One of the challenging aspects of writing about the visual gifts and differences displayed with Autism Spectrum Disorder (ASD) comes from the array of presentations that one finds within the ASD community. The phrase “once you’ve seen one person with autism, you’ve seen one person with autism” quite accurately describes just how unique each presentation can be. Out of necessity, much of this discussion will make use of generalizations, but I think it’s important to acknowledge that there is almost no guaranteed consistency of findings – making optometric management as unique as the very condition itself.

My interest in working with this particular community began after having a conversation with my sister-in law about a pilot project that her team was developing – linking individuals with ASD with jobs suitable to their immense and unique talents (http://meticulon.com/). Having personally witnessed the gifts of visual processing displayed by those with ASD, it made perfect sense to direct these individuals toward roles best suited to their particular skill sets. As with any developmental condition however, these visual gifts can be accompanied by certain challenges. It is these challenges that I aim to support.

Given the widespread neurological underpinnings of our visual system, it is not surprising that a developmental neurological condition such as ASD would affect visual processing in a variety of ways. I think the best way to begin this discussion of visual function is to outline the areas in which we typically find enhanced skill. Static visual search skill, or figure-ground differentiation (the ability to attend to one particular point in a visual scene) has often been found to be superior in the ASD population. An enhanced ability to visualize experienced events and manipulate images associated with these memories in a complex fashion has also been described by members of the ASD community – most notably in Temple Grandin’s book “Thinking in Pictures.” Both of these visual skills allow one to succeed in areas of life requiring heightened visual concentration and attention. The main areas of visual difficulty in ASD include: photosensitivity, hyper- and hyposensitivity to visual scenes, colour perception processing, and differences in processing central and peripheral stimuli. At ~44%, the incidence of refractive error (glasses prescriptions) also tends to be higher in the ASD population, as well as the incidence of strabismus (eye turns) at ~21%. Visual closure – the ability to integrate visual parts into identifiable wholes – has also been found to be an area of difficulty for those with ASD.

Given the diversity of presentations, visual support for this population comes in a wide variety of forms. These can include refractive correction, yoked prism glasses correction (a therapeutic style of glasses prescription that can be assistive with posture as well as expanding central-peripheral visual integration skill), coloured overlays and lenses, environmental modifications and in-office Vision Therapy. Vision Therapy in this population is typically aimed at enhancing the integration of vision with other senses, improving visual spatial skill, encouraging central-peripheral visual integration, as well as reducing or eliminating the intermittent eye turns that are fairly common with ASD. As you can likely suspect from the tone of this article, no two treatment protocols are the same.

When managing an individual case of ASD, it is important to differentiate between what are modifiable patterns of visual behaviour and what visual behaviours are inherent to the condition. We know for example that an individual with ASD is far more likely to visually attend to the speaker’s lips or look away entirely when engaged in conversation. Looking away can help reduce the amount of incoming stimuli that one has to process and can actually be an assistive adaptive skill – it should not, and likely cannot be altered with Vision Therapy. An aversion and heightened sensitivity to certain colours has also been noted in this population, and if present should be addressed in your therapy room or with lifestyle recommendations. Understanding these and many other inherent visual trends within this population can be extremely helpful when one is assessing or developing a Vision Therapy treatment plan.

Visual processing in ASD is a complex and layered topic. Treatment will almost always need to incorporate multi-disciplinary management and must be specific to the needs and goals of the individual. Given the large role that vision and visual processing plays in our day-to-day lives, it is imperative that this fascinating aspect of the autistic experience continue to be to be properly assessed, supported and researched.

Until next month,
Paul Rollett, OD

Pertinent Links:
http://www.covd.org/?page=Autism
http://c.ymcdn.com/sites/www.covd.org/resource/resmgr/ovd40-3/article_understandingvisuals.pdf