Behaviors that indicate a visual-perceptual problem

If your child exhibits these behaviors, he or she may have a visual-perceptual problem that impacts learning. The list comes from the recent article titled Visual Impediments to Learning published in the journal Optometry & Visual Performance.

The child/student:

• Exhibits poor motor coordination

• Uncoordinated–frequent tripping, stumbling, bumping into

things, having trouble skipping and jumping

• Communicates infrequently with gestures or through

physical “acting”

• Does not enjoy books or pictures, perhaps does not enjoy

video games

• Demonstrates restlessness, short attention span,

perseveration

• Plays games poorly; cannot imitate children in games

• Exhibits poor handwriting, artwork, drawing

• Exhibits reversals of the letters b, d, p, q, u, n when writing

[beyond age 7]

• Inverts numbers or reverses numbers

• Requires auditory cues

• Gives correct answers when teacher reads test but cannot

put answer on paper

• Fails to understand what is read

• Exhibits poor performance on group achievement tests

• Appears brighter than test scores indicate

• Has poor perception of time and space

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Vision Therapy improves reading comprehension and overall classroom attention

A study of  students with below average reading scores found that providing visual attention therapy can significantly improve their attention and reading comprehension.  Visual attention is one component of a group of skills related to visual information processing- the way the brain takes in and makes sense of the images received by the eye.

The developmental optometrists at ourVancouver eye clinic have witnessed this improvement first hand.  Kids who hate reading, can't do it very well and read a below grade level have improved following therapy to become kids who love reading and often can read at above grade level! Read more...

Visual function development: behaviors to watch out for in your children

Developmental optometry and ophthalmology

Dr. Lea Hyvarinen is one of the worlds few developmental ophthalmologists.  Usually, if you or your child has a developmental vision problem you will see a developmental optometrist like Dr. Randhawa  who is a member of the College of Optometrists in Vision Development (COVD).  Dr. Lea has just commenced a blog on children's vision development, which you can visit here and was a well-received speaker at the COVD annual meeting last weekend.

Dr. Lea Hyvarinen

In a recent post about infants with normal visual development, she provided the following table, which summarizes the development of visual functions that are easy to for parents and teachers to observe.  The table and the related post give an excellent indication of the quality of her new book called "What and how does this child see?" 

Visual information processing

The book covers many of the topics discussed on this blog, including as visual information processing, a topic that North American ophthalmologists tend not to be familiar with.  For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors say that patients with potential visual information processing deficits "should be referred to a behavioral or neuro-optometrist" and noted that  "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."  Of course, Dr. Lea is an exception to this and would likely provide excellent assessments of her patient's visual information processing skills.

Visual development behaviors to watch for

Parents can refer to this table when trying to assess their child's visual development.  But understand that trained professionals should be consulted for reliable assessments and diagnoses.  As noted by Dr. Lea, the table "summarizes the main steps of the visual development. These milestones are used in many countries in the follow-up of normal development of visual functions and in detecting symptoms and signs of deviations from the norm."

Age (months)	Behavior
0–1	•       turns eyes and head to look at light   sources  •       horizontal eye tracking, tonic focusing
2–3	•       intense eye contact at 6-8 weeks  •       vertical and circular tracking •       interested in mobiles •       interested in lip movements
3–6	•       watches own hands  •       reaches toward, later grasps hanging objects •       observes toys falling and rolling away •       shifts fixation across mid-line •       visual sphere of attention widens gradually •       very active in visual interaction
7–10	•       notices small bread crumbs, touches them  •       adjusts the grasp to the size of the objects •       interested in pictures, also stereo images •       recognizes partially hidden objects •       recognizes family members by facial features
11–12	•       knows places at home  •       looks through window and recognizes people •       recognizes pictures, plays hide-and-seek •       can predict adult’s goals of motor actions

For more information of children's vision, eye care, and children's optometry, please visit www.kidsvision.ca.

Related articles:

Study proves that vision problems - visual information processing deficits -  interfere with learning to read and cause dyslexia

The former First Lady of the United States on her daughter's developmental vision problem and how vision therapy worked for her

Mom of struggling reader speaks out

Vision problems can have drastic effects on brain development and learning

How to choose a children's (pediatric) optometrist

Binocular vision dysfunctions ate my homework 

TED: ideas worth spreading - Dr. Susan Barry on vision therapy and depth perception

Patient story - Five year old girl sees her mom's face for the first time in our Vancouver eye clinic

Study proves that vision problems interfere with learning to read and cause dyslexia

Researchers from the fields of optometry and neuroscience continue to be at the forefront of understanding the connection between vision and learning and the ways that brain-related visual problems such as visual information processing deficits affect reading and learning - and learning how to read. 

A new study published in the journal Current Biology in April 2012 has proven a causal connection between visual attention deficits and problems learning to read (dyslexia).  The study suggests that since visual attention deficits predict who will develop dyslexia, testing and treating these deficits in children may be a way to prevent dyslexia.  


Optometrists have been diagnosing and treating visual information processing deficits (visual attention is one component of visual information processing) for decades with vision therapy and have observed improved reading and learning in patients.  It's nice to have a study that objectively proves these clinical observations.

Here is a short summary of the study taken from Science Direct:

Reading is a unique, cognitive human skill crucial to life in modern societies, but, for about 10% of the children, learning to read is extremely difficult. They are affected by a neurodevelopmental disorder called dyslexia. Although impaired auditory and speech sound processing is widely assumed to characterize dyslexic individuals, emerging evidence suggests that dyslexia could arise from a more basic cross-modal letter-to-speech sound integration deficit . Letters have to be precisely selected from irrelevant and cluttering letters by rapid orienting of visual attention before the correct letter-to-speech sound integration applies. Here we ask whether prereading visual parietal-attention functioning may explain future reading emergence and development. The present 3 year longitudinal study shows that prereading attentional orienting—assessed by serial search performance and spatial cueing facilitation—captures future reading acquisition skills in grades 1 and 2 after controlling for age, nonverbal IQ, speech-sound processing, and nonalphabetic cross-modal mapping. Our findings provide the first evidence that visual spatial attention in preschoolers specifically predicts future reading acquisition, suggesting new approaches for early identification and efficient prevention of dyslexia.

Here are the highlights of the study:

► Poor readers show impaired visual search and spatial cueing when prereaders
► About 60% of poor readers displayed visual-attention deficit when prereaders
► Visual attention in preschoolers specifically predicts future reading acquisition
► Efficient visual-attention is crucial for learning to read independently of phonology

The study's findings highlight the need for parents to see a developmental optometrist who will do detailed testing for visual attention deficits.  If you don't live in the metro Vancouver area where our clinic is located, you can go to www.covd.org, which is the website of the College of Optometrists in Vision Development, to find a doctor near you. 

Not all health care professionals are trained to be aware of visual attention problems and how to diagnose and test for them.  In particular, one study from the neuroscience literature cautioned that an opthalmologists eye exam is focused on the physiology of the eye and not on brain-vision problems that are routinely diagnosed and treated by an optometrist. 


For example, in study published by Raymond et al. in the journal NeuroRehabilitation, the authors recommend the assessment of visual information processing should be done by an optometrist – not an ophthalmologist. The ophthalmologist, according to the authors, does not have the expertise to make the assessment. The study authors note that patients:

should be referred to a behavioral or neuro-optometrist. It was also noted that referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only, and ophthalmologists are mostly experienced with acute medical problems rather than rehabilitation issues. This assertion is supported by considering the typical components of an ophthalmologic exam, which may yield a lack of specificity, and/or provide information which is inadequately defined in terms of rehabilitation consequence. Trobe, Acosta, Kirscher and Trick identify a lack of measurement in areas of distance and near acuities, contrast sensitivity and confrontation, while Gianutsos and Matheson describe a need for greater quantification in terms of field gradations and boundaries, and binocularity conditions. A more thorough investigation is important for the rehabilitative efforts of all patients who demonstrate visual processing deficits.

There are other studies on the link between visual information processing deficits and learning problems. One example is a 2005 study by Goldstand et al. published in The American Journal of Occupational Therapy entitled "Vision, Visual-Information Processing, and Academic Performance Among Seventh-Grade Schoolchildren: A More Significant Relationship Than We Thought?" The researchers (consisting of professors of optometry and occupational therapy), set out to compare visual and visual-information processing skills between children with and without mild reading and academic problems and examine the incidence of visual deficits among them. They found that visual function significantly distinguishes between children with and without mild academic problems, as well as on visual-perception scores.


Another study published in Optometry and Vision Science in 2002 by Kulup et al. found that poor visual memory (one component of visual information processing) as significantly related to below-average reading decoding, math, and overall academic achievement (as measured by the Stanford Achievement Test) in second- through fourth-grade children, while controlling for age and verbal ability.

TED: Ideas Worth Spreading: Dr. Susan Barry on how vision therapy cured stereoblindess

Neuroscientist, Dr. Susan Barry, gave a TED talk on how optometric vision therapy allowed her to see in three dimensions for the first time at the age of 48.  Until then, she was stereo-blind, meaning that she could not see the world in 3D like people with normal vision.  Stereo-blindness is also called stereopsis.


TED stands for Technology, Entertainment and Design and is a global set of conferences owned by the private non-profit Sapling Foundation, formed to disseminate "ideas worth spreading".

Dr. Barry's story is now fairly well known.  Her 2009 book, Fixing My Gaze was Amazon.com's number 4 most popular science book of the year.  Her story was also the subject of an article in the New Yorker by famous scientist Oliver Sacks (who was played by Robin Williams in the film Awakenings).  


In this talk, Dr. Barry discusses the notion of the "critical period", a long-held belief among neuro-scientists which is being dis-proven by Sue Barry's story as well as current research.  Until very recently, it was thought that there was a critical period in human brain development beyond which the brain was "set in stone" and could not change.  The implication of this belief was that people with disorders like stereo-blindness or amblyopia that originate in the brain could not be cured beyond the age of 5 or 6.


Scientists now accept that the brain displays considerable neuroplasticity and that even the brains of adults can be trained to see normally.  In addition to conditions such as stereo-blindness, this has important implications for other brain-eye disorders such as strabismus, amblyopia and visual information processing disorders.  


Neuroplasticity is actually a prime reason for the success of vision therapy in treating these disorders.  As developmental optometrists will often say, vision therapy is like physical therapy for the eyes and brain.


More people that ever before are discovering that they are stereo-blind.  With the explosion of 3D entertainment, some parents are noticing that their children do not experience 3D media the way that normal-seeing people experience it.  This is often a red flag that prompts the parents to take their child to the optometrist for an eye examination.  Fortunately, as Susan Barry's story demonstrates, we can successfully treat people who are stereo-blind.


Click here to learn more about 3D vision and stereo-blindness.