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3 4 ALTERNATIVE TREATMENTS

To SEE OR NOT To SEE Visual therapies for children with autism can yield far-reaching benefits

BY NE IL MARGOLIS 00 FCOVD

Eighteen yea rs ago 1 ex ploring and becom ing was asked to eva lu - used to my presence and

my voice while I talk to the had been diagnosed on the

te a young boy who parent Often I will sit on

auti sm spectrum What a lo w sea t or even on the immediate ly ca ught my floor to make m yself less attention was tha t he was int im idating an d whil e squinting his eyes and reshy talking to the parent about peatedly winking one eye the childs school placeshyHe was squinting so badly ment other therapies and in fact that you could hardshy observa tions re lative to the ly see his eyes His mother child s visual behavior I explained to me that her ge t th e chance to observe sons other doctors had reshy the c hild as h e mo ves ferred to the squinting as a around the room stim behavior and that it Once hes comfortable would go away with time in his surround ings I will

After eva luating this ha ve him look across the boy who was nonverbal room at th e VId eo or to I was able to determine mec hanical puppets while that h e was actually 1 measur e his refraction experienc ing double vi shy error (a fault in how the Sion - sq uinti ng and eye fo c uses light) using a repea tedly closing one retinoscope a hand-held inshyeye was his way of solvshy strument that incorporates ing the problem-and by a light I also have a camera prescribing specia l prism that screens for high refracshyglasses I was able to ge t tion problems while taking

FU N GAMES- Timothy Price enJoys one of several fun vision therapyrid of hI S double vision a picture four fe et awayexercises with Visi 11 Therapist nil Bayless

His squint ing ceased his from the chil d This a llows face opened up and he was me to determine in an obshymore visually attentive Jecti ve man ne r-without

This served as a valushy getting too close- whether able lesson in the fact that Vision therapy i individualized ne e ds gl as sesthe child nonverbal child ren o fshy This in itself can be a solushytherapy designed Lo facilitate Lheten te ll us through their tion for visual inattention b e h av iors whaL their and I give parents tips fordevelopment of vision skills uLilizingpro bl ems are For this helping children with tacshyparticular child squintshy tile senSi ti vit y adapt tolenses equipmenL and appropriate ing was a so lu tion for me new glasses it was an opp ortuni ty to developmental learning activities look for answers through EVALUATING VISION

ampvision thera py with the Th e vision eva lu a tion I aim of helping to resolve perform serves to profile vision skill issues that can adve rsely affect how children a childs visual skills ma tch perfor mance concerns to process or interpret visual information weaker skills and recommend strategies or therapies to

address the performance concerns Furthermore 1 a im CASUAL OBSERVER to highlight how relati ve visual strengths may be put to When I first meet a child typically I will pu t on a video best use [or the child But what do I ac tually look [or dim the lights and encourage him to roam the ro om when Im assessing a child)

ALTERNATIVE TREATMENTS 35

Iming e and LO the sit on In the l[less whi le about )l dceshys and to the n or I )serve naves

rtable I will

55 the or to

vvhite act ion IW th e sing a leld inshyJorates amera Tefracshytaking away

allows an ob shyithou t hether asses a solushy~ ntion

ips for th tacshyapt to

ION tion 1 )rofi Ie rns to

pies to I aim put to

10 k fo r

EVE TEAMING

Eye teaming relates to depth perception and near-point visual attention Poor eye teaming causes squinting blinking head lilling poor depth perception and can limit visual attention on the page or interfere with eye contact

I evaluate eye teaming using toys and activities to attract the child s attention while eye alignment is studied The symmetry of light reflections relative to the pupils is judged Observation of eye movements in response to blocking the childs view in an intermittent manner reveals whether the eyes are aligned in a typical manner Having the child reach and pull on a stretchy elastic string held close to his [ace will reveal how well he can team his eyes at short distances and whether he is reaching and looking away or integrating his visual and motor systems in a typical manner

TRACKING I also assess tracking skills by observing the chi ld track a flicker light or iPhone picture or having him look back and forth between changing lights Poor tracking interferes with scanning ones surroundings during times of movement

4 WAYS TO ENCOURAGE COOPERATION

o For lower functioning cllildren use d picture board to show the activities that you wi~h to complete that day Let tilCm be in

charge 01 (11005ing 1he activity they wdnl to do noxr

o Use an hourglass or any visible trmPr to 11elp your child undershystand IIOW much lme b I fT for each dctivity

ror some children iis appropriate 0 use a ~tar reward system

which accurnulates toward ci bigger prize Others may need a

more Immediate tangible reward

G Give your child a sensory break between activities

This affects awareness and the ability to safely negotiate the environment Good tracking is also required to scan all the opllons on a communication device or keep ones place when reading on the page

VISUAL PROCESSING Visual processing defines the ability to learn and remember from visual presentations and to organize and categorize visual information Developmental delays in visual processshying interfere with the learning and identification of letters and words and should be conside red when designing the

GET SOME THERAPY

Adev loprnemal optometri5t 15 a vision care prOVider who is quahfied beyond rou ine eye care to evaluate he functional visual skills ~uch a) trackingeye teaming visual spatial proce5sing Visual analysis skills and he visual sensory system The developmen al optometrist is also qualified 0 prOVide recom mendations for appropriate accomrnodations to compensate for Vision skill weaknesses and to prescribe lenses andor herapy to develop visual skills

The best way to find a doctor to evaluate and trea your child is ~o consult the website of he College of Vision Developmen1 (see rind Out More) board certified doctors Will have Ihe tit le ot Fellow of the College of Vision DeVelopshyment (fcOvD) aher their names In addition Its worth speaking to 0 her therapists who treat your child iJS they might have experience III working wilh a vision therapy praaice In your areaParenr support groups or vebsites will usually provide feedback on tl profeSSional name supplied (0 the group

When it comes to meeting tht cost ot therapy insurance predetermina ion can be made aflci he first evaluation as usually a mediLal diagnosis III addishytion to autism spec rum disorder will be available After testillg is completed most praCtices Will be able to estimate the number of sessions expectecl and the professionill fee per sessior Insurance reimburSlment varie) from plan to plan and from state to state aM policy coverage can -hange over time A practicE WI h an expe1enccd insllrltlnce coordinlt1tr)r can heir ensure the best hance ot reimb J1Semtnt Families should ahvaylt be able to obtain a least oJ

brackering or expected costs before herapy begins Most pradi 5 allow payshyment at the ime services ~(e renderpd r~ther than uptron payrner t

Therapy pro rams Villy inlenCJth based on need goab availabilitysuppOrt from other [llerargti5ts and co-operation f Ihe child ill nle clinic and at home Prograr 115 last on average six months to d year although ome children may leed to be seen fOI a few years Progresgt evaluarions ilTld consultations ilfe used to (I termine the effeuiveness Ol1d ppropriateness of continued rnerilpy

visual display of communication devices In a more advanced child visual processshying skills determine his ability to not ice copying errors and to read known words accurately

To learn about a childs ability to visually analyze or process visual information I sit on the floor with him and watch him solve developmental puzzles Important clues for me include whether a child will insert round shapes into round templates or attempt to fit a square in a round shape and whether he will orient the puzzle shape using vision before mserting it in the template or turn it around and around until it fits (non-visual)

If the child can complete basic form puzzles there are more complex puzzle deshysigns that provide further inSight on visual analytic skills For more advanced children there are abstract tests which use designs and patterns on the page to test how well they can notice differences manage visual clutter or remember what they see-imporshytant requirements for academic learning

VISUAL SPATIAL JUDGMENT Children who appear clumsy or cant orient themselves spatially in their surroundings often have poorly developed visual spatial judgment references Watching how a child phYSically responds to activities requiring him to judge distance to cross his midshyline or separate his body sides to refershyence against himself gives me inSight as to

36 ALTERNATIVE TREATMENTS

VISION THERAPY WAS A VITAL

PUZZLE PIECE FOR My SON

Although my son Leo had been ill occupational and speech rhddflY since he was 17 months old Ile srruggled with nne and ~Jross motor skills So when I altendpd ~n IEP meeting In hiS last yea of early childhood prescho JI lIld he)(d his occupationdllilerapisl ~tale that he was progressin] nicely especldlly in his Ime motor skills It was d

shock-as far lt1S I was concerned that seemed to be his big est is)ue

I continueci stressing in the IEP meetilg~ hat some IlIn9 was mlssinq but the tearn didnt see my son the sarn way Idid I knew what he w scapabltmiddot of ilnd what he was prociuclng wa)nl even 1IOSe to what I ~ new he had in his head-bu it wasnt until the end of the school year thal he schoolnurs 011 a hunch test d Leo ror 3D ision lie failed the est and she suygeste J I take him to an olJometrisl I las corn

pletelv perplexed now LUulJ he have VISion problems when he passed his school ision tests had better distilnce vision tllm I dill and he was reading books hefore h

was even In Kindergarten

I sought advice Irom Dr Neil Margolis and after our Arst appoill rnenl wilh the riO(tor iI wl10lp new worl J opened I JP for Leo and me W discovPred thiJl even though I () had passed all f hi~ school ey exams he had significant farsightedness Correcti 9 Ilis vision witf giasses helped him not only see bet er but dlso helpe-i to corred hi~ 3D vision Ir Ilat init iltl l VISit Dr Margolis did a series of tests USing simple Items like a pen with ln vbjeci on it to eh J k Leos eye trilcking abilities a barre that lit up like il disco light 0 check Leos plipheral vision senSItivity and several puzzles to est hiss vi~ual perceptior One of tile things that -rruck me most wa~ that when Leo was lskeclto lift lip his riqht arm md his left leg (to che(J hiS ability [0 ClOSS his rnidline) he WilS unable to do it What a surprise to find that somelhlno 50 ~impl e (ould InelishyGlttgt a prollem with visual perception I also learned that Ofltn children who (ant spatially organize themselves using their viSion use tactile LUes ~uch as louchlng evshymiddotytl1lllg ill ordlt1 to Ilelp themselve~ spatially organize things

Dr MargOliS told me l1(lt aithouyllile hild concerns about Leos visuallnformaflon JCtIUISitlon dnd prOces51r y Sklll~ he felliliany or Ihese issues could be corrected with vislolllfierapy llnust admit that I was ~ eptical at nrst-the Imiddotist thing I wanted ro do wa commit to yedr~ of till more therapy But Dr Margolis believed hal Leo would be able TO n lake siqr IInCnt progress within a years time TIerapy would be middot15-minutc weekly SEssions wilh d vl~ion Iherapist anci in order fOI hh therlry to btmiddot effective WE

would heNe to prJctiLe )p~cifiL Illivities will him on a dally basis We ended up payshyIng for the therlpy In advance bUllulklly I)ur il1sLJfan(l~ wmpally picked up cJ good por ion ot tha bill (be Slife to check wi I y)ur il lgturance mrnpany ior covprage and illk to your doctor ~bout possible payment op ions)

Most 01 Leos therapy sessions Involved playing yarn sur rTldkln9 rhe tl- Napy seem like a game to hold his a elltion Our experiences wllh the activities at horne were vpry ~imtl r Much 01 the time we spenT together turned Olll to b quality bon ling lil11p for us and I v1a~ amazed at how quiLkly WI saw irnpr wernents in Iilll I could seELeos ollhdence bUilding his hand-eye coordmiddotnil Ion iml roved he wa~ at Ie to read ITiore n J(~ntly and hi~ hdl1dwriting becarnl legibli bull rhe h 5t Improvement fOI me Nas thatlle dpveioped il better ~ense ot sclt-awarcn(5~ md foe J5 Negative reporl~ frolll ~C11001 were nllJcl1less frequent and he didnt feel he leeJ LO touCI) tverything around him in order to qet il ptrspective of where his bouy was in re latioT 11ip to thil1gs arounu hll11 lit can now attend to non preferred a t ivities for

longer periods of time

We contillue to rnonilor Leos progres yeatJv dUring vision exams I now teel WIgt hilve 1euro tools to keep thiS pilrt 01 his developmpnt in check and am grJtefullo Dr Milrgolis for helping our filmily ~ee more clpally VIsion therapy helped us hn J one more piece of the puzzlt for)Uf SOl I

-Morio Mllik

wnelher the fundamenta l mental map of his body is sufficiently deve loped These foundational references are necshyessary to altow him to advance to mo re sophist icated spatial judgments on the page Watchi ng how the ch ild rota tes his puzzle pieces and orga nizes layo ut on the page are fu rt her applications of visual spatial judgment skills

Spacing on the page when copying ando r reve rsa ls when wr iting are reshylated to developmental delays in visual spatial processing Child re n who are good at reading (hyperlexic) but appea r clumsy wnen [hey move around may have poor visual spatia l skills

CENTRAL AND

PERIPHERAL VISION Children wno appear to use side vi shysion to see or carry out repetitive moveshyment activities often have an imba lance between thei r central and periphera l vision Watching the child respo nd to flicker lights s pin toys and mov ing patte rns or lines gives insight into this

Obser ving a chi ld s postu re ga it orientation and awa reness while wearshying spec ial prism lenses (which acU ust peripheral vision) proVides fu rt her inshyformati on on centralperi pheral vision ba lance Peripheral vision helps LI S or ishyent ourselves to our surroundings and is sensitive to move ment and changes in lighting When peripheral vision is overly dominant it wi ll cause a ch ild to be hype rVig il ant and ove rly dist racted by his su rroundings It will also beshycome an effective patnway for the child to regulate hi mself when he is anxious bored or disregulatecL When a child is completely overwhelmed by visual senshysory input he may respond by tunneling his vision res ulting in clumsiness and poor scanning

VISION THERAPY INTERVENTION If my evaluation suggests that a child s vision skills may be a Signi fica nt barshyrier to progress a vision l nerapy inshytervent ion program can be designed to develop these skil ls A repo rt is writt en to request acco mmodat ions in the classroom and [or integration of

ALTERNATIVE TREATMENTS 37

map oped necshymore n the )tates ayout lI1S of

lying Ie reshy isual o are ppear may

Ie vi shynoveshylance heral nd to )ling lil is gait

wearshyIdJust r inshyision s orishyand mges on IS

ild to

aued J beshych ild LOUS

lid is Isenshyleling and

hilds barshy

y lTI shy

gncd gtrt is [iollS

therapy actlvities with other professionals in the classroom ca rdboard wa lls on the desk glasses with tinted sidcs or wea ri ng ( visor can help chan nel visual attent ion towards the teacher Use of spJc ing Ime guicies dIfferent color lilies couing vlsual clutter and mu ltisensory teaching hel p to compensilte lor visua l processing problems

Outside 01 the educational environment vision therapy can be designed to targe t tracking or eye tea mi ng probshylems using game-like activities that sepa rate head and eye movement comroL Polarized lenses can also be used to ensure both eyes are teaming Visua l ana lytica l experiences are created which require selections in itially using blocks puzzles and shape sorters and wh ich proceed over time (in a deelopmemal hierarcby) to visua l processi ng of deSigns and lener shapes on tbe page

Visua l spatial refe rences are deeloped by engaging the child in physical activ ities that develop body image in space awareness which requires Judgments oj disLance time or orientation Activities thaL practice the app lication of these references include copying and Judging object layout of geoshymetric pieces on a tablejudgi ng right

Periphcrallcentral vision attemion is developed by engaging the child in acci ities that requ ire move ment and balance (periphe ral vision bias) while also attend ing to visual detail for identiflcation (centra l vision bias) By changing the nature of the activ it ) as well as using different lighting and peripheral vision lens the ability to process and manage more visual input is developed in a progressive manner

HELPING CHILDREN SEE CLEARLY I-or many children wit h autism undeveloped and d isregushylaLec vision ca n inter fere with performance in several areas Addressing these visual issues can lead to improvements in learning attention and een behavior

il is incumbclll on the developmemal optometrist-through testing and obse rvation-to understand whether vision is helpi ng or in terfe ring with per formance and development Optimizing the visUJI strategies and therapies avallable to us can yield signiFicant beneflts to children wi th autism Parental involvement also IS key The more the parent understands the reason for the therapy activiti - the mo re the) understand

how to raise and lower the level of and left sides and direction on a page FIND OUT MORE diffIculty of the acti vities the more or Judging bow to space words on interesting and appropriate they canbull College of Vision Development wwwcolldorg the page so that all the wo rds fit make the therapy

AutisDl ~kill Acquisition

JFr 0 gr a Dl TMBehav~Analyst Inc

Creators of ABLLSmiddot R

wwwstimuluspublicationscom or call us 877-221-6099 on of

3 4 ALTERNATIVE TREATMENTS

To SEE OR NOT To SEE Visual therapies for children with autism can yield far-reaching benefits

BY NE IL MARGOLIS 00 FCOVD

Eighteen yea rs ago 1 ex ploring and becom ing was asked to eva lu - used to my presence and

my voice while I talk to the had been diagnosed on the

te a young boy who parent Often I will sit on

auti sm spectrum What a lo w sea t or even on the immediate ly ca ught my floor to make m yself less attention was tha t he was int im idating an d whil e squinting his eyes and reshy talking to the parent about peatedly winking one eye the childs school placeshyHe was squinting so badly ment other therapies and in fact that you could hardshy observa tions re lative to the ly see his eyes His mother child s visual behavior I explained to me that her ge t th e chance to observe sons other doctors had reshy the c hild as h e mo ves ferred to the squinting as a around the room stim behavior and that it Once hes comfortable would go away with time in his surround ings I will

After eva luating this ha ve him look across the boy who was nonverbal room at th e VId eo or to I was able to determine mec hanical puppets while that h e was actually 1 measur e his refraction experienc ing double vi shy error (a fault in how the Sion - sq uinti ng and eye fo c uses light) using a repea tedly closing one retinoscope a hand-held inshyeye was his way of solvshy strument that incorporates ing the problem-and by a light I also have a camera prescribing specia l prism that screens for high refracshyglasses I was able to ge t tion problems while taking

FU N GAMES- Timothy Price enJoys one of several fun vision therapyrid of hI S double vision a picture four fe et awayexercises with Visi 11 Therapist nil Bayless

His squint ing ceased his from the chil d This a llows face opened up and he was me to determine in an obshymore visually attentive Jecti ve man ne r-without

This served as a valushy getting too close- whether able lesson in the fact that Vision therapy i individualized ne e ds gl as sesthe child nonverbal child ren o fshy This in itself can be a solushytherapy designed Lo facilitate Lheten te ll us through their tion for visual inattention b e h av iors whaL their and I give parents tips fordevelopment of vision skills uLilizingpro bl ems are For this helping children with tacshyparticular child squintshy tile senSi ti vit y adapt tolenses equipmenL and appropriate ing was a so lu tion for me new glasses it was an opp ortuni ty to developmental learning activities look for answers through EVALUATING VISION

ampvision thera py with the Th e vision eva lu a tion I aim of helping to resolve perform serves to profile vision skill issues that can adve rsely affect how children a childs visual skills ma tch perfor mance concerns to process or interpret visual information weaker skills and recommend strategies or therapies to

address the performance concerns Furthermore 1 a im CASUAL OBSERVER to highlight how relati ve visual strengths may be put to When I first meet a child typically I will pu t on a video best use [or the child But what do I ac tually look [or dim the lights and encourage him to roam the ro om when Im assessing a child)

ALTERNATIVE TREATMENTS 35

Iming e and LO the sit on In the l[less whi le about )l dceshys and to the n or I )serve naves

rtable I will

55 the or to

vvhite act ion IW th e sing a leld inshyJorates amera Tefracshytaking away

allows an ob shyithou t hether asses a solushy~ ntion

ips for th tacshyapt to

ION tion 1 )rofi Ie rns to

pies to I aim put to

10 k fo r

EVE TEAMING

Eye teaming relates to depth perception and near-point visual attention Poor eye teaming causes squinting blinking head lilling poor depth perception and can limit visual attention on the page or interfere with eye contact

I evaluate eye teaming using toys and activities to attract the child s attention while eye alignment is studied The symmetry of light reflections relative to the pupils is judged Observation of eye movements in response to blocking the childs view in an intermittent manner reveals whether the eyes are aligned in a typical manner Having the child reach and pull on a stretchy elastic string held close to his [ace will reveal how well he can team his eyes at short distances and whether he is reaching and looking away or integrating his visual and motor systems in a typical manner

TRACKING I also assess tracking skills by observing the chi ld track a flicker light or iPhone picture or having him look back and forth between changing lights Poor tracking interferes with scanning ones surroundings during times of movement

4 WAYS TO ENCOURAGE COOPERATION

o For lower functioning cllildren use d picture board to show the activities that you wi~h to complete that day Let tilCm be in

charge 01 (11005ing 1he activity they wdnl to do noxr

o Use an hourglass or any visible trmPr to 11elp your child undershystand IIOW much lme b I fT for each dctivity

ror some children iis appropriate 0 use a ~tar reward system

which accurnulates toward ci bigger prize Others may need a

more Immediate tangible reward

G Give your child a sensory break between activities

This affects awareness and the ability to safely negotiate the environment Good tracking is also required to scan all the opllons on a communication device or keep ones place when reading on the page

VISUAL PROCESSING Visual processing defines the ability to learn and remember from visual presentations and to organize and categorize visual information Developmental delays in visual processshying interfere with the learning and identification of letters and words and should be conside red when designing the

GET SOME THERAPY

Adev loprnemal optometri5t 15 a vision care prOVider who is quahfied beyond rou ine eye care to evaluate he functional visual skills ~uch a) trackingeye teaming visual spatial proce5sing Visual analysis skills and he visual sensory system The developmen al optometrist is also qualified 0 prOVide recom mendations for appropriate accomrnodations to compensate for Vision skill weaknesses and to prescribe lenses andor herapy to develop visual skills

The best way to find a doctor to evaluate and trea your child is ~o consult the website of he College of Vision Developmen1 (see rind Out More) board certified doctors Will have Ihe tit le ot Fellow of the College of Vision DeVelopshyment (fcOvD) aher their names In addition Its worth speaking to 0 her therapists who treat your child iJS they might have experience III working wilh a vision therapy praaice In your areaParenr support groups or vebsites will usually provide feedback on tl profeSSional name supplied (0 the group

When it comes to meeting tht cost ot therapy insurance predetermina ion can be made aflci he first evaluation as usually a mediLal diagnosis III addishytion to autism spec rum disorder will be available After testillg is completed most praCtices Will be able to estimate the number of sessions expectecl and the professionill fee per sessior Insurance reimburSlment varie) from plan to plan and from state to state aM policy coverage can -hange over time A practicE WI h an expe1enccd insllrltlnce coordinlt1tr)r can heir ensure the best hance ot reimb J1Semtnt Families should ahvaylt be able to obtain a least oJ

brackering or expected costs before herapy begins Most pradi 5 allow payshyment at the ime services ~(e renderpd r~ther than uptron payrner t

Therapy pro rams Villy inlenCJth based on need goab availabilitysuppOrt from other [llerargti5ts and co-operation f Ihe child ill nle clinic and at home Prograr 115 last on average six months to d year although ome children may leed to be seen fOI a few years Progresgt evaluarions ilTld consultations ilfe used to (I termine the effeuiveness Ol1d ppropriateness of continued rnerilpy

visual display of communication devices In a more advanced child visual processshying skills determine his ability to not ice copying errors and to read known words accurately

To learn about a childs ability to visually analyze or process visual information I sit on the floor with him and watch him solve developmental puzzles Important clues for me include whether a child will insert round shapes into round templates or attempt to fit a square in a round shape and whether he will orient the puzzle shape using vision before mserting it in the template or turn it around and around until it fits (non-visual)

If the child can complete basic form puzzles there are more complex puzzle deshysigns that provide further inSight on visual analytic skills For more advanced children there are abstract tests which use designs and patterns on the page to test how well they can notice differences manage visual clutter or remember what they see-imporshytant requirements for academic learning

VISUAL SPATIAL JUDGMENT Children who appear clumsy or cant orient themselves spatially in their surroundings often have poorly developed visual spatial judgment references Watching how a child phYSically responds to activities requiring him to judge distance to cross his midshyline or separate his body sides to refershyence against himself gives me inSight as to

36 ALTERNATIVE TREATMENTS

VISION THERAPY WAS A VITAL

PUZZLE PIECE FOR My SON

Although my son Leo had been ill occupational and speech rhddflY since he was 17 months old Ile srruggled with nne and ~Jross motor skills So when I altendpd ~n IEP meeting In hiS last yea of early childhood prescho JI lIld he)(d his occupationdllilerapisl ~tale that he was progressin] nicely especldlly in his Ime motor skills It was d

shock-as far lt1S I was concerned that seemed to be his big est is)ue

I continueci stressing in the IEP meetilg~ hat some IlIn9 was mlssinq but the tearn didnt see my son the sarn way Idid I knew what he w scapabltmiddot of ilnd what he was prociuclng wa)nl even 1IOSe to what I ~ new he had in his head-bu it wasnt until the end of the school year thal he schoolnurs 011 a hunch test d Leo ror 3D ision lie failed the est and she suygeste J I take him to an olJometrisl I las corn

pletelv perplexed now LUulJ he have VISion problems when he passed his school ision tests had better distilnce vision tllm I dill and he was reading books hefore h

was even In Kindergarten

I sought advice Irom Dr Neil Margolis and after our Arst appoill rnenl wilh the riO(tor iI wl10lp new worl J opened I JP for Leo and me W discovPred thiJl even though I () had passed all f hi~ school ey exams he had significant farsightedness Correcti 9 Ilis vision witf giasses helped him not only see bet er but dlso helpe-i to corred hi~ 3D vision Ir Ilat init iltl l VISit Dr Margolis did a series of tests USing simple Items like a pen with ln vbjeci on it to eh J k Leos eye trilcking abilities a barre that lit up like il disco light 0 check Leos plipheral vision senSItivity and several puzzles to est hiss vi~ual perceptior One of tile things that -rruck me most wa~ that when Leo was lskeclto lift lip his riqht arm md his left leg (to che(J hiS ability [0 ClOSS his rnidline) he WilS unable to do it What a surprise to find that somelhlno 50 ~impl e (ould InelishyGlttgt a prollem with visual perception I also learned that Ofltn children who (ant spatially organize themselves using their viSion use tactile LUes ~uch as louchlng evshymiddotytl1lllg ill ordlt1 to Ilelp themselve~ spatially organize things

Dr MargOliS told me l1(lt aithouyllile hild concerns about Leos visuallnformaflon JCtIUISitlon dnd prOces51r y Sklll~ he felliliany or Ihese issues could be corrected with vislolllfierapy llnust admit that I was ~ eptical at nrst-the Imiddotist thing I wanted ro do wa commit to yedr~ of till more therapy But Dr Margolis believed hal Leo would be able TO n lake siqr IInCnt progress within a years time TIerapy would be middot15-minutc weekly SEssions wilh d vl~ion Iherapist anci in order fOI hh therlry to btmiddot effective WE

would heNe to prJctiLe )p~cifiL Illivities will him on a dally basis We ended up payshyIng for the therlpy In advance bUllulklly I)ur il1sLJfan(l~ wmpally picked up cJ good por ion ot tha bill (be Slife to check wi I y)ur il lgturance mrnpany ior covprage and illk to your doctor ~bout possible payment op ions)

Most 01 Leos therapy sessions Involved playing yarn sur rTldkln9 rhe tl- Napy seem like a game to hold his a elltion Our experiences wllh the activities at horne were vpry ~imtl r Much 01 the time we spenT together turned Olll to b quality bon ling lil11p for us and I v1a~ amazed at how quiLkly WI saw irnpr wernents in Iilll I could seELeos ollhdence bUilding his hand-eye coordmiddotnil Ion iml roved he wa~ at Ie to read ITiore n J(~ntly and hi~ hdl1dwriting becarnl legibli bull rhe h 5t Improvement fOI me Nas thatlle dpveioped il better ~ense ot sclt-awarcn(5~ md foe J5 Negative reporl~ frolll ~C11001 were nllJcl1less frequent and he didnt feel he leeJ LO touCI) tverything around him in order to qet il ptrspective of where his bouy was in re latioT 11ip to thil1gs arounu hll11 lit can now attend to non preferred a t ivities for

longer periods of time

We contillue to rnonilor Leos progres yeatJv dUring vision exams I now teel WIgt hilve 1euro tools to keep thiS pilrt 01 his developmpnt in check and am grJtefullo Dr Milrgolis for helping our filmily ~ee more clpally VIsion therapy helped us hn J one more piece of the puzzlt for)Uf SOl I

-Morio Mllik

wnelher the fundamenta l mental map of his body is sufficiently deve loped These foundational references are necshyessary to altow him to advance to mo re sophist icated spatial judgments on the page Watchi ng how the ch ild rota tes his puzzle pieces and orga nizes layo ut on the page are fu rt her applications of visual spatial judgment skills

Spacing on the page when copying ando r reve rsa ls when wr iting are reshylated to developmental delays in visual spatial processing Child re n who are good at reading (hyperlexic) but appea r clumsy wnen [hey move around may have poor visual spatia l skills

CENTRAL AND

PERIPHERAL VISION Children wno appear to use side vi shysion to see or carry out repetitive moveshyment activities often have an imba lance between thei r central and periphera l vision Watching the child respo nd to flicker lights s pin toys and mov ing patte rns or lines gives insight into this

Obser ving a chi ld s postu re ga it orientation and awa reness while wearshying spec ial prism lenses (which acU ust peripheral vision) proVides fu rt her inshyformati on on centralperi pheral vision ba lance Peripheral vision helps LI S or ishyent ourselves to our surroundings and is sensitive to move ment and changes in lighting When peripheral vision is overly dominant it wi ll cause a ch ild to be hype rVig il ant and ove rly dist racted by his su rroundings It will also beshycome an effective patnway for the child to regulate hi mself when he is anxious bored or disregulatecL When a child is completely overwhelmed by visual senshysory input he may respond by tunneling his vision res ulting in clumsiness and poor scanning

VISION THERAPY INTERVENTION If my evaluation suggests that a child s vision skills may be a Signi fica nt barshyrier to progress a vision l nerapy inshytervent ion program can be designed to develop these skil ls A repo rt is writt en to request acco mmodat ions in the classroom and [or integration of

ALTERNATIVE TREATMENTS 37

map oped necshymore n the )tates ayout lI1S of

lying Ie reshy isual o are ppear may

Ie vi shynoveshylance heral nd to )ling lil is gait

wearshyIdJust r inshyision s orishyand mges on IS

ild to

aued J beshych ild LOUS

lid is Isenshyleling and

hilds barshy

y lTI shy

gncd gtrt is [iollS

therapy actlvities with other professionals in the classroom ca rdboard wa lls on the desk glasses with tinted sidcs or wea ri ng ( visor can help chan nel visual attent ion towards the teacher Use of spJc ing Ime guicies dIfferent color lilies couing vlsual clutter and mu ltisensory teaching hel p to compensilte lor visua l processing problems

Outside 01 the educational environment vision therapy can be designed to targe t tracking or eye tea mi ng probshylems using game-like activities that sepa rate head and eye movement comroL Polarized lenses can also be used to ensure both eyes are teaming Visua l ana lytica l experiences are created which require selections in itially using blocks puzzles and shape sorters and wh ich proceed over time (in a deelopmemal hierarcby) to visua l processi ng of deSigns and lener shapes on tbe page

Visua l spatial refe rences are deeloped by engaging the child in physical activ ities that develop body image in space awareness which requires Judgments oj disLance time or orientation Activities thaL practice the app lication of these references include copying and Judging object layout of geoshymetric pieces on a tablejudgi ng right

Periphcrallcentral vision attemion is developed by engaging the child in acci ities that requ ire move ment and balance (periphe ral vision bias) while also attend ing to visual detail for identiflcation (centra l vision bias) By changing the nature of the activ it ) as well as using different lighting and peripheral vision lens the ability to process and manage more visual input is developed in a progressive manner

HELPING CHILDREN SEE CLEARLY I-or many children wit h autism undeveloped and d isregushylaLec vision ca n inter fere with performance in several areas Addressing these visual issues can lead to improvements in learning attention and een behavior

il is incumbclll on the developmemal optometrist-through testing and obse rvation-to understand whether vision is helpi ng or in terfe ring with per formance and development Optimizing the visUJI strategies and therapies avallable to us can yield signiFicant beneflts to children wi th autism Parental involvement also IS key The more the parent understands the reason for the therapy activiti - the mo re the) understand

how to raise and lower the level of and left sides and direction on a page FIND OUT MORE diffIculty of the acti vities the more or Judging bow to space words on interesting and appropriate they canbull College of Vision Development wwwcolldorg the page so that all the wo rds fit make the therapy

AutisDl ~kill Acquisition

JFr 0 gr a Dl TMBehav~Analyst Inc

Creators of ABLLSmiddot R

wwwstimuluspublicationscom or call us 877-221-6099 on of

ALTERNATIVE TREATMENTS 35

Iming e and LO the sit on In the l[less whi le about )l dceshys and to the n or I )serve naves

rtable I will

55 the or to

vvhite act ion IW th e sing a leld inshyJorates amera Tefracshytaking away

allows an ob shyithou t hether asses a solushy~ ntion

ips for th tacshyapt to

ION tion 1 )rofi Ie rns to

pies to I aim put to

10 k fo r

EVE TEAMING

Eye teaming relates to depth perception and near-point visual attention Poor eye teaming causes squinting blinking head lilling poor depth perception and can limit visual attention on the page or interfere with eye contact

I evaluate eye teaming using toys and activities to attract the child s attention while eye alignment is studied The symmetry of light reflections relative to the pupils is judged Observation of eye movements in response to blocking the childs view in an intermittent manner reveals whether the eyes are aligned in a typical manner Having the child reach and pull on a stretchy elastic string held close to his [ace will reveal how well he can team his eyes at short distances and whether he is reaching and looking away or integrating his visual and motor systems in a typical manner

TRACKING I also assess tracking skills by observing the chi ld track a flicker light or iPhone picture or having him look back and forth between changing lights Poor tracking interferes with scanning ones surroundings during times of movement

4 WAYS TO ENCOURAGE COOPERATION

o For lower functioning cllildren use d picture board to show the activities that you wi~h to complete that day Let tilCm be in

charge 01 (11005ing 1he activity they wdnl to do noxr

o Use an hourglass or any visible trmPr to 11elp your child undershystand IIOW much lme b I fT for each dctivity

ror some children iis appropriate 0 use a ~tar reward system

which accurnulates toward ci bigger prize Others may need a

more Immediate tangible reward

G Give your child a sensory break between activities

This affects awareness and the ability to safely negotiate the environment Good tracking is also required to scan all the opllons on a communication device or keep ones place when reading on the page

VISUAL PROCESSING Visual processing defines the ability to learn and remember from visual presentations and to organize and categorize visual information Developmental delays in visual processshying interfere with the learning and identification of letters and words and should be conside red when designing the

GET SOME THERAPY

Adev loprnemal optometri5t 15 a vision care prOVider who is quahfied beyond rou ine eye care to evaluate he functional visual skills ~uch a) trackingeye teaming visual spatial proce5sing Visual analysis skills and he visual sensory system The developmen al optometrist is also qualified 0 prOVide recom mendations for appropriate accomrnodations to compensate for Vision skill weaknesses and to prescribe lenses andor herapy to develop visual skills

The best way to find a doctor to evaluate and trea your child is ~o consult the website of he College of Vision Developmen1 (see rind Out More) board certified doctors Will have Ihe tit le ot Fellow of the College of Vision DeVelopshyment (fcOvD) aher their names In addition Its worth speaking to 0 her therapists who treat your child iJS they might have experience III working wilh a vision therapy praaice In your areaParenr support groups or vebsites will usually provide feedback on tl profeSSional name supplied (0 the group

When it comes to meeting tht cost ot therapy insurance predetermina ion can be made aflci he first evaluation as usually a mediLal diagnosis III addishytion to autism spec rum disorder will be available After testillg is completed most praCtices Will be able to estimate the number of sessions expectecl and the professionill fee per sessior Insurance reimburSlment varie) from plan to plan and from state to state aM policy coverage can -hange over time A practicE WI h an expe1enccd insllrltlnce coordinlt1tr)r can heir ensure the best hance ot reimb J1Semtnt Families should ahvaylt be able to obtain a least oJ

brackering or expected costs before herapy begins Most pradi 5 allow payshyment at the ime services ~(e renderpd r~ther than uptron payrner t

Therapy pro rams Villy inlenCJth based on need goab availabilitysuppOrt from other [llerargti5ts and co-operation f Ihe child ill nle clinic and at home Prograr 115 last on average six months to d year although ome children may leed to be seen fOI a few years Progresgt evaluarions ilTld consultations ilfe used to (I termine the effeuiveness Ol1d ppropriateness of continued rnerilpy

visual display of communication devices In a more advanced child visual processshying skills determine his ability to not ice copying errors and to read known words accurately

To learn about a childs ability to visually analyze or process visual information I sit on the floor with him and watch him solve developmental puzzles Important clues for me include whether a child will insert round shapes into round templates or attempt to fit a square in a round shape and whether he will orient the puzzle shape using vision before mserting it in the template or turn it around and around until it fits (non-visual)

If the child can complete basic form puzzles there are more complex puzzle deshysigns that provide further inSight on visual analytic skills For more advanced children there are abstract tests which use designs and patterns on the page to test how well they can notice differences manage visual clutter or remember what they see-imporshytant requirements for academic learning

VISUAL SPATIAL JUDGMENT Children who appear clumsy or cant orient themselves spatially in their surroundings often have poorly developed visual spatial judgment references Watching how a child phYSically responds to activities requiring him to judge distance to cross his midshyline or separate his body sides to refershyence against himself gives me inSight as to

36 ALTERNATIVE TREATMENTS

VISION THERAPY WAS A VITAL

PUZZLE PIECE FOR My SON

Although my son Leo had been ill occupational and speech rhddflY since he was 17 months old Ile srruggled with nne and ~Jross motor skills So when I altendpd ~n IEP meeting In hiS last yea of early childhood prescho JI lIld he)(d his occupationdllilerapisl ~tale that he was progressin] nicely especldlly in his Ime motor skills It was d

shock-as far lt1S I was concerned that seemed to be his big est is)ue

I continueci stressing in the IEP meetilg~ hat some IlIn9 was mlssinq but the tearn didnt see my son the sarn way Idid I knew what he w scapabltmiddot of ilnd what he was prociuclng wa)nl even 1IOSe to what I ~ new he had in his head-bu it wasnt until the end of the school year thal he schoolnurs 011 a hunch test d Leo ror 3D ision lie failed the est and she suygeste J I take him to an olJometrisl I las corn

pletelv perplexed now LUulJ he have VISion problems when he passed his school ision tests had better distilnce vision tllm I dill and he was reading books hefore h

was even In Kindergarten

I sought advice Irom Dr Neil Margolis and after our Arst appoill rnenl wilh the riO(tor iI wl10lp new worl J opened I JP for Leo and me W discovPred thiJl even though I () had passed all f hi~ school ey exams he had significant farsightedness Correcti 9 Ilis vision witf giasses helped him not only see bet er but dlso helpe-i to corred hi~ 3D vision Ir Ilat init iltl l VISit Dr Margolis did a series of tests USing simple Items like a pen with ln vbjeci on it to eh J k Leos eye trilcking abilities a barre that lit up like il disco light 0 check Leos plipheral vision senSItivity and several puzzles to est hiss vi~ual perceptior One of tile things that -rruck me most wa~ that when Leo was lskeclto lift lip his riqht arm md his left leg (to che(J hiS ability [0 ClOSS his rnidline) he WilS unable to do it What a surprise to find that somelhlno 50 ~impl e (ould InelishyGlttgt a prollem with visual perception I also learned that Ofltn children who (ant spatially organize themselves using their viSion use tactile LUes ~uch as louchlng evshymiddotytl1lllg ill ordlt1 to Ilelp themselve~ spatially organize things

Dr MargOliS told me l1(lt aithouyllile hild concerns about Leos visuallnformaflon JCtIUISitlon dnd prOces51r y Sklll~ he felliliany or Ihese issues could be corrected with vislolllfierapy llnust admit that I was ~ eptical at nrst-the Imiddotist thing I wanted ro do wa commit to yedr~ of till more therapy But Dr Margolis believed hal Leo would be able TO n lake siqr IInCnt progress within a years time TIerapy would be middot15-minutc weekly SEssions wilh d vl~ion Iherapist anci in order fOI hh therlry to btmiddot effective WE

would heNe to prJctiLe )p~cifiL Illivities will him on a dally basis We ended up payshyIng for the therlpy In advance bUllulklly I)ur il1sLJfan(l~ wmpally picked up cJ good por ion ot tha bill (be Slife to check wi I y)ur il lgturance mrnpany ior covprage and illk to your doctor ~bout possible payment op ions)

Most 01 Leos therapy sessions Involved playing yarn sur rTldkln9 rhe tl- Napy seem like a game to hold his a elltion Our experiences wllh the activities at horne were vpry ~imtl r Much 01 the time we spenT together turned Olll to b quality bon ling lil11p for us and I v1a~ amazed at how quiLkly WI saw irnpr wernents in Iilll I could seELeos ollhdence bUilding his hand-eye coordmiddotnil Ion iml roved he wa~ at Ie to read ITiore n J(~ntly and hi~ hdl1dwriting becarnl legibli bull rhe h 5t Improvement fOI me Nas thatlle dpveioped il better ~ense ot sclt-awarcn(5~ md foe J5 Negative reporl~ frolll ~C11001 were nllJcl1less frequent and he didnt feel he leeJ LO touCI) tverything around him in order to qet il ptrspective of where his bouy was in re latioT 11ip to thil1gs arounu hll11 lit can now attend to non preferred a t ivities for

longer periods of time

We contillue to rnonilor Leos progres yeatJv dUring vision exams I now teel WIgt hilve 1euro tools to keep thiS pilrt 01 his developmpnt in check and am grJtefullo Dr Milrgolis for helping our filmily ~ee more clpally VIsion therapy helped us hn J one more piece of the puzzlt for)Uf SOl I

-Morio Mllik

wnelher the fundamenta l mental map of his body is sufficiently deve loped These foundational references are necshyessary to altow him to advance to mo re sophist icated spatial judgments on the page Watchi ng how the ch ild rota tes his puzzle pieces and orga nizes layo ut on the page are fu rt her applications of visual spatial judgment skills

Spacing on the page when copying ando r reve rsa ls when wr iting are reshylated to developmental delays in visual spatial processing Child re n who are good at reading (hyperlexic) but appea r clumsy wnen [hey move around may have poor visual spatia l skills

CENTRAL AND

PERIPHERAL VISION Children wno appear to use side vi shysion to see or carry out repetitive moveshyment activities often have an imba lance between thei r central and periphera l vision Watching the child respo nd to flicker lights s pin toys and mov ing patte rns or lines gives insight into this

Obser ving a chi ld s postu re ga it orientation and awa reness while wearshying spec ial prism lenses (which acU ust peripheral vision) proVides fu rt her inshyformati on on centralperi pheral vision ba lance Peripheral vision helps LI S or ishyent ourselves to our surroundings and is sensitive to move ment and changes in lighting When peripheral vision is overly dominant it wi ll cause a ch ild to be hype rVig il ant and ove rly dist racted by his su rroundings It will also beshycome an effective patnway for the child to regulate hi mself when he is anxious bored or disregulatecL When a child is completely overwhelmed by visual senshysory input he may respond by tunneling his vision res ulting in clumsiness and poor scanning

VISION THERAPY INTERVENTION If my evaluation suggests that a child s vision skills may be a Signi fica nt barshyrier to progress a vision l nerapy inshytervent ion program can be designed to develop these skil ls A repo rt is writt en to request acco mmodat ions in the classroom and [or integration of

ALTERNATIVE TREATMENTS 37

map oped necshymore n the )tates ayout lI1S of

lying Ie reshy isual o are ppear may

Ie vi shynoveshylance heral nd to )ling lil is gait

wearshyIdJust r inshyision s orishyand mges on IS

ild to

aued J beshych ild LOUS

lid is Isenshyleling and

hilds barshy

y lTI shy

gncd gtrt is [iollS

therapy actlvities with other professionals in the classroom ca rdboard wa lls on the desk glasses with tinted sidcs or wea ri ng ( visor can help chan nel visual attent ion towards the teacher Use of spJc ing Ime guicies dIfferent color lilies couing vlsual clutter and mu ltisensory teaching hel p to compensilte lor visua l processing problems

Outside 01 the educational environment vision therapy can be designed to targe t tracking or eye tea mi ng probshylems using game-like activities that sepa rate head and eye movement comroL Polarized lenses can also be used to ensure both eyes are teaming Visua l ana lytica l experiences are created which require selections in itially using blocks puzzles and shape sorters and wh ich proceed over time (in a deelopmemal hierarcby) to visua l processi ng of deSigns and lener shapes on tbe page

Visua l spatial refe rences are deeloped by engaging the child in physical activ ities that develop body image in space awareness which requires Judgments oj disLance time or orientation Activities thaL practice the app lication of these references include copying and Judging object layout of geoshymetric pieces on a tablejudgi ng right

Periphcrallcentral vision attemion is developed by engaging the child in acci ities that requ ire move ment and balance (periphe ral vision bias) while also attend ing to visual detail for identiflcation (centra l vision bias) By changing the nature of the activ it ) as well as using different lighting and peripheral vision lens the ability to process and manage more visual input is developed in a progressive manner

HELPING CHILDREN SEE CLEARLY I-or many children wit h autism undeveloped and d isregushylaLec vision ca n inter fere with performance in several areas Addressing these visual issues can lead to improvements in learning attention and een behavior

il is incumbclll on the developmemal optometrist-through testing and obse rvation-to understand whether vision is helpi ng or in terfe ring with per formance and development Optimizing the visUJI strategies and therapies avallable to us can yield signiFicant beneflts to children wi th autism Parental involvement also IS key The more the parent understands the reason for the therapy activiti - the mo re the) understand

how to raise and lower the level of and left sides and direction on a page FIND OUT MORE diffIculty of the acti vities the more or Judging bow to space words on interesting and appropriate they canbull College of Vision Development wwwcolldorg the page so that all the wo rds fit make the therapy

AutisDl ~kill Acquisition

JFr 0 gr a Dl TMBehav~Analyst Inc

Creators of ABLLSmiddot R

wwwstimuluspublicationscom or call us 877-221-6099 on of

36 ALTERNATIVE TREATMENTS

VISION THERAPY WAS A VITAL

PUZZLE PIECE FOR My SON

Although my son Leo had been ill occupational and speech rhddflY since he was 17 months old Ile srruggled with nne and ~Jross motor skills So when I altendpd ~n IEP meeting In hiS last yea of early childhood prescho JI lIld he)(d his occupationdllilerapisl ~tale that he was progressin] nicely especldlly in his Ime motor skills It was d

shock-as far lt1S I was concerned that seemed to be his big est is)ue

I continueci stressing in the IEP meetilg~ hat some IlIn9 was mlssinq but the tearn didnt see my son the sarn way Idid I knew what he w scapabltmiddot of ilnd what he was prociuclng wa)nl even 1IOSe to what I ~ new he had in his head-bu it wasnt until the end of the school year thal he schoolnurs 011 a hunch test d Leo ror 3D ision lie failed the est and she suygeste J I take him to an olJometrisl I las corn

pletelv perplexed now LUulJ he have VISion problems when he passed his school ision tests had better distilnce vision tllm I dill and he was reading books hefore h

was even In Kindergarten

I sought advice Irom Dr Neil Margolis and after our Arst appoill rnenl wilh the riO(tor iI wl10lp new worl J opened I JP for Leo and me W discovPred thiJl even though I () had passed all f hi~ school ey exams he had significant farsightedness Correcti 9 Ilis vision witf giasses helped him not only see bet er but dlso helpe-i to corred hi~ 3D vision Ir Ilat init iltl l VISit Dr Margolis did a series of tests USing simple Items like a pen with ln vbjeci on it to eh J k Leos eye trilcking abilities a barre that lit up like il disco light 0 check Leos plipheral vision senSItivity and several puzzles to est hiss vi~ual perceptior One of tile things that -rruck me most wa~ that when Leo was lskeclto lift lip his riqht arm md his left leg (to che(J hiS ability [0 ClOSS his rnidline) he WilS unable to do it What a surprise to find that somelhlno 50 ~impl e (ould InelishyGlttgt a prollem with visual perception I also learned that Ofltn children who (ant spatially organize themselves using their viSion use tactile LUes ~uch as louchlng evshymiddotytl1lllg ill ordlt1 to Ilelp themselve~ spatially organize things

Dr MargOliS told me l1(lt aithouyllile hild concerns about Leos visuallnformaflon JCtIUISitlon dnd prOces51r y Sklll~ he felliliany or Ihese issues could be corrected with vislolllfierapy llnust admit that I was ~ eptical at nrst-the Imiddotist thing I wanted ro do wa commit to yedr~ of till more therapy But Dr Margolis believed hal Leo would be able TO n lake siqr IInCnt progress within a years time TIerapy would be middot15-minutc weekly SEssions wilh d vl~ion Iherapist anci in order fOI hh therlry to btmiddot effective WE

would heNe to prJctiLe )p~cifiL Illivities will him on a dally basis We ended up payshyIng for the therlpy In advance bUllulklly I)ur il1sLJfan(l~ wmpally picked up cJ good por ion ot tha bill (be Slife to check wi I y)ur il lgturance mrnpany ior covprage and illk to your doctor ~bout possible payment op ions)

Most 01 Leos therapy sessions Involved playing yarn sur rTldkln9 rhe tl- Napy seem like a game to hold his a elltion Our experiences wllh the activities at horne were vpry ~imtl r Much 01 the time we spenT together turned Olll to b quality bon ling lil11p for us and I v1a~ amazed at how quiLkly WI saw irnpr wernents in Iilll I could seELeos ollhdence bUilding his hand-eye coordmiddotnil Ion iml roved he wa~ at Ie to read ITiore n J(~ntly and hi~ hdl1dwriting becarnl legibli bull rhe h 5t Improvement fOI me Nas thatlle dpveioped il better ~ense ot sclt-awarcn(5~ md foe J5 Negative reporl~ frolll ~C11001 were nllJcl1less frequent and he didnt feel he leeJ LO touCI) tverything around him in order to qet il ptrspective of where his bouy was in re latioT 11ip to thil1gs arounu hll11 lit can now attend to non preferred a t ivities for

longer periods of time

We contillue to rnonilor Leos progres yeatJv dUring vision exams I now teel WIgt hilve 1euro tools to keep thiS pilrt 01 his developmpnt in check and am grJtefullo Dr Milrgolis for helping our filmily ~ee more clpally VIsion therapy helped us hn J one more piece of the puzzlt for)Uf SOl I

-Morio Mllik

wnelher the fundamenta l mental map of his body is sufficiently deve loped These foundational references are necshyessary to altow him to advance to mo re sophist icated spatial judgments on the page Watchi ng how the ch ild rota tes his puzzle pieces and orga nizes layo ut on the page are fu rt her applications of visual spatial judgment skills

Spacing on the page when copying ando r reve rsa ls when wr iting are reshylated to developmental delays in visual spatial processing Child re n who are good at reading (hyperlexic) but appea r clumsy wnen [hey move around may have poor visual spatia l skills

CENTRAL AND

PERIPHERAL VISION Children wno appear to use side vi shysion to see or carry out repetitive moveshyment activities often have an imba lance between thei r central and periphera l vision Watching the child respo nd to flicker lights s pin toys and mov ing patte rns or lines gives insight into this

Obser ving a chi ld s postu re ga it orientation and awa reness while wearshying spec ial prism lenses (which acU ust peripheral vision) proVides fu rt her inshyformati on on centralperi pheral vision ba lance Peripheral vision helps LI S or ishyent ourselves to our surroundings and is sensitive to move ment and changes in lighting When peripheral vision is overly dominant it wi ll cause a ch ild to be hype rVig il ant and ove rly dist racted by his su rroundings It will also beshycome an effective patnway for the child to regulate hi mself when he is anxious bored or disregulatecL When a child is completely overwhelmed by visual senshysory input he may respond by tunneling his vision res ulting in clumsiness and poor scanning

VISION THERAPY INTERVENTION If my evaluation suggests that a child s vision skills may be a Signi fica nt barshyrier to progress a vision l nerapy inshytervent ion program can be designed to develop these skil ls A repo rt is writt en to request acco mmodat ions in the classroom and [or integration of

ALTERNATIVE TREATMENTS 37

map oped necshymore n the )tates ayout lI1S of

lying Ie reshy isual o are ppear may

Ie vi shynoveshylance heral nd to )ling lil is gait

wearshyIdJust r inshyision s orishyand mges on IS

ild to

aued J beshych ild LOUS

lid is Isenshyleling and

hilds barshy

y lTI shy

gncd gtrt is [iollS

therapy actlvities with other professionals in the classroom ca rdboard wa lls on the desk glasses with tinted sidcs or wea ri ng ( visor can help chan nel visual attent ion towards the teacher Use of spJc ing Ime guicies dIfferent color lilies couing vlsual clutter and mu ltisensory teaching hel p to compensilte lor visua l processing problems

Outside 01 the educational environment vision therapy can be designed to targe t tracking or eye tea mi ng probshylems using game-like activities that sepa rate head and eye movement comroL Polarized lenses can also be used to ensure both eyes are teaming Visua l ana lytica l experiences are created which require selections in itially using blocks puzzles and shape sorters and wh ich proceed over time (in a deelopmemal hierarcby) to visua l processi ng of deSigns and lener shapes on tbe page

Visua l spatial refe rences are deeloped by engaging the child in physical activ ities that develop body image in space awareness which requires Judgments oj disLance time or orientation Activities thaL practice the app lication of these references include copying and Judging object layout of geoshymetric pieces on a tablejudgi ng right

Periphcrallcentral vision attemion is developed by engaging the child in acci ities that requ ire move ment and balance (periphe ral vision bias) while also attend ing to visual detail for identiflcation (centra l vision bias) By changing the nature of the activ it ) as well as using different lighting and peripheral vision lens the ability to process and manage more visual input is developed in a progressive manner

HELPING CHILDREN SEE CLEARLY I-or many children wit h autism undeveloped and d isregushylaLec vision ca n inter fere with performance in several areas Addressing these visual issues can lead to improvements in learning attention and een behavior

il is incumbclll on the developmemal optometrist-through testing and obse rvation-to understand whether vision is helpi ng or in terfe ring with per formance and development Optimizing the visUJI strategies and therapies avallable to us can yield signiFicant beneflts to children wi th autism Parental involvement also IS key The more the parent understands the reason for the therapy activiti - the mo re the) understand

how to raise and lower the level of and left sides and direction on a page FIND OUT MORE diffIculty of the acti vities the more or Judging bow to space words on interesting and appropriate they canbull College of Vision Development wwwcolldorg the page so that all the wo rds fit make the therapy

AutisDl ~kill Acquisition

JFr 0 gr a Dl TMBehav~Analyst Inc

Creators of ABLLSmiddot R

wwwstimuluspublicationscom or call us 877-221-6099 on of

ALTERNATIVE TREATMENTS 37

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therapy actlvities with other professionals in the classroom ca rdboard wa lls on the desk glasses with tinted sidcs or wea ri ng ( visor can help chan nel visual attent ion towards the teacher Use of spJc ing Ime guicies dIfferent color lilies couing vlsual clutter and mu ltisensory teaching hel p to compensilte lor visua l processing problems

Outside 01 the educational environment vision therapy can be designed to targe t tracking or eye tea mi ng probshylems using game-like activities that sepa rate head and eye movement comroL Polarized lenses can also be used to ensure both eyes are teaming Visua l ana lytica l experiences are created which require selections in itially using blocks puzzles and shape sorters and wh ich proceed over time (in a deelopmemal hierarcby) to visua l processi ng of deSigns and lener shapes on tbe page

Visua l spatial refe rences are deeloped by engaging the child in physical activ ities that develop body image in space awareness which requires Judgments oj disLance time or orientation Activities thaL practice the app lication of these references include copying and Judging object layout of geoshymetric pieces on a tablejudgi ng right

Periphcrallcentral vision attemion is developed by engaging the child in acci ities that requ ire move ment and balance (periphe ral vision bias) while also attend ing to visual detail for identiflcation (centra l vision bias) By changing the nature of the activ it ) as well as using different lighting and peripheral vision lens the ability to process and manage more visual input is developed in a progressive manner

HELPING CHILDREN SEE CLEARLY I-or many children wit h autism undeveloped and d isregushylaLec vision ca n inter fere with performance in several areas Addressing these visual issues can lead to improvements in learning attention and een behavior

il is incumbclll on the developmemal optometrist-through testing and obse rvation-to understand whether vision is helpi ng or in terfe ring with per formance and development Optimizing the visUJI strategies and therapies avallable to us can yield signiFicant beneflts to children wi th autism Parental involvement also IS key The more the parent understands the reason for the therapy activiti - the mo re the) understand

how to raise and lower the level of and left sides and direction on a page FIND OUT MORE diffIculty of the acti vities the more or Judging bow to space words on interesting and appropriate they canbull College of Vision Development wwwcolldorg the page so that all the wo rds fit make the therapy

AutisDl ~kill Acquisition

JFr 0 gr a Dl TMBehav~Analyst Inc

Creators of ABLLSmiddot R

wwwstimuluspublicationscom or call us 877-221-6099 on of