Ian Jordan

Research in ASD is very difficult due to the hetergenous grouping within ASD. Extrapolation of research findings may often be inappropriate and this is perhaps the greatest problem in evidential based practice. In complex systems reseach is often at best difficult, at worst - impossible. Is there any area of research that you are interested in in particular?

Symptoms can be stopped - which is not a cure - but it is close You can't cure many conditions e.g. if you have a cold you may take drugs to suppress symptoms - but you don't cure the cold - but it can be a big difference

There is a possibility that this problem can be treated in seconds - and as it will not just be affecting computer work (even if not percieved) - it should be considered seriously. But, there again, I believe that every person on the spectrum should have their sensory processing addressed - as it causes so many of the problems encountered. And every parent of a child on the spectrum should treat it as a priority - when you see what I do every day of the week - you would be horrified at what so many children have to put with.

This is excellent We should have a similar one (or more) here for all professions. It needs to be funded (postage and printing are expensive) - but best thing I have ever seen for professional use. Know any charity that is prepared to fund?

If anyone wants more info they can download two of my books on the subject free on www.jordanseyes.com Visual processing problems are endemic in ASD - the advice given in previous posts worries me - the subject is extremely complex and needs professional advice. And some of the advice has been inaccurate / poor. Irlen is first generation assessment - essentially trial and error - a poke and hope method The intuitive colorimeter is second - subtractive colour - covers around 33% of colour space Orthoscopicss - 3rd generation - additive colour - covers around 75% of colour space and is almost the ideal technique. is there a difference - massive!

I understand - but that is their problem - how dare they say it is alright for you to have problems with facial recognition to prevent their discomforture in not seeing your eyes. They should have much less difficulty dealing with it - sorry, but I consider their position disgraceful - and in some cases the disability acts would apply. But, We are now finding that over a period of wear - the treatment can become curative - but no promises Contact lenses are possible - but expensive and difficult to get right - so that is an option If it was a crutch would they complain?

Most difficulties with eye contact can be treated - we do it every day and it works immediately. The option is available - and every child on the spectrum should be assessed - pity that it is not easily available though - it is best undertaken as early as possible, and can make an enormous difference For opticians with the instrumentation necessary (weblink removed) - sorry if this is advertising - but it is the only site that can guide people to places that can treat this problem

sorry

Eye drops in ASD Children on the spectrum often present with symptoms that are "difficult" and would in normal development children indicate the need for dilation / cycloplegia. However, these symptoms are often indicative of sensory processing problems in ASD. Sensory problems that can mimic normal optometric difficulties are common and need to be differentiated. The 1st problem is therefore a recognition of application problem (particularly in binocular vision anomalies). The need to consider non standard causes for visual symptoms is particularly important in ASD as drug reactions can be abnormal, the effects of the drug may be considerably different, pain may be intense and persistent. This persistence is common and can last days, be referred (pain may appear in a different part of the body), or be time delayed (or a combination). There always has to be a balance of when drug instillation is critical (and sometimes it is essential - regardless of discomfort / pain / side effects) - but unless the optometrist has knowledge of ASD sensory problems, they are likely to treat children on the spectrum in the same way as NT children. Yes - of course its better to work together- but the public expect when they go to an optometrist that they do exactly what you've said - that they know the limits of their expertise, and then refer (but who to?) - and that the optometrist is trained to recognise when a problem could be a processing difficulty, whether there is a cross sensory problem involving vision / visual processing. Should a person on the spectrum expect that the optometrist has sufficient time in the eye test (assuming sufficient training and instrumentation etc) to determine which factors are contributing to visual and other sensory processing problems caused by the visual system. Should an optometrist be expected to ask the right questions of the child (where possible), the parent - to analyse an act on the results? A standard history and symptoms will inevitably miss many of the problems experienced by someone on the spectrum. The public however, expects the optometrist to be knowledgable and take appropriate action to determine whether a problem is present. Standard eye examinations cannot possibly do this for a high proportion on the spectrum, and it is extremely rare that the optometrist advises appropriate extra testing. If an optometrist can recognise visual processing problems and their comorbidities - I agree without reservation that a standard eye test is the best starting point. But is this really the case for the majority of optometrists? I suspect that what we would both agree to is optometrists training taking into account ASD - and because of ASD being a hetergenous group - to be trained to determine optimum interventions - perhaps in the future? But until then - is the present system acceptable to the parents of those children on the spectrum? - what percentage of children on the spectrum get optimum visual assessments (including visual processing)? - should optometrists tell parents of children with ASD to check visual (and other sensory ) processing - perhaps we need to get all ASD children to have both a straightforward eye exam + a visual and other sensory processing test as standard. In this economic climate I suspect that those on the spectrum will have a long wait. And because I consider the visual processing problems experienced by those on the spectrum to be more common and more often mush more profound than refractive difficulties - I must question whether it is not essentail that parents are aware that it is unlikely that it is even considered as a difficulty in the eye test - surely that is of critical importance - and that therefore they should know how to find an appropraiye practice. The question is therefore How does a parent choose a good optical practice for a child on the spectrum - from high functioning to non verbal / non cooperative? What questions should they ask? What criteria should be considered? All practices are not the same - and recommendation should be based on knowledge - how would you recommend?

As an optician it may interest you to know that most optical professionals have little or no training in ASD or the potential problems that can be experienced. There are a lot of things that may be necessary as adjustments to the "normal" eye test. In children for instance "recommended practice" will often include using eye drugs during the eye test. This can be abusive in ASD (and is rarely necessary). There are simple questions to ask the optometrist to detemine whether they would be sympathic and empathetic to ASD e.g. 1 How do you deal with prosopagnosia and metamorphopsia? (simply put - facial recognition and distortion) 2 How do you deal with sensory integration and processing problems? 3 How long does your eye examination take for a person with ASD? Most people on the spectrum have significant visual processing problems - a simple eye test will not address them in any way - and consequently you should understand that most eye tests are of limited use in visual problems in ASD. Choose VERY carefully - If they say they understand - ask"how will you deal with echolalia in the eye test?" Important in ASD (even if not for you or your child) and anyone with knowledge should be able to answer these questions without thinking. If they can,t answer even these simple questions - walk away. The differences can be massive! There are some excellent people around - but very few nationally that have the instrumentation and training necessary to address all the likely problems in ASD. Oh - its not an eye test (what you say does not concern the optician - don't worry about being "wrong" - it really won't matter, if the you give inconsistant answers they can be dealt with easily - if necessary it is possible to test the refraction (strength of lenses) and make sure the eyes are healthy) in the noncooperative, or non verbal) It is even possible to get a fair idea of visual processing problems in these cases - but most optical professionals would not be able to do this. Hope this helps

Kaplans book would be controversial in optical / medical circles (myself I consider it to be of limited use, there is so much that is not addressed in the book, and much of that unaddressed is important). Irlen syndrome is only a part of the range of visual processing problems that may cause dyslexia (and some of them can be addressed under the NHS)

It could be a sensory integration issue - particularly if there is a dorsal stream problem But physical problems must be ruled out

we stopped using overlays as being inadequate for professional use around 11 years ago! we do not make any charges for assessment (and can test much more than reading!)

Any UK resident can get NHS eye tests in Scotland - so we get about 3 people every day from England and see them through the NHS.

Visual processing disorders and colour naming are very different. There are also a number of colour vision difficulties ranging from matching difficulties to complete loss of colour perception, they are related but separate to the range of visual perceptual anomalies due to stimulus. It is EXTREMELY complex and most optical professionals find it a difficult area. There are very few competent people nationally in this area and satisfactory instrumentation is rare (there are only around 12 instruments in the UK that can assess to absolute standards and although there are many people that use colour therapies, the difference can be massive between methodologies ) It is impossible for a parent / teacher /non specialist to assess, and also know the level of knowledge of the colour "expert" that they go to. The simple question you should ask is "Do you prescribe to CIE standards?" This is the internationally recognised method of determining colour. If they don't - don't go!

It may be either a vestibular problem, proprioceptive problem, systemic difficulty or visual problem. All need professional input = don't wait too long as it could be important to be seen quickly

bad english - sorry - and not changeable People on the spectrum perceive the world in a spectrum of ways, varying from "simple" methods that would be recognised by doctors and optical professionals, to visual worlds that are extremely disturbing and frightening, and totally alien to professionals, causing inadequate responses. Most fall between these extremes, but it is important that parents realise that their world may be completely different to the world experienced by their child. They need to know, and the options that are available that can reduce stress, anxiety and sensory difficulties

I have just placed an informative video on youtube to introduce parents to visual problems and ASD I hope it is helpful

Next month we are announcing the treatment of posopagnosia, metamorphopsia and dysmorphia at the autism society of americas national conference. I have also written an article for "Optometry Today" and it will be published soon. Virtually everyone with a problem can have it addressed, the results are impressive. We treat it through the NHS routinely

We would NEVER use eye drops in ASD routinely even though the guidelines suggest otherwise. (it would have to be a serious situation to justify drug usage in a child on the spsectrum) It is actually cruel for some children on the spectrum and is unnecccesary - but you may find that the hospital resist bcause of published guidlines (which do not take into account ASD). It is a complex issue - and there are very good reasons why those on the spectrum should not have eye drops routinely - they do not respond normally in many cases and issues such as pain persistence and level make eyedrop instillation a potentially abusive situation. (But, like many other areas - there are no exceptions to the rule!!!!) I have just written an article for an optometry magazine on how to approach ASD - it will challenge many techniques that are standard in the NHS (many don't work well and are often very unpleasant to the child). If the parents of children with ASD only knew what can be done with vision and visual processing in comparison to what is usually done.................... But changing guidlines is a big task - you cannot imagine how much resistance there will be to innovative thinking

There are a number of visual processing problems that could exempt a person from jury service. These include prosopagnosia - around 75% of those on the spectrum show symptoms, the McGurk effect - which will make it difficult to understand evidence - again common in ASD, visual sequencing and mapping anomalies - common is ASD, and other visual perceptual difficulties and visuallly evoked sensory integration problems. Obviously some on the spectrum will have no problems and should become a juror, but serious consideration should be given to exemption to many.

With permission of the moderators Many people on this site want to see what can be achieved using state of the art visual interventions. I am giving two presentations (each of one hour) in London in October at the Times Ed / Nasen conference / exhibition in London Islington / Design Centre on Saturday 18th October. The first is entitled "Visual Dyslexia - demystified" The second "Can't Catch, can't read, can't write - and you are very ugly" Both will have an enormous amount of info for parents of children on the spectrum - such as how to treat facial recognition / expression recognition difficulties, spatial awareness, changing of timing in sensory processing. There will videos that will be very exciting - and show what can and should be done. There is a charge (but it is low - most of my presentations are inaccessable) and they will inevitably sell out early. The exhibition will also be useful to parents - to see what is available - to find out more - the site with info is http://www.teachingexhibitions.co.uk/

Estimates suggest about 50% of those on the spectrum have binocular vision problems (Kaplan). This compares with around 10 percent of overall population. Why this is is not known, but I believe that it is part of the sensory profile difficulties and control of responses. Obviously not all difficulties are due to spectrum problems - but many appear to be comorbid. Standard vision interventions may not be optimum for those on the spectrum, indeed I believe them to be abusive in some cases eg the use of drugs is normally "best practice" in evaluating the prescription of young children, but I have real concerns as whether this is even an acceptable practice in those on the spectrum.

This is a complex one Depression is often affected by visual stimulus e.g. SAD - in particular the magnocellular system appears to be implicated. This system is dependent on colour for stimulus inhibition - but it is essentially a flicker / edge recognition system. Old fashioned screens flicker - I'd guess this is the effect that you are experiencing (most people find this flicker a problem - but a small number find it helpful - hue saturation modulation and frequency may be critical) Alternatively there may be other causes - but they would need to be investigated professionally.

To clarify - binocular vision problems are rarely emergencies - are often very complex - and they may not be addressed in a "normal" eye test in England (different in Scotland). NHS direct however should have got back when they said they would, but it does not surprise me that they may not be able to give immediate advice. GPs rarely would want to be involved in a binocular vision problem - they would usually refer to a hospital. When going to a "high street" optometrist ask whether they will undertake an orthoptic assessment through the NHS- they may not - there is often tremendous pressure on their time - all eye examinations are NOT the same. IF THE PROFESSIONAL SUGGESTS EYE DROPS BE WARY - those on the spectrum often respond inappropriately - does the professional know this? If there is a complex problem it would be usual to refer to the hospital eye service for Orthoptic management. Around 50% of children on the spectrum have binocular vision / processing problems. It is critical therefore that all children on the spectrum are assessed regularly, and by a practice that has sufficient knowledge and committment. The differences are often literally life changing. Training in this area for the optical professions (like virtually all other professions) is limited (mine was nil - its been a long learning curve), choose your practice very carefully, it is likely that you will not have a specialist practice locally. In England the costs can be high - but the costs of not addressing the problem are much higher. A guide is - how long does the eye test take for someone on the spectrum - we allow 2hrs as a start. 20 minutes is insufficient even for a basic assessment. Hope this helps