Optometric and orthoptic findings in autism: a review and guidelines for working effectively with autistic adult patients during an optometric examination

  • 20 September 2017
  • Volume 18, Issue 3

In this article, we provide guidelines on how to modify procedures within the clinical routine to achieve optimum outcomes for autistic individuals.

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Introduction

Autism spectrum condition (ASC, referred to as autism in this article) is a lifelong developmental condition that affects how a person communicates and interacts with people. Around 1% of the UK population have autism (Baird et al. 2006; Brugha et al. 2009), although many remain undiagnosed (Brugha et al. 2011; Jones et al. 2014). Autism is diagnosed using criteria laid out in the International Statistical Classification of Diseases (ICD-10: World Health Organization 2010) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-V: American Psychiatric Association 2013) by psychologists or psychiatrists. The criteria consist of: (A) impairments in social interaction and communication; (B) restricted or repetitive patterns of behaviour; (C) symptoms must be present in the early developmental period; (D) symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning; and (E) that these disturbances are not better explained by intellectual disability or global developmental delay. Examples of social difficulties include reduced reciprocity (eg failure to initiate or respond to social interactions) and altered eye contact (too much or too little), body language and facial expressions. Communicative difficulties may include stilted back-and-forth conversation, monotonal or inappropriate intonation, inappropriate responses in social conversation and inability to understand double-meaning words, puns or metaphors. Restricted or repetitive behaviours may be apparent as repetitive motor movements, inflexible adherence to routines or highly restricted, fixated interests. Around a third of autistic individuals have a learning disability (Lemmi et al. 2017), and it is typically reported that five times as many men are diagnosed with autism than women (Baird et al. 2006). However, this figure is likely to be due to underdiagnosis of women (Gould and Ashton-Smith 2011), and better awareness may be leading to increased submission and diagnosis of females.

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