Did you know many visual disturbances in autistic children (or perhaps even with other disabilities) cannot be described just by visual acuity? Or even by visual processing?

Dana Johnson talks about Ocular Motor difficulties in many autistic children (and adults). It was eye-opening (yes, pun intended) to learn about the effect of ocular motor on peripheral vision, eye contact and more.

Audio Transcription:

Welcome back to functional nutrition and learning for kids your stop for all things learning, education, nutrition, gut, brain chemistry, and more for your kid with disability be that autism or Down syndrome. I am your host Vijay, and I’m also a parent to a child with diagnosis of autism and Down syndrome. And I’m learning so much from doing this podcast. If you are also learning stuff that you value, I would so appreciate it if you could put in a review on iTunes.

Now this serves two purposes. A it makes my day and be it helps other people find this podcast. Of course, another way to do this is by sharing this podcast with a friend, or your child’s teacher or doctor. Request number two, if your child with disability has something they would like to share with the larger world, or would like to be a guest on this podcast. Please write to me advice at functional nutrition for kids.com.

Now let’s move on to the super special episode and I guarantee that you’re going to learn stuff that you’re off monologist, and optometrists never told you, among other things, why does your child look through the corner office eyes? And why does she not make eye contact?

Today’s guest is Dana Johnson, originally from Canada data now resides in sunny Tampa, Florida, where she owns interplay Therapy Center, and occupational therapy practice devoted to supporting families of nonspeaking and unreliably speaking individuals, Dana was first introduced to spelling to communicate, or she was introduced to this about five years ago through a mentor and transformed her practice. Her passion for the non speaking community intensified. And in 2014, she founded Invictus Academy, Tampa Bay, and nonprofit private schools for students with sensory motor differences.

All of these students utilize spelling to communicate as their primary method of communication in this school. Dana now makes it our mission to educate others about the neuro diverse community and all aspects of spelling to communicate. So welcome, Dana, what I’m so excited to have you here and one of the things I’m most excited to talk to you about is ocular motor or visual motor. Thank you for joining us today. Thank you. I’m really excited to be here. Yeah. And I was going to start off by asking you, can you tell us what ocular motor is? And is that different from visual motor?

Absolutely. So ocular motor. When you think about ocular, often people think about eyes and seeing. And so I often have to make the distinction between visual acuity, which is our ability to see near and far and make sure that things are clear. But ocular motor is different than that, it is actually the way that we move our eyes. And typically we we are I talked about tracking, which is our ability to read for examples and moving our eyes left to right. And then there’s also what we call saccadic eye movement, which is being able to move your eyes in any direction, almost like jumping around. So thinking about doing like an eye spy book or something like that.

That’s what your eyes are doing and those Socratic eye movements. So that’s really the difference one is actually seeing clearly and the other one is just with respect to the actual movement of your eye. And is that is this is that all very new to me. So thank you for saying this. And I think I had been definitely one of the people that had confused the two because I would use visual motor. And often I would mean accurately. So this is good to know. And when you said I Spy, and that brought in a lot of memories, and probably this has happened to other families as well. But when we were young, or when Sid was young, and we were we used to do the standard ice five books, and I remember that it was so frustrating for him, he would just not even look at the book. And it was always interpreted as not knowing what the object was, or as not understanding the command is that your experience as well.

Absolutely. And it’s often that we look at what the child is doing and just assume that it’s you know, they’re not interested or they don’t want to do it without thinking about the fact that it may be a purposeful motor thing, meaning that they literally can’t, they don’t have control over their eyes. Our eye muscles are extremely tiny and very, very minute in terms of being able to move them those movements are so small that it takes a lot of work. And so a lot of the kids that I work with and certainly my students ocular motor is is something that we focus a lot on. But the other thing is that is often missed, because we don’t necessarily look at the eyes we look at the body a lot and notice easily that it’s they’re having difficulty with their purposeful movement, but when it comes to the eyes, it’s not as easily seen and it’s probably even hard to see right? How do you know whether the child has a motor issue or not when the child is it might be just visual avoidance or the child isn’t looking at the thing, because it’s too hard.

Exactly. So what I typically talk to parents about is making sure to rule out any acuity issues. So I’ll ask about, you know, when was your last eye exam, and Now thankfully, technology is on our side where, you know, they have the ability to be able to understand the child’s visual acuity without them having to look at the typical eye chart that we had, we were younger. So they’re able to really decipher whether or not they do have an acuity issue or not. So once that’s ruled out, then I’ll look at a number of things. I look at the two main, the main things, ocular motor tracking, and then also this mechanic I movements. And I’ll do those screenings in my clinic. And then I also do them at the school. And it is very telling when I show parents that because you can see the eyes almost jump or you can see them leg, it’s very difficult for them to track anything in a very smooth way.

Wow. I mean, as you say that this is something I feel like I want to do right away for set, because if we what we have done is we’ve seen ophthalmologists. And as you’re seeing this, I realized that all they’re looking at is visual acuity. And we were told that by different people, some people said he needed glasses, and he never wore them, because I can understand now that they probably didn’t help with the actual issue at hand. And some people said that they knew he needed prisms. And I can see that with a prism really help with accurate or not accurately, but with a prism helps with ocular motor. See, that’s the difference is, when I have some clients that come in and they go to a vision therapist, are they going out and have their eyes assessed, probably similar to what you were just describing was said is that sometimes that is suggested, but then also, they’ll do vision, vision therapy, which is in fact things that address the tracking.

Now with our guys, it’s a little bit difficult, because they often will have difficulty with their gross motor, purposeful movement. So a lot of these exercises require the regulation and require their bodies to be still. And so we have to kind of decide what what are we going to work on first. So as far as the prism glasses go, there’s a number of reasons as to why they might have prescribed those. But certainly, they would probably if it was more of a vision Therapy Center, they would probably have prescribe some vision therapy as well, just to address specific motor part. That is probably what they did.

Interestingly, we have been in vision therapy centers that I’ve actually refused to work with said, and I understand now from what you say that it was probably very difficult for them to work with said because conventional vision therapy doesn’t work because he has control over his movements.

There’s a lot of things that are actually clicking into place in my mind as we speak. So that’s very interesting. And I think just putting these things into words, and defining and differentiating in our mindset, what are we talking about accurately? Are we talking about tracking or ocular motor? How does that fit into a child with autism that has very dysregulated?  or, if not dysregulated, and not much control over gross motor movements and fine motor movements?

How do we adapt this to them? So there’s, there’s so much and as we differentiate, I think it becomes easier even on people that do this therapy, as opposed to them being overwhelmed by seeing a child like said and just saying, we can’t work with him and his. So when I was talking with Elizabeth, one of the things that I this was about five or six years ago, perhaps that she said that I didn’t know until then was that is a fine motor movement. Right? Yeah. So do you think that vision is also a fine motor move, is that what you’re saying is, is that the ocular muscles are also fine motor.

Absolutely. So very similarly, we have the speech as far as our mouth. And then we also have our digits, which is our fingers, and then we have our eyes. So all of those movements are very, very, very fine with the ocular muscles being extremely fine motor movements. So when we have our guys that are working, whether it’s, you know, doing any kind of gross motor movement, often you’ll see them not looking at a target or not putting their eyes on something and then trying to get their bodies in the right position.

It’s very, we were dependent on our eyes for a lot of things that we don’t really realize because we take it for granted. And so when you have that difficulty with your control and the purposeful movement of your eyes, it affects every single thing. So, so I when we’re when We’re working, whether it’s on the letter boards, or we’re working in doing some fitness activities, everything is focused on the eyes. In the back of my mind, I’m always thinking about that, how, why is this difficult for this client, and often it comes back to they’re not either getting their eyes on their target, or it’s just their eyes are tired.

I mean, we can’t forget that it doesn’t take long for the eye muscles to tire out. And so we have to work and build up that endurance just like we would any other muscle in our body. Right. And I’m guessing this ties into even when we’re looking at alternate academic or communication systems, when you a lot of times the immediate next thing that is tried if a augmentative device doesn’t work is I guess, I can just see how that would be such a terrible fit for many of our kids.

Right? Absolutely, that would be extremely frustrating. And one reason why when I’m doing either a gross motor activity, or even more of a fine motor, where it’s, it could be something like a crossword puzzle, or a maze, you know, really targeting the tracking those kinds of things, it probably requires a lot of visual prompting at first, because they’re not going to be able to get their eyes on the target. Right away, they’re going to need that extra support just like we would, for any gross motor tasks that we’re starting, they still need that same amount of prompting or support.

Right? And that makes sense. So Dana, lead us through something that you do, maybe, how do you work with a child that has ocular motor issues, and if you could lead us through what what a good outcome might be or what is a good outcome that you saw when you actually addressed this through whatever is it that you do.

It really varies as to where the child is starting. So I have a variety of different clients, where some of them have a very difficult time with purposeful motor movements. And they have a lot of sensory motor differences, where their bodies are in constant motion, and or tend to be impulsive. And so with those, with those clients, what I typically do is really work on more of that purposeful gross motor movement, but in the back of my mind thinking about their ocular motor and their their eye movements, specifically, by doing things like coaching their eyes first.

When we’re trying to move or we’re looking to go in a specific direction, or we’re going to pick something up, we automatically look at that item, and then pick it up. So these are my clients that really struggle with their ocular motor, and then of course, their gross motor, they’ll often not be able to get their eyes in the direction that they need to go. So that’s the very first thing is really prompting their eyes, and giving them a target.

Get your eyes on the chair, you know, put your eyes on that chair, look at that chair, if the goal is to get their bodies in the chair, look at the you know, box, or if we’re doing you know, step ups or something like that, as far as a fitness program, is get your eyes on that box, because once they can get their eyes there, then you can coach their body, or often their body can go and get and they can they can move over to that location so much easier once they can get their eyes there. So that’s the first thing that you know, with with an individual that may have more significant motor differences.

Then I have other students and clients where they do have that ability to be regulated, sitting in a chair. And you know, may or may not have mentioned to me that one of their goals is to read. So one thing that we do, which is takes a lot a lot of work and can be very tiresome to to the eyes, is to visually track. And so what I do is I’ll blow up a paragraph of a book that they are interested in reading, and I work with them to get their eyes tracking on each individual word.

They’re not saying the word at the same time, they’re not reading aloud, because that’s like we were just talking about with respect to the amount of motor that’s a lot of motor so the speech being motor in the eyes. So I’m just letting them know that their goal is just to read in their head and then I’m observing their eyes and making sure that their eyes aren’t going faster than I might be pointing to the word or slower so and I do that by just coaching them. So really getting your eyes back on that word, you know really, really helping them to maintain that tracking.

I will tell you that it is extremely difficult. So we do we typically do that separate from any type of academic any type of spelling sessions, anything like that. Maybe five minutes, maybe 10 minutes at the most. And then throughout the day, just doing things like crossword puzzles, mazes, Sudoku, things like that, that just take a lot of ocular motor focus and things like that to be able to make it more fun and enjoyable, but still may, depending on their ability, they may need more prompting to be able to help with that.

Couple of questions that come off from what what you said is, you were kind of referencing, you know, even reading a book. So is that something that within of prompting, like kids can eventually move on to reading perhaps big print? I mean, we’re not, I mean, however we adapt the book for them is that is that usually a goal? Or is that sometimes a goal to read a book independently, I have a number of students that that’s a goal, not every single one. But certainly it is for a couple of my students and, and, you know, with respect to them, working on the keyboard and being able to move their eyes between the keyboard and the screen.

That’s also a lot of work. So it’s not necessarily tracking that’s more saccadic Eye Movement, but it’s still tiresome to the eyes. So a lot of my guys that their goal is to get spelling on the keyboard. So that is something that we want to work on in terms of developing those ocular motor skills. So yes, it’s not all it’s not every everyone, but certainly I have a number and they work so incredibly hard to get that. And thankfully, we live in the world of audiobooks. So we can carry about 24. Such strain on the eyes and audio books are literally saving our life here. But I did one more thing is how does peripheral vision fit into this? So is this why a lot of kids will use peripheral vision to compensate and to kind of figure out where things are and to move themselves and manipulate stuff in space?

Yes, I mean, this is so blows my mind all the time, because so many of my guys use their peripheral vision. And it’s just like you said a compensatory strategy that they’ve developed. But then it also, you know, when we’re looking at doing something like crossword puzzles, or maze or written work or spelling, you know, really still having to prompt those eyes, because it’s about being purposeful, and being able to have them control where their eyes go. So that brain body connection, that’s the goal. So it’s even if they’re absolutely perfect using their peripheral vision, I’m still working with them on getting their eyes on whatever it is the whatever the task is at hand that they need to write, and you still see there’s benefit with that, despite them using peripheral vision to optimal.Yes, absolutely. It Again, it’s about that purpose. So so for them, they’re they’ve developed this, this strategy, which is worked, but you also want to help them and support them with their purposeful movement. So that’s this is just another way of being of doing that. Awesome, I want to segue into three things that we can, we can give parents as either action items or mindset shifts, that could be anything. But if there were three things that you wish every parent of a child with an autistic child would know, what would they be.

The first thing is, and this is something I’ve learned from my guys is that eye contact and forced eye contact is it can be painful, and is difficult. So I know that that is also part of the reason why, you know, the guys are my guys will have difficulty with looking purposely at something. So that’s, that’s a one thing for sure is is understand that it is a very difficult thing to do. And again, purposely getting their eyes, they may want to look at someone and they just can’t they can’t get their eyes there.

The second thing is would be you know, always remember that if you want your child to do something in whether it’s moving from one spot to the next or to do something with their hands, a fine motor task and you know activities of daily living anything like that coaching their eyes is going to make a world of difference.Really getting their eyes on it and you hear me saying this a lot.

You know, get your eyes on this, get your eyes on that look, look, you know as far as making sure because that is going to probably make things go a little bit quicker because then they can actually see exactly where they’re going. And just just being really empathetic and understanding towards your child that the eyes muscles are so small that they can get tired. And they can get to a point where they’re achy. I mean, I know that being in college and staring at the computer and having those headaches and having that kind of thing.

It is something that does happen. And we just have to remember that, that that’s all there. So those are the three main things that I would just, you know, off the top of my head just mentioned to parents to understand that the eyes do a lot for us. And when you don’t have control over your eyes, it’s difficult, very difficult.Yes, thank you for that. And I see that there’s so much information and more to share today, that can actually that can and that should cascade through many different professions.

I mean, I can visualize a future where this should cascade to OTS to pts too often managers, optometrist, visual vision therapist. Yeah. So this is because everywhere I can see that a lack of vision is so easily assumed to be a lack of cognitive ability. Right. And this is this is throughout this, like I said, this permeates every area for for autistic children that have trouble with motor movements, fine motor movements, especially. So thank you for sharing all of this with us and to tell our listeners where they can reach you.Okay, yes, absolutely.

I am in Tampa, and I have a website. And I also have my email address. My website is www dot interplay Therapy Center, calm. And then my email address is Dana, at interplay Therapy Center, calm. And Dana is also our interplay Therapy Center is also an Instagram and I’ve just started following her. Absolutely, and Facebook and yeah. Well, thank you so much for joining us, Dana. I was such a pleasure to have you and I cannot tell you how many things I learned in the past 20 minutes.Oh, thank you so much.

It’s been wonderful. I really enjoyed talking with you today. Thanks so much. Thank you, my friend for listening to functional nutrition and learning for kids. We are a team of two bringing me right. Close to researcher interview and my daughter might see you next Friday.