The long, hot, lazy days of summer will soon be replaced by vibrant colored leaves, crisp air and the distinctive roar of bright yellow school buses. As the summer winds down, families prepare for the new school year by buying clothes, lunch boxes and backpacks, and by scheduling physicals for their kids. In anticipation of these preparations, Prevent Blindness America has designated August as Children’s Eye Health and Safety Month. The importance of vision to how children learn, process and understand information can not be overstated. Nonetheless, despite everyone’s best efforts, pediatric opthamological problems may go undetected for years, and are often mistaken for learning disabilities – ADD, ADHD, dyslexia, etc.
Visual issues in children with pervasive developmental disorders (PDD), such as Asperger’s and autism, may also be overlooked, especially if they test at normal visual acuity (20/20 eyesight). But many ASD children in fact suffer from poorly developed ambient vision, causing malfunctions in their three-dimensional processing, balance, coordination and movement. The visual process has two aspects: focal vision where our eyes attend to details and pattern recognition; and ambient vision for three dimensional processing and spatial orientation. The two facets must work in tandem, and when they don’t, simple tasks such as walking while reading become virtually impossible.
In moving through spaces children confirm what they are seeing. Any impairment of this process and the child may develop behaviors to overcompensate for the deficit. Toe- walking is a unique example of just such a behavior. Until the age of two, toe-walking is a common developmental stage for infants, but past that age marker, it may be a sign of some underlying condition such as Muscular Dystrophy or short Achilles tendons. However, if the behavior is idiopathic, i.e. with no perceivable underlying cause, the trouble may be vestibulo-visual. In most cases, treatment of idiopathic toe-walking involves visual-motor exercises and wearing prism lenses during therapy sessions. The use of these lenses has been shown to be a “miraculous” and immediate “cure” for the behavior. Since occupational therapists are often the first line of defense when vision skills impairment is suspected, they should add toe-walking to their list of red flags when assessing their young clients. Developing a strong working relationship with a local developmental optometrist should also be added to the therapist’s arsenal to ensure successful treatment outcomes of vision skills impairment.