InfantSEE: Early Detection of Autism?

I had the pleasure of attending Dr. Glen Steele's course at this year's AOA meeting last June, and was truly inspired by the research being done with the InfantSEE program.  For those of you who do not know, InfantSEE is a program with the American Optometric Association where a FREE eye examination is provided for children 6 to 12 months of age.  These exams are aimed at detecting eye turns, high prescriptions that could lead to poor visual development, and diseases of the eye like potentially deadly retinal tumors.  Click here for more details about this program.

photo via InfantSee program site with AOA

InfantSEE is not just at the leading edge for detecting childhood visual disorders, its founder Dr. Steele envisions using the program for detecting and intervening when infants express early autistic tendencies.  I'm not about to jump into the internet debate concerning what causes autism and how to treat autism.  But what we do know is that autism is a spectral disorder where children express hampered abilities for social interactions.  How do children learn their social skills?  Well, most of an infant's ability to learn comes from direct visual input.  As optometrists, we are the experts on vision and vision development, so looking for early issues can make a big difference in a child (and a parent's!) life.

AUTISM AND THE EYE EXAM:  Evaluating Eye Contact Patterns

Photo Via Vision Aakriti

Patients often ask me how I can perform an infant eye exam since I can't check an infant's vision.  Doctors can, in fact, take a gross measurement of the infant's visual ability.  Of course a baby can't read anything, so doctors use a method called "Forced Choice" or "Preferential Looking" task. A common used tool is a set of 2 paddles: one with a face or other interesting stimulus, one with nothing.  You hold the two paddles up side by side, and it can be assumed that the child will spend more time looking at the paddle with the face.  A lot of the time, the infant is just going to look at the doctors face and not the paddles at all, but that is ok too.  Eye contact and interest in focusing on faces is a big clue that the child's vision and social skills are developing on target.  Studies have shown that a normal infant will spend more time looking at a persons eyes and mouth, versus a child with autism who will devote an equal amount of time to all areas, without any real preference for the face.  Link here for one recent study investigating eye contact and autism

Dr. Steele's advice to parents with
a child who seems to avoid
eye contact:  more face time
with mom and dad, less texting
during critical parent/child interactions

What to do if you see an infant who seems disinterested or appears to avoid eye contact?  One thing that is important to remember is that optometrists are not charged to diagnose autism in their chair.  But when you see the warning signs, it is perfectly reasconable and encouraged to discuss activities to increase visual development.  The word autism doesn't even have to be mentioned!  Dr. Steele recommends discussing "face time" activities.  In the world of social media, smart phones, and texting, parents are often multi-tasking while spending time with their infants during activities like nursing or changing diapers. During these activities, it is so important to focus on the child, look them in the eye and develop that important "face time."  Simple interventions like this could make a big difference in the child's developmental skills in the future.  Referral to area specialists is always another option, but autism is typically not diagnosed before the age of 2.