Bait-and-switch symptoms
In preschool, Ethan Wehse had trouble doing puzzles. By first grade, his teacher noticed him struggling to copy from the blackboard. Suspecting her son had attention-deficit/hyperactivity disorder, Terrie Wehse of Stowe, Vt., took him to see a neurologist, who found no evidence of AD/HD.
At the end of first grade, the mother of another child on Ethan's T-ball team noticed that he was having trouble drawing. Her daughter went to a pediatric optometrist, and she recommended to Terrie that Ethan do the same. An optometrist found that Ethan had poor depth perception. "Just because you have 20/20 vision doesn't mean that you're seeing properly," says Terrie. "That was a huge lesson."
Eyes and ears checkup
Worried about your child's vision? Ask your doctor about recommending a special evaluation. Note that there are many controversies surrounding what's known as vision therapy, which is offered by optometrists. A joint statement from the American Academy of Ophthalmology and the American Academy of Pediatrics sharply criticized the use of vision therapy for the treatment of dyslexia or LD. A rebuttal from the American Optometric Association charges that it misrepresents vision therapy and the scientific research about its effectiveness.
Concerned about your child’s hearing? You can ask the school's nurse, speech pathologist, or educational audiologist to do a hearing screening. In a quiet place, the child will put on headphones and be exposed to very soft tones of varying pitches. If the child fails that screening, an auditory clinic can offer a more comprehensive exam.
In search of a diagnosis
Every year thousands of parents struggle to find out why their child is having trouble — or making trouble — in school, just as Terrie did. A third-grader who can't see the chalkboard may be suspected of having a behavioral disorder like AD/HD. A second-grader who can't hear what the teacher is saying may be mistakenly identified as cognitively delayed.
"If a child can't see or can't hear, they're not going to learn, and they're not going to behave," explains Dr. Charles Shubin, director of pediatrics at Mercy FamilyCare, a division of Family Health Centers in Baltimore.
Young children may simply be unaware that something is wrong. "Kids don't realize that seeing double or letters slipping apart as they are reading is not normal," says Dr. Larry Lampert, a behavioral optometrist from Boca Raton, Fla. This means vision and hearing problems can go undetected for years.
According to the National Commission on Vision and Health, some 25% of school-age children suffer from a vision problem. While the majority of states require some vision screening before a child enters school, only three — Kentucky, Illinois, and Missouri — mandate comprehensive exams using the latest screening methods.
Misdiagnosing misbehavior
The unawareness of the child combined with the misinformed assumptions of the teacher can lead to some miscarriages of classroom justice. In 2008 Lampert treated a 7-year-old girl who was ordered by her teacher to sit on a stool in the corner of the classroom because she wasn't paying attention. It turned out the student wasn't acting up: Severe farsightedness prevented her from seeing her work.
"Nothing was wrong with her other than she needed an eye exam," Lampert says. "This was obviously missed in the screening."
Even a child with 20/20 vision can suffer from convergence insufficiency, in which the eyes have trouble working together as a team, which can cause blurred vision, eye strain, double vision, or difficulty comprehending after short periods of reading. Or the child could have an "accommodation" problem, in which the eyes struggle to focus when rapidly going from near (the paper on the desk) to far (the blackboard) and back again.
The eye exam
A comprehensive eye exam includes evaluating visual acuity, ocular alignment, and depth perception, according to Mary Louise Collins, a pediatric ophthalmologist in Baltimore who is a spokesperson for the American Academy of Ophthalmology. An ophthalmologist also measures the refractive error with the pupils dilated and examines the structural health of the eye, including the retina and the optic nerve.
