07 Autism and Vision - a podcast by The InBound Podcasting Network

>80-90% of kids on the spectrum can't move, look, and listen in a fast, accurate, effortless, sustainable-appropriate, and meaningful way. This results in high fear, high anxiety, high distractibility, and will leave your child in a perpetual state of fight or flight or your child will simply adapt and learn how to not pay attention. In this episode, Douglas W. Stephey, O.D., M.S provides information regarding children on the Autistic spectrum and how to effectively assess the visual system and provide solutions for them to move, look, and listen through their life with greater ease.

Douglas W. Stephey, O.D., M.S.

208 West Badillo St Covina, CA 91723

Phone: 626-332-4510

Website: http://bit.ly/DouglasWStephey

Website Videos: http://bit.ly/DrStepheyOptometryVideos

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Transcription Below:

Tim Edwards: The Move Look and Listen Podcast with Dr. Doug Stephey is brought to you by audible. Get a free audio book download and a 30 day free trial audible membership www.audibletrial.com/inbound. You'll find over 180,000 titles to choose from, including several books mentioned here in the podcast. Support the Move Look & Listen Podcast by visiting www.audibletrial.com/inbound. 

Dr. Stephey: If our two eyes are not working together well as a fast synchronized team. Our internal mapquest continues to be off. It's consistently inconsistent with our ability to judge time and space. Those that don't feel well-grounded, those that have some measure of anxiety, oftentimes it starts in the visual system. If you can't move, look and listen in a fast, accurate, effortless, sustainable, age-appropriate, meaningful way, you're in a world of hurt. There's a whole world in vision and how it affects brain function that no one's ever shared with you. 20/20 is perceived as a holy grail of going to the eye doctor. Well, I'm here to change that paradigm. 

Tim Edwards: Hello and welcome to episode number seven of the Move Look & Listen pocast with Dr. Doug Stephey. I'm Tim Edwards with the Inbound Podcasting Network and a patient of Dr. Doug Stephey, who is an optometrist practicing in the southern California area. Now Dr. Stephey. Today's topic, I believe is going to be a gold nugget found by parents of children who happened to land somewhere on the autistic spectrum. Never have I heard how autism and vision are connected, but we're going to discuss that here today. 

Dr. Stephey: We're talking about autism and vision because about 80 percent of our brain's neurons are wrapped up in the processing of visual information. Remember, there's about 3 million sensory neurons that feed information to the brain, vision, auditory, taste, touch and smell. And of that 3 million fibers, there's about 30,000 auditory fibers per ear and roughly 1.2 million per eye. A staggering difference, and there's instances clinically. 

Dr. Stephey: What I've seen this happen in the office where vision has the capacity to change how you hear, vision has the capacity to change balance and gait and posture. Vision has the capacity to change the way your body feels, your feet on the floor. It changes a term called proprioception or the awareness of your body in space. I've had patients, kids and adults alike where I'll tell them, I'm going to take my index finger and lightly rub it along your forearm. And I want you to tell me how it feels. And if you're a touch sensitive in this manner, it just about freaks you out. It's like walking into a spiderweb when it gives you the heebie jeebies. Who hasn't done that? 

Tim Edwards: No. But it is fun to watch people do it. 

Dr. Stephey: It sends a shiver through your whole body. 

Tim Edwards: It's creepy. Yes. 

Dr. Stephey: So people in this manner don't like light touch. And so I'll lightly rub their forearm and I can, sometimes I can see them visually get the shutters. And or they'll get a screwed up look on their face where it's like, oh man, I really don't like that. And then I stop and I say, how does it feel? And they're like, well, I didn't like it, number one. And if they don't spontaneously tell me, I always then ask, is it still itchy? And they're like, yeah, well then itch then and make it go away. So then they'll itch their forearm and I'll say, okay, well you know what, let's put on this pair of glasses with color in prism in them or color or prism or whatever. Whatever the combination is. And I'll say, let's try it again. And more times than not I'll do that when they put the glasses on and they're like, oh, just feels like you're touching me now. 

Dr. Stephey: And how about when I stopped? They're like, well, you just stopped. It's not itchy anymore. No, it didn't feel like anything. Tim, it's the craziest stuff. 

Tim Edwards: That is something you see at a circus that just seems like hocus pocus. I mean that's like something you'd see at a magic show or something. 

Dr. Stephey: Well, it seems like hocus pocus to me as well, but I've learned over the years that this is repeatable outcomes. There's two adult stories to tell you. One is I did this with a wife who was in the exam room with me and her child. And she laughed about how annoyed she was by touch. And essentially she said it's a wonder we have any kids. Because I like it so little. 

Tim Edwards: Never heard it put that way before. I like it, so little to be touched. Wow. 

Dr. Stephey: So yeah, so I put the glasses on her and she's like, this is crazy. And then I had a different mom do the same thing and she remarked about how she didn't like it and hugs from her husband. And we put the glasses in prism on her and it again, remarkably changed her sense of touch. And then I said, well, you know what I want you to go out of my exam room. I want you to go out to the reception area with my glasses on and I want you to give your husband a hug and come back again and tell me how it was. And so she did. And she's like, oh, it was awesome. And he let go of me before I was ready for him to let go. 

Tim Edwards: Dr. Stephey, it sounds like you could add marriage counselor to your repertoire there.

Dr. Stephey: I am the love doctor. 

Tim Edwards: And she had this and it's immediate. This is something that's immediate. Because they're putting the lenses on right there and boom, there's change instantaneously. 

Dr. Stephey: It is the craziest stuff. Now, has anybody written an article about this? No. I don't know if any of my colleagues are even trying stuff like this. You know, I've, I've. 

Tim Edwards: How did you discover this? Like how did you, how did you know? Maybe you didn't discover this. Maybe this is just something that that's been happening for years in your industry, but no one's talking about. Or is this something that you just happen to discover while experimenting with lenses with your patients? 

Dr. Stephey: You know that's a good question, Tim. And I don't really know how to answer that because I don't think I've had this discussion with my colleagues, so I don't know if they're doing similar stuff. I haven't had anybody spontaneously tell me that they do. So I don't really know. I do know that there's a modest amount of time that I feel like I'm the only person on the planet thinking about these things and putting these things together. And there's very few people that I can really talk to about this because they just don't know. 

Dr. Stephey: So if we circle back to the kids with autism, let's recognize a couple of things first of all. It is a behavioral disorder by its very definition. There's no test for autism per se, but you look at a checklist behaviors and the timelines of which they manifest and the consensus is you then fall on the spectrum based upon the checklist that's completed. Arguably and most commonly speech delays. Right? Kids have delayed speech or their nonverbal. It's one of the most easily recognized markers. There's some research that I don't particularly know all that well. That indicates that we might be able to use eye movement and eye contact and gaze of infants as a predictor of autism even before they're were even close to having speech. 

Tim Edwards: Yeah, I've heard that many times. 

Dr. Stephey: So I think speech becomes one of the most common indicators because if the kid's not talking when they should be or they're talking very little, well, it's obvious that that's the case. But if you have a child who doesn't know how to point and focus their eyes and space easily or effortlessly or accurately or sustainably, that's not obvious. 

Dr. Stephey: They might be clumsy. They might not like wearing certain clothes or the tags in their shirts or the seams in their socks. So remember there's normal quote unquote, is a pretty broad spectrum and that's a pretty continuous continuum. And because again, autism and ADD and ADHD are behavioral disorders. They're really driven by a checklist of behaviors. And my whole contention is if you can't move, look and listen in a fast, accurate, effortless, sustainable, age-appropriate, meaningful way, you're in a world of hurt. So that's what I think in great part is happening with kids on the spectrum. Because so much of our sensory input is tied up in vision and the vision input we're talking about has nothing to do with the ability to see 20/20, which is where most eye exams default to, right? If you can see 20/20, everything's fine and vision has no role to play in your kid's autism. 

Dr. Stephey: I could not disagree more. 20/20 is the tiniest little bit of what we're talking about. 

Tim Edwards: And that's where most parents, this parent included just stops. Oh, you're 20/20. We're good. Don't need to investigate any further, as far as your vision is concerned. 

Dr. Stephey: No absolutely. 

Tim Edwards: You know 20/20 is what we're taught. That's what we were told. You get your glasses to fix it or contacts. Let's move on to something else and that's where it should not stop. 

Dr. Stephey: This is universally as what is happening and that's why so many kids have trouble recovering function because in most cases I'm going to be so bold as to tell you conservatively 80 to 90 percent, 100 percent seems too boldt. But I can tell you 80 to 90 percent of kids on the spectrum have vision problems that have remained undiagnosed and untreated. And unless your finding somebody who really is taking the time to look at components of nutrition, retained primitive reflexes, something called a millisecond timing clock deficit, motion processing or magnocellular vision. 

Dr. Stephey: Eye focusing, eye tracking, eye taming and working memory in executive function and visual-auditory integration, visual-cognitive skills, visual-spatial skills, visual processing speed, your kid's been under assessed, underdiagnosed and undertreated. 

Tim Edwards: Now, are you talking about every child or just a child that might have been diagnosed as being somewhere on that spectrum? 

Dr. Stephey: Well, the thing that I would just rattle off, they're all skills that we have to possess to function in a relatively normal way. What might be referred as neuro typical behavior. So I would suggest to you that any child who's been diagnosed with dyslexia or a learning disorder or a specific learning disability or reading disorder or have been diagnosed or suspected of having ADD or ADHD or is on the spectrum or has a diagnosis called clumsy childhood disorder, they likely have a vision component that again, has been underassessed, underdiagnosed, and undertreated. And the problem that I see is this is so commonly true that oftentimes these kids get lots of other therapies, speech therapy, occupational therapy, maybe adaptive P.E. through the school district. ABA therapy as a behavioral therapy. But the missing factor in all of that is nobody's looking at the vision piece. And it's tremendously huge. 

Tim Edwards: Sounds foundational, again. 

Dr. Stephey: It is foundational. And as an extension of that, I go back to something I believe we talked about before. It has to do with our subconscious mind continuously asking ourselves the question, do I feel safe? Do I really feel safe? I'm not sure if I feel safe. If you can't subconsciously answer that question, then you're gonna default to, well, I don't feel safe, which now means that all of your sensory systems are going to be at defcon one. You are on high alert status because your brain is perceiving your environment as one giant eminent, unrelenting threat. 

Tim Edwards: Can't even imagine the anxiety going through one's being living like that and how it affects their behavior. 

Dr. Stephey: Oh, absolutely. Because at that juncture, and especially when you're a kid, these outcomes now are reflexive in their outcome. Meaning you have no ability to control how you're behaving. So if you're that child and you have a meltdown that is beyond your voluntary control, because what..

Dr. Stephey: Whatever the episodic event was, it triggered you to have a fight or flight response, which is high anxiety, high fear, high distractability and survival at all costs. Which means that if you feel that you're being cornered, there's an expression that a wild animal is the most dangerous when you corner them. If you don't leave them an escape route, they have no choice but to go crazy. 

Tim Edwards: For self-defense. Right.

Dr. Stephey: Yes, their very survival is based upon them escaping the perceived or real threat. So much of these kids' aggressive behavior is beyond their voluntary control. You can talk to your blue in the face. But until they can regulate their autonomic nervous system and facilitate a more calmer response, you can't talk them off the ledge. It's very challenging because it's beyond their voluntary control. And remember, vision and auditory are our two primary threat detectors. 

Dr. Stephey: They are the two sensory systems that we use to gauge a threat at distance in preparation for fight or flight. And you know, the idea of personal space and that your arm's distance is like a personal space bubble. 

Tim Edwards: Yeah, no doubt. 

Dr. Stephey: I don't know if somebody's written about it, I wouldn't be surprised. But my clinical take on this is if your visual system is operationally functional, you don't need a bigger bubble than arm's distance. Because your ability to perceive a threat at arm's distance gives you the opportunity to punch it away or push it away and then turn and run. Right? Does that make sense? 

Tim Edwards: It does. Perfect sense. Yes. 

Dr. Stephey: But here's the problem. If you can't see a large volume of space and you can't see it fast, arm's distance isn't good enough for you. You've got a bubble around you that's maybe 20 feet in diameter and any sound within 20 feet or any motion within 20 feet or any target or object visually within 20 feet is going to freak you out. 

Dr. Stephey: So now the question becomes, remember separate from 20/20 because all that means you can see a tiny letter at 20 feet on a chart. The volume of space that you can see and the speed with which you see it is paramount to you being able to ask that question, do I feel safe? And is arm's distance as a personal space bubble around me an adequate amount of space? Well it's not, for these kids. One of the things that patients never accused me of is never giving them enough information. 

Tim Edwards: That is true. I have a folder over here of information that you've given me, which I love. Thank you. 

Dr. Stephey: And so because I read not only within my own discipline but because I read in so many other disciplines, I've got a book list that I put together that I share with parents. I have a computer full of articles that touch on every topic that I'm likely to discuss and assess. In the kind of evaluation that I do. 

Dr. Stephey: The primary thing that I want parents to know is that almost without exception, the child has been under assessed and underdiagnosed and undertreated. So whatever they thought their child's life trajectory was going to be, I'm here to point them in a different direction and give them a different trajectory. Because of how the kids have been underassessed and underdiagnosed and undertreated. Typically when someone comes to see me for a first visit, I am going to talk about eye focusing, eye tracking, and eye taming. I'm going to talk about a concept called visual elea scene, which is the inability to look at black and white stripes either comfortably or without having eyestrain or the patterns move or blur or wiggle or you see colors or it's just overwhelming. And that you can't get yourself to look at these stripes. I might initially look at aspects of balance and gait and posture and how those things change with a low plus lenses or colored lenses or prism lenses. 

Dr. Stephey: Because if I can notice a behavioral change in visual output or sensory input on the first visit, we have an opportunity right then to change that kid's life. Just by prescribing a pair of glasses, even if they can't see 20/20. So I will oftentimes prescribed glasses in this manner that have nothing to do with seeing 20/20 because I'm interested in how these glasses change the kids' physicality or their motor abilities or their ability to hold the pencil and improve their handwriting skills or make it so that they can tolerate a hug for mom or dad. Or they can play with a sibling and not freak out. Or they can join in other kids on the playground at school and not be overwhelmed by the motion and the sound of their environment. That's the initial part of what we do. When I do have patients come back and we do further testing, we do discuss components of nutrition. We look at a term called retained primitive reflexes. We look at this millisecond timing clock in our brain and how it facilitates our attentional control networks and how it facilitates our brain's ability to integrate different lobes in the brain, so that it improves our cognitive efficiency. We will look at eye focusing, eye tracking, eye taming. We look at working memory. What I want to do is do a comprehensive assessment so that when I come up with a treatment plan, we've got enough data to be able to do it in a logically, developmental hierarchy. 

Tim Edwards: So you mentioned treatment plan. What are some examples of a treatment plan beyond lenses now? Something that I want to make sure that our listeners are not confused by. You said if a child comes in or a person comes in with 20/20 vision, you will still prescribe lenses. So we're talking color? 

Dr. Stephey: Yes, we're talking color. We could be talking prism or we could be talking low plus lenses are any combination there of. 

Tim Edwards: All right, so it doesn't just stop at seeing clearly. 

Dr. Stephey: That's right. It doesn't stop at seeing 20/20. 

Tim Edwards: So what other type of treatments are there? 

Dr. Stephey: Well, typically there's nutritional interventions. Could be inulin fiber to change the gut bacteria. Could be omega-3 fatty acids to change and reduce inflammation in the body and in the brain. It could be zinc and magnesium discussion or calcium or sodium. I think the two most common things though are dealing with the microbiome. Microbiome being in the gut bacteria, and the omega-3 fatty acids. Those two things are monstrously huge. 

Tim Edwards: And we'll be discussing omega-3s in our next episode. 

Dr. Stephey: The next thing I look at is retained primitive reflexes. Retained primitive reflexes can be simply thought of as software that we're born, within our brain stem. And they're pre-programs, if you will, that facilitate our survival behavior. 

Dr. Stephey: It helps us as a baby roll over on her stomach, lift our head, push up our upper body off the floor, get up on all fours, start to crawl, get up on two feet, free our hands to manipulate space around us and begin walking. And all of that motor planning and sequencing, serves a role into a springboard for developing speech and language and eye movement control and working memory and cognitive abilities. So primitive reflexes is something that's been commonly overlooked for a long time. And it can no longer be. It's too critical. I alluded earlier about this millisecond timing clock, the instrument that I use and the company that's been around for 25, 30 years now is called Interactive Metronome and there's no other device like it on the planet that I'm aware of. It is a powerful tool, not only for measuring whether you're timing clock is off, but more importantly to facilitate your brain's ability to retrain it and get it back to a normal timing function. 

Tim Edwards: To retrain it. So that seems like a monumental task? Or is it? 

Dr. Stephey: No, it's simple. It couldn't be simpler. The interactive metronome instrument was originally created by a music producer and a conductor. And it was designed to look at other musicians timing so that he wanted to produce better sounding music. So if your timing was a little faster, a little slow, he wanted you to be able to change that and feel where you were in that timing output. And he created this instrument to measure that. And it has just turned into this a wonderfully creative tool to change brain function. It is a powerful tool. 

Tim Edwards: My goodness. Great Story. 

Dr. Stephey: So, so the initial stage of therapy for me typically is nutrition intervention, retained primitive reflexes and this millisecond timing clock. Now I have some kids on the spectrum where the timing clock therapy, it's beyond their current abilities. 

Dr. Stephey: So when that's true, I will either incorporate something called the safe and sound program put together by a researcher, neurophysiologist by the name of Stephen Porges, who has written about the Polyvagal Theory of affect, emotions, self-regulation and communication. It's a big deal. So if I, if I find somebody who is highly dysregulated, they don't feel safe and sound in their environment, we will do this program as a, as prep work for the other therapies. 

Tim Edwards: To build them up too. 

Dr. Stephey: Yeah, the safe and sound program is specifically filtered music where you, you do the listening one hour a day for five consecutive days. 

Tim Edwards: That doesn't sound too arduous or painful, that's for sure. No sounds almost kind of fun. ]

Dr. Stephey: It is. And it can really change your body's ability to regulate your autonomic nervous system or the part of your body that pushes you to be in fight or flight, or that you're so overwhelmed that you go into shutdown. 

Dr. Stephey: So if we do the safe and sound program as a five hour introduction and interactive metronome is still beyond the child's ability. We'll then on incorporate different sound therapy into our treatment model. And this sound therapy is best done with bone conducting headphones and bone conducting headphones are over the ear headphones that have a, a button or a vibrating transducer, if you will, that sits on the top of your cranium. And it vibrates imperceptibly. 

Tim Edwards: Wow. 

Dr. Stephey: So if I turned the headphones off, but turn the music on, you'd still hear the music. But only by the way the bones in your cranium were vibrating. 

Tim Edwards: Now is that how those who are deaf are able to enjoy music? 

Dr. Stephey: Yes, it's called, it's called a cochlear implant. And they're getting sound into their head through that cochlear implant, which is vibrating the bones in the cranium. 

Tim Edwards: Gotcha. Wow. 

Dr. Stephey: And the bone conduction is different than air conduction. It's getting sound in the brain in a different way and in a more powerful tool and it seems to stimulate the stipular system or the inner ear in a way that air conduction can't do. And the reason that's a big deal for me as an optometrist is because the vestibular system and the visual system are intimately linked with each other. So we might see better eye movement control when we do sound therapy. And just like when we developed the visual skills and somebody is able to see faster, that person can use lip movements in order to prime the auditory cortex to change auditory processing outcomes. So the two systems are very interconnected with each other. So just to review, stage one, nutritional discussion, retained primitive reflexes, safe and sound program, if needed. Sound therapy. If they can't handle interactive metronome and if they can handle interactive metronome, I will usually start with that intervention rather than more conventional sound therapy. 

Dr. Stephey: And the reason I do that is because interactive metronome involves physical movement in conjunction with this metronome beat and there's something magical about this temporal sequencing or you generating physical output in conjunction with this beat and being given feedback about changing your internal timing clock. So for me, that's stage one. Stage two, we're going to move on to magnocellular vision or motion processing and eye taming, eye focusing and eye tracking. And stage three therapy in my office is then working memory and executive function skills, the ability to multitask, how large of a chunk of information you can hold in your mind, components of processing speed, divided attention, selective attention, sustained attention. And that's stage three. And stage four might move us on into phonological processing and something called rapid naming speed. And then in stage four, I might even weave in some reading therapy at that juncture, either provided through my office and the training that I've had. Or then at that point suggest that the kids get other reading therapy even if it's not through my office. 

Dr. Stephey: And that model, Tim, for me, it makes perfect sense. It's based on a developmental model. It's done in a order that we develop in as humans and it is not the model that is happening in practice today. 

Tim Edwards: And you're talking about these four phases of therapy. 

Dr. Stephey: I'm talking about these four phases of therapy and what I'm really more getting at is I think that the kids on the spectrum should see a developmental optometrist first, not last. And too often, what I see, is I get kids that come to my practice and let's say they've had an IEP through their school district since they were three years of age and maybe I see them at eight or nine or 10, so they've had an IEP for five, six, seven, eight, nine, 10 years, and never had this kind of a developmental vision exam. So they might've done speech therapy or occupational therapy six, seven, 800 hours, but they never had an exam like this. 

Dr. Stephey: I think that parents need to know that this exists and need to seek out and find optometrist like myself that will do this body of work and do it in a comprehensive way. And too often I'll see kids again on the spectrum. Eight, nine, 10, up to 15, 16, 17 years of age who've had hundreds of hours of reading interventions and are still struggling to make any substantial gains in their ability to read and comprehend. And then I find them and they've got a whopping array of all the stuff that we're talking about today and parents have never heard it before. 

Tim Edwards: Oh, my. That's a tragedy and that's why we're doing what we're doing. 

Dr. Stephey: That's exactly why we're doing what we're doing. We want to. We want to get this word out so people know one, that this exists. Two, what's the depth of what exists and three, that they know if they're getting a comprehensive assessment or not. 

Dr. Stephey: It's not enough to go and be told that you've had a vision therapy assessment. If it doesn't include all of these pieces. And that's one of the other reasons that I'm doing this podcasting because I would tell you that vision therapy either seems like it's the best thing since sliced bread. Or it doesn't work at all. And don't waste your time and money. And that really bothers me as an optometrist. Because I know the power of vision therapy when it's done correctly. I know the power of vision therapy when it's done comprehensively. I know the limitations of vision therapy. So if kids need assistive technology or they need an audiological assessment or they need further speech or occupational therapy or they need assistive technology to facilitate their ability to access the curriculum at school, I'm the first one to make those recommendations. And the supportive parent in and looking at other things. But there is just a vacuum of information that parents don't know because medicine hasn't told them that. Nor has the educational community. I'm hoping to fill that void. 

Tim Edwards: Thank you for listening to the Move Look & Listen Podcast with Dr. Doug Stephey brought to you by audible. Get a free audio book download and a 30 day free trial of audible membership at audibletrial.com/inbound. You'll find over 180,000 titles to choose from, including books mentioned here in the Move Look & Listen podcasts. You can listen to these books through your iphone, your android, your kindle, your computer, or even an MP3 player. And if for any reason and at any time you choose to cancel your membership, you keep all of your audio book, downloads. Give it a shot for 30 days. You got nothing to lose. Support the Move Look & Listen podcast by visiting audibletrial.com/inbound. We will include a link for your convenience, in the show notes of this and every episode of the podcast. And of course if you like some more information regarding Dr. Stephey's practice or to make an appointment, we will include links in the show notes to Dr. Stephey's website and his youtube channel. 

Tim Edwards: Dr. Stephey's website is stepheyoptometry.com. That's s t e p h e y optometry.com. You can also call the office at 626-332-4510. Again, all of Dr. Stephey's contact information will be included in the show notes of each and every episode. One last request before we let you go on to the next episode. Please subscribe to the podcast from whichever platform you might be listening in. Of course, it is free to subscribe and it ensures that every time we post a new episode, you'll find it right there waiting for you to listen in your podcast app of choice. We really do appreciate your listening and until next time for Dr. Stephey of the Move Look & Listen podcast. I'm Tim Edwards with the Inbound Podcasting Network. 

 

 

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