Background and history of autism in relation to vision care.

Although autism existed before 1943, it was Leo Kanner who is credited with the first detailed description of autistic behavior. Before Kanner's report, the behavior was generally known as childhood schizophrenia. He noted that the outstanding common feature of all the children was certain parental personalities, like obsessiveness and lack of warm-heartedness. Concurrent with Kanner's report and observations were those of Asperger in 1944. However, Asperger's report, in a German-language journal, was not brought to the forefront until the 1980s. The children described by Asperger had milder forms of behavior disorders than those described by Kanner, with the resulting diagnosis of autism broadened and blurred. The main features of the new autistic spectrum included a triad of developmental deficiencies: recognition, communication, and understanding. Regardless of whose research is read, autistic behavior is considered peculiar and difficult to treat. Early treatments included LSD, tranquilizers, and developmental remediation. A later treatment, which proved to be the most successful, is applied behavior analysis (ABA), an outgrowth of B.F. Skinner's conditioning research. The etiology of autism remains a puzzle to scientists, with the most likely hypothesis being a central nervous system dysfunction. With regard to vision, people with autism tend to have abnormal electroretinograms, deficient evoked visual potentials, and atypical opticokinetic nystagmus. Other than a higher than expected incidence of strabismus and oculomotor deficiencies, refractive and binocular vision status of people with autism have been reported to be within normal ranges. Accordingly, the most useful tests for a patient with the diagnosis of autism are those for oculomotor function, opticokinetic nystagmus, and strabismus. The optometrist, thereby, becomes a member of the team helping to diagnose and treat the visual sequelae of autism.