Challenges with handwriting can sometimes be related to issues with visual skills such as eye teaming and visual perception, despite a child having 20/20 vision.
Gaps or delays with visual skills create a poor foundation for building academic achievement including handwriting, reading, school performance and even focus and attention.
In the past decade there has been an explosion in the numbers of children diagnosed with ADD/ADHD. With this increase, parents and teachers alike are beginning to question how viable this diagnosis is and what other underlying issues could mimic the signs and symptoms associated with ADD/ADHD.
Presently there are no objective assessments available to help make a diagnosis of ADD/ADHD. All tests of the disorder are done with subjective checklists of observed behaviors. Due to the ambiguity that comes with this diagnosis, it is important to be able to identify who is a true sufferer.
It is always best to rule out any and all underlying developmental roadblocks, such as ocular motor deficits, visual perceptual deficits, diet and environment factors, before seeking a formal ADD/ADHD diagnosis.
It is important to have effective protocols in place to help provide a differential diagnosis between ADD/ADHD and vision related learning disorders.
There is no dispute that a diagnosis of ADD/ADHD can be valid. However, distractibility, difficulty focusing or staying on task are not always related to ADD/ADHD.
Often times attention and concentration issues are related to vision, focusing, eye teaming, eye tracking and perceptual vision problems, as opposed to when they are psychiatric in nature.
Interestingly, the signs and symptoms of ADD/ADHD and vision related learning disorders overlap.
Writing involves both handwriting and composition skills. It is necessary for vision to lead the hand for handwriting and this can be very difficult if the student cannot see well.
There are several vision-related skills that are critical to good handwriting that may be underdeveloped in a student with vision problems.
- Poor peripheral awareness may cause difficulty writing straight on a page.
- Visualization is also important in handwriting because the student needs to remember what different words look like in order to reproduce them on the page.
- Spatial concepts are important in handwriting to know and plan how words will go together.
- Good laterality and directionality are important to differentiate similarly-shaped letters in different orientations (e.g. b, d, p, q).
- Visualization is also critical for writing composition because the student needs to be able to organize and re-organize the composition in his or her head.
- Visual recall, the ability to create a visual image based on past visual experience, is a visualization skill that is critical for spelling. In spelling, it is the ability to create a mental image of a word without actually looking at the word.
In order to be able to see effectively to read you need to have clear vision as well as have efficient eye teaming, eye focusing and eye tracking. Too often people believe that having 20/20 sight means that vision is effective for reading. This is not the case. An undiagnosed eye problem can often cause an issue which may present itself as dyslexia.
Eyesight is only a very small part of the entire visual system. “Normal” vision does not always mean normal eyes.
If visual skills are compromised a child may experience blurred or double vision, suffer from headaches, experience eye strain, have difficulty sustaining clear and single vision up close, avoid near work tasks, often skip lines when reading, reverse letters or pronounce words wrong. Experiencing even one of these symptoms can cause problems with reading which can closely resemble dyslexia.
It is important to have effective protocols in place to help provide a differential diagnosis between dyslexia and vision related learning disorders.
There are a number of mechanisms that come into play when a child is asked to read. The skills needed for effective reading include: good visual acuity, good eye tracking, eye focusing, eye teaming, visual form perception and visualization.
From birth to 5 years old, children are ‘learning to see’. From kindergarten to 2nd grade most children are ‘learning to read’. From 3rd grade and up they are ‘reading to learn’.
When a child is ‘learning to read’ vision problems can reduce their ability to know what they are looking at and impact their ability to remember numbers and letters. An aspiring reader will struggle to keep pace with fellow classmates as they acquire this new skill.
When a child is ‘reading to learn’ and has blurry or double vision, their ability to read for long periods of time and comprehend what they are reading can be severely reduced. They won’t be able to process information as quickly as their fellow students and will fall behind.
75% of children identified as learning disabled have their biggest deficit in reading. Out of those children who are reading disabled, 80% of them have difficulties with one or more basic visual skills.
Dyslexia is a term used to describe a condition which affects reading and spelling. In its truest form it can be described as a neurological dysfunction in which the brains’ language center struggles with the translation of written symbols to spoken sounds. Those that have this condition often reverse letters and words, and have issues reading.
|Signs and Symptoms||ADD/||Vision Related Learning||Normal Child Under age 7|
|Inattention (at least 6 are necessary):|
|Often fails to give close attention to details or makes careless mistakes||X||X|
|Often has difficulty sustaining attention in tasks or play activities||X||X||X|
|Often does not listen when spoken to directly||X||X|
|Often does not follow through on instruction or fails to finish work||X||X||X|
|Often has difficulty organizing tasks and activities||X||X||X|
|Often avoids, dislikes or reluctant to engage in tasks requiring sustained mental effort||X||X||X|
|Often loses things||X||X||X|
|Often distracted by extraneous stimuli||X||X||X|
|Often forgetful in daily activities||X||X|
|Hyperactivity and Impulsivity (at least 6 are necessary):|
|Often fidgets with hands or feet or squirms in seat||X||X||X|
|Often has difficulty remaining seated when required to do so||X||X||X|
|Often runs or climbs excessively||X||X|
|Often has difficulty playing quietly||X|
|Often “on the go”||X||X|
|Often talks excessively||X||X|
|Often blurts out answers to questions before they have been completed||X||X|
|Often has difficulty awaiting turn||X||X||X|
|Often interrupts or intrudes on others||X||X||X|
Vision is a complex process that involves not only the eyes but the brain as well. Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input. The third primarily affects visual processing and integration.
If your child habitually places her head close to her book when reading, she may have a vision problem that can affect her ability to learn.
Eye health and refractive problems. These problems can affect the visual acuity in each eye as measured by an eye chart. Refractive errors include nearsightedness, farsightedness and astigmatism that can be corrected by conventional eyeglasses, contact lenses or refractive surgery.
Functional vision problems. Functional vision refers to a variety of specific functions of the eye and the neurological control of these functions, such as eye teaming (binocularity), fine eye movements (important for efficient reading), and accommodation (focusing, accuracy and flexibility). Deficits of functional visual skills can cause blurred or double vision, eye strain and headaches that can affect learning. For example, Convergence Insufficiency is a specific type of functional vision problem that affects the ability of the two eyes to stay accurately and comfortably aligned during reading.
Perceptual vision problems. Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. This means, for example, recognizing words that you have seen previously, and using the eyes and brain to form a mental picture of the words you see.
Most routine eye exams evaluate only the first of these categories of vision problems — those related to eye health and refractive errors. However, not all optometrists offer exams to evaluate functional vision problems and perceptual vision problems that may affect learning.
Did you know that children with vision related learning problems often have 20/20 vision?
Our culture continues to foster higher educational standards and produces work related tasks, which are increasingly visually demanding.
Vision is not simply the ability to read a certain size letter at a distance of 20 feet. Vision is a complex and adaptable information gathering and processing system which collects, groups, analyzes, accumulates, equates, and remembers information.
Vision and learning are intimately related. In fact, experts say that roughly 80 percent of what a child learns in school is information that is presented visually. Good vision is essential for students of all ages to reach their full academic potential.
Vision is a learned process just like learning to master abilities such as sitting up, rolling over, walking and talking. The development of good visual skills are necessary to become an efficient learner and for a child to perform at their highest potential.
Gaps or delays with visual skills create a poor foundation for building academic achievement including reading, writing, school performance and even sports.
In fact, 1 out of 4 children have a vision challenge significant enough to affect their performance in school.
When children have difficulty in school, from learning to read to copying off the blackboard, many parents and teachers believe these kids have vision problems.
Sometimes, they are right. Eyeglasses or contacts often help children clearly see the board in the front of the classroom and the books on their desk.
Ruling out simple refractive errors is the first step in making sure your child is visually ready for school. But nearsighted, farsighted or astigmatism are not the only visual disorders that can make learning more difficult.
Less obvious vision problems related to the way the eyes work together as a team and how the brain processes visual information also can limit your child’s ability to learn.
Any vision problems that have the potential to affect academic and reading performance are considered learning-related vision problems.