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| The role of Behavioural Optometry in Learning Difficulties |
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| Author : Paul Dickson
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| Created : 29 Jan 2002
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| Last Revision : 24 Feb 2002
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Learning Difficulties
Many children who are experiencing learning difficulties, have a vision problem. Visual abilities are the skills which give us the means to locate, identify and remember what we see. In addition to visual acuity - the ability to see the small letters on the chart, there are a number of other abilities necessary for the child to perform at school. These abilities include the ability to keep things clear at a distance (including reading distance),to keep things from going double, judging depth, locating words when reading, guiding a pencil, recognising what is seen, and remembering it.
Without these abilities school can become a struggle for the child and a source of frustration for parents, teachers and child alike.
Accommodation (focusing)
This is the ability to change the shape of the lens of the eye to focus clearly at different distances. The child needs flexible accommodation, so that he can visually move from one distance to another easily (from teacher, board, book). He also needs to be able to sustain this so that he can change his focus from one distance to another, whenever he needs to, over a period of time.
Signs of an accommodation problem include:
Blurred vision
Child avoids reading
Reading comprehension is good to start, but rapidly reduces the longer reading is continued, or the child has a problem with "attention"
Child complains of discomfort around eyes, and headaches, younger children may rub eyes and avoid reading, rather than complain
Child makes careless errors when copying from board
Child's reading comprehension is not as good as his intelligence would predict
Eye teaming ability
There are few parts of the body which must work together with more precision than the eyes. A person's eyes must co-ordinate and move inexactly the same direction, distance and same time. When eyes work as a team the image coming in from both eyes will be combined in the brain to form a single image.
Signs of an eye teaming problem:
Child complains of double vision
Child covers one eye when reading
Child holds book to one side or turns held so that both eyes cannot see print at the same time.
Child adds or removes parts of word when reading
Repeats letters within word when copying from board
When performing maths problems, fails to align the columns of numbers correctly
Eye movement ability
Children need good eye movement whether they are keeping their eyes on a ball in sport, or looking from word to word when reading, or maintaining eye contact.
Unless eye movements are accurate, mistakes will be made. If eye movements are slow and inaccurate, then reading will be slow and inaccurate, and the child will make seemingly careless errors.
Signs of and Eye movements problem:
Child moves head rather than eyes when reading
Frequently loses place when reading or copying
Skip words or lines often
Child makes careless errors
Child is labelled as having a problem with attention
Visual perceptual Skills
This is the ability to understand what is seen and be able to make decisions about that information quickly and efficiently. This includes the ability to tell the difference between similar looking objects, being able to pick out and focus attention on a specific object or detail from surrounding information, such as a specific word in a paragraph. It also includes accurate interpretation of objects as being the same when seen in various orientations. If the child is to successfully learn to read, these abilities must be present.
Signs of a Visual perceptual problem:
Child is not learning to read on schedule, has difficulty learning to recognise words
Child is still having difficulty recognising letters or numbers past the age of 6
Child is still writing "b" and "d" etc backwards after the age of 7
Child frequently confuses similar beginnings or endings of words
Recognises the sounds of individual letters, but cannot break words down into syllables so as to sound them out.
Is easily distracted, has difficulties finding specific objects, especially in different context
Hand eye coordination skills
Children who lack ability in the area of eye-hand co-ordination have difficulty with controlling a pencil. So much 'thinking' goes into moving the pencil that little remains for neatness , accuracy, or just getting thoughts down on paper. The child is left with two choices - write slowly and carefully and not finish assignments on time, or he can finish on time at the expense of legibility. If the child appears otherwise bright, then often the child gets labelled as having problems with attention, or not putting enough effort into his work.
Signs of an eye-hand co-ordination problem:
Child has difficulty spacing his words and keeping them on the line when writing
Child's handwriting is poor
Child does not seem to use his eyes to guide his hands to stay inside the lines when colouring. He avoids colouring, drawing or maze tracing activities.
When working with written maths problems, child has difficulties keeping the columns lined up.
Child easily understands and can discuss what he has heard, but has difficulty getting his thoughts down on paper.
Visual imagery Ability
The ability to retrieve or remember a picture in the mind is called visual memory - being able to picture something you saw when last in the supermarket, or where you left your car keys would be an example of visual memory. Another example would be the ability to picture in your mind a word you had seen in the past. While there are good spellers who do not have good visual memory, it can be an real asset to good spelling.
The ability to form new pictures in your mind is called visualisation. An example would be the ability to picture you living room if you rearranged all the furniture. This same form of visualisation could be used by the math student to picture the next step of the problem before actually performing it on paper.
The child with good visual imagery can not only recall the past, he can plan for the future.
Signs of a difficulty with visual imagery:
Child had persistent difficulty learning to spell
Child fails to recognise same word in next line
Fails to picture in mind what is read
Has difficulties recalling what he did during the day, or what he saw on the way home from school
When he loses his place when reading or copying, has difficulty remembering where he was so he can find his place
Has trouble remembering letters in correct sequence
Laterality and spatial relationships
A child needs to have an understanding of above, in front of, beside, etc. These concepts are made up of a combination of visual, auditory, tactile, kinesthetic and - to a lesser degree - other senses. If the senses do not work together properly, the child may not have an accurate perception of his position in space. He may have problems with knowing left and right on himself and others as well as on objects.
Signs of difficulties with Laterality/Directionality and Spatial Relationships:
Left and right still confused after the age of seven and a half
Confuses similar letters such as "b" and "d" and words such as "was" and "saw"
Reverses numbers, eg. 24 and 42
Has problems with sequential tasks, and remembering steps in problem solving
Child has problems with concepts of up, down, front, back etc.
Children who possess all these visual abilities have the visual tools they need to perform at school. Children who lack these abilities have to struggle to make their way. For some the struggle may allow them to get by but not reach their potential. For others the struggle is too great. They fail, usually without understanding why. Vision, like other abilities, is learnt. The idea that vision is learnt and can be taught at any age forms the basis for a form of treatment which has largely been developed by the vision-care profession of Optometry. The name of this form of treatment is Vision Therapy. Vision Therapy (VT) is a process which relies on giving an individual feedback and practice to teach him or her to develop or enhance his or her visual abilities. It is not generally a substitute for the child wearing glasses if they child needs them to compensate for an eyesight problem. However, vision therapy can be used in conjunction with glasses to improve the child's visual skills. It can also be used to teach the child the other visual abilities listed above.
Further Information can be found at
www.vision-care.co.nz
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