Poor visual awareness and poor eye contact negatively affects socialization and poor visualization can hinder the development of skills for imaginative play.

What is important is that the time period from age 18 months to four years of age, when autism is usually diagnosed, is an extremely important window of development for vision, as well as language, socialization and other crucial areas.

During this very critical time frame, vision should begin to dominate the movement system, to coordinate the proprioceptive, vestibular and tactile systems. As vision combines with the other senses, central or focal vision should emerge. If there is faulty information processing in any of the primitive sensory systems, visual dysfunction is inevitable. These patients then still need to touch and move to experience their environment because their visual systems are so inefficient. Some of their stimulatory behaviors such as flapping and side looking, may actually serve the purpose of allowing them to interact with their world, and tell the brain where the body is in space.

The literature supports that a very high percentage of children with autism spectrum disorders demonstrate eye movement disorders and a high incidence of strabismus. Many children with autism also have many competing stressors on their bodies during the critical second year of life. Inadequate or inappropriate sensory stimulation and health problems, ranging from food allergies to ear infections and asthma can all wreck havoc with vision development. Whether the health or the vision issues come first, visual concerns are real, and parents and professionals must pay attention to them. Even when health issues subside, and behavior, attention, and even eye contact improve, underlying visual delays often remain, and optometric intervention is necessary. Those with autism spectrum disorders simply have gaps in sensory, motor and visual areas so enormous that they cannot be closed without therapy.

Source: Randy Schulman, MS, OD, FCOVD