What is Functional Vision?
In my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills, I describe some of the factors that impact functional vision. Functional vision is not the same as acuity. Acuity is sharpness or focusing power measured by discerning numbers or letters on a chart from a specified distance. Functional vision is the ability to use visual information to perform functional tasks such as reading, writing, catching a ball and scanning to sort pictures (shown in photo below).
Of course, acuity or focusing power are important for functional vision but there are several other skills that are also important such as following moving objects and using the eyes together in order to perform 3 dimensional tasks such as ring stacks.
The 7 F's
Children with autism may have difficulties with one or more of what is called " the 7 Fs. Occupational therapist, Lois Hickman and optometrist, Rebecca Hutchins describe these in their book: Eyegames: Easy and Fun Visual Exercises: An OT and Optometrist Offer Activities to Enhance Vision (2010)
The 7 Fs are:
1) Following a moving target using smooth, coordinated eye movements
2) Fixation to gaze at a stationary object
3) Focus to see clearly
4) Fusion to use the eyes together to see in 3 dimensions
5) Flexibility to look back and forth between different things
6) Field or the breadth of what the eyes can see while staring straight ahead. For example, people with glaucoma may have extremely diminished visual fields to the point of using "tunnel vision". Children with autism may not seem to be aware of what is in their visual field.
7) Fatigue- is eye strain from the effort put into using the eyes. Also some people with autism tend to use side or peripheral vision and using peripheral is more tiring than using the direct central gaze.
Behaviors Indicative of Visual Impairment
My son discovered that he was a very slow reader and was exhausted after reading for 15 minutes due to his eyes not working together. A developmental optometrist gave him helpful exercises to help his eyes work together .
Parents and others may notice that their child with autism does not look directly at objects or may look briefly directly and then look away while picking them up. Other atypical behaviors include stimulating the visual system by flicking fingers or an object near the eyes (often from the side of the eyes) or staring at lights.
- They may be particularly bothered by fluorescent lights
- seek out darkened areas, perhaps play in a tent or large cardboard box to avoid lights
- have difficulty using the eyes together or
- having difficulty to move gaze back and forth between distances or from vertical to horizontal planes.
My son avoids sunlight when possible, and can only sleep in a very darkened room while wearing eye covers. However, he can do a Rubiks cube in under 2 minutes !
Here are a few of the strategies that I describe in my book in greater detail.
FOR YOUNGER CHILDREN:
Adapt an inset puzzles using a cardboard box, sticky back Velcro and puzzle.
- Use Velcro to attach puzzle pieces to the top of a box lid. (see photo above)
- Attach puzzle board to the bottom of the box with tape or Velcro
Children will need to use one hand to stabilize the box lid while removing the puzzle pieces. This is a great way to promote bilateral hand skills.
There are many benefits to using any vertical plane activity. However, this strategy requires the child to repeatedly switch her gaze back and forth between the vertical and horizontal planes. This skill is called visual flexibility, number 5 in the above list.
The skill of being able to look back and forth between distances and planes is also called Accommodation . It is used when students look back and forth between the board and desk to copy from board to paper. It may be difficult to fixate on the word on the board, find the last word on the paper to continue writing and then go back to the board to again find where one left off reading. There are some compensatory strategies that teachers can implement to help students such as
- allowing them to sit closer to the board or
- have a copy at the desk to copy from instead of copying from the board.
FOR OLDER CHILDREN
I learned the following strategy to promote accommodation by reading-Let's Do It Write! Copying From the Board by Gail Kushnir (1999) Parents can easily set this up to do at at home.
Tape cards, words or pictures on the wall and provide identical cards at the table or desk. Start out with 2-3 cards that are fairly close together on the wall and gradually
- increase the number used and
- spread them further apart.
As you can see in the photo above, I needed to look back and forth in order to arrange the cards to be in the same sequence. I don't have great visual memory, but this activity works on that skill, especially when you use a full deck or sentences to sequence in the same order.
Younger children may start out using only a few simple pictures, shapes or photos that are very different from each other . A more advanced task involves using the cards shown above to help children discriminate the diagonal and vertical lines used to form letters and numbers.
Visual-Motor activity to Promote Visual Accommodation and Writing Skills
Attach three strips of Velcro fastener to a frame. The frame shown in the photo above is a large plastic envelope that also provides storage. Cut small ovals and circles out of white plastic milk bottles.
- The taller ovals are used to write uppercase and ascender and descender letters (such as H, p, y and d) and
- the smaller circular shapes are used to write half-space letters such as a or s.
Attach dots of velcro to the letter pieces so that they can be repatedly rearranged on the board. Place written letters or words to copy on the wall so that children need to look back and forth between the vertical and horizontal planes to copy onto the plastic pieces and then attach to the frame. Wiping the plastic clean and pulling them off Velcro backings provides much appreciated sensory stimulation, too!
I hope that these tips, adaptations and activities are helpful. I share a few Amazon resources below. If you have any questions about your child's functional vision please check with a developmental optometrist who specializes in working with children with these types of challenges. Check out this website to find one. http://www.covd.org/
