The Vision Piece of the Dyslexia Puzzle
If you’re like most parents who have a child who has been having a difficult time learning to read, you’ve had your child’s vision checked out by your family optometrist. And, as has been the case with many of my clients’ parents, you’ve very likely been told that your child’s vision is fine, with the possible exception that glasses were prescribed to compensate for near or far sightedness or to correct an astigmatism. So you feel that you can rule out any vision explanation for your child’s reading problem.
Not So Fast - Vision Skills Might Still be a Problem
Based on my experience with children I've seen in my reading tutoring business, the likelihood that your child still has an undiagnosed vision problem is quite high, particularly if reading problems run in your family.
While your child’s eyesight might be fine, or have been corrected with glasses, this doesn’t mean that he has good binocular control. He could be having difficulty getting both eyes working together when he attempts to read. The result can range from his getting headaches after reading a while, to his avoiding reading for pleasure, all the way to his being completely unable to grasp basic phonics instruction as a young child.
My experience has taught me that certain vision skills must be in place before a child can handle the task of learning to read. The vision skills of the sort I’m talking about are developmental in nature. A baby doesn’t have them. They develop in response to his need to get along in the world. But some children don’t develop the proper vision skills. We end up thinking of them as dyslexic not because we know they have poor visual skills, but because we see the symptoms of those poor visual skills. And one of the most prominent symptoms is that these children struggle to learn to read.
Well-Developed Visual Skills are Important
Visual skills are not the same as visual acuity. Almost all of the young clients in my private reading practice had already had vision exams and their parents were assured that their child could see print clearly (although some did require prescription glasses to achieve that.) Virtually all the children I saw had acceptable visual acuity, but many showed symptoms of poor visual skills. The most common problem many faced was that both eyes didn’t work well together to form a clear, single image of the print they were viewing.
I eventually concluded that nearly all children (and many adults) who struggle with reading are also dealing with undiagnosed problems with their vision skills. Read on to learn why I came to that conclusion.
If you're a parent of a child having trouble with reading or a reading teacher, you might find my first vision therapy referral particularly interesting. Take a side trip to David's Story and read that page and the next page of The OnTrack Reading Story. (Open it in a new tab so you return easily when done reading them.)
The Genetic Component
Reading struggles most likely have a genetic cause. To put it bluntly, it is very likely that the reason a child is struggling is because a parent also struggled to learn to read, or his parents' siblings or his grandparents. I suspect it's a 50/50 gene carried by either father or mother. By a "50/50 gene" I mean that if you carry the gene (whatever gene or combination of genes it turns out to be) and you have ten kids, about half of the ten kids will learn to read easily just like their classmates and about half of them will struggle.
Here is how I came to this conclusion. After a few years I began to recognize a pattern in my client base. Parents kept mentioning that one child learned to read easily while another struggled. And if there were several children in the family, it seemed like another child besides the one I had as a client was also having trouble. I also noticed how often a mother would mention that her husband didn’t like to read either, or that she herself only began to feel comfortable reading when she became an adult. Now, I probably never would have taken it beyond that, except that for several years I had the opportunity to do reading level assessments for children being brought to a vision therapy department for vision evaluations.
An Informal Survey of Parents
Most parents bringing their child to a developmental optometrist for a full developmental vision exam were doing so because they were already at their wit’s end trying to figure out why their child was having so much trouble learning to read. Or, if the child could read reasonably well, he either tended to avoid reading or complained of headaches or fatigue when he read. I would estimate that well over 90% of the children brought to vision therapy departments have reading issues of some sort, and that most are found to have vision skills deficits that require vision therapy to correct.
So, for several years I asked the parents a simple question after doing their child’s reading assessment. I asked them if either of them remembered first grade being a tough time in school. If a child can’t learn to read along with his peers in first grade, that child is going through his personal version of hell, and he tends to remember the experience. (Just a reminder: I consistently use the masculine pronoun, but there are many girls with vision problems also.)
I asked the question in that particular way because people will admit to first grade being tough, whereas they won’t easily admit that they didn’t learn to read on schedule, especially if they still don’t read very well. I asked the parents of over 200 children that question.
A Consistent Response
Almost every time I asked the question, the parent I was talking to opened up and revealed that one of the two parents or a significant cohort of near relatives (aunts/uncles/grandparents) of the child struggled with reading.
Answers ranged from “That would be me, I just skim articles,” to “My husband still doesn’t like to read,” to “My oldest daughter has always gotten headaches even though she likes to read,” to “I really hated school until I hit third grade and then everything started to make sense.” Almost none of the parents that I asked responded with “No, I can’t think of anyone. Both my husband and I have always liked to read and so do our other kids,” or a similar answer.
Bear in mind that most of those parents didn’t know much at all about the sort of vision issues that cause reading problems. You might not either, for that matter, since I haven’t said much about them yet. So they couldn’t tell me whether they had vision problems. What they could tell me is that, yes, a pattern of reading problems ran in the family.When I finally went back over the data I’d collected, over 90% of parents had confirmed that a reading problem ran in their family. In nearly all cases, their child who was struggling with reading was found to have vision skills issues that could be addressed with vision therapy.
So What’s Going On?
I think we’ll eventually find that there is no reading gene responsible for poor reading. Instead, there is a gene (or genes) that affects child development unfavorably and one way it does so is to cause a delay, either temporary or permanent, in the development of normal visual skills (and possibly other developmental skills as well.) When this gene, or combination of genes, is active, your child’s vision skills will not develop normally and that is what will cause, or at least contribute to, his reading problem. If he has a great phonics education and doesn’t get beat up too much by the system during his early years he might even learn to read, but he’ll tend to avoid it because the act of reading makes him uncomfortable visually.
I’ve known class valedictorians with vision problems that made them uncomfortable but who managed to excel because they got proper reading instruction at the outset and were encouraged to work twice as hard as everyone else for thirteen years of schooling. That’s doing it the hard way, but it can be done and it no doubt built a great work ethic.
But Is It Dyslexia?
Here’s how I think you can decide if your child is dyslexic. Let’s assume that your child was (or is now) an otherwise normal six-year-old who seemed to struggle to learn to read compared with his or her classmates. If you had an older child already go through school without a problem, or a younger child who passed the older one by with little effort, the difference in abilities will have been obvious. And, if you or your spouse had the same thing happen to you, or to a couple of your brothers and sisters, your child is likely to exhibit enough symptoms to be considered dyslexic.
But what does that menacing word, dyslexia, mean if I’m correct? Here’s what it means to me, based on my personal experience with a couple hundred children. Your child inherited a genetic condition that, among other things, causes a vision problem that interferes with learning to read. About ten to fifteen percent of your child’s classmates are in the same boat, by the way. Fortunately, you can do something about it.
There are two steps you should consider taking. First, locate a competent developmental optometrist. Second, consider the possibility that the genetic predisposition was triggered by something specific, something that might possibly be remedied. More on that in a bit.
The First Step: Find a Good Developmental Optometrist
The profession that diagnoses and treats visual skills problems is called Developmental Optometry. A developmental optometrist is a fully-trained optometrist who has decided to further specialize in treating vision skills deficits. As a reading instructor, I found that developmental optometrists offer a huge piece of the long-term solution to the reading problems, though professionally they are just diagnosing vision skills problems and then treating those problems, usually with vision therapy. On the following pages of The Vision Piece of the Dyslexia Puzzle you will find most of the information I've learned about vision therapy and the sort of vision issues I associate with reading struggles.
If you decide to follow my recommendations, the page Find a Vision Therapy Provider offers guidance in locating one. However, you need to be aware that an effective phonics course might also be necessary following vision therapy. Vision therapy will make reading easier to learn, but it doesn’t teach reading.
The Second Step: Investigate the Possibility of a Vitamin D Deficiency
This should actually be the first step if you are concerned about the potential of a very young child, even a baby, if reading problems in your family. Recently, many studies have focused on the health effects of a deficiency in vitamin D, known as the sunshine vitamin because most of the vitamin D we each get is manufactured by the body when we're exposed to direct sunlight. In the next section, titled The Diet Piece of the Dyslexia Puzzle, I discuss some of what has been learned recently and lay out why I suspect that a deficiency of vitamin D might well be the "trigger" that activates the dyslexia gene (or genes.) This is information that I've gathered over the past few years and, unlike the vision information I present, is not based on experience, but rather on some relatively extensive reading I've done in that area.
Still a Long Road Ahead
I can’t close this section without cautioning you that a lot of time, effort and expense still lies ahead of you and that the ultimate outcome still might not be satisfactory. I’ll go over some of the difficulties in later pages and I’ll give you an idea of the expense and the time involved if your child needs vision therapy. I’ll also go over the cases I’ve had where vision therapy wasn’t enough and where even a combination of vision therapy and phonics still wasn’t enough. And remember, despite everything I’ve said here, I could be wrong. In fact, a lot of people will tell you that I’m almost certainly wrong.
But you’re the parent. You know your child and you know when people have been wrong about your child in the past. They’ve said things that you know in your gut are just not true. They’ve said he’s not working hard enough. They’ve said he just needs more time to mature. They’ve said he doesn’t pay attention, and even suggested that he needs medicating. They’ve implied that you’re doing something wrong in parenting. You’ve heard it all if your child is in third or fourth grade already.
And by now you also have a pretty good idea whether or not I’ve accurately described your situation. If I have, you’re probably wondering whether your child actually does have an undiagnosed vision problem. As the parent, it’s up to you do decide how best to help your child, but I recommend that you at least rule out the possibility that your child suffers from undiagnosed, and therefore untreated, vision skills problems by taking him to a developmental optometrist for an evaluation.
I would also ask you to keep an open mind as you consider the information on vitamin D. The research evidence that a vitamin D deficiency is associated with multiple health issues continues to grow, although any link to vision is, so far, just speculation on my part.
The next page has a Vision Assessment Checklist that I put together to give you some idea if your child, or a child you're working with, is likely to be dealing with a vision issue of the sort that interferes with learning to read.