Vision-Related Learning Disabilities

When children have difficulty in school, from learning to read to understanding fractions to seeing the blackboard, many parents and teachers believe these children have vision problems.

And sometimes, they're right. Glasses or contact lenses will help children see the board better, and they may help children succeed in school if they have difficulty seeing. Ruling out simple refractive errors is the first step, but they're not the cause of all learning problems. There are other vision-related problems — having to do with the way the eye functions and how the brain processes visual information — that can make learning difficult.

There is also a broader range of problems educators and policymakers define as "learning disabilities." These have to do with spoken and written language, math aptitude and reasoning. There may be overlapping causes contributing to a child's learning problem. For example, a visual disorder and an additional factor unrelated to vision may be to blame. In that case, you may need to consider a team approach to helping the child overcome his difficulty.

If you're concerned about a child's poor performance in school, you need to know the possible causes of the problem. You will then be better prepared to pursue a suitable remedy.

Let's first look at the visual causes of learning problems and then consider briefly the broader range of factors that can cause learning disabilities.

Vision obviously is an important part of learning. Almost 80 percent of what a child learns in school comes to him visually. In order for vision to help rather than hinder learning, all three parts of vision must be working properly:

The state of the eyes pertains to eye health, visual acuity and refractive errors such as nearsightedness, farsightedness and astigmatism.

The functioning of the eyes encompasses focusing, the eyes working in tandem and eye movement. A child with a focusing problem may have difficulty reading the chalkboard because she cannot change focus rapidly from near to far. If her eyes do not function properly as a team she may have eyestrain, double vision, headaches and difficulty sustaining attention. Inability to control eye movements means she will lose her place frequently while reading.

Visual perception includes understanding what you see, identifying it, judging its importance and linking it to previously stored information. Eye-hand coordination also has to do with visual perception. Visual perception relates to visual memory, too. 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.

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.

Symptoms of learning-related vision problems include:

• Blurred vision at any distance.
   
• Double vision.
   
• Eyes that are crossed or turned in, or that move independently of each other. (Read more about amblyopia and strabismus.)
   
• Dislike or avoidance of close work.
   
• Short attention span for the child's age.
   
• Turning or tilting the head to use one eye only, or closing or covering one eye.
   
• Placing the head close to the book or desk when reading or writing.
   
• Excessive blinking or rubbing the eyes.
   
• Losing place while reading, or using a finger as a guide.
   
• Trouble finishing timed written assignments.
   
• Difficulty remembering what was read.
   
• Omitting or repeating words, or confusing similar words.
   
• Persistent reversal of words or letters (after second grade).
   
• Difficulty remembering, identifying or reproducing shapes.
   
• Difficulty with sequential concepts.
   
• Poor eye-hand coordination.
   
• Evidence of developmental immaturity.
   
• Headaches, nausea and dizziness.
   
• Burning or itchy eyes.
   
• Color blindness, especially in situations where learning materials are color-coded.

Many professionals, including teachers, pediatricians and some eyecare practitioners focus only on the first of the three parts of vision — the state of the eyes, specifically refractive errors. If vision is defined as seeing a certain size letter on a chart at a specific distance, then many children will have perfect vision even if they must wear glasses or contact lenses. But if vision is defined more broadly as seeing clearly, understanding what you see and processing what you see, some children will be diagnosed with a visual dysfunction that affects how they learn.
 

An estimated two to three percent of children have a learning disability, which according to federal law is a "disorder in one or more basic psychological processes involved in understanding or using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations."

That covers a lot of ground. The U.S. Department of Education divides learning disabilities into four categories:

• Spoken language. There may be a delay or disorder in listening and speaking skills.
   
• Written language. There may be a difficulty with reading, writing or spelling. This includes dyslexia, a deficit in understanding or using language that frequently causes children to reverse letters or words.
   
• Mathematics. The child may have difficulty performing arithmetic functions or understanding basic math concepts.
   
• Reasoning. The child may have difficulty organizing and integrating thoughts.

These learning disabilities may extend beyond academic performance to more general problems of social interaction. Often associated with learning disabilities — but not defined as learning disabilities per se — are hyperactivity, inattention, perceptual-coordination problems, hearing problems and motor-skills defects.

If your child is having difficulty at school or exhibiting any other sign of a learning disability, consult your eyecare practitioner. Work with your doctor to ensure that all three parts of your child's visual capacity are working properly.

If a non-refractive visual dysfunction is part of your child's learning difficulty, special lenses or vision therapy may help. If your child's visual function is not an issue, ask your eyecare practitioner for referrals to appropriate specialists. Visit your family doctor or pediatrician as well for more information on diagnosing your child.

Also keep in mind that children with learning difficulties may experience emotional problems as well, such as depression, low self-esteem, anxiety and stress. Reassure your child that help is available and he or she is not stupid. Many children with learning difficulties have above-average IQs and simply process information differently from their peers.