When Daniel was four, he avoided looking at or listening to his teachers or to other children in his kindergarten. He was distressed in visually overloaded spaces, had difficulties with changes in his environment, with transitions or altered sequences. He was particularly inattentive during instruction and interactive play activities. He paid little attention to what his siblings or classmates were doing or saying.

His vision and hearing were tested and found to be within normal limits.

Daniel looked away as complex directions were given verbally or being modeled. He frequently bumped into objects or other children or adults and seemed unaware of where his arms or legs or self were in space. His behaviors were initially assumed to be due to “poor vision,” “immaturity,” “inattention,” “shyness” and “cognitive impairment.” Later, he was diagnosed on the autism spectrum.

Careful observation of Daniel by his parents dedicated teachers and therapists during the following months found that bright lights, quick movements in his visual field, and cluttered areas seemed to confuse and overwhelm him. His eye movements were erratic and he had difficulty scanning. He relied heavily on his peripheral vision when looking at a distance.

When asked to look and to listen at the same time to whoever was speaking, he was uncomfortable and often looked away, or closed his eyes, or covered his ears.

His parents found that Daniel paid more attention when they made adjustments in his environment.

At his parents’ suggestion, Daniel was tested and fitted with custom-tinted glasses designed to filter out specific wavelengths of light which he wore without objection. Within minutes, he began looking at books with pictures and letters that he had been avoiding for months.

Even though his hearing tested normal he was fitted with low-gain hearing aids to clarify speech without over-amplifying background noise. Visual clutter in his room and his play areas were reduced. His family members, his teachers and his speech therapist became even more patient. They consulted with each other, and all agreed to try to slow down their speech. They would emphasize certain syllables and words, would repeat more often, would try to use different vocabulary if he was having trouble understanding and responding. They would remind themselves to pause more frequently to check if Daniel had understood.

Visual information was sometimes paired with slowly repeating hand gestures and interesting, playful and predictable language. Daniel did not have to look directly at the speaker’s face if it was difficult for him. Sometimes he would look at their cheek instead of their eyes or mouth. One of his therapists would hold a small toy that Daniel particularly liked next to her mouth for a few seconds when she wanted him to see her lips.

Daniel was encouraged to position himself with others according to Daniel’s most comfortable visual field, sometimes closer and sometimes further away, whichever Daniel preferred at the time. He was allowed to occasionally look away or to take short breaks when he felt overwhelmed, tired or stressed.

Daniel formed close interpersonal play and learning relationships with particularly sensitive and motivating mediators who knew how to form calm, interesting, trusting and successful social and cognitive learning experiences with him.

Daniel has always been gentle and caring, and is always ready to help and to contribute, so it is not surprising that his adult mediators respond with understanding and kindness. His warm heart and gentle personality were nurtured by his always believing, empathic, encouraging and supportive family who always found the right professionals, the right persons, activities and community to help teach and connect with Daniel.

Gradually, Daniel became more visually and more auditorily present for longer periods. His gaze stabilized and focused more on relevant stimuli. He started watching his hands more carefully during meals and during play activities and was better able to manipulate objects. He paid longer attention to verbal instructions with improved understanding. He startled less often when certain surprise sounds were heard. He seemed to tolerate the noise of crowds better.

With people he trusted, he eventually observed faces and made longer eye contact for social referencing and for communication. As he was able to exert more control of his visual and auditory input, his emotional regulation stabilized and his visual and auditory organization improved. He initiated more shared attention and was better able to imitate his teachers’ and his therapist’s behaviors during lessons.

He was able to communicate with siblings and peers during play activities when informed adults helped to mediate the interactions by rephrasing communications, rules, and instructions, and helped to slow down the activities.

His calmer and more trusting interpersonal relationships and better intentional control during his visual and auditory social and learning experiences helped him to attend better and to participate longer and more successfully.

As Daniel’s seeing and hearing became less unpleasant, less confusing and exhausting, more meaningful and more successful, he became more confident and more motivated. And as he participated more often every day and more successfully, his visual and auditory processing continued to improve.

In the years that followed, Daniel’s continuing advances in visual and auditory input processing served as important foundational prerequisites for his learning how to read and to write, which he learned very well and relatively quickly.

Improved verbal expression and communication output during his activities of daily living, including when he is working at his three-day-a-week responsible job, are high on the list of current priorities.

Daniel is lucky to have such caring and dedicated parents, siblings and adult mediators in so many life and development-affirming experiences. And they are all lucky to have Daniel in their lives.

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