Neurodiversity and vision

A University of Bradford academic outlined the different visual behaviours children with autism may use to manage the flow of sensory information during her presentation at the AOP’s Hospital and Specialty Optometrists Conference (London, 8–9 November).

Professor Rachel Pilling shared that her career has focused on delivering eye care to groups who are often on the fringes of society and do not receive eye care.

“More recently this has focused on ‘testing the untestable’,” she said.

“This relates to a group of children who have traditionally been thought of as challenging to test – you can’t get the information you want, and therefore they are ‘untestable’,” Pilling explained.

“There has to be another way. We have been finding different ways of adapting what we do in order to help this group access eye care,” she added.

Pilling told delegates that while she was addressing this question, the focus switched from concentrating on what a child sees, to how they see.

“How does this person interact with their environment? How do they use their vision to do what they need to do?” she said.

“What happens when they are out of the clinic? Children do not live in the clinic, they live in the world,” Pilling observed.

The consultant pediatric ophthalmologist at Bradford Teaching Hospitals highlighted the diverse ways that people use their vision – from communicating to learning and navigating through the world.

Pilling noted that most children with autism have difficulty regulating the flow of sensory information – what they can see, hear, touch, taste and smell.

“We have a sensory mixing desk in our brains that is all the time adjusting – it is tuning out information that is not important in that moment,” she explained.

“Some people with autism can’t do that. All that information is coming at them all the time,” Pilling added.

She highlighted that a person with autism may have different visual responses to becoming overloaded with sensory information – for example, by shutting down, with their vision going grey or black, or they may focus on only one small part of their vision.

“Children may have short bursts of visual inattention. Their vision is not necessarily on all the time – they use vision on their own terms,” Pilling said.

“So many families have used that phrase with me that it has become part of my lexicon,” she added.

Pilling outlined different visual behaviours that are common among those with autism: central processors, off-centre processors, position processors and single channel processors.

Central processors may only focus on one part of the visual information before them.

They may find moving objects difficult to follow and find visual search tasks challenging – for example, finding someone in a crowd.

Pilling added that central processors may have difficulty navigating narrow spaces and move single-mindedly towards an object, appearing to overlook people or objects in their path.

Off-centre processors may view objects side-on to reduce sensory input and sensitivity to light flicker.

Position processors find it difficult to use their vision to determine where they are in a space, so they may walk with their hands away from their body or trail their hands along a wall.

Single channel processors are hypersensitive to multiple sensory inputs and may experience vision ‘blackouts.’

Pilling outlined how the transition from primary school to secondary school can present significant challenges for young people with autism.

“At primary school, you have one teacher, you are going to and from the same places all the time. You have known everyone for ten years,” she said.

“Then you get to secondary school and there are more people, more teachers and multiple buildings. There is a huge jump in what your vision needs to do,” Pilling emphasised.