A Qualitative Investigation of Therapist and Diagnostician Perspectives on Visual Disorders in Autism Spectrum Disorder.

Abstract

Visual behaviors such as reduced eye contact, impaired eye tracking, limited joint attention, delayed responses to visual stimuli, and prolonged visual exploration of objects are central to autism spectrum disorder (ASD) diagnosis and intervention. However, these behaviors may also result from unrecognized visual impairments, increasing the risk of diagnostic overshadowing and suboptimal intervention planning. This study explored how diagnosticians and therapists perceive and address visual impairments in children with ASD, and how clinical reasoning and systemic factors influence their integration into diagnostic and therapeutic processes. A qualitative design was employed, based on in-depth interviews with 23 health care professionals, including developmental pediatricians, psychologists, occupational therapists, and speech-language therapists. Data were analyzed thematically to capture both theory-driven and emergent insights. Four themes emerged: vision assessment as an unstructured component of diagnosis and treatment; limited professional awareness of the vision - ASD relationship; constraints in applying clinical tools and guidelines; and reflective processes elicited during interviews. A persistent gap exists between professionals' awareness of vision-related difficulties and their systematic integration into ASD care. Structural barriers, including limited follow-up and reliance on parental initiative, hinder translation into practice. Strengthening professional education, interdisciplinary collaboration, and holistic care protocols may improve diagnostic accuracy and intervention effectiveness.Lay AbstractSome behaviors commonly associated with autism spectrum disorder (ASD), such as reduced eye contact, difficulties with visual tracking, or unusual responses to visual information, may also be linked to undetected vision problems. When these difficulties are overlooked, they may be attributed solely to autism and influence decisions about diagnosis and treatment. This study examined how professionals involved in ASD diagnosis and treatment recognize and manage visual impairments in children with ASD, and how clinical reasoning and systemic factors influence their integration into diagnostic and therapeutic processes. In-depth interviews were conducted with 23 health care professionals, including developmental pediatricians, psychologists, occupational therapists, and speech-language therapists. The interviews were analyzed to identify common themes and shared patterns in professional experiences. Professionals described inconsistent approaches to vision assessment, differences in awareness of the relationship between vision and ASD, limited practical guidance, and gaps in how visual concerns are followed up. These findings suggest that vision should be considered more systematically as part of ASD care. Greater professional awareness, clearer referral and follow-up pathways, and stronger collaboration across disciplines could help ensure that visual difficulties are identified and addressed when planning care for children with ASD.