As research is continuing to improve and develop, we know more about autism - which helps us unravel some of the mystery surrounding the diagnosis. At this time there is still not a causative factor to autism. However, there are several hypotheses regarding the cause of autism. According to research 1 out of 68 children in the United States is being diagnosed with Autism Spectrum Disorder (ASD). This is a large percentage of children in our schools and communities. Increased prevalence rates are possibly secondary to increased awareness of ASD. Children are receiving a proper diagnosis sooner, which allows them to receive proper services. Autism is an interesting diagnosis because every presentation is different. Each person with ASD has different characteristics as well as responses to their environment. Generally these individuals will had increased difficulty with social interaction, communication, and processing sensory stimuli. Processing sensory stimuli shows a huge range in presentation where some people are drawn to excessive stimuli (such as very bright lights), while others react to stimuli as if it were painful for them to take in.
While each individual with ASD is unique it is worth discussing the fact that they can have co-existing disorders that can impede on their day-to-day activities. Some of these difficulties can stem from a visual perspective. It is known that individuals with ASD have difficulty integrating visual information (properly interpreting what they see). Current research is evaluating what level of cortical processing is causing the most difficulty. While this is important to determine cortical levels it is also important to evaluate if there are visual barriers that can be causing a skewed.
Picture this: you have a child who has been diagnosed with ASD who tends to squint or close an eye while outside. In some circumstances some people may consider this to be a sensory response associated with autism. Now, when this child has a proper eye examination with a residency-trained pediatric optometrist it is found they have a strabismus (an eye-turn) that causes them to squint. A strabismus has potential to skew this child's visual world causing him to see double so he closes an eye or squints. He has already figured out how to alter his visual system so he doesn't see double, but now he is unable to appreciate depth or 3D vision. This can then affect coordination.
Also if you have a child who has a refractive error (hyperopia, myopia, astigmatism) that is uncorrected they may appreciate things as blurry and may not be able to interpret fine details, or they may be disengaged because they are unaware of the visual stimuli they are missing. The blurriness caused by an uncorrected prescription can make a child under-respond to stimuli because they do not see them. It can also cause them to be fearful as they cannot see what is approaching them until it is very close (try running through life at kid-speed without your glasses on if you are very nearsighted).
Let's not forget binocular vision dysfunction; such as convergence insufficiency, accommodative dysfunction, and oculomotor dysfunction. Convergence insufficiency can cause double vision, headaches and blurred vision. Accommodative dysfunction can cause blurred vision, eye-strain, fatigue. Oculomotor dysfunction can cause difficulty with near tasks such as skipping words while reading, skipping lines. All of these symptoms can be visually disturbing and can be physically uncomfortable to anyone experiencing them, autism or not. This can lead to aversion to tasks because it is uncomfortable. Simply put, individuals with autism thrive with routine and consistency. If binocular vision dysfunction constantly changes the way you see things it can be very disruptive.
According to research completed by a team in Sweden, 11% of individuals with ASD had visual impairments. Exact requirements to constitute as a visual impairment were not listed, but it is important to recognize 11% is a large percentage of people who have autism.
As we work to improve quality of life for individuals with autism spectrum disorder it is time to look to the eyes to remove any visual/ocular barriers that may be present. While this blog is not designed to say that certain characteristics of autism are secondary to the eyes it is designed to find solutions to make activities easier for individuals with ASD. Please keep in mind that individuals with ASD may require an eye examination that is designed to meet their needs and is a comfortable environment to get the most information and to have a positive experience. Residency trained pediatric optometrists have the knowledge and experience to perform a comprehensive eye examination for these individuals. Depending on the individual and their visual needs, further investigation may be required such as a Binocular Vision Assessment or a Specialized Vision Assessment. These assessments can further address any visual barriers and make recommendations to assist in their daily activities.
April may be Autism Awareness Month but every month should be devoted to inclusion, awareness, and promoting success for individuals who have been diagnosed with ASD. Let's remove barriers to success, one step at a time.