First published in SHINE! By Parenting on the Peninsula, October 2010(Reprinted with Permission) child wearing dark glasses

How Developmental Optometry Can Help

Working with a special needs child to develop skills necesssary for success in the classroom and life can be rewarding, but also challenging and frustrating for parents, family, and teams of teachers, doctors, an therapists. Collaborating with a developmental optometrist can make all the difference as children with special needs and developmental disabilities commonly also have a host of vision problems that can directly contribute to their difficulties.

Vision and the Special Needs Child

Although on the surface these disorders seem to have little to do with the eyes, they in fact can have a huge impact on a child’s behavior and ability to learn and interact with his or her world. The fact that vision occurs in the brain and not the eyes and that vision pathways mingle extensively with social and emotional pathways in the brain, compels one to look more closely at the role vision plays in the special needs child and his or her overall development and behavior.

For example, one study performed at the Ratner Children’s Eye Center, Department of Ophthalmology at UC San Diego, found that patients diagnosed with a common visual problem, Convergence Insufficiency (CI), also had the diagnosis of Attention Deficit Disorder with or without hyperactivity (A-D/HD) three times more than would be expected in the general population. This study supports what we see clinically in our practice. Therefore, patients with A-D/HD symptoms should be evaluated to determine if they have CI or any other vision problems that may contribute to inattention when reading or learning.

Behaviors That May Indicate a Visual Problem

Because a child does not often know to report visual symptoms, it’s vital that parents know what to look for. Here are some of the more common symptoms that there may be an underlying vision problem: avoids close work; poor eye contact; quick to fatigue; inability to listen and look at the same time; headaches; rubs or pokes eyes; covers one eye; turns or tilts head; has an eye turn; stares at lights, shiny , or spinning objects; confuses left and right; is clumsy; has poor balance; difficulty going up or down stairs; or is afraid of heights.

Early Intervention of Vision Problems That Interfere with Learning Is Best

Vision problems can also hinder school performance. Symptoms parents can watch for here include: takes forever to complete homework; has a short attention span; works at a close distance; omits or confuses small words when reading; loses place when reading; whispers to themselves while reading silently; trouble copying from the board poor handwriting; and poor visual memory.

According to the American Public Health Association, “25% of regular students in grades K-6 have visual problems that are serious enough to impede learning.” In addition, the American Optometric Association has found that a remarkably high percentage, as much as 60%, of children in special education suffer from undiagnosed visual problems. As an example, many of those on the Autism Spectrum often have difficulty processing both central and peripheral vision simultaneously. When untreated, these vision problems may severely impair attention, processing speed, and the ability to understand the world around them an respond normally to others.

Many children with developmental delays and other disabilities often have convergence problems or eye turns. While the eye turn can be corrected surgically, it is typically a cosmetic solution only. Dr. Susan Barry, author of Fixing My Gaze, shares how she was put into a special problems classroom in grade school (which is the equivalent to today’s special education), due to her poor academic performance which was a result of what she suspects were undetected visual problems. Her vision problems were successfully treated in her late 50s. Thus, although it is best to treat visual problems as early as possible, they can be effectively treated at any time.

Developmental Vision Examination and Treatment of Visual Problems

Treatment may include regular glasses, therapeutic lenses (such as special prism lenses, which bend the light differently than regular glasses), and/or optometric vision therapy. Vision therapy is often performed in coordination with other therapies and the combination can have a very synergistic effect.

Children with sensory integration issues often have a visual component contributing to their difficulties as well. In her book, Raising a Sensory Smart Child, Lindsey Biel, M.A., OTR/L, states, “Consider going to a developmental optometrist even if no one refers you, because an undiagnosed vision problem is a major obstacle for any child.”

For more information and an in-depth symptom checklist, please visit our Web site at www.familyvisioncare.org

Carole L. Hong, OD, FCOVD, board certified in vision development, is an expert in children’s vision, vision and learning, and treatment of vision problems for those with developmental disabilities. (650) 593-1661