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PEDIATRICS Vol. 102 No. 5 November 1998, pp. 1217-1219
AMERICAN ACADEMY OF PEDIATRICS:
Learning Disabilities, Dyslexia, and Vision: A Subject Review
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ABSTRACT |
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Background
Recommendation
Summary
References
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Learning disabilities are common conditions in pediatric patients. The etiology of these difficulties is multifactorial, reflecting genetic influences and abnormalities of brain structure and function. Early recognition and referral to qualified educational professionals is critical for the best possible outcome. Visual problems are rarely responsible for learning difficulties. No scientific evidence exists for the efficacy of eye exercises ("vision therapy") or the use of special tinted lenses in the remediation of these complex pediatric developmental and neurologic conditions.
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Learning disabilities have become an increasing personal
and public concern. Among the spectrum of issues of concern in learning disabilities, the inability to read and comprehend is a major obstacle
to learning and may have long-term educational, social, and economic
implications. Family concern for the welfare of children with dyslexia
and learning disabilities has led to a proliferation of diagnostic and
remedial treatment procedures, many of which are controversial or
without clear scientific evidence of efficacy. Many educators,
psychologists, and medical specialists concur that individuals who have
learning disabilities should: 1) receive early comprehensive
educational, psychological, and medical assessment; 2) receive
educational remediation combined with appropriate psychological and
medical treatment; and 3) avoid remedies involving eye exercises, filters, tinted lenses, or other optical devices that have no known
scientific proof of efficacy.
Reading involves the integration of multiple factors related to an
individual's experience, ability, and neurologic functioning. Research
has shown that the majority of children and adults with reading
difficulties experience a variety of problems with
language1-3 that stem from altered brain function and
that such difficulties are not caused by altered visual
function.4-7 In addition, a variety of secondary emotional
and environmental factors may have a detrimental effect on the learning
process in such children.
Sometimes children may also have treatable visual difficulty along with
their primary reading or learning dysfunction. Routine vision screening
examinations can identify most of those who have reduced visual acuity.
Pediatricians and other primary care physicians whose pediatric
patients cannot pass vision screening according to national
standards8,9 should refer these patients to an
ophthalmologist who has experience in the care of children.
Role of the Eyes
Decoding of retinal images occurs in the brain after visual
signals are transmitted from the eye via the visual pathways. Some
vision care practitioners incorrectly attribute reading difficulties to
one or more subtle ocular or visual abnormalities. Although the eyes
are obviously necessary for vision, the brain performs the complex
function of interpreting visual images. Currently, no scientific
evidence supports the view that correction of subtle visual defects can
alter the brain's processing of visual stimuli. Statistically,
children with dyslexia or related learning disabilities have the same
ocular health as children without such
conditions.10-12
Controversies
Eye defects, subtle or severe, do not cause the patient to
experience reversal of letters, words, or numbers. No scientific evidence supports claims that the academic abilities of children with
learning disabilities can be improved with treatments that are based on
1) visual training, including muscle exercises, ocular pursuit,
tracking exercises, or "training" glasses (with or without bifocals
or prisms),13-15 2) neurologic organizational
training (laterality training, crawling, balance board, perceptual
training),16-18 or 3) colored lenses.18-20
These more controversial methods of treatment may give parents and
teachers a false sense of security that a child's reading difficulties
are being addressed, which may delay proper instruction or remediation.
The expense of these methods is unwarranted, and they cannot be
substituted for appropriate educational measures. Claims of improved
reading and learning after visual training, neurologic organization
training, or use of colored lenses, are almost always based on poorly
controlled studies that typically rely on anecdotal information. These
methods are without scientific validation.21 Their reported benefits can be explained by the traditional educational remedial techniques with which they are usually combined.
Early Detection
Pediatricians, other primary care physicians, and educational
specialists may use screening techniques to detect learning disabilities in preschool-aged children, but in many cases, the learning disability is discovered after the child experiences academic
difficulties. Learning disabilities can include dyslexia, problems with
memory and language, and difficulty with mathematic computation. These
difficulties are often complicated by attention deficit disorders. A
family history of learning disabilities is common in such conditions.
Children who are considered to be at risk for or suspected of having
these conditions by their physician should be evaluated for more
detailed study by educational and/or psychological specialists.
Role of the Physician
Ocular defects in young children should be identified as early as
possible, and when they are correctable, they should be managed by an
ophthalmologist who is experienced in the care of children.22 Treatable ocular conditions among others include refractive errors, focusing deficiencies, eye muscle
imbalances, and motor fusion deficiencies. When children have learning
problems that are suspected to be associated with visual defects, the
ophthalmologist may be consulted by the primary care pediatrician. If
no ocular defect is found, the child needs no further vision care or
treatment and should be referred for medical and appropriate special
educational evaluation and services. Pediatricians have an important
role in coordination of care between the family and other health care services provided by ophthalmologists, optometrists, and other health
care professionals who may become involved in the treatment plan.
Multidisciplinary Approach
The management of a child who has learning disabilities requires a
multidisciplinary approach for diagnosis and treatment that involves
educators, psychologists, and physicians. Basic scientific and clinical
research into the role of the brain's structure and function in
learning disabilities has demonstrated a neural basis of dyslexia and
other specific learning disabilities and not the result of an ocular
disorder alone.4-6
The Role of Education
The teaching of children, adolescents, and adults with dyslexia
and learning disabilities is a challenge for educators. Skilled educators use standardized educational diagnostic evaluations and
professional judgment to design and monitor individualized remedial
programs. Psychologists may help with educational diagnosis and
classification. Physicians, including pediatricians,
otolaryngologists, neurologists, ophthalmologists, mental health
professionals and other appropriate medical specialists, may assist in
treating the health problems of these patients. Because remediation may be more effective during the early years, prompt diagnosis is paramount.20,21 Educators with specialty training in
learning disabilities play a key role in providing help for the
learning disabled or dyslexic child or adult.
BACKGROUND
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Recommendation
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EVALUATION AND MANAGEMENT
RECOMMENDATIONS
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SUMMARY |
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Recommendation
Summary
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Reading difficulties and learning disabilities are complex problems that have no simple solutions. The American Academy of Pediatrics and the American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus strongly support the need for early diagnosis and educational remediation. There is no known visual cause for these learning disabilities and no known effective visual treatment.23,24 Recommendations for multidisciplinary evaluation and management must be based on evidence of proven effectiveness demonstrated by objective scientific methodology.23-24 It is important that any therapy for learning disabilities be scientifically established to be valid before it can be recommended for treatment.
COMMITTEE ON CHILDREN WITH DISABILITIES, 1998-1999
Philip R. Ziring, MD, Chairperson
Dana Brazdziunas, MD
W. Carl Cooley, MD
Theodore A. Kastner, MD
Marian E. Kummer, MD
Lilliam González de Pijem, MD
Richard D. Quint, MD, MPH
Elizabeth S. Ruppert, MD
Adrian D. Sandler, MD
LIAISON REPRESENTATIVES
William Anderson
Social Security Administration
Polly Arango
Family Voices
Paul Burgan, MD, PhD
Social Security Administration
Connie Garner, RN, MSN, EdD
United States Department of Education
Merle McPherson, MD
Maternal and Child Health Bureau
Marshalyn Yeargin-Allsopp, MD
Centers for Disease Control and
Prevention
SECTION LIAISONS
Chris P. Johnson, MEd, MD
Section on Children With
Disabilities
Lani S. M. Wheeler, MD
Section on School Health
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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REFERENCES |
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- Mattis T, French JH, Rapin I Dyslexia in children and young adults: three independent neuropsychological syndromes. Dev Med Child Neurol. 1975; 17:150-163 [Medline]
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- Galaburda A Ordinary and extraordinary brain development: anatomical variation in developmental dyslexia. Ann Dyslexia. 1989; 39:67-80
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Hynd GW,
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Brain morphology in developmental dyslexia and attention deficit disorder/hyperactivity.
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Metzger RL,
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Use of visual training for reading disabilities: a review.
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Eye examination and vision screening in infants, children, and young adults.
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[Abstract/Free Full Text] - American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus. Vision Screening for Infants and Children. 1996
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- Helveston EM, Weber JC, Miller K, Visual function and academic performance. Am J Ophthalmol. 1985; 99:346-355 [Medline]
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Levine MD
Reading disability: do the eyes have it?
Pediatrics.
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[Abstract/Free Full Text] - Keogh B, Pelland M Vision training revisited. J Learn Disabil. 1985; 18:228-236
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Beauchamp GR
Optometric vision training.
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Some considerations for evaluating the Doman-Delacato "patterning method."
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[Abstract/Free Full Text] - Kavale K, Mattson PD One jumped off the balance beam: meta-analysis of perceptual-motor training. J Learn Disabil. 1983; 16:165-173
- Black JL, Collins DWK, DeRoach JN, A detailed study of sequential saccadic eye movements for normal and poor reading children. Percept Mot Skills. 1984; 59:423-434 [Medline]
- Solan HA An appraisal of the Irlen technique of correcting reading disorders using tinted overlays and tinted lenses. J Learn Disabil. 1990; 23:621-623
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Sedun AA
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Arch Ophthalmol.
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[Abstract/Free Full Text] - Bradley L. Rhyme recognition and reading and spelling in young children. In: Masland RL, Masland MW, eds. Preschool Prevention of Reading Failure. Parkton, MD: York Press; 1988:143-162
- Ogden S, Hindman S, Turner SD Multisensory programs in the public schools: a brighter future for LD children. Ann Dyslexia. 1989; 39:247-267
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- Silver LB Controversial therapies. J Child Neurol. 1995; 10(suppl 1):S96-S100
Pediatrics (ISSN 0031 4005). Copyright ©1998 by the American Academy of Pediatrics
Statement of reaffirmation:
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AAP Publications Reaffirmed and Retired, February and May 2008
Pediatrics 2008 122: 450.[Extract] [Full Text] [PDF]
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