Posts Tagged ‘vision’


Posted July 8, 2012 by pehl

All of the children with whom I work have sensory processing difficulties of one sort or another, to one degree or another.  Because all of the sensory channels work together synergistically it is highly unlikely for any one system to be unaffected.  But the one sensory channel that is the most over-looked and taken for granted is the visual system.  It is also, in many ways, the most important, as well as the most controversial.

A child with perfect eyesight may suffer from significant visual difficulties, which can negatively impact academic learning, sports and daily function.  Visual development and behavior begins at birth and progresses along a continuum with clear milestones.  By the age of 12 months visual tracking skills are typically mature and this is one area I screen in all of the children I see.  A typical 5-year-old should be able to visually track a moving target horizontally, 180 degrees in both directions without moving his/her head, (upon request) and without any jerks or loss of pursuit at midline.  This same child should be able to do this in the vertical plane as well, follow a moving target in a large circle both directions and in random patterns that cross his midline and should also be able to maintain convergence on an object moving towards his nose to approximately 2- 4 inches from his nose.  If I see any difficulties including fatigue with this exercise, I have concerns.

Another visual screening tool I use is a game of catch with a playground ball of approximately 9-inches in diameter.  A five-year-old should be able to catch this without allowing it to touch his/her body, consistently.  If the child traps the ball against his body, closes his eyes, looks away and guesses or grabs at it, or consistently misses the ball, his visual skills are not supporting a functional outcome, and again I have concerns.

Likewise the manner in which a 5, 6, 7-year-old sits while writing or coloring at a table is full of clues to his visual function.  Can he hold his paper or project still with his non-dominant hand, while his dominant hand is busy?  Does he hold his chin in his non-dominant hand?  Does he cover the eye on the non-dominant side after working for a few minutes?  Kids can be cagey about this – it can appear that he is holding his head up, when in fact he may be doing both, covering his eye and holding his head.  Does he always tilt his head to one side, or turn his head so one eye is closer to the page than the other?  I’ve seen children who do all of these things, (not one child who does all of them, but often a couple) and they all had difficulty with writing and/or reading.

Yet another big red flag with respect to visual function is the child who “just doesn’t like to _______” color, draw, write – you fill in the blank.  Kids start wanting to use a writing tool as soon as they’re able to take yours away from you, so not wanting to, or not liking to color just isn’t a typical response.  I worry about these kids and I feel that it is my job to try to figure out the, “why not?”

One strategy in figuring out the “why not”, and/or the “why” is an assessment by a Developmental/Behavioral Optometrist.  This is usually where the issue becomes controversial.  Unfortunately not all insurance companies will pay for these evaluations, or reimburse for vision therapy.  Their reason is often because they consider it to be “experimental” and this is unfortunate because it’s been around almost as long as Occupational Therapy, which officially began in the early 1900’s.

The field of Behavioral Optometry was founded in the 1920’s, based on the work of Dr. A. M. Skeffington.  I found the following quote from Dr. Skeffington in Seeing Clearly, by Lois Hickman MS, OTR, FAOTA & Rebecca Hutchins MS, OTR, FAOTA:

“Vision cannot be separated from the total individual or from any other sensory systems, as it is integrated in all of human performance.  Vision is learned, and therefore, trainable…Behavioral optometrists put a major emphasis on the prevention of vision problems as well as enhancing visual related performance which is at a level less than the individual’s potential.”

Did you know that once a child enters school, approximately 75% of all classroom learning is through the visual pathways; that 90% of the people who have problems with their visual skills are never diagnosed.   I agree, it’s a little overwhelming but as Dr. Richard Kavner, OD, FAAO says, “…seeing, more than any other sense, guides and shapes a person’s behavior and experience of life…it is one gift all people deserve.”