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Double Take: Developmental Optometry and Autism Spectrum Disorder

Optometry and Autism

One of the most valuable, life-changing referrals I make for my patients with Autism Spectrum disorder is to the Developmental (or Behavioral) Optometrist. It seems to catch parents and teachers by surprise, and yet pays significant benefits for the child.

Does it break your heart that your son or daughter works twice as hard to get half the grade they are capable of? Are you told your child is “lazy” or “avoids homework”, even though you feel he is actually quite bright? Some parents even catch themselves saying it! Children with undiagnosed and uncorrected visual coordination problems can become frustrated, have low self-esteem, or begin to believe they aren’t smart.

As a concerned parent, I’m sure you arrange for tutoring, attend IEP meetings, try ADHD medications…and yet still get those grumpy notes from teachers scrawled across your child’s schoolwork, expressing dissatisfaction with performance and behavior!

According to visionandlearning.org, a behavioral optometry website, it has been estimated that “75-90% of learning in the classroom is through the visual system. Many children who are diagnosed… on the autism spectrum … have a 70-80% chance of having a vision problem significant enough to affect their performance.”

It doesn’t stop there – as an autism mother, I know our children struggle with hyperactivity and coordination problems, often getting chosen last for sports teams or avoiding them altogether. Has your child been described as clumsy and awkward, or lacking in self-esteem? Have you noticed your son or daughter is cautious on stairs, trips over nothing, or bumps into doorways? Does your toddler hold toys close to his eyes, or do a lot of sideways glancing? Some children may have a “lazy eye”, or even dislike 3-D movies. Unbeknownst to anyone, your child may have trouble coordinating his eyes for proper vision and depth perception, and doesn’t mention it because it is his “normal”.

What is a Developmental or Behavioral Optometrist? According to www.childrensvision.com: “Developmental optometrists must complete two to three years of post-graduate training after their optometric degree. They are also required to complete extensive clinicals and submit case studies before they can sit for their national boards.”

A behavioral optometrist can prescribe glasses and contacts, just like a regular optometrist. But they also measure the teamwork between your eyes and your brain, and that makes a world of difference. Think of it this way: a regular optometry visit checks out the car, whereas a developmental optometry visit checks out the car and the driver!

I refer about 25% of my patients to a Behavioral Optometrist, and I have seen it make a dynamic improvement with reading, learning and spelling, as well as difficulties with hyperactivity, attention and clumsiness. Once the children put on their new pair of prism lenses, they are almost instantly more coordinated and confidant in their surroundings.

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And don’t be complacent just because your child is a good reader. Consider the case of Odell, a 10-year old youngster with Asperger syndrome. Odell is a bright, well-spoken, voracious reader who was making straight F’s in school. When I delved into his terrible grades, both he and his mother explained it away as being mostly due to “bullying”, and “the teacher picking on him”. I began to question Odell about how well he could catch a ball, and to my surprise, both he and his mother assured me he was quite good at it. My clinical intuition was nagging, and I persisted in questioning about his ball skills. Exasperated, Odell smacked his palm on the table in front of me, and barked out, “I can catch a ball just fine, “especially if I shut one eye, and there’s just one ball!”

Odell was actually seeing double and didn’t realize it; simply put, it had always been his “normal”. He had learned to compensate and complete his schoolwork despite having double vision, but had to work ten times harder than classmates with normal vision. I am pleased to report that Odell went to see a Behavioral Optometrist, and is now a happy A and B student. I hate to imagine his future if he hadn’t made the appointment.

According to Visionandlearning.org, children with vision-related learning problems often have 20/20 eyesight. I’ve noticed that in my own practice when parents, including Odell’s mother, protest and exclaim, “He just had an eye exam, and his eyes are fine!” This is not so much about the eyes themselves, but how the brain coordinates the eyes. If they aren’t working together perfectly, your child’s world may not make much sense.

So what can you expect at a “Behavioral Work-up”? What is the exam like? My patients report it can take anywhere from one and a half to two hours, and is quite interactive. In addition to eye health and acuity, the developmental optometrist will assess:

• Depth Perception
• Eye Alignment
• Do the eyes work as a team?
• Binocularity
• Eye Movements Skills (including tracking and fixating)
• Focusing ability
• Color vision
• Visual Perception
• Gross and Fine Motor development

The exam includes the standard eye charts and looking through various lens combinations. In addition, the child is asked to move about quite a bit, sometimes standing with eyes closed, or lying in the floor raising arms or legs. Consider how much cooperation your child with Autism Spectrum disorder can offer, and discuss it with any potential providers before making an appointment.

So how does a Behavioral Optometrist correct poor coordination of the eyes? Many use what are called “prism lenses” - and don’t worry, they look just like regular eyeglasses! Vision Therapy is another helpful tool to build new neural patterns, and can conveniently be done on a home computer. Sometimes specific moving exercises are prescribed as well. Many insurance plans cover a developmental eye exam and glasses, but be sure to check with yours ahead of time. Medicaid may help in some cases, but may vary from state to state.

Intrigued and want to know more? A fascinating book on the topic is “Seeing through New Eyes” by Melvin Kaplan.

If your child struggles with school or sports, is labeled clumsy or dyslexic, or just seems to consistently underachieve, don’t delay – get thee to a Developmental Optometrist right away! It may make a world of difference.