ICBO 2010 Patricia S. Lemer, M. Ed., NCC devdelay@mindspring.com - - PDF document

1/22/2010 1

Optometry’s Role: Optometry s Role:

Using a Trans-Disciplinary Approach for Patients with Autism Spectrum Disorders

ICBO 2010

Patricia S. Lemer, M. Ed., NCC devdelay@mindspring.com Autism Spectrum Disorders (ASD)

AD(H)D LD NLD Asperger’s PDD PDD-NOS Autism ( ) p g

…………………………..…………………………..

Least severe More severe Most severe

Statistics

According to the Autism Society of America:

• 1 in 150 children is diagnosed with autism
• 1 in 94 boys is on the autism spectrum
• 3 - 5% have attention deficit disorders
• 5-17% have learning disabilities

Some have both

• 5-17% have learning disabilities. Some have both.
• On average, 67 children are diagnosed with autism

per day – nearly one every 20 minutes!

• More children will be diagnosed with autism this year

than with AIDS, diabetes and cancer combined

• Full blown autism alone costs the nation over $90

billion per year, a figure expected to double in the next decade

Is There an Autism Epidemic? Some Possibilities

• More inclusive categories

Ch d di i i i

• Changed diagnostic criteria
• Better record keeping

Question: Where are the adults with autism? Thinking Has Changed

• Old Thinking: ASDs are inherited life-long

neurological disorders. Interventions can help individuals cope and compensate for their difficulties. (Kanner, Bettleheim)

• New Thinking: ASDs result from a

combination of genetic susceptibility and environmental causes. The right interventions can result in reversal of symptoms, and even full recovery.

• Autism is Treatable! (Rimland, www.autism.com/ari)

Causes: Nature? Nuture?

• Genetics Loads the Gun

– Parental immune system issues; allergies – Endocrine dysfunction – Low thyroid Poor ability to detoxify (methylation) – Poor ability to detoxify (methylation)

• Environment Pulls the Trigger

– Toxic exposures – pre- & post-natal – Birth trauma – Role of vaccines – Insufficient sensory stimulation – Changes in today’s world – Immune suppressing medications including antibiotics

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Total Load Theory

• The body is like a bridge, and can

handle only a limited number of stressors

• Cumulative effect of stress factors

Cumulative effect of stress factors

• verloads it
• Body’s top priority is staying well
• Degree of overload determines

diagnosis Use a Trans-Disciplinary Approach because…

• Thinking is a “team sport” and requires

many types of players

• Restoring health is like restoring a fine

Restoring health is like restoring a fine painting: know and respect its history

• It takes time to get well: at least as long

as it did to get sick

Vision Behaviors in Autism

• Squints or closes an eye; pushes or rubs eyes
• Stares at certain objects or patterns
• Looks through hands
• Flaps hands, flicks objects in front of eyes
• Looks at objects sideways or with quick glances
• Shows sensitivity to light (photophobia)
• Fearful of changes in flooring or on stairways
• Has difficulty making eye contact
• Bumps into objects
• Is fascinated by lights and shadows
• Holds onto walls or furniture when walking

Interpret Behaviors as Symptoms of Visual Dysfunction

• “Autistic” and “ADD” behaviors are often a

result of poor compensation for integration of central and peripheral vision Visual “stims” are attempts at “jump starting”

• Visual stims are attempts at jump starting

faulty visual function

• Poor eye contact shows that visual system is
• ver-loaded, and that the brain is not coping
• Motor clumsiness may be a result of visual

inefficiency

The Role of the Optometrist

• Evaluate and treat underlying visual issues
• Consider possible causes for visual

problems, such as nutrition, diet, metal toxicity birth trauma environment toxicity, birth trauma, environment

• Take continuing education courses to learn

how to evaluate and treat those areas

• Develop a referral network for collaborating

with other professionals expert in those areas

Interventions from Other Disciplines

• Structural therapies
• Reflex integration
• Biomedical intervention through Defeat

Autism Now! physicians Autism Now! physicians

– Dietary modification – Nutritional supplementation

• Sensory therapies

– Occupational therapy – Sound/Auditory therapies

• Energy therapies

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Collaboration with “Structural” Professionals

• Chiropractic
• Chiropractic neurology
• Osteopathy

Osteopathy

• CranioSacral therapy
• Massage
• Bioneurofeedback
• Other “Bodyworks Therapies”

Reflexes

• Over 100 involuntary movements that are

controlled by the brain stem

• In infancy protect and assist with survival
• Lead to the development of voluntary

Lead to the development of voluntary movement

• As they integrate person gains volitional

control over body

• Result is skilled, intentional behavior
• If unintegrated, interfere with development

and behavior

Consequences Of Reflex Abnormalities

• Aberrant motor development
• Poor lateralization
• Hyper- or hypotonic muscles

Hyper- or hypotonic muscles

• Vestibular dysfunction
• Poor binocularity
• Eye motor difficulties
• Perceptual problems

Immune System

• WHAT GOES WRONG

–System becomes exhausted from constant assaults from too many load factors, including over-use of antibiotics g

• SIGNS TO LOOK FOR

–Allergies, asthma, leaky gut, skin problems –Chronic ear/sinus/strep infections –Heavy use of antibiotics –Dark circles, red ears and cheeks

Get Bad Stuff Out - Detoxify

• Remove mercury-containing amalgams
• Homeopathic detox

Assists the body to heal itself from inside

• Antioxidants, foods and nutrients
• Chelation

Changing medical protocols

• Sweat: use a sauna
• Hyperbaric oxygen treatments
• All require strict medical supervision

Biological Statistics

• 99% - Omega 3 Fatty Acid Deficiencies
• 90% - Zinc Deficiencies
• Copper Excess

I Di l ti

• Immune Disregulation
• 80% - Chronic Diarrhea / Constipation
• 80% - > 5 Ear or strep infections
• 50-70% - Mercury (Hg) Toxic

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Add Back the Good Stuff with Nutritional Supplementation

• Closes the gap between what is eaten

and what the body needs

• Helps with poor absorption

Helps with poor absorption

• Detoxifies environmental chemicals
• Heals the leaky gut
• Repairs the nutritional deficiencies
• Boosts the immune system

Dietary Modification: Single Most Important Intervention

• Many kids with ASD are picky eaters who are addicted to

the very foods that harm them

• Removing gluten- and casein-containing products

reduces their “total loads”

• 1/3 improve dramatically when GF/CF with speech

emerging for the first time emerging for the first time

• Another 1/3 show improvement in sleep & general

behaviors

Reichelt, Ekrem, Scott. Gluten, milk proteins and autism. Dietary intervention effects on behavior and peptide secretion. J. Applied Nutrition 1990; 42:1. Knivsberg, Reichelt, Nodland. Reports on dietary intervention in autistic

• disorders. Nutritional Neuroscience 2001; 4.

Shattock, Whitely. How dietary intervention could ameliorate the symptoms

• f autism. The Pharmaceutical Journal 2001, 267.

Sensory Therapies as Adjuncts to VT

• Occupational therapy – Works on touch,

vestibular foundations for vision

• Perceptual- motor therapy – Reinforces

motor foundations for vision motor foundations for vision

• Sound therapies – Lays neurological

pathways for normalizing vestibular function and for integrating vision and auditory

“Hybrid” Programs

• HANDLE: Judith Bluestone – Holistic Approach to

Neuro- Developmental and Learning Efficiency – small, measured doses of simple activities.

www.handle.org

• Sensory Learning

Mary Bolles vestibular

• Sensory Learning – Mary Bolles – vestibular,

visual (syntonics), auditory, www.sensorylearning.com

• S’Cool Moves – Debra M. Wilson- reading

readiness www.schoolmoves.com

• Interactive Metronome – James Cassily –

Computer-based visual, auditory sequencing. Some ODs are being trained to use it in VT. www.interactivementronome.com

More Interventions

• Brain Gym
• Speech-language therapy
• Applied Behavioral Analysis

pp y

• Social-Emotional therapies – play
• Homeopathy
• Klinghardt model for autism

treatment The Role of Vision in Speech-language Development

• Speech language pathologist (SLP) is often

the first specialist families turn to

• Oral-motor issues related to prematurity
• Interaction with feeding/eating problems
• Ideally, co-treatment with OT and OD
• Consider missing links to talking
• Help families and SLP understand the role of

movement and vision in language development

• Relationships between receptive, expressive

language, reading and writing

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Applied Behavioral Analysis (ABA)

• The most popular “adjunct” therapy based
• n small sample of children
• Now a part of many school programs
• Work of Ivor Lovaas

Work of Ivor Lovaas

• Intensive therapy, up to 40 hours per week
• Some therapists disregard children’s

sensory needs, others integrate with OT/VT

• Can be a “push-me/pull-you” if too

structured

• CARD Centers all over the country

The Role of Vision in SOCIAL SKILLS

• Interpersonal interaction is the most

complex outcome of sensory integration

• Where am I; where are you?

Focus

• Focus
• Giving meaning to body language
• Depth perception
• Social skills training MUST take Vision

into account! Play Therapies: Social-Emotional Development

• DIR – Stanley Greenspan

– Collaborating with Dr. Harry Wachs – Integrates vision along with other senses – Offers great opportunities to incorporate VT – Offers great opportunities to incorporate VT

• RDI – Guttstein

– Also multi-sensory – More focus on social and play

• Social Stories – Carol Gray
• Son Rise – Raun Kaufman

Klinghardt Autism Protocol

• Five Levels of Healing

– Only model that takes into account energetic imbalances from EMFs and past generations – Work bottom up and top down

• ART is sophisticated “muscle testing” that allows quick

ART is sophisticated muscle testing that allows quick diagnosis of cause and treatment simultaneously

• Psycho Kinesiology – Alleviation of stress from of

past trauma

• Lyme – now recognized as causal in families with

multiple children on the spectrum

• EMFS – How to discover and mitigate them
• www.neuraltherapy.com

Working with PARENTS Help Them Understand that…

• VISION and VISUAL dysfunction play a

huge role in “autistic” and “ADD” behaviors.

• Behaviors are often a result of poor

compensation for integration of central and i h l i i peripheral vision

• Visual “stims” may be attempts at “jump

starting” faulty visual function

• Poor eye contact shows that visual system is
• ver-loaded, and that the brain is not coping
• Motor clumsiness may be a result of visual

inefficiency

Help Other Professionals them Understand that…

• Vision therapy COMPLEMENTs, rather than

competes with the work they are doing

• That you want to work collaboratively with

them in the best interest of the patient them in the best interest of the patient

• By teaching the visual system to work more

efficiently, you are making their jobs easier

• Specifically, the role vision plays in their

discipline, ie, language delays, social skills, emotional develpment, eye contact, etc.

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Working with EDUCATORS

• Help them understand that efficient vision and

motor skills lay the foundations for efficient learning and appropriate behavior

• Offer to consult on a “difficult” student with

ASD “pro bono.” Show the difference that lenses, positioning, lighting & movement make

• Offer in-service training for teachers and

related service providers

• Ask for psychological testing results; discuss

the role of vision in “low” scores

Take Home Points

• Thinking about ASD has changed
• Individuals with ASD are physically sick.
• Total Load Theory explains how and why

individuals go over their own personal limits and become diagnosed with ASD

• By understanding “load factors”, ODs can

recognize when a referral to a nutritionist, OT, homeopath or physician is appropriate

• Behavioral/Developmental Optometry is a huge

missing link in the treatment of ASD

• Collaboration with parents, health care

professionals and educators can help get the word out!

EnVISIONing a Bright Future EnVISIONing a Bright Future

Interventions that Work for Children and Adults on the Autism Spectrum Patricia S. Lemer, M. Ed., NCC, Editor Available from OEP