A beautiful image from art therapist Sara Roizen is mindful of how eloquent writers can bring issues to life revolving around social interaction. Last week I blogged about great insights from a book on visual impairment regarding visual and motor development. That book referenced Selma Fraiberg and her groundbreaking work that led to more serious consideration of interrelationships between autism and legal blindness. I recall Harry Wachs giving a talk at a COVD meeting about 15 years ago with Selma’s book in hand, sharing her insights and Piagetian framework. Its title was Insights From The Blind.
I obtained a copy of Professor Fraiberg’s book, deciding it was time to give it a cover-to-cover read, and it did not disappoint. Early on (p. 9), regarding Clinical Observations, she shares a picture of developmental arrest in the autistic blind child and the distinguishing characteristic of a failure in human connection. She proceeds to relate this failure to a flawed connection between the visual stimuli within a human face that normally elicits a smile from a baby at three months of age. Fraiberg notes that a subset of children in settings for the visually impaired will present with a clinical picture of developmental arrest with characteristics that resemble those of early infantile autism in the sighted population.
Here are more key quotes from Professor Fraiberg, describing The Absence of an Eye Language: “The blind eyes that do not engage our eyes, that do not regard our faces, have an effect upon the observer that is never completely overcome. When the eyes do not meet ours in acknowledgement of our presence it feels curiously like a rebuff … Eye contact connotes greeting and acknowledgement. Eye contact elicits the smile. Visual discrimination leads to preferential smiling … We helped our parents to read the alien sign vocabulary of the blind baby, to see the signs of discimination, preference, and valuation that are often obscured by the absence of mutual gaze … We encouraged patty cake games and other hand-clapping game with rhythmic chants for midline engagement of the hands …
… There is a definite please in new motor mastery. There is an urge to motor activity at this age that is unmistakable … Each change in position from sit to stand, or from stand to sit, each step he takes whether supported or not, produces an endlessly varied and fascinating series of visual spectacles. Wherever he casts his eyes, the space is furnished with a mixture of shadows and textures and patterns and contrasts and 3-dimensional objects, including the people he knows. One glance brings him the entire scene and informs him about his relationship to each element.”
Lacking a central coherence, the infant with autism functions as if he is blind in the central field, and builds a space world like based on separate parts of the elephant rather than perceiving the whole. Fraiberg notes (p.69) that there is a subset of blind children who may achieve bonding by the 8th month, but hits a developmental impasse between 9 and 18 months. During this crucial period the child regresses, reverts to passive postures, and exhibits autistic behavior. This begs the question of the extent to which the high prevalence of autism among visually impaired children reflects common properties. Conferences have been held to explore this, and books have been written about the connection.
Now that Autism has taken center stage in Optometry, it is time to capitalize on Professor Fraiberg’s insights.