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The View From the Clinic

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Presentation on theme: "The View From the Clinic"— Presentation transcript:

1 The View From the Clinic
Miss Rachel Pilling

2 Origins Theory Research Case studies

3 The theory..... Coloured lenses and filters
Suppress wavelengths which cause visual stress symptoms May improve print clarity

4 The problem.... Cross over with symptoms Refractive error
Other eye pathology Cerebral visual impairment/visual processing Dyslexia

5 discomfort or difficulty reading in bright or fluorescent light
difficulty reading print, numbers or music problems with concentration slow reading rate feeling sleep, tension or getting headaches when reading eye strain difficulty copying writing (either from paper, a book or a whiteboard)

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7 What about the research
Positive evidence is limited Very few studies scientifically sound Excluded those who didn’t improve Other interventions also used

8 Scotopic Sensitivity Syndrome

9 Dyslexia Receptive language based learning disability
Difficulties decoding Probem with fluent word recognition Poor reading comprehension skills Deficit in phonologic component

10 Visual symptoms of dyslexia
Difficulties with storage, retrieval and decoding Require 40 exposures to a word to “learn” it (vs 4-14) Reading is tiring, slow Causes fatigue, headache, poor concentration, blurred vision, eye strain or pain,

11 Role of coloured lenses and filters?
Suppress wavelengths which cause visual stress symptoms May improve print clarity Do not solve problems with decoding or phonologic awareness Do not solve problems with processing and comprehension

12 Research No pre and post reading speed assessment
Improvement over period of months Improvement could be Developmental anticipated Due to additional input

13 Case 1 6 year old Poor vision detected age 5
Surgery at start of Year 1 Normal vision LE, moderate reduction RE No symptoms fatigue or visual stress Struggling with reading Staff suggested Irlen’s syndrome as cause Pressure on Mum to obtain referral

14 Case 2 11 year old boy Difficulties reading at school apparent KS2
Bright child, high achieving parents Referral for Irlen’s suggested by school Lilac glasses Vision normal Some improvement in concentration

15 Case 2 Reading accuracy good for larger print
Difficult with small print, blinks a lot Poor accomodation Prescribed weak “reading” glasses Symptoms disappeared overnight

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17 Why does the medical profession have a problem with Irlen’s syndrome?
Promoted condition and treatment via media Based on anecdotal evidence and patient testimonies No formal research undertaken or published until after initial promotion Wide range of symptoms make it non specific Many of positive results can be explained by placebo/additional time spent with child

18 Why does the medical profession have a problem with Irlen’s syndrome?
No scientific explanation Distraction from real pathology and treatments Doesn’t help underlying cause May improve print clarity Do not solve problems with decoding or phonologic awareness, processing, awareness Cost

19 Vision and the Autistic Child
Do children with autism have vision problems? Why do children sometimes not seem to “see”? Do children with autism have problems reading? Why do children with autism not look directly at people?

20 Literature Vast Over 1000 publications Neuroscience
Little on practical solutions

21 Do children with autism have vision problems?
Some do and some don’t

22 Do children with autism have vision problems?
Small, selected cohorts Wide range of acuity Increased incidence squint ?struggle to integrate binocular input Increased incidence of refractive error But not needing glasses

23 Visual behaviours in autism
Light sensitivity Unusual blinking or eye rubbing Clumsiness or poor coordination Unusual posture Avoids near tasks

24 out central vision – use only periphery

25 out central vision – use only periphery

26 out central vision – use only periphery

27 out central vision – use only periphery

28 out central vision – use only periphery

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30 How can we help? Keep environment very simple Clutter, colour, spacing
Eg PE, pencils in box, counting Finding edge of paper Distraction of wall display/hangings Reduce strip lighting Reduce ambient noise

31 Why do children sometimes not seem to “see”?
Seeing the world differently Local vs global processing . Baron-Cohen S. The cognitive neuroscience of autism. J Neurol Neurosurg Psychiatry 2004;75;

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34 Why does my child not seem to “see”?
Peripheral vs central A) can’t “switch off” B) can’t integrate A) - can’t concentrate on centre of page (eg reading) if lots of pictures round edge – too much to process

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36 Why does my child not seem to “see”?
Peripheral vs central A) can’t “switch off” B) can’t integrate B) can only look at one part of picture at a time – can’t integrate whole scene

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42 Reducing input, enabling partitioning of sections to allow processing

43 Lateral vision Using only one visiual hemisphere - cannot integrate images from both eyes Lower quality peripheral vision Elimiate “flicker” Optometry and Vision DevelopmentVolume 40, No. 3, 2009

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45 Will my child have vision problems?
May not see objects unless they are touching them Translation 2D to 3D - picture of a cup vs real cup

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47 How can we help? Allow child to use head posture
Consider aligning child so they can use their posture to see board/teacher/ resources Offer “real” objects rather than pictures Consider other ways of assessing vision

48 Will my child have problems reading?
Skips lines or loses place when reading Writes crooked or poorly spaced Difficulty tracking moving objects Poor reading comprehension Confuses or reverses letters, words or numbers Does not want to look at pages of words

49 Will my child have problems reading?
Overload

50 Will my child have problems reading?
Onceuponatimetherewasabigbearwholivedinacastleatthetopofthehillonedayheleftthecastleandwentintothetownhewasagentlebearwhowaskindbuthescaredthepeopleinthetowntheyranawaywhenhecameneartothemandthismakethebearverysadsoonedayhedecidedtogotoanothertown Overload Fatigue

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52 Will my child have problems reading?
Overload Fatigue May see “letters” not “words”

53 Will my child have problems reading?
Overload Fatigue May see “letters” not “words” Problems with saccades

54 Once upon a time there was a big bear who lived in a castle at the top of the hill.

55 Once upon a time there was a big bear who lived in a castle at the top of the hill.

56 Once upon a time there was a big bear who lived in a castle at the top of the hill.

57 Once upon a time there was a big bear who lived in a castle at the top of the hill.

58 Once upon a time there was a big bear who lived in a castle at the top of the hill.

59 Once upon a time there was a big bear who lived in a castle at the top of the hill.
“ ”

60 Once upon a time there was a big bear who lived in a castle at the top of the hill.

61 Once upon a time there was a big bear who lived in a castle at the top of the hill.

62 Once upon a time there was a big bear who lived in a castle at the top of the hill.

63 Once upon a time there was a big bear who lived in a castle at the top of the hill.

64 Once upon a time there was a big bear who lived in a castle at the top of the hill.
“ ”

65 How can we help Larger text Less on a page ?present one word at a time
Cover ups

66 Why does my child not look at me?
Eye movement disorder Sensory Competition Facial processing

67 Why does my child not look at me?
Sensory competition Can’t “see” and “hear” at the same time

68 Can children with ASD “hear” a speaking face?
Mismatch auditory vs visual information ASD children failed to complete as many tasks Where fixing on face, less accurate ASD not globally impaired in audiovisual perception tasks vs TD children Delay in language re phonetic learning Child Dev September; 82(5): 1397–1403.

69 Why does my child not look at me?
Eye movement disorder Sensory Competition Facial processing

70 Why does my child not look at me?
2 studies A) matching pictures of faces to one another B) determing expression from “eye reading” Research in Autism Spectrum Disorders 5 (2011) 1327–1342 Research in Autism Spectrum Disorders 3 (2009) 462–473

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72 Why does my child not look at me?
Both studies showing ASD perform same as TD However, struggle with moving images Test conditions Research in Autism Spectrum Disorders 5 (2011) 1327–1342 Research in Autism Spectrum Disorders 3 (2009) 462–473

73 How can we help Do not give verbal and visual instructions at the same time. Stand still when talking Give verbal clue to facial expression

74 Vision and the Autistic Child
Will my child have vision problems? Why does my child not seem to “see”? Will my child have problems reading? Why does my child not look at me?

75 How can we help? Remove clutter, reduce noise Reduce strip lighting
Encourage head postures Larger print, single words, cover ups Offer “real” objects Avoid verbal and written instructions together Stand still when talking

76 Thank you


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