By Lauretta Justin, OD, Orlando, Florida
Autism, or autism spectrum disorder (ASD), refers to a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences. We now know that there isn’t one autism but many types, caused by different combinations of genetic and environmental influences.
According to the Centers for Disease Control and Prevention, 1 in 68 children (1 in 42 boys) have ASD. With such high prevalence, we all will eventually have a patient with ASD in our chair. As a mother of two boys in the spectrum, I know from personal experience that this population has unique needs. As optometrists, we need to remain informed and aware in order to properly care for people with ASD. I compiled this list of tips to help us be more prepared for the ASD patient.
Remember, the term “spectrum” reflects the wide variation in challenges and strengths possessed by each person with autism. Each patient will be different; therefore, these tips will not apply to all patients.
10 tips for examining ASD patients:
1. Use few words when giving directions and wait patiently for the response due to a potential delay in processing.
2. Be very specifc when giving instructions. People with autism are concrete thinkers; they have difficulties with inferences.
3. Talk to them, not at them. These patients want to know that they can trust you. They should be treated as equals.
4. Be observant. Observe how the patient walks into the room and whether they make eye contact or are sensitive to lights or sounds.
5. Get the patient’s OK before performing a test. People with ASD do not like surprises or an unexpected touch.
6. Respond, don’t react. Staying calm is a key thing to remember when examining patients on the spectrum.
7. Do the exam in free space as much as possible. For example, try retinoscopy with a lens rack or use prism bars for binocular testing. Careful binocular testing is a must!
8. Demonstrate a test on yourself or a parent first.
9. Use visuals to support your message. Visuals decrease frustration and may help decrease problem behaviors that result from difficulty communicating. Visuals can promote appropriate, positive ways to communicate. Use iPhones or iPads, for example.
10. Be flexible! Being able to adjust and modify your examination techniques according to the patient’s needs will help you and the patient greatly.