Seeing Through New Eyes

Changing the Lives of Children with Autism, Asperger Syndrome and other Developmental Disabilities Through Vision Therapy

Melvin Kaplan

• Publisher: Jessica Kingsley Publishers
• Year: 2005
• ISBN:
  9781846422478
• Topic: Education
• Subtopic: Inclusive Education

Seeing Through New Eyes offers an accessible introduction to the treatment of visual dysfunction, a significant but neglected problem associated with autism spectrum disorders (ASDs) and other developmental disabilities.

Dr. Kaplan identifies common ASD symptoms such as hand-flapping, poor eye contact and tantrums as typical responses to the confusion caused by vision disorder. He also explains the effects of difficulties that people with autism experience with "ambient vision", including a lack of spatial awareness and trouble with coordination. Other chapters give guidance on how to identify the visual deficits of nonverbal children, select prism lenses that will alter the visual field, and create individually tailored programs of therapy in order to retrain the system.

This book is essential reading for parents of children with ASDs, and professionals in the fields of autism, optometry and ophthalmology, psychology and education.

Part I

Understanding Visual Dysfunction and the Role of Prism Lenses and Vision Therapy

CHAPTER 1

The Behavior is the Solution

We don’t think of autism spectrum disorders, hyperactivity, and other learning and behavior disorders as problems that involve visual dysfunction, but we should. That’s because vision involves the brain as well as the eyes, and many disabled children suffer from neurological problems that prevent them from correctly perceiving what their eyes see. These perceptual deficits can translate into impaired social skills, poor language skills, motor problems, and a host of other severe symptoms—even in children with 20/20 eyesight.

Why do vision problems have such far-reaching consequences? The human organism is a “spatial action system,” and most of the information we receive from our environment comes from our visual processes. When these processes break down, the result can be catastrophic—because seeing a world that’s distorted, fragmented, two-dimensional, or incomprehensible can be as disabling as not seeing anything at all.

Frequently, disabled children or adults respond to the confusion and fear created by visual impairment by developing the symptoms that doctors see as “problems"—rocking, hand-flapping, toe-walking, poor eye contact, social withdrawal, tantrums, odd posture, rituals, hyperactivity. If you are a clinician, the most important idea I will ask you to consider in this book is to see these symptoms not as problems, but as solutions to problems. By viewing the behaviors of your patients as clues, and allowing these clues to guide you to the correct treatments for your patients’ visual deficits, you will discover that you can free these individuals to see their once-frightening world in a new and exciting way.

Anna, a nonverbal autistic eight-year-old, failed to respond to puzzles, the TV, a game of catch, or any other activities until I placed a pair of ambient prism lenses on her face. Instantly, she rose and began exploring the room, stopping in front of a full-length mirror to dance.

When I attempted to remove the lenses, she held them tightly to her face and cried, “My eyes! My eyes!”

I’m not a fan of labels in my practice. The patients I see have lots of these labels—autistic, learning disabled, emotionally disturbed, hyperactive, attention disordered—but I don’t view people with disabilities as different. Instead, I view them as having different levels of visual performance.

Visual performance can be conceived as a bell curve, with optimal performance at the peak. On one end of the curve are people who experience visual compression, and at the other end are those who experience visual disparity. I’ll discuss both of these perceptual problems later, but for now it’s important simply to understand that almost nobody is at the peak of this bell curve. To some degree, we are all autistic, or learning disabled, or attention disordered, because our vision doesn’t work perfectly.

For most of us, however, this visual dysfunction is mild enough to masquerade as normal behavior or slight eccentricity. For instance, you might know a person who says, “Don’t talk to me while I’m driving.” Or maybe you know someone who can’t tell left from right, or reads with one eye shut. All of these are ways of coping with visual dysfunction.

What is the difference between these people, and Anna, my nonverbal autistic patient? It’s simply a matter of degree: the greater the degree of sensory dysfunction, the harder it becomes to process information, and to organize and orient to the environment—and, as a result, the harder it is to behave in what we consider a “normal” way.

The brain can be compared to a system of roads, with information traveling from one location to another. If the roads are direct and smooth, travel is easy. If construction creates a barrier, however, the highway is blocked and traffic may be redirected into clogged side streets. There is still movement, but it is slow and frustrating. Children with severe visual dysfunction spend too much time on these side streets, and the simple act of perceiving the world, and reacting to that perception, becomes a nightmare.

From vision problems to behavior problems

The children I treat have varying levels of visual problems, and the more severe their problems, the more pronounced the behavioral and academic effects. Here is a hierarchy of the effects of increasingly severe visual dysfunction:

Level 1:Problems with reading; difficulty with physical activity and sports; some types of social problems.

Level 2:Problems with visual organization and depth perception. This can manifest as anxiety, panic, or difficulty with night vision.

Level 3:Weakness in visual organization and visual orientation. This severe level of visual dysfunction can contribute to autistic behavior, as well as to symptoms of bipolar disorder and schizophrenia.

Of course, children with behavioral problems have multiple sensory issues, and visual dysfunction is just one of them. But because 80 percent of the information we receive from our environment is visual, the visual aspect of sensory dysfunction can have far-reaching and devastating consequences. It is hard to overestimate the difficulty of functioning in a world where you can’t tell where you are, where other people are, where objects are, or even where your body ends and the outside world begins.

To show a parent or professional just how debilitating visual dysfunction can be, I like to offer a real-life example. To do this, I set up two chairs, 10 to 15 feet apart, and ask my subject to sit in one of the chairs. Then I ask the person to stand up, walk to the other chair, and sit down on it without “feeling” for it by hand. It’s a simple task, and no one has any trouble performing it.

Next, I place disruptive ambient lenses on my subject, and ask, “Can you see the other chair?” The answer is always “Yes,” because ambient lenses have no effect on the ability to identify an object. I then ask my subject, once again, to walk to the other chair.

When people try this with the disruptive lenses in the “down” position, they knock over the chair. When they try it with the lenses in the “up” position, they stop short of the chair. Their loss of orientation affects their vestibular system, and they feel as if the room is swaying. Fearful, they respond by slowing down, shifting their bodies forward or back, toe-walking, or waving their arms as they walk. All of these are consistent with the “stims” we see in autism.

The people who participate in this experiment move from an ordered view to a disordered view, and within minutes they develop “symptoms” as a result. I ask them to imagine what it’s like to live in that disordered world not for a few minutes, but for a lifetime.

Another way in which I help parents and professionals comprehend the disabling effects of visual dysfunction is to correct their own (usually relatively mild) visual deficits. One day, for instance, while I was working with the five-year-old daughter of an attorney named Jim, he asked me, “Why does she respond so well to the lenses?” Rather than simply telling him, I showed him.

First, I conducted a few quick tests that allowed me to identify Jim’s perceptual style. Then I asked him, “Did you ever play sports?” He said yes—he’d played football, as a linebacker. “Your perceptual style tells me that you’d defend well in the outside, but you’d have trouble over the middle,” I told him. “Let me show you why.”

I threw a ball to him, and although he caught it, his timing was off and he caught it close to his body. Then I gave him ambient lenses, and threw the ball to him again. This time, he reached out and caught it easily. Shaking his head, he said, “I could have been a pro.” He shared that he’d played on a university team, but his timing was off and he wasn’t picked by the professional scouts.

Jim’s subtle visual impairment cost him a chance at a professional sports career, but it didn’t seriously affect his ability to function in other areas. The patients I typically see, however—patients like Jim’s daughter—are much further from optimal on the bell curve of visual performance. For them, the world is an alien, confusing, and frightening place that can’t be effectively addressed in any “normal” way.

Many hyperactive children, for instance, see the world as two-dimensional rather than three-dimensional. Objects in their environment appear flat to them, and they don’t visually “feel” them. When you look at a house plant or a vase, you can easily grasp its form and location, but a hyperactive child can’t, and thus he or she has an overwhelming urge to grasp the object physically—often with disastrous results. What looks like a behavior problem—"Johnny’s out of control, he’s like a bull in a china shop"—is actually the child’s way of accommodating to a world in which space and form are distorted. Johnny can’t locate objects with his visual system, so he uses his motor system. He’s not bad, or wild; in fact, he’s being perfectly logical.

Hypoactive children, on the other hand, react to their visual problems by saying, in effect, “I give up.” Like a person simultaneously being told to turn left, turn right, go straight, and go backward, these children attempt to deal with a barrage of conflicting messages by doing nothing at all. These are the wallflowers, the kids who sit in the back of the class and hope they won’t be noticed, and the children who sit on the sidelines as spectators. They’re not lazy, or obstinate; rather, they’ve learned that they’re likely to fail or even get into trouble by trying to act on the distorted visual data they receive.

To autistic children, the world can appear even more alien and unwelcoming, because their visual systems are far more impaired. Well-known autistic author Donna Williams, for example, remembers how walls would ripple and shimmer when she looked at them. Other autistic people experience “white-outs” and “black-outs,” or say that looking at people directly is like looking “through a bowl of jelly.”

These problems stem from deficits in the ambient vision processes involved in peripheral vision. Autistic and other disabled children often have perfectly normal focal vision—the central vision that allows us to identify objects when we look straight at them. In other words, they have no problem with the “What is it?” function. The problem lies instead with ambient vision, which involves the entire field of vision and tells us about the location of objects in space—the “Where is it?” function (more about this in Chapter 2).

When ambient vision is functioning properly, the eyes work as a team, producing separate but overlapping images. This allows us to see in three dimensions, and to accurately judge distance and movement. In patients with autism or related disabilities, we typically see two types of altered vision:

•“Tunnel vision” or compressed vision (hyperconvergence), in which the field of vision is constricted to a relatively small circle. Focusing only on what they see in this “tunnel,” people with compressed vision view the world in two dimensions and cannot accurately judge distance or motion. In some cases, the world appears to be collapsing in on them.¹

•“Alternating” vision (hypoconvergence or visual disparity), in which the eyes see two different images with no overlap. The person who exhibits hypoconvergence is basically seeing two dissimilar and competing views of the world. The result can...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Contents
• Dedication
• Foreword
• Part I: Understanding Visual Dysfunction and the Role of Prism Lenses and Vision Therapy
• Part II: The Kaplan Nonverbal Battery: Testing and Interpretation of Results
• Part III: Planning a Visual Management Program
• Appendix: The Van Orden Star: A Window Into Personal Space
• Glossary
• Subject Index
• Author Index