|Jeremy practices visual rehabilitation techniques with his mother.|
My Patient, Aidan
When Aidan first came into my office last year, he seemed disconnected from this world. His mother explained that she and her husband had long suspected that he was on the autism spectrum. He had verbal delay and preferred to play alone. His parents had difficulty getting his attention, and he was afraid of loud noises. He did not enjoy physical affection, make eye contact or adjust well to changes in his daily schedule.
At age four, Aidan’s teacher told his mom that, in order for him to color a page, she would have to pick out a crayon for him. The teacher reported that it seemed like all of the colors in the Crayola box were too overwhelming for Aidan to consider, and he did not know which one to choose.
Aidan’s parents expressed concern to his regular pediatrician, who agreed that he likely had autism. His pediatrician then referred him to a developmental pediatrician, who also suspected an underlying learning disability.
In kindergarten, Aidan’s problems continued. Thankfully, the school nurse recommended that he get an eye exam. So, his mom brought him to my office.
I diagnosed Aidan with refractive amblyopia of his left eye and prescribed spectacles. Within eight weeks, his parents noticed that his listening skills improved and that he was making more eye contact. We began vision therapy to improve the acuity in his amblyopic eye and eliminate suppression, as well as to work on the visual skills he needed to succeed in school and life.
My Son, Jeremy
When I think of Aidan, I’m reminded of my own son, Jeremy. When he was Aidan’s age, Jeremy displayed many of the same characteristics. Jeremy had verbal delay, difficulty making eye contact and a sensory integration disorder. Perhaps we were in denial, but we thought he would outgrow it.
By the time Jeremy was seven or eight, it became obvious that he was on the spectrum. Over time, his sensory integration disorder became more of a problem. One time, we had to leave Rain Forest Café in San Antonio because the flashing lights and noise overwhelmed him.
Jeremy also fixated on subjects that interested him. For example, he knew every Pokémon character, their behaviors, what they evolved into and what region they were from. (There are hundreds of them, and he knew them all.) His speech patterns also clued us in. It became apparent that he was not going to outgrow over-pronouncing his words or exhibiting the flat inflection that is characteristic of Asperger syndrome.
In fifth grade, Jeremy was officially diagnosed so that he could receive an individual education plan (IEP) at school. Jeremy is now in eighth grade, and as his peers have behaviorally matured into teenagers––he has not. He does well academically, but from a social perspective, he is well below grade level.
To help people empathize with him, I tell them to imagine putting the brain of an academically advanced eight-year-old into the body of a thirteen year old and expect that child to navigate the world of junior high. Middle school has been a challenge, and my husband and I keep homeschooling as an option, should things become too difficult for Jeremy.
A Growing Interest in Developmental Optometry
During the last few years, I’ve become increasingly fascinated by the study of neuro-developmental optometry. This interest began after I became good friends with a PhD candidate at Texas Tech in the College of Education, whose special interest was traumatic brain injury. Together, we are intrigued by the principle of neuroplasticity and its possible application in visual training and rehabilitation.
Additionally, I’ve recently met several highly influential physicians and eye care professionals who have dramatically enhanced my understanding of autism’s impact on the visual system.
For my blog (wittmanvision.com), I was able to interview pediatrician Janna Jennings, MD, of Benton, Ark., whose autistic son experienced dramatic improvement following vision therapy. Additionally, I met Nancy Torgeson, OD, FCOVD, who has a large vision therapy practice near Seattle that specializes in treating kids on the spectrum.
I’ve also had the opportunity to learn from Robert Sanet, OD, FCOVD and his wife Linda Sanet, COVT, of Lemon Grove, Calif. Both individuals are leading experts in behavioral optometry.
Then, at the 2013 Annual Neuro-Optometric Rehabilitation Association meeting in San Diego, I met Susan Daniel, OD. I ran into her on the deck of the conference center. We talked for an hour about her son, who has autism and was non-verbal for much of his life. Dr. Daniel informed me that, via specialized vision training, she was able to help improve her son’s symptoms tremendously. So, this summer I took Jeremy to her office in Carlsbad, Calif. for an evaluation and to experience her program. She has the latest technology and techniques to help her patients with autism, as well as those with traumatic brain injury.
The last two years have been filled with many of these seemingly coincidental encounters. I can’t help but take this as confirmation that this is where I should be focusing my career. Currently, I am interested in finding novel methods to help people on the autism spectrum, patients with traumatic brain injury and those with vision-related learning problems.
At times, I feel both guilty and saddened that we did not start working with Jeremy when he was Aidan’s age. It would have been better for Jeremy and our entire family if we had addressed his issues earlier; however, I remain hopeful, because I’ve learned that neuroplasticity continues after childhood. In conjunction with my husband (who now works with children with autism for our local school district), I am trying many approaches to improve Jeremy’s symptoms.
For Aidan, my goal is not just for him to be better connected to the world around him, but also to help him succeed in school and meet other goals he decides to set for himself. Helping young patients achieve better vision for their entire lifetime is one of the most rewarding accomplishments in my career, and I look forward to serving my community in this capacity for many years to come.
Dr. Wittman is in private practice in Lubbock, Texas.