Mariah’s vision challenges were caught in a regular eye exam …
Dyslexia, ADHD, DCD and Learning Disabilities
Just the other day a mom from Nanaimo asked the question about her daughter who has been diagnosed with dyslexia and ADHD, and her other child with developmental coordinations disorder. ‘Could vision be a problem? If so, why doesn’t vision get looked at as part of testing?’ A great question, and an area that can create a lot of confusion between educators and health professionals. There are three reasons why (see the TedX talk for more info):
The definition of vision that most optometrists, paediatric ophthalmologists, other doctors and educators run on is that it’s really only about seeing clearly an the physical health of the eye. It completely negates the idea that problems with how the eyes move and track could interfere with reading (which is a process relying on accurate eye tracking). This means that the ‘all clear’ given on vision really only relates to clarity, and not the critical functions needed for reading, writing, coordination and ability to sustain attention.
Vision needs to include: Eye tracking, binocularity (eye teaming), and other functions such as visual processing (related to letter reversals and left/right abilities).
Much of psychological testing requires the use of a person’s vision, but it is assumed that vision is all ok because the eye test gave the all clear. The DSM5 states: ‘The individual’s difficulties must not be better explained by developmental, neurological, sensory (vision or hearing), or motor disorders..’ Think of it like this. If we wanted to diagnose a problem with riding a bicycle, we would want to make sure that they had a properly functioning bicycle. Assuming the bicycle worked properly when it didn’t, may lead to a diagnosis that assumes the problem is with the child, not the bicycle. Assuming vision works properly potentially leads to diagnoses that assume the problem is with child, not a treatable visual condition.Imagine if a child had flat tires and stuck brakes. They wouldn’t be able to ride for as long as their peers. If you fixed the bike, they could stay riding longer (even if they were still behind).
This is why if a child has ADHD and a problem with vergence (eye teaming), treating the vergence problem reduces the ADHD symptoms (studies).
Professionals get stuck. The combination of the above two things makes for many professional debates. It’s common to hear that vision therapy won’t help dyslexia. And this is absolutely true, if visual function was completely ruled out before the diagnosis (almost always it is not). So a truly diagnosed case of dyslexia, developmental coordination disorder or other learning disability should have completely ruled out all visual function that could cause the same signs and symptoms. For example, if your brain can’t calculate where things are in space (coordinates), wouldn’t it make sense that developing accurate motor coordination (developmental coordination disorder) will not be easy?
The problem is that both sides of the argument are absolutely right. If the diagnosis of dyslexia, developmental coordination disorder, learning disability or adhd has been strictly followed, vision should be totally ruled out and therefore vision therapy won’t help. Unfortunately, or fortunately depending on how you look at it, this is almost never the case, and the reason why almost every child seen with a learning disability has a large visual component. This doesn’t mean that vision is the entire problem, but it certainly makes everything a lot worse, and a lot harder than it needs to be.
This is why we are so fortunate to have Dr. Alison providing in depth vision examinations for patients from Nanaimo, Courtenay-Comox, Campbell River, Duncan and the rest of Vancouver Island. Computer assisted eye tracking and more can help to find any problems with how vision is functioning that may be playing a role in why a child may be having reading troubles, attention problems, or poor coordination. These are treatable conditions and it can have a significant impact on the life of a child and their family.