Naushin Fathima S, B. Optom

Fellowship in Clinical Optometry, Aravind Eye Care System, Chennai, India



The defining feature of autism is the presence of a distinctive impairment in the nature and quality of social and communicative development. They have difficulty with imitation, imaginative play, and non-verbal communication (eye contact).(1)


  1. Genetic cause – Hereditary, Genetic mutation, Down Syndrome, Fragile X syndrome, Rett syndrome.
  2. Environmental cause – Maternal obesity, premature birth, fever during pregnancy, exposure to pesticides during pregnancy, depletion of neurotransmitters.
  3. Idiopathic.


The repetitive and restricted behaviour such as

  1. Sensory feature:
  • Hypersensitivity to auditory, tactile, visual, and olfactory.(1)
  • Low intensity exposure can result in distress and discomfort.(1)
  • Delayed speech, difficulty in eye contact
  1. Motor feature:
  • Rigid body
  • Compulsive behaviour – Ordering and Rearranging.(1)
  • Ritualistic- Pattern walking and repetitive action like on and off lights.(1)
  • Stereotypic- Hand and arm flapping, toe walking, repetitive jumping, head shaking, weaving and side to side rocking.(1)

Aggression and self-injurious behaviour.

Figure 1: Signs of autistic child

 [Image courtesy-]


Parents, family members, physicians, and early childhood teachers play a vital role in monitoring and screening the developmental milestones of children from birth to 5 years of age.

Table 1: Assessment of autistic children

Functional Assessment Other Routine Assessment
  • Psychologically assessing the adaptive behaviour and independent functioning of the child in the social environment.(1)
  • Cognitive and Developmental assessment measures the IQ level.(1)
  • Behavioural and functional assessment is the assessment of learning and understanding of the environment, physiological factors, and purposeful response to the opponent’s behaviour.(1)
  • Oculomotor and postural physiology assesses the aspects of sensory, motor, and cognitive functions at multiple levels in neural pathways.(3)
  • Electrocardiogram
  • Blood test.
  • Brain Imaging
  • Chromosomal Analysis
  • Illicit drug and toxicology screening.


  1. Family centred support is a combination of emotional, educational, and social development.
  2. Professional Therapy
  • Functional Therapy – such as Behavioural, Occupational, Speech, Auditory and Vision Therapy will help in the development of children.
  • Pharmacotherapy – depends on behavioural abnormalities (symptoms) and underlying biochemical (depletion of certain neurotransmitters).The goal of psycho pharmacotherapy is to correct both with an effective.(2)

Figure 2: Simple tips for managing the autistic child

[Image courtesy-]

Professional approach:

  • Observing the child and collecting information in the area of interest.
  • Creating a bond between therapist and child by being playful, familiar, focusing on their interests.
  • To work, plan and organise the visual, realistic, and work difficulties of the child.
  • Keeping the child in the comfort zone is more important.
  • Approaching a child with permissive manner.(3)

Optometrist role:

  • Optometry role is not only performing refraction but also prescribing the Compensatory glass prescription.
  • Also assessing the visual acuity, extraocular muscles, pursuits, fixation, saccades, accommodation, and convergence.
  • Assessing the higher level of visual function such as eye and hand coordination, visual auditory response, visual perception.(4)



  • Stone-MacDonald, A., Cihak, D.F., & Zager, D. (Eds.). (2016). Autism Spectrum Disorders: Identification, Education, and Treatment (4th ed.). Routledge.
  • Moldin, S.O., & Rubenstein, J.L.R. (Eds.). (2006). Understanding Autism: From Basic Neuroscience to Treatment (1st ed.). CRC Press.
  • (2022, October 17). Neural Engineering Techniques for Autism Spectrum Disorder, Volume 2 – 1st Edition.
  • Schulman, R. (2020, June 13). Optometry’s Role in Autism Spectrum Disorders – VisionHelp. VisionHelp.