• Visual memory—recognizing, associating, storing, and retrieving visual details that one has seen previously.
• Sequential memory—perceiving words and pictures in order and remembering the sequence, important for reading and spelling.
• Visualization—forming and manipulating images of objects, people, or scenarios in one’s mind’s eye, a prerequisite for language development.
• Visual-sensory integration, combining vision with touch, movement, balance, posture, hearing, and other sensory messages.
With both components of vision in sync, we not only see, but also respond adaptively to what we see in social and physical surroundings. Visual-motor skills are movements based on the discrimination of visual information. These skills gradually evolve, and we learn to connect seeing with doing, or praxis. After much practice, we can coordinate the “what, where, and how” of vision with gross-motor and fine-motor movement. Is our sock covered with lint? We can pick it off. Is the pothole deep and wide? We can move around it.
Visual-motor skills include:
• Eye-hand coordination—the ability of the eyes to guide fine-motor tasks, such as manipulating toys, fitting round pegs into round holes, using tools, eating, dressing, writing, and following printed patterns to lace beads or build block structures.
• Eye-foot coordination—the ability of the eyes to guide gross-motor activities such as playing hopscotch, stepping into the bathtub, and kicking a ball.
• Eye-ear coordination—the ability of the eyes to see a letter, integrate the message with stored auditory information, and tell a person how to say it or use it in a word.
The child who has developed visual discrimination and visual-motor skills has had much practice in looking around, moving around, and actively participating in a variety of sensory experiences. This child can judge accurately where objects are in space and can build a block tower or visualize an elegant bridge design in 3-D. He can recognize a hammer, an “R,” and a trapezoid, whether it is right-side up or upside down. In his schoolwork, he can line up columns of numbers and write neatly between the margins. He can move fluidly across a room or playing field. He can travel in the same direction as everyone else in a parade. He can ride a bike from garage to grocery store and draw, read, and follow a treasure map.
AN EXAMPLE OF VISUAL SKILLS AT WORK
Envision this scenario to understand how important all the components of vision are for survival: You are walking on the sidewalk beside the green park and notice a diagonal path cutting through to the opposite side. You veer off the sidewalk and take the path (directionality). You sweep your eyes (binocularity) from left to right (scanning) and sense that the park environment is peaceful. From the corner of your eye (peripheral vision), you espy a slight motion (detection of movement) coming from a big lump wrapped in a red blanket and lying on a bench (visual discrimination). You freeze so the lump won’t notice you. From afar, you evaluate the scene. Could that lump be a person lying down (formconstancy)? It looks like other lumps you have seen (visual memory). You focus so your vision won’t be blurred (accommodation). You gaze at the lump, the bench, the tree, and the path (fixation) and concentrate on the whole scene (visual attention). Is this situation good for you, bad for you, or neutral? Where is the lump in relation to where you are and where are you relative to safety on the busy street (spatial relationships)? Can you find your way out of the park (wayfinding)? The lump stirs suddenly, and you jump (visual defensiveness). Without hesitating to analyze whether to fight it, flee from it, feed on it, feed it, or mate with it, you make a self-protective adaptive response. You simply point your feet in the opposite direction and run (eye-foot coordination).
THE OUT-OF-SYNC VISUAL SENSE
Dr. Ayres and her gifted followers have found that many children with learning disabilities have visual dysfunction. Usually, their brains are inefficient in coordinating visual discrimination and visual-motor skills with vestibular, proprioceptive, and postural mechanisms. In other words, their eyes and bodies are out of sync.
Erratic vision development is common in children with autism—although often it is overlooked. The child with autism often has poor eye contact and has difficulty attending to and giving meaning to objects and people in his environment. When he is visually stressed, he may squint and “self-stim” (flap his hands in front of his eyes). “Self-stimming” is a compensatory attempt to open up visual space, relax his compressed visual attention, and function better.
Of course, many children without autism have obvious or not-so-obvious visual dysfunction, too. When dysfunction involves movement (tripping on air), posture (slumping at the desk), and body awareness (difficulty learning left and right), then chances are that the problem is sensory based, and SPD is the root.
However, when dysfunction involves visual discrimination without movement (such as matching colors or reading a map), SPD is not necessarily the root. The cause could be an acuity problem, such as nearsightedness, or a cognitive disorder, such as Down Syndrome. Determining the underlying cause of visual problems matters greatly so that the appropriate treatment will match the specific problem.
The child with SPD and poor vision may have one or more problems with modulating, discriminating, and using visual sensations to respond adaptively to the world.
Sensory Modulation Disorders
VISUAL OVERRESPONSIVITY—“OH, NO!”
The child with overresponsivity, or visual defensiveness, reacts dramatically to benign environmental stimuli such as contrasts, reflections, shiny surfaces, and bright lights. She may turn her eyes away from sudden, vivid, or flickering lights, perhaps shielding her eyes with her hands, sunglasses, or a cap visor. The child may also be disturbed by moving objects, such as dangling mobiles or people bustling in a busy environment. She may duck when objects come toward her, such as a ball or another fast-moving child.
HOW OVERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Visual Overresponsivity
Leah, eleven, is looking after her little brother at the playground. He toddles toward the swings. In the nick of time, Leah notices that he is in the direct path of a child swinging down in a wide arc. Without hesitation, she grabs her brother’s arm and tugs him out of the way. Dorothy, eleven, babysits for a neighbor. At the park, the toddler tugs Dorothy toward the swings. The rapid movement of the children on the swings alarms her. She closes her eyes to avoid the commotion. One of the swingers inadvertently knocks her and her little charge to the ground.
VISUAL UNDERRESPONSIVITY—“HO, HUM”
The underresponsive child may not pay attention to novel visual stimuli, such as holiday decorations or rearranged classroom furniture. She may not respond quickly and efficiently when objects come toward her—for example, when a beanbag is tossed her way.
HOW UNDERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Visual Underresponsivity
Connor, a fourth-grader, looks up at the homework assignment chalked on the blackboard. He copies the assignment in his notebook, glances up again to compare it to what he wrote to be sure he got it right, gathers his gear into his backpack, and heads for the door. While other children copy the assignment from the board, Rex, nine, stares out the window. The teacher beckons him and says, “It may be easier to hear the assignment than to read it. I’ll tell you what to write down.” Rex is grateful but can’t hold her gaze. He stares right through her.
She may be unaware of bright light or sun. She may not blink or turn away from the dazzling light. She may stare at objects without seeming to see them, or at people’s faces as if they are not even there.
SENSORY CRAVING—“MORE!”
The child who craves more visual stimulation than most children may clamor for excessive time in front of the television or computer screen, and may be attracted to bright, flickering lights, such as strobe lights or stripes of sunlight pouring through window blinds.
HOW SEN
SORY CRAVING AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Sensory Craver
The defective fluorescent light slightly annoys Lucy, four, but she ignores it during Show and Tell. Then, it is time to play outdoors. After school, she goes to Lynne’s. She joins Lynne briefly to watch a video until she gets bored and looks for some dress-ups to try on. Lynne, four, gazes up at the flickering fluorescent light. The long “on” and brief “off” distract her from Show and Tell. After school, Lucy comes to her house to play. Lynne sits close to the TV and stares at a mesmerizing video, while Lucy slips away and tries on dress-ups.
Poor Visual Discrimination
The typical child can distinguish specific qualities about what she sees and can tell the difference between the people and things she looks at.
The child with poor visual discrimination does not perceive what he sees. Instead of linking visual information with auditory, touch, and movement sensations, his brain may misconnect the messages. For instance, if connecting sights with sounds is a problem, he may not know where to look when he hears the teacher’s voice. If connecting sights with touch sensations is a problem, he may not know—just by looking—that a nail is sharp and a hammer is heavy. If connecting sights with movement sensations is a problem, he may not swerve to avoid bumping into furniture. If all the sensory pieces don’t come together in his brain into a unified whole, it is most challenging to adapt responsively to the sights his eyes record.
The child may be unable to match or separate colors, shapes, numbers, letters, and words. He may not distinguish words in print, even his own name. As he grows, he may stumble over similar symbols, letters, and numbers, such as and , “b” and “d,” and 1,000 and 1,000,000. He may have difficulty focusing and concentrating on details in pictures, puzzles, Lego instructions, history books, geometric proofs, recipes, sewing patterns, and so forth.
HOW VISUAL DISCRIMINATION AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Poor Visual Discrimination
Samantha, five, is studying a magazine page called, “What’s Wrong with this Picture?” She spots an upside-down “4” on a kitchen clock, a banana where a telephone receiver should be, and a tiny spider in a line of ants marching toward a sugar bowl. Giggling, she tries to share the page with Opal, but Opal’s inattention disappoints her. Opal, a kindergartner with visual dysfunction, looks briefly at “What’s Wrong with this Picture?” when Samantha shows it to her. But Opal cannot easily pick out the visual details, so the page does not hold her attention. She shrugs and hands it back to Samantha. She does not recognize Samantha’s disappointment.
The child may be unsuccessful at differentiating between objects in the foreground and in the background. He may not enjoy examining richly illustrated books such as Where’s Waldo? He may misjudge which jigsaw pieces fit into a puzzle and be unable to spot a friend in a crowd.
He may misread important visual cues in social interactions, such as facial expressions and gestures, which make up more than half of our human communication. The inability to discriminate whether another person is scowling or smiling is a significant disadvantage!
Visual-Motor Skills
The typical child uses visual information to guide her planned and purposeful movement. With synchronized visual-motor skills, she can move her body efficiently, get from Point A to Point B, look at and copy a simple drawing or block structure, and see, reach for, and grasp an object.
The child with poor visual-motor skills has difficulty using her vision to guide her movements. Visual dyspraxia may cause problems in visualizing, planning, and carrying out a sequence of complex movements, such as rolling over in bed to see the alarm clock. She may overreach for objects. She may stumble up stairs. She may find it hard to walk on a balance beam, ride a bicycle, tie shoes, cut out paper dolls, spread butter on toast, or thread a needle. She may be bewildered, emotionally insecure, and “lost in space.”
Poor eye-hand coordination may mean the child struggles to use his eyes and hands together. He may have difficulty manipulating toys and school materials, catching balls, using crayons and pencils, and fastening his clothes.
Poor eye-foot coordination will impede a child’s smooth walking, running, and success on the playing field. Poor eye-ear coordination will interfere with his ability to see and then say a letter or word, and thus, with his speaking, reading and writing skills.
HOW EYE-HAND COORDINATION AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Poor Eye-Hand Coordination
At snack time, David, three, pours juice into a cup, stopping just before the juice reaches the brim. After snack, he works on a puzzle. One piece doesn’t seem to fit. He studies it and realizes that it is upside down. He corrects his error and completes the puzzle. Then he does another, more complicated one. At snack time, Freddy pours juice until the cup overflows. The teacher cleans him up and offers him a simple jigsaw puzzle. Freddy attempts to put in the four pieces but can’t get them to fit. Frustrated, he shoves the puzzle off the table. He asks just to sit in the cozy corner and hold the guinea pig.
The child with visual dyspraxia may be unable to plan ahead and solve problems in his mind’s eye. He may look at materials, know something can be done with them, and be unable to recruit the visual functions and skills needed to make something desirable actually happen.
HOW VISUAL PRAXIS AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Visual Dyspraxia
Herbie and Curt, second-graders, are playing with toy soldiers. Herbie’s idea is to map out a battlefield in the sandbox, add pebbles and twigs, and arrange their armies in strategic positions. As the work progresses, he visualizes how to place his men strategically—some behind a rock, others between leafy branches, and others behind sand hills. This is exciting and engrossing work. Curt agrees that a battlefield in the sandbox is a good idea, but he has no design or strategy in mind. He has difficulty sequencing and using visual information well. He lets Herbie propose and carry out his plan. Curt’s side of the battleground is mostly open territory. He lines up his soldiers in parallel rows and waits for the battle to begin.
Poor bilateral integration and poor postural responses frequently interfere with visual-motor skills. The child may have difficulty coordinating both sides of the body and stabilizing his head, trunk, and limbs to function effectively and to support visual-motor skills.
HOW POSTURAL RESPONSES AFFECT A CHILD’S BEHAVIOR
A Typical Child A Child with Postural Disorder
At his table, Benjamin, a first-grader, sits upright and reads the workbook instructions. He understands them, picks up his crayon, and connects the dots. Clark, six, slumps at the table. He twists on the chair, trying to get comfortable so he can read the workbook. He cocks his head this way and that. The words dance on the page.
Fortunately, help is available. A developmental optometrist can provide vision therapy to strengthen eye-motor control, visual discrimination, and eye-hand coordination (see Chapter Eight).
Also, when occupational therapists provide therapy using a sensory integration framework to alleviate vestibular, proprioceptive, and postural problems, vision often improves. If therapy is not an option, a sensory diet rich in visual experiences is essential to ensure adequate vision development. To move is to see!
CHARACTERISTICS OF VISUAL DYSFUNCTION
These checklists will help you gauge whether your child has visual dysfunction. As you check recognizable characteristics, you will begin to see emerging patterns that help to explain your child’s out-of-sync behavior.
The child with a problem with basic visual skills may:
Have headaches, eye strain, or red, burning, itchy, or teary eyes.
Rub eyes or blink, frown, and squint excessively.
Complain about blurred images when looking at pictures, print, or faces.
Complain of seeing double.
Complain that words seem to move on the page.
Turn or
tilt her head as she reads across a page.
Hold a book too closely, or lower her face too closely to the desk.
Have difficulty seeing the storybook or chalkboard, and request to move nearer.
Have difficulty shifting her gaze from one object to another, such as when looking from the blackboard to her own paper, and make errors in copying.
Have difficulty focusing on stationary objects.
Frequently lose her place on the page, reread words or lines, and omit numbers, letters, words, or lines when reading or writing, and need to use her finger to keep her place.
Have difficulty tracking or following a moving object, such as a ping-pong ball, or following along a line of printed words.
Fatigue easily during schoolwork and sports-related activities.
The child with difficulty modulating visual sensations may:
Shield her eyes to screen out sights, close or cover one eye, or squint.
Avoid bright lights and sunlight, perhaps preferring to wear sunglasses, even indoors.
Be uncomfortable or overwhelmed by moving objects or people.
Duck or try to avoid objects coming toward her, such as a ball or another child.
Withdraw from classroom participation and avoid group-movement activities.
Avoid direct eye contact.
Experience headaches, nausea, or dizziness when using eyes.
Be unaware of light/dark contrast, edges, and reflections.
Be unaware of movement, often bumping into moving objects such as swings.
Respond late to visual information, such as obstacles in her path.
Seek bright lights, strobe lights, and direct sunlight.
Seek visual stimulation, such as finger flicking, spinning, and peering at patterns and edges, such as ceiling and fence lines.
Move excessively (squirm, fidget) during visual tasks, such as workbook activities.
The child with poor visual discrimination may:
The Out-of-Sync Child Page 17