In our last issue, Dr. K. Sharieff, a neuro-developmental optometrist, outlined the visual perceptual deficits related to Autism Spectrum Disorders (ASD) and the adaptive visual skills that should be evaluated.   This is central in facilitating social and educational goals for all persons with ASD including those who may have some but limited vision and certainly those deaf or hard of hearing. I am repeating this concern here to encourage teachers, speech and language and other specialists and parents to review skills related to eye movement, spatial awareness, binocularity or eye teaming, and visual-motor control.

Clinically, other professionals (such as occupational therapists, speech and language clinicians) and I have noted that as youngsters, small delays and/or errors in tracking and orienting may be overlooked especially for deaf and blind.  At the time of discovering the dual diagnoses of a  sensory disability and autism, it may seem reasonable to think delays may occur with shifts in communication systems and social relatedness issues. However, we should be very cautious that such differences do not become accepted as part of the overall behavior of autism and sensory loss.

As a result, we can begin to think children are less able and/or less interested in communication and consequently impact the educational and safety components of their everday lives.

It is also very important for deaf children to have the necessary tracking skills for receiving signed communication or even gestures directed to them. Without the advantage of sound or voice alerting them from the environment, teachers and family members may need to learn techniques to clarify sending and receiving messages.  

Deaf students with autism may have difficulty with both visual spatial components of presenting a sign to another person. They may need, for example, to anchor their arms on a desk surface when working on imitating, motor planning, and executing a sign. They must also learn the pragmatic elements of giving a sign to another communicator's receiving space. That is, it is ineffective for students to initiate signing in their lap or in a lower position in order to watch their own hands without recognizing that another person may not see it or mistake it for something else.