Learning Problem? Is it attention, potential or just a vision problem?

By:  Carol E. Marusich, OD, MS, FCOVD

It is obvious to us that some children do not fit the typical classroom profile.  These children may not be flourishing in the traditional classroom or even special programs designed to help them learn.

They are often bright children who struggle in school in spite of how “smart” they may be at everything else.  Sometimes even gifted children have noticeably weak areas in their academic performance (reading, writing, spelling, etc.)  which may be overlooked because of their ability to discuss and remember complex subject matter and the fact that their overall performance is acceptable.

This gap between potential and performance in certain areas can not only limit academic progress, but ultimately, the opportunity to develop to their full potential in many areas outside the classroom.

The frustration these children experience when they become aware of their difficulties, yet do not understand why they struggle when their friends do not, can lead to behavior problems.  Worse yet, there may be a tendency for others who also observe this discrepancy (good at some things, poor at others), to misidentify the child’s behavior as lazy or a symptom of AD(H)D.

Even if some children may not be “bad enough” in their overall performance to be identified for special assessment, or qualify for special programs or assistance in the classroom, this does not mean that they are free from selective gaps in their underlying abilities which can limit their achievements.

My premise is a simple one – easy to remember.  We only get answers to the questions we ask.

When you suspect that this child is working harder than they should have to in order to be successful, or is not working up to their potential in certain areas, it is time to start asking those questions.

In the classroom we refer to books, charts, instructions; maintain eye-contact to attend; remember where to sit, put homework; stay on the line, be neat.  Our eyes direct our hands, our attention, and our movements through space, on paper and across a line of print.  Researchers estimate that 80% or more of what takes place in the classroom involves vision.

The impact of a vision problem, therefore, is especially noticeable in the classroom setting where kids cannot avoid these visual demands. The consequences of these vision problems can be profound.

When we look at an unfamiliar picture we can’t quite figure out and then suddenly realize what it is, we begin to understand that vision is more than simply being able to see the lines clearly.  That is not enough.

So what is Vision?  According to the American Optometric Association, “Vision is the learned process of deriving meaning from what you see.”  It is more than just being able to see clearly one eye at a time across the room.  Yet that is all we screen for in most medical & school screenings!

We do need clear sight for good vision, but VISION involves a whole lot more,  … how we look for, collect, understand, integrate, store, retrieve, and use the information we see.

So where does vision take place?  While we need healthy eyes to focus light; we need educated minds to seek out and understand what we see to have good VISION.

Vision is Learned.  We can hear children learn language as they struggle with more complex sounds  (Pisghetti, bumblejacket). But we forget that they need to learn vision as well.  And just as there can be difficulties mastering all the underlying abilities involved in speech and language, there can also be difficulties mastering all of the various aspects of vision.

We assume that by age six, the child will come into school with a healthy, developmentally ready visual system, with all the abilities necessary to meet the visual demands of classroom learning; that the child has adequately learned how to use their visual system and has good “vision”, not just clear eyesight.

What does it mean to have a “healthy, developmentally ready” visual system?

We are assuming that visual skills are efficient to:

FIXATE (aim eyes accurately)

FOCUS (keep it clear)

FOLLOW (accurately track the object or jump from word to word)

FUSE (do this with both eyes together) with good neuromuscular control.

This determines visual speed, accuracy, endurance & comfort.  Can I get it quickly, in the proper sequence, without errors, for as long as I need to before I fatigue or lose interest?  When these skills are not efficient, we are likely to have visual confusion from blurred, unstable or double images, which can create symptoms of fatigue, headache and discomfort.

We are assuming that visual information processing is accurate and age appropriate including:

Form perception for similarities & differences (e, c / r, n, m)

Spatial Relations and Directionality (b, d, p, q)

Figure Ground to find what we want in a busy background (small print)

Visual Closure for sight vocabulary

Form Constancy to recognize different fonts

Visual Memory for symbols (letters & numbers) and sequences of symbols (words)

We are assuming that visual input matches other sensory input:

Visual – Auditory Integration for punctuation to be meaningful

Visual – Motor Integration to direct action (writing) with accurate visual feedback

Visual information perceived or processed incorrectly interferes with learning.  Individuals who cannot use vision efficiently to understand their environment, may touch everything to compensate appearing “hyperactive.”  Individuals who cannot sustain comfortable vision may lose their visual focus and appear distracted or to have an “attention deficit.”

Our cognitive experience also plays an important role in how we process visual information.  When visual imagery and visual memory are poor, we have little visual experience to bring to new tasks so past experience cannot help us learn.

As you can see, there is a lot more involved with vision than just “seeing a letter chart clearly across the room”.  Vision can be a big piece of the puzzle when inattention, discomfort, poor performance, learning problems or the need to work harder than you should are the symptoms.  With definitive diagnostic testing vision problems which interfere with learning or sustaining visual attention can be identified and treated with appropriate lens, prism and vision therapy.  Vision can be developed so our children are ready to take full advantage of educational opportunities and achieve their full potential.