Thursday, March 25, 2010
Visual Skills - Beyond Visual Acuity
When a child struggles with school work, one of the first recommendations I make is to have an evaluation completed by a developmental optometrist. A child can have 20/20 vision, which means that her visual acuity is within a normal range. Yet some children with good visual acuity may not have good vision skills for other visual processing tasks. "Eyesight" is not the same as "vision". In my son Josh's case, his eyesight was excellent. But when I had him evaluated by a developmental optometrist at age 6, I found out that he had difficulty with some visual processing tasks. First, the optometrist confirmed for me that Josh was colorblind. I had suspected that, since my brother is also colorblind and I had noticed some indications that Josh might be as well, but the simple test done in the eye doctor's office made it official. Second, and to me this was even more important because I hadn't noticed any indication of difficulty, the doctor was able to assess many aspects of Josh's visual processing abilities and revealed that Josh's eyes were not working optimally to complete vision tasks. Josh was unable to sustain focus at a set distance without quickly fatiguing during the task. I watched the examination with fascination, as the doctor held the stimulus in front of Josh's eyes with the instruction "Tell me when this starts to get fuzzy." After three trials, with Josh's response coming sooner each time, it was clear he was having a hard time with this particular task. I had no idea that Josh was having trouble seeing clearly when items were fairly close to him. This information was hugely important for me to be aware of, since at age 6 Josh was beginning to do more up-close academic work during homeschooling with writing and various workbooks. I had also been spending time each day working with Josh on his reading skills while unbeknownst to me, the words were going out of focus while Josh was just learning to decipher print. Josh, of course, didn't know that what he was experiencing was any different than what others experience so he had no reason to try and tell me what he was going through with the various visual activities we engaged in each day. Josh's visual processing difficulty was significant, though fairly mild when compared to some of the visual processing challenges children can experience. Josh was prescribed glasses to wear only for school tasks requiring close-up work. Within a year, Josh's struggles with vision tasks had resolved and he no longer needed glasses. Other students who struggle with visual processing skills may need to practice exercises designed to help them develop their vision so that both eyes are working together efficiently. If a child has undiagnosed vision problems, he may present as inattentive, hyperactive, fidgety, unmotivated, and more. Think about it. If you are trying to read and the letters appear to be wiggling around on the page or go out of focus while you are trying to decode them, you might become a reluctant learner. Some of our children don't stay in their seats and seem to have a short attention span, which makes perfect sense if we are asking them to do something that is beyond challenging for them. Yet they don't realize that their experience is different than others' so they have no way of telling us what is going on with their vision. Would you enjoy reading if you couldn't sustain visual tracking across a line of print and instead picked up words above and below what you were trying to read? If reading is that difficult, it is not pleasurable and someone who experiences those types of vision challenges is not likely to choose to read for enjoyment and may become quite resistant for tasks that prove so frustrating time and time again. Some of our students do not do well with academic tasks, and it's important to be aware that they may be capable of understanding the material but struggles with vision may hinder them. A developmental optometrist can do a full battery of tests and provide precise information on what vision struggles, if any, are impacting a child's ability to function in accordance with her ability. They can offer treatment suggestions and strategies to address any areas of deficits in the visual realm. Heads Up offers two books that are packed with ideas for working on vision skills at home for additional practice. Seeing Clearly offers checklists and activities to help children and even adults improve visual skills. Developing Your Child for Success offers information and activities for young children (beginning around age 4 years) to work on vision skills needed for reading, writing, eye-hand coordination and more. I never would have known just by looking at Josh that he had any difficulty with his vision. I could easily have drawn the wrong conclusion about him and lowered my expectations as a result. I am so grateful that I had him evaluated and that his vision problem was identified and treated. Josh had several other learning challenges, but at least we could eliminate one of the many hurdles in his path.