Vision Problems in Children with Disorder

Lynn F. Hellerstein, OD, FCOVD, FAAO

10 Sensory Focus Magazine — Fall 2014 Focus on Vision

ensory Processing system, including the visual someone else is looking Disorder (SPD) system. Since these students • Stares into affects a wide rely heavily on visual strate- • Poor spatial variety of people. gies and visual for • sensitivity Individuals with , it is essential that vi- • on light patterns, SSPD and other different sual processing skills be appro- windows, or blinds diagnoses or labels may have sensory issues such as sound sensitivity, difficulty screening “Many students with SPD ... have been out background noise, or visual described as being visual learners. That sensitivity to fluorescent . SPD can occur in conjunction means they understand what they see better with autism, , atten- than what they hear.” tion-deficit/hyperactivity disorder, speech delay, and learning problems (Temple priately evaluated and treated. • Gaze aversion Grandin, PhD, Sensory Focus The typical vision screening • Academic related signs, Magazine; Spring 2013). tests that these students may which may include: Many students with SPD receive do not identify VISUAL • Poor tracking with (and those with other special PROCESSING PROBLEMS , loss of place or needs or learning challenges) (described later in the article). need for a finger/mark- have been described as being er when reading visual learners. That means Which behaviors can be • Difficulty with hand- they understand what they related to see better than what they difficulties? • Difficulty with movement hear. Vision may be their or sports, such as: The following are some specific learning strength, compared • Poor balance and coor- behaviors that can be observed to their ability to respond to dination in children with SPD. Parents auditory information. • Poor -hand coordi- and teachers may attribute But that doesn’t mean they nation these behaviors to the diagnosis have perfect vision. Even if they • Physical symptoms, such as: of SPD without realizing how are tested at 20/20 eyesight, • Headaches in the fore- they can indicate a possible they can still experience vi- or temple problem with visual processing. sion problems that affect their • Closing or covering learning and participation. • Peering at objects/tilting an eye Visual processing skills are the head • Turning or tilting often affected among those in • Looking out of the corner the head this population. Visual symp- of the eye • Having an unnatural toms in people with SPD are • Poor eye contact posture when reading linked to underlying differ- • Squinting or performing sus- ences in the central nervous • Does not follow where tained visual tasks

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Figure 1 ( by Annie Harmon)

What is important to know circle represents the life activi- The second concentric about vision? ties that are important to your circle out from the core repre- child: school, work, coordina- sents visual information pro- A vision acuity screening test tion, sports, play, relationships, cessing. This refers to under- measures what size letter or and success in life. standing what we see, where picture you can see at 20 feet. A strong foundation is things are in space, integrat- For example, if a person has required to build success. The ing visual information with 20/20 vision, he can see a letter foundation is represented as other , eye-hand-body about 1 inch high from that dis- the central core of the concen- coordination, visual , tance. But vision involves much tric circles. This core includes and . more than 20/20 eyesight. A the structural integrity of the This Model of Vision repre- person can have double vision vision system; this involves the sents the basis for a thorough and pass the vision screening physical health of the , eye- vision evaluation and determi- test. More skills are necessary sight, and the visual pathways. nation of a treatment program for a person to be able to see, The first concentric circle for your child. As you can see, process, integrate, and respond outside of the core represents good vision involves much to visual information. visual efficiency. That includes more than 20/20 eyesight; how well the eyes fixate (look), even if an eye doctor says What else is involved with follow (track), fuse (coordinate your child has 20/20 vision, it vision? together), and focus (make ob- doesn’t mean all these other Figure 1 depicts a Developmen- jects clear). These visual skills visual skills have been appro- tal Model of Vision. The outer are movement based. priately evaluated.

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What type of eye doctor in Vision Development (COVD) sits, walks, stands, catches and should you find for a child emphasize an expanded func- throws a ball, etc. Such tests with SPD? tional and behavioral approach help to determine how the SPD to patient evaluations. Their ap- student is seeing and how he or Selecting an optometrist for proach to vision care is direct- she can be helped. you and your family is an ed at correcting existing vision You can also ask your fam- important decision. For some problems and enhancing visual ily optometrist the following common vision problems, abilities to allow individuals two questions. eyeglasses, contact lenses, to see clearly and comfortably. • Do you see many patients medication, or surgery may be Fortunately, there are several with /SPD? necessary. These are typical well-qualified COVD members • Do you provide vision treatments in which optome- located in large cities and small therapy or refer to an op- trists are uniquely skilled, with towns throughout the United tometrist who does? surgery falling into the domain States as well as in many coun- of . tries throughout the world. What are some successful But when basic visual skills optometric treatment are problematic, there are (Check out www.covd.org for a options? more treatment options that developmental optometrist in can be investigated. A develop- your area.) Depending on the results of mental/behavioral optometrist testing, lenses to compensate treats special vision problems How can an eye doctor for nearsightedness, farsight- such as visual eye focusing, eye evaluate a person with SPD? edness and astigmatism (with coordination, eye movements, or without a ) may be A vision evaluation may be and visual . Vision prescribed. Special prism challenging for both your child problems are addressed to im- may help with spatial with SPD and the doctor. How- prove visual function and com- localization and movement. ever, with time, patience and fort. More specialized treat- Vision therapy activities special tools, a good eye doctor ments such as vision therapy, can be used to stimulate gen- can obtain a great deal of vi- tinted lenses or special prism eral visual arousal, eye move- sual information. Methods for glasses may be necessary to ments, and the central visual evaluating the vision of people manage these problems. system. The goals of treatment with SPD will vary depend- may be to help the student ing on the individual levels Where can I find a with SPD organize visual space of intellectual, emotional and developmental optometrist? and gain peripheral stability so physical development. Testing that he or she can better at- Not all optometrists provide in- is often done while the patient tend to and appreciate central depth testing for developmental is asked to perform specific vision and gain more efficient and functional vision problems activities while wearing special eye coordination and visual and the relevant treatment, lenses. For example, observa- information processing. such as vision therapy. Op- tions of the patient’s postural tometrists who are members adaptations and compensa- of the College of Optometrists tions will be made as he or she

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What is vision therapy? is beginning to point to objects knew that Joey was still expe- and communicate better us- riencing significant visual skill The goal of vision therapy is ing visual strategies. She used and processing problems. Take to train the eyes and to to demonstrate many autistic a look at his handwriting (see work together more effective- characteristics when watching figure 2). ly, and to integrate these abil- ities with the rest of the body. Think of the as “Improvement of visual processing skills working like steering and di- recting your car; your visual can help a child with SPD become more system is your body’s pri- successful in communication, school, mary GPS for spatial position and motor guidance. Vision sports and life.” therapy enhances the brain’s ability to control eye align- TV (hand flapping, squinting, At Joey’s first vision evalu- ment, tracking, eye team- staring in space). With her ation at my office, he was ing, focusing, , new glasses, those behaviors prescribed glasses for farsight- visual processing and visual have stopped, and she can sit edness, with a bifocal to help spatial skills. Visualization more comfortably on the couch focus and eye alignment for or visual imagery strategies without the classic symptoms near objects. Vision therapy may be useful for relaxation attributed to autism. was then prescribed. After six and reduction of anxiety, months of weekly vision ther- more successful learning and Joey, 7 years old – apy treatment, all of his visual sports performance. student with fine motor skills improved, as did his deficits, strabismus ability to read and write. In ad- Case studies receiving glasses and dition to improving Joey’s eye vision therapy movement control, focusing Melissa, 5 years old— and eye teaming skills, take a student with SPD and Joey was a bright second look at how his handwriting autism receiving glasses grader who struggled with fine transformed (see figure 3). with motor skills. Joey was born Joey’s insight was pro- with strabismus esotropia— found; as he told us after com- Before glasses, Melissa crossed eyes. He received three pletion of vision therapy, “My wouldn’t look at objects and eye muscle surgeries to correct writer in me was crammed and had poor eye contact. Since his condition. The ophthalmol- squished. Now it’s gotten much wearing the glasses (extreme ogist told Joey’s mother that bigger and I can write better!” farsightedness with yoked his eyes were “pretty straight” prisms), she is much more and no other eye/vision treat- Summary aware, pays better ment was needed. and shows more interest in in- Joey was referred by his Visual problems found in chil- teracting with her family. She who dren with SPD are pervasive

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Figure 2: Figure 3: Pre-vision therapy Post-vision therapy

and often severe in their in- tensity. Yet, many of these students see 20/20, are vi- sual learners and benefit from Lynn F. Hellerstein, OD, improving visual processing FCOVD, FAAO is a develop- GOOD THINGS skills. To identify their individ- mental optometrist, author come to those ual learning needs, have your and speaker. She has pub- who DON’T wait! student tested by a develop- lished extensively on vision- mental optometrist. Improve- related topics, including her Now you can have our entire inventory ment of visual processing skills award-winning books, See of outstanding products on your computer or tablet in just seconds! can help a child with SPD It. Say It. Do It!: The Parent’s Visit www.SensoryWorld.com and become more successful in & Teacher’s Action Guide To click “Free Sensory Catalog” on communication, school, sports Creating Successful Students the lower right to view and buy our and life.  & Confident Kids (2012), Or- products immediately. We carry over 150 ganize It (2012), and 50 Tips SENSORY books, videos, and CATALOG “1 in 6 children experiences sensory symptoms strong enough to Improve Your Sports Per- to affect everyday life CDs that will help functions.” ~ SPD Scientifi c W formance (2013). To learn solve problems, ork Group An swers to All of Yo Sensor ur Resources y Challenges INSIDE more or to sign up for her educate, and, in ! some cases, just www.LynnHellerstein.com free e-newsletter, visit www. bring a smile. 2013

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