Vision and Autism

M.O.V.E. Therapy^SM

improving the lives of those with Autism Spectrum Disorders

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"The very essence of leadership is that you have to have a vision."
        - Theodore Hesburgh

"The best work we can all do is create the highest vision possible for our lives and be
led by that vision to the greatest good."
        - Oprah Winfrey

"It is a terrible thing to see and have no vision."
        - Helen Keller

OVERVIEW OF VISION

As the above quotes indicate, vision is more than just a person's ability to see 20/20. Helen Keller's quote sums it up well. It is possible to have fine eyesight yet have poor vision. In fact, the majority of children with autism have fine eyesight, but extremely poor vision.

Eyesight is an important part of vision, but vision involves more. Specifically, vision is:

the brain's ability to control the eyes to bring in visual information quickly, accurately and comfortably
the brain's ability to analyze the visual information
the ability to utilize the visual information.

Ability to Bring in Visual Information

The physical eyeball is like a camera and the brain is like the person using the camera. The more highly skilled the cameraperson, the better the pictures taken by the camera will be. If the person controlling the camera does not know how to use the camera well, then the pictures taken will not be good.

In order for accurate visual information to be taken, the brain must be able to control the eyes to do the following:

focus
work as a coordinated duo
execute fine eye movements
point accurately at an object
actively bring in visual information at the same time

If a person brings in inaccurate visual information, then what is analyzed and utilized for higher level thinking and performance will be adversely affected.

Ability to Analyze Visual Information

After visual information is brought in by the eyes, the brain must figure out what it sees. Visual information enters the eye in the form of light. The light is then sent to the back of the eye. This light information is then changed into neuronal signals, and is sent to the back of the brain.

Once the neuronal signal arrives at the back of the brain, the brain begins to analyze what it sees. For example, the object that a person looks at arrives in the back of the eye as an upside-down picture. The brain will then analyze the information and help the person see the picture in the correct orientation. Another example would be the analysis of the alphabet and numerals. Numbers and ABC's are merely a series of lines and curves placed in different positions. Proper analysis of the visual information is required to consistently identify the numbers and alphabet correctly.

Ability to Utilize Visual Information

Once the visual information is analyzed at the back of the brain, this information is sent to over 30 different areas in the brain that affect processes such as language, movement, cognition, balance, attention and more. Since vision affects so many areas in the brain, severe deficits in vision may lead to, or contribute heavily to, certain behaviors.

AUTISM AND VISION

The diagnosis of autism is based upon the appearance of symptoms or behaviors across three specific areas - social interaction, communication and repetitive/stereotyped behaviors. If a child shows a combination of specific behaviors within those three areas, then he will be diagnosed with an autism spectrum disorder.

Behind every behavior is a cause. For example, whenever a person in Chicago walks outside in the month of January, she will wear a heavy coat. The reason for this behavior is the sub-20 degree weather in Chicago during January. Similarly, behind each autistic behavior is a cause. Autism is a complex disorder. In some children, the cause may be nutrition. In others, the cause may be something completely different. Vision is one of the possible causes behind the behaviors seen in some children with autism.

Vision and Social Interaction

One of the important building blocks in developing social interaction is a skill called joint attention. Joint attention is the ability to look at the same thing at the same time as another person through the use of eye contact and gestures. There are two types of joint attention - Response to Joint Attention (RJA) and Initiating Joint Attention (IJA). Children with autism often have poorly developed joint attention. In particular, children with autism often have a greater deficit in IJA. The purpose of IJA is to share interests with others. Not coincidentally, one of the behaviors associated with autism is the lack of spontaneous sharing of likes and dislikes with others.

The ability to perform IJA is controlled in the brain by four areas, one of which is the Frontal Eye Fields (FEF). In clinical studies that take pictures of the brain during social situations, the part of the brain that is shown to be the most consistently active is the FEF. These pictures of the brain provide neurologic evidence that the FEF and the functions that it is responsible for plays an important role in social interaction.

The FEF is responsible for starting eye gaze movements, fine eye movements and visual attention. Eye gaze movements, or the ability of the brain to accurately move the eyes to an object of interest, is important for joint attention. In turn, joint attention is important in developing social skills. Vision, therefore, plays a vital role in social interaction because eye movements and subsequent visual attention affects the development of joint attention.

Vision and Language

For the longest time, scientists believed that only two areas in the brain affect language - Broca's area for receptive language and Wernicke's area for expressive language. More recent picture studies of the brain show that there is a third area in the brain that directly affects language - the inferior parietal lobule. Information from the inferior parietal lobule travels to both Wernicke's area and Broca's area to affect the development of language.

One of the areas in the brain that visual information travels to is the inferior parietal lobule. Vision affects language by sending visual information through the inferior parietal lobule directly into the parts of the brain that are responsible for language. This visual information changes the messages in Broca's area and Wernicke's area, and language is thereby affected.

Vision also affects early word acquisition through its role in joint attention. Infants begin learning new words by associating the sound that is made by the parent with the object or picture that the parent is pointing to. In other words, joint attention is an active part of teaching an infant her first words. For example, a mother will try to direct her infant's attention towards the father through eye contact and/or gestures. Once the infant is looking at the father, the mother will repeatedly say, "Daddy", in order to teach the infant who is or what is "Daddy". If eye gaze movements and visual attention is poorly developed, then the mother's attempt to teach her infant a new word will be difficult.

Vision and Repetitive/Stereotyped Behaviors

Children with autism often have a difficult time answering the question of "Where is it?". Many of the self-stimulatory behaviors that are seen as the problem in children with autism are actually the children's own solutions to a problem that they are having. Behaviors such as toe-walking, hand-flapping, and rocking back and forth are a child's solution to his problem of answering the question of "Where is it?" in his environment. Children with autism often have a difficult time understanding where something is in space, where they are in space and where things are in relation to themselves.

One of the areas in the brain that visual information travels to is the parietal lobule. Studies involving brain-injury patients show that the nerves carrying visual information in the parietal lobule is crucial in answering the question of "Where is it". Some MRI studies show that people with autism have abnormalities in their parietal lobule when compared to people without autism. These studies seem to provide neurologic evidence for the struggles in answering the question of "Where is it" in children with autism.

Another vision problem that leads to repetitive/stereotyped behaviors in children with autism is the poor integration of central visual detail and peripheral visual detail. Some people with autism have difficulty understanding the whole because they only seem to notice the part. For example, a child may look at a picture of a forest and focus in on one of the trees, but not understand that there are many other trees in the picture that make up the forest. There are many examples of this in real life. Take, for example, crossing a busy street. A person who can combine central and peripheral visual detail will understand that there are many cars driving by, and that crossing the street before all the cars have passed would be dangerous. On the other hand, a child who has difficulty using central and peripheral detail simultaneously may get stuck on the red fire hydrant that is across the street. The child may seem to only notice the red fire hydrant at the exclusion of the cars going by. This is the reason why a child may not seem to notice the cars even though it is obvious to the frightened, and perhaps, frustrated parent.

Face recognition is another day-to-day activity that is affected by poor integration of central and peripheral visual detail. Some people with autism may tend to lock into one part of the face instead of seeing the whole. They will see a nose, an ear or a chin, but not be able to combine this information into forming the entire face. It is like taking pieces of a jigsaw puzzle and spreading them apart rather than placing them all together. Separating the individual pieces makes it more difficult to understand and consistently recognize the picture. Consequently, some children with autism may not be able to consistently recognize even their primary caretaker.