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Autism spectrum disorder is characterized by severe deficits in socialization, communication, and repetitive or unusual behaviors. Autism is a neurodevelopmental disorder in the category of pervasive developmental disorder.

Autism typically appears during the first three years of life. It affects normal functioning of the brain, and has an impact on the development of social interaction and communication skills. Here are some common associated behaviors:

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Social behavior:

  • Limited use and understanding of non- verbal communication such as eye gaze, facial expression and gesture
  • Difficulties forming and sustaining friendships
  • Lack of seeking to share enjoyment, interests and activities with other people
  • Difficulties with social and emotional responsiveness

Visual behavior:

Visual behavior for individuals with ASD includes photosensitivity, hyper and hyposensitivity, anomalous color perception process- in, and difference in processing central and peripheral stimuli. Face processing, gaze shifts, visual integration with the other senses, and visual closure are affected as well. It has been also noted that motion processing, visual spatial and visual-motor processing and spatial awareness including visual neglect are anomalous. There are many other visual behaviors associated with ASD, such as looking at an object while tilting head and looking through the corner of the eyes, repetitious movements of the fingers and hands, often within the line of the subject’s vision, stereotypical behavior such as fixating on windows and blinds. Poor eye contact, fidgeting with objects, and looking at spinning objects are also some common symptoms and behavior in ASD.

Gaze aversion is a visual behavior fre- quently associated with ASD in which the individual looks away or avoids eye contact. Poor eye tracking and fixation skills are the most common reasons that contributes to this particular behavior.

Lateral vision or looking through the corner of the eyes has been attributed to faulty binocular processing and poor inter- hemispheric integration.

Hand flapping or flicking fingers near the face is explained as the compensation for poor visual spatial skills as the individual with ASD lacks the awareness of their body parts.

Communication behavior:

Impaired communication is characterized by:

  • Delayed language development
  • Difficulties initiating and sustaining con­versations
  • Stereotyped and repetitive use of language such as repeating phrases from television

Lack of eye contact, ill sustained fixation and gaze aversions may create obstacles for an individual with ASD in understanding the process of imitation. This serves as a foundation for lip reading and producing sounds in early childhood. Deficiencies in these skills may result in delayed speech and poor acquisition of language and communication.

At Caring Vision Therapy Center with decade of experience and research we have developed and validated a protocol to address these issues in ASD population with vision therapy in a very phasic and strategic manner, which includes 7 different phases:

1) Gross motor and spatial orientation training:

Gross motor control includes bilateral coordination, visual motor integration and body awareness. Bilateral coordination allows the child to differentiate right from left and to gain an inherent knowledge of midline and laterality. Visual motor integration enables the child to transition from motor to vision as the primary learning modality.

Orientation can be viewed as eye-body control, which is essential to knowing where we are in relation to other people and to our surroundings. Management of orientation is vital for success since it enables us to sit still, stay on task, and direct concentration.

2) Primitive reflex integration

Primitive reflexes help to coordinate the fine movements of eye muscles, gain accurate accommodative abilities, and develop fusion, fixation and convergence. If primitive reflexes are retained in the body system beyond the maturation periods, they can hinder the normal development of postural reflexes and eye movements.7

3)Eye movements “ fixation, saccades & pursuits

The eye movement skill of tracking and locating includes the eye control abilities of fixation, saccades, and pursuits. These include our ability to visually look at and sustain fixation of a target, capability to follow a moving target (pursuits), and the skill to shift one’s center of focus between successive points of fixation (saccades).

4) Focusing ability- accommodation

Focusing skills require both of the following: 1) an adequate range or ability to shift focusing for both far and nearby seeing, and 2) good flexibility to make shifts quickly, easily, and automatically. Accommodative range and flexibility are required to discern what we select, look at, and perceive.

5) Eye teaming ability

Eye teaming is the ability to yoke and align the eyes precisely so that the brain can unify the input it receives from each eye. Binocular problems encompass difficulty in coordinating and using both eyes together effectively.

6) Visual attention and span:

Visual Attention and Span refers to how much an individual can visually take in, attend to, and gain understanding at any one time.12

7) Visual information processing- Visuo -Perceptual Cognitive Therapies

Visual information processing can best be described as the developed process of correlating and relating to things, people, and the world around us. Visual unification occurs as one utilizes past experience and correlates information from all areas of vision with inputs from other sensory systems. This overseeing operation of vision embraces many functions often classified as visual perception.13

As visual behavior is an important aspect of Autism Spectrum Disorder, our developed and validated protocol has shown improved outcome and reduction of overall symptom scores post vision therapy, along with improvement in social behavior and communication.

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