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Autistic Spectrum Disorders and Cortical Visual Impairment: Two Worlds on Parallel Courses - 
Part 2

Mary Morse, Ph.D.*, Terese Pawletko, Ph.D. & Lorraine Rocissano, Ph.D.**
* Educational Consultant, N.H., ** Psychology Department, Maryland School for the Blind

AER/DENVER, July 18, 2000

Download "Autism and the Visually Impaired Child" PowerPoint slides (237k)

Note: the following sections were depicted as "icebergs." They detail the key diagnostic features of autism using an iceberg approach - the behaviors one might observe on the surface, and the processing difficulties that might account for them.

Pattern and Predictability

YOU SEE:

Autism

• Gets fixated on certain activities or sensory stimuli (e.g., certain visual and auditory patterns)
• Insistence on things remaining the same (e.g., sequence of events, placement of objects)
• Performance may be better with certain materials or in familiar context - may seem more impaired in new context

CVI

• Fixated on certain sensory stimuli (e.g., certain colors, lights, finger or hand gazing, certain visual patterns)
• Performance may be better w/some types of visual stimuli than others (e.g., objects, faces, spatial orientation) and in familiar context - may seem more impaired in new context

What you do not see: 

Brain is looking for patterns it can recognize (e.g., visual, auditory; sequencing) in the environment - child may not recognize different phonemes and their pattern and sequence, yet recognize pattern in inflection or music and thus, more likely to attend to the latter

Processing Problems: Figure-ground

YOU SEE:

Autism

• Cannot discriminate foreground from background noise (e.g., seems to attend to conversations across the room while ignoring language directed toward him).
• Fiddles with string while ignoring toy the string is attached to.

CVI

• Difficulty discriminating what visual stimuli is important to attend to
• Does not see and/or show recognition of some types of visual stimuli

What you do not see: 

Brain is having difficulty sorting essential from non- essential information, brain may perceive things as a whole for some individuals, or attend only to certain details disregarding the gestalt.

Processing Problems: Multi-sensory Input

YOU SEE:

Autism

• Stops listening when cat jumps
• Sensory overload can lead to total or partial shutdown, or over over-arousal

CVI

• Tends to look away when reaching/touching on lap
• Has more difficulty in using vision when managing other sensory or motor demands
• Sensory overload can lead to total or partial shutdown, or over over- arousal

What you do not see: 

• Brain is having difficulty regulating and processing information coming in (e.g., type, rate, amount, multiplicity)
• Brain may only be able to process information from only one modality at a time
• Can suffer from cumulative effects of overstimulation

Do Not Spontaneously Generalize Learning

YOU SEE:

Autism

May understand scripted directives in context but not out of context

CVI

May recognize objects or people in familiar context but not in unfamiliar context

NOTE: typical child can be taught and know "a cup is a cup" across settings; autistic and CVI children are not able to apply old learning to new situations without specific instruction.

What you do not see: 

Brain relies on the "total package" to comprehend the situation. The package may include a specific subset of the following kinds of features: the sequence of events, location, specific materials, specific person teaching, specific words, etc. etc. etc. to define "the event" or "the concept." What feature the child uses as an anchor is unique to the individual.

MISLEADING BEHAVIORS: Instability of Function

YOU SEE:

Autism

• No reaction to loud noise at one one point in time, but may have extreme reaction at another time (may change moment to moment)
• Seems to understand instructions one day, seems lost the next

CVI

• At one point in time seems to recognize objects and/or persons, but at another time (even moments later) may not recognize object or person

What you do not see: 

Parts of the brain that regulate sensory thresholds, efficiency of neurotransmission, and ability to access memory may all impact on the child's functional ability at any point in time. This is also true for the child's physical condition (e.g., illness, medication side effects, fatigue).

Note: the sections above were to begin to alert VI teachers to the some potential similarities and distinctions between some children who are autistic and other children with CVI. The next sections offer concrete suggestions for intervention and make distinctions between what is used for non-autistic vs. autistic visually impaired children; also to review the components of structured teaching that we use with our autistic-vi students across settings.

Comparing Strategies for the Blind vs. Blind Autistic Student

For a blind child:

• Use a lot of language paired simultaneously with object exploration.
• Use a lot of vestibular input, tactual input.
• Moderate levels of extraneous noise generally will not cause distraction.
• Provide lots of social stimulation. The child can be expected to enjoy a variety of social contacts.
• His sensitivity to social reinforcement, including withdrawal of attention, means that praise and "time out" will be effective motivators

For an autistic blind child:

• Use brief statements, moderating the pace of speech; pace of exploration of object.
• Control the amount & type of input so child is not over aroused, unable to attend.
• Be aware of impact of even subtle noise on child's stress level and ability to attend.
• Balance social time with alone time. Child may often find social experiences aversive rather than reinforcing.
• Social experience is generally not important to child. Praise, "time out," are typically not effect motivators.

Components of Structured Teaching

Physical Structure

• What activity will occur in "X" location?
• What sensory sensitivities need to be addressed by the physical structure?

Ideally, only one activity occurs in one location (e.g., teacher table is sole place that 1:1 work occurs; independent work desk used only when child works independently; independent play activities occur in one location; craft activities occur in a different location)

Processing and sensory needs: use controlled language, minimize extraneous noise through use of sound absorbing materials (e.g., tennis balls on bottom of chair feet, hang sound absorbing materials from windows and walls, replacing faulty buzzing fluorescent bulbs, staff to use conversational tones only); use barriers (e.g., book cases) to define space, provide visually calm environment

Schedules

• What will we do?
• In what order?

Minimizes demands on memory and attention, decreases problems with time and attention, compensates for problems with language comprehension, aids motivation (e.g., "first work, then play"), and allows for greater independence in functioning.

Individual Work Systems

• What am I going to do?
• How much will I do/for how long?
• When will I be finished?
• What comes next?

Predictable, methodical, consistent approach to tasks - takes advantage of autistic individual's love of sameness - follows left to right, top to bottom format

Modify work system based so child can be successful in independent completion of task - if can't be independent, back down and add more structure