HomeLearning DifficultiesLearning Disabilities & ADHDIdentifying a Learning Disability

Bait-and-switch symptoms

Worried your child has a learning disability or behavioral problem? Make sure his eyes and ears are tuned in before testing his brain.

By GreatSchools Staff

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."

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.

Comments from readers

"This article leaves me wondering what to do for my own child. It's important to know about the controversy, but I would have appreciated some guidelines for sorting it all out."
"My daughter was falling behind in reading and getting frequent headaches. A functional eye exam showed she was having troubles with eye tracking and convergence. After 6 weeks of vision therapy, she has made great progress and not had a single headache!"
"This article is in STARK contract to the recent policy statement issued by the American Academy of Pediatrics that came out on July 27, 2009 which can be found here: In an article written regarding this policy: 'The academy came down hard on these 'scientifically unsupported' alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations. Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics. 'Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation,' they cautioned.' See the full article "