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The Hidden Disability

By Dr. Robert A. Copeland, Parents' Source, July 20, 2000.

Last year the National Parent Teachers Association passed an important resolution recognizing the fact that vision problems can adversely affect learning. It is estimated that more than 10 million children suffer from vision problems. Many visual skills are necessary for successful learning in today's classrooms. Poor visual skills can contribute to a child's poor performance in school yet often are not diagnosed or treated.

Routine eye examinations and vision screening programs are only designed to test eye health and how clearly the eye chart can be seen. Some may have a few additional tests, however screenings are not designed to test all of the visual skills needed for good academic performance, leaving most visual deficiencies undiagnosed and untreated. Unfortunately, this means that a child could be struggling with schoolwork due to a vision problem, yet never have it diagnosed. These types of vision problems are often referred to as the "Hidden Disability" because of this. Signs and symptoms of a possible vision based learning problem include: headaches, avoidance of reading, poor reading comprehension, skipping lines, reversing letters and small words, rereading lines, skipping lines, inattentiveness and inappropriate behavior. David Granet, M.D., director to the Ratner Children's Eye Center of the University of California in San Diego, has noted a relationship between children with ADD/ADHD and a common vision problem known as convergence insufficiency. Convergence insufficiency is a condition whereby the eyes do not work together properly when a person is trying to do close work for any length of time. It is not uncommon for someone with this type of vision problem to see "double" or see 'ghost' images when they read for any period of time. In many cases even though as adults we would assume someone would complain when seeing something like this, children don't say a word because they think this is normal. Imagine, not being able to make sense out of what you see, and thinking everyone else can!

Interestingly, the symptoms that must be present to diagnose ADD/ADHD are also symptoms of a vision based learning problem. One of the criteria used to identify a child with ADHD is that the symptoms must be present in 2 or more environments. A child with a vision problem will manifest symptoms whenever they try to read - regardless of where they are.

Dr. Granet has noted that about 16% of children diagnosed with ADD/ADHD have convergence insufficiency. This means these children do not have a necessary visual skill for doing long-term close work. Treatment for convergence insufficiency is accomplished with a program of vision therapy and requires no drugs, or surgery, but is generally provided as a specialty service and is not available in all eye doctors' offices.

During my 27 years practicing optometry I have seen many bright children labeled as having a learning disabilities who were struggling with previously undetected vision problems. Educationally, the child may be receiving extra help, but he or she never seems to catch up to the rest of the class. In some cases the child may have an educational aid who reads all printed material to the child because the child cannot visually process written words. Reports from the school psychologist frequently mention visual motor or visual perceptual deficits. Yet since the child is generally sent for a routine eye exam, the visual problem often goes undetected.

How can a parent ensure that all the visual skills required for learning are tested? There are a few questions a parent should ask a practitioner to be sure he or she is going to do all the required tests:

1. Will the eye doctor test for eye movements, eye teaming, focusing and visual processing?

2. Does the doctor offer treatment programs if he or she diagnoses a vision problem? If not, will the doctor refer the child to a practitioner who does offer treatment programs?

3. Will the doctor send written reports to the teacher, school guidance counselor, and the primary care physician?

Developmental optometrists have taken special courses in all phases of vision development and will usually be a member of the College of Optometrist in Development Vision. They will test all the visual skills a student needs for academic success.

The National PTA resolved "Knowledge regarding the relationship
between poorly developed visual skills and poor academic performance is not widely held among students, parents, teachers, administrators and public health officials; now therefore be it resolved, that National PTA, through its constituent organizations, provide information to educate members, educators, administrators, public health officials and the public at large about learning related visual problems."

If you know a bright child who is struggling with reading and schoolwork, it is possible that vision is the culprit. Please help spread the word.

This article has been written for Parents' Source by Dr. Robert A. Copeland of Wyomissing Optometric Center

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