Visual Rehabilitation for Special Needs

To learn more about vision therapy as it relates to developmental delays or disorders, see:

Success with Learning Disabilities: Autism Spectrum Disorders and Eyesight

Editor’s Note: Few ophthalmologists or optometrists can claim extensive experience with autistic individuals. If you are looking for an eye doctor for a person with autism or suspected autism spectrum disorders, locate a developmental optometrist and ask the following questions before scheduling the eye examination: (1) Does the optometrist (1) have experience in evaluating the vision of a non-verbal and/or autistic person? and (2) If the appropriate to the case, does the optometrist offer special corrective lenses for autistic individuals (i.e., prisms and/or filters)?

Our family began vision therapy in April, 1994. It was recommended to us by our son’s speech therapist and audiologist, along with other therapies. At that time our son was receiving many other therapies to help him deal with autism, including allergy medications, music therapy, auditory training (three times), speech therapy, sensory integration therapy, craniosacral therapy, and the medications Naltrexone, Trilafon, vitamin C, and a multivitamin.

We were leery of adding a new therapy that we did not understand, but followed the advice of a valued and trusted therapist. Our first visit was an eye-opener. We did not believe that our 12 year old son would tolerate wearing the glasses because he is very touch sensitive. As soon as his eye exam was over and the doctor told Jimmy to pick himself out a pair of glasses, he did it! He tried glasses on and even looked in the mirror to see how he looked in them!

When the glasses came in we picked them up right away. Jimmy wore them out the door with no problem. On the way home we stopped at the park to walk on a trail. This was always a gambit because Jimmy had a strong fear of all animals, and if someone was walking their dog Jimmy would jump up on our backs to safety until the dog was gone out of sight. On this day a very large and mean looking dog passed us on the trail and Jimmy was not afraid. He simply looked at the dog as if, “Huh! So that is what a dog looks like. No big deal.” He had only had his glasses for thirty minutes and already our lives were changed.

For the first few weeks he only wore his glasses for two to three hours per day and we did nor push the issue, since we wanted him to want to wear them. By the end of the third month he was wearing them 90% of the day. Ten months later he has them on when he comes down to breakfast and they are still on when he falls asleep at night.

The changes made in our home life were gradual but steady. Before vision therapy he spent long periods of time staring trance-like into space, even as he walked. After vision therapy, Jimmy began to visually investigate his immediate environment. He is now investigating his therapists’ offices as though seeing them for the first time. He plays with his toys more appropriately instead of tapping them or making rows of them.

At age 13 Jimmy can now tie his own shoes. He is able to do this now because he has learned to “look” at what he is doing. He always puts his clothes on by himself, front-ways, and is very proud of this accomplishment. Before, dressing was hit-or-miss, with clothes put on backwards, or shoes on the wrong feet. Jimmy cares about his appearance now. After his shower he wants his hair blow-dried and styled, and wants to be told he looks handsome. He now washes himself and shampoos his own hair; drying himself when he is done. I believe this is because he now “looks” at what he is doing, something he could not seem to do before vision therapy.

All of his other therapies have benefited from vision therapy as well His progress in speech therapy has sky rocketed! He was basically non-verbal a year ago, and now uses speech to communicate. He makes eye contact while communicating with no trouble — before now, eye contact was fleeting.

School is as different as night from day since vision therapy began. Jimmy has a longer attention span, follows instructions better, listens more closely and can sit for longer periods of time. Last year his time was spent doing sheltered workshop jobs, daily living skills, and he had lots of free time.

This year he has three or four five-minute breaks during his morning, with the rest filled with learning activities.

His classes are in the high school building this year and Jimmy has noticed that the kids there look and act different than the elementary kids did. He is trying very hard to be like the older kids. Socially, he is much happier. He wants to be in our company at home, instead of shut in his bedroom. He used to cry when told we were going out, but Jimmy loves outings in the community now, asking to go places every day. He wants to be a part of the world now. In stores, he pushes the shopping cart. If told he can pick a snack, he takes time and scans the shelves looking for what he likes, instead of blindly grabbing the first item. Stores used to give him panic attacks which sent him running for the nearest exit.

Our life together has definitely changed! Our son is still autistic, and in need of years more of his therapies, but he now makes steady progress and is happy and proud of himself. He likes himself and wants to be an active part of his family, community and world.
by Mrs. Roxane Barricklow

I am writing to explain some of the changes I noticed when a child with autism temporarily stopped going to Vision Therapy. The day after her last appointment I noticed that she was doing a considerable amount of “hand flapping.” This followed with at least a week of noise making, hand flapping, short attention span when reading, defiance, and increased talking to herself. I asked her mother if something unusual was happening at home. She didn’t think anything had changed. I realized that this self-stimulating behavior could be the result of a number of things happening both internally and externally in the world of a child who has autism. I looked at the situation from all angles and arrived at the conclusion that this behavior was a result of the break in Vision Therapy.

The Vision Therapy she receives has not only been helpful in her vision, but also helps her stay focused in activities for a longer period of time. Her speech therapist reports that she can start a task and stay completely focused for as long as 12 minutes. Since beginning Vision Therapy, she has been able to remain in control (with reminders to stay focused) and sit on her own with others for as long as 30 minutes, this is something she could not do 7 months ago. The structure that the therapy provides is apparent in her increased ability to complete a task such as reading 1-2 pages aloud, and also her ability to stay in control in unfamiliar environments.

Thank you very much for all your work and patience, it has been beneficial. I will be trying to come up with funding for her to continue with the Vision Therapy, because it is essential, especially as she is growing and changing. Hopefully, the therapy will continue to assist in the goal of independence in most or all areas of her life. Thank you.
Chris VandeHey, Teacher, 2/25/95

Developmental optometrist Randy Schulman has reported seeing marked improvements in autistic individuals treated with both traditional prescription glasses and special lenses and prisms that alter sensory input. Schulman reported in 1994 that “of the cases in which I had the opportunity to do vision therapy, …25% [of patients] made slow progress, 30% made fair progress, and 45% made good progress.” Schulman notes that farsightedness, intermittent strabismus (misalignment of the eyes), and other vision problems are frequently encountered in autistic individuals. Schulman suggests that autistic symptoms such as poor visual pursuit and fixation may be linked to cerebellar defects reported by autism researchers.

Schulman cites Donna Williams, a well-known author with autism, who benefited dramatically from wearing tinted lenses. Williams stated that when she put on her glasses for the first time, “the room didn’t seem so crowded, overwhelming or bombarding. The background noise I had always heard before was not even apparent.” Schulman speculates that for autistic individuals, special lenses and prisms “may break the dependence on an inflexible structure based on misperceptions.”

‘Optometry’s role in the treatment of autism,’ Randy L. Schulman, Journal of Optometric Vision Development, Vol. 25, Winter 1994

The poor eye contact, toe walking, and odd neck and body postures of many autistic individuals may be due to vision problems, according to a study that suggests that these abnormal symptoms can be reduced by corrective lenses.

Melvin Kaplan et al. suggests that autistic children have abnormal “ambient vision,” the type of vision used to orient oneself to the environment, movement, and depth. The symptoms demonstrated by autistic children,” the researchers say, “may be an adaptation to an ambient visual system that has distorted the appearance of the spatial environment.”

Kaplan et al. studied 14 autistic children between the ages of 4 and 15, noting their head positions and body posture during activities such as watching television, balancing on a beam, or catching a ball. In addition, the researchers studied the facial expressions of the children. Then they evaluated the children’s head positions, posture, and facial expressions when corrective prism lenses (clear glass lenses slightly thicker at the top or bottom) were introduced. The researchers’ findings:

  • Children who previously tilted their heads during activities were significantly more likely to hold their heads erect, in the correct position, while wearing the lenses.
  • In the ball-catching task, the prism glasses led to an increase in active catches, and a decrease in passive catches and misses. “Performance improvements in the group were immediate,” the researchers report, saying that “head tilt, posture, and interaction with a moving object were improved.”
  • The children’s facial expressions were generally much less tense while they were wearing the corrective lenses.

Kaplan et al. conclude that professionals should consider incorporating corrective ambient lenses into standard treatment programs for autism. The higher level of performance seen in autistic individuals wearing the glasses, they say, “may lead to improved interaction with others at school and play, and perhaps a more pleasurable interaction with the environment.”

Reprinted from Autism Research Review International, Biomedical Update, Page 4, Volume 10, Number 4, 1996, Based on the following study: Postural orientation modifications In autism. In response to ambient lenses, Melvin Kaplan, Dennis P. Carmody, and Alexa Gaydos, Child Psychiatry and Human Development Vol. 27, No. 2, Winter 1996, pp. 81-91.