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Special Needs Children & Vision: Why should they visit the Optometrist?

Special Needs Children & Vision:  Why should they visit the Optometrist?

Now, more than ever before, there are greater numbers of children with special needs and challenges in the classroom. Many of these children, particularly those with dyslexia, attention deficit disorder (ADD) and high functioning autism (Asperger’s), have average and often above-average intelligence. But regardless of their IQs, they often struggle in school because their brains process information differently than others. Given that more than 25% of the brain is devoted to processing vision, it is not surprising that visual processing issues are often among the processing differences of the special needs child. Failing to address these visual processing issues makes the child’s learning experience more difficult than it needs to be. Sometimes it may be a combination of both visual processing and visual function (seeing, focusing, tracking, eye coordination) that is contributing to your child’s difficulty. The optometrist can help to identify what is the appropriate intervention, including treatment, therapy, and/or coordination of care with other professionals such as speech and language therapists, reading specialists and programs, neuropsychologists, behavioral therapists, specialized tutors and others.

Fortunately, a visit to the optometrist can go a long way toward getting your special needs child on the right track toward success in the classroom. There are 5 steps that your optometrist can take to help improve your child’s learning outcomes:

Kids eye chart

Step 1: Assessing visual acuity – A thorough assessment of visual acuity is particularly important for the special needs child. Visual acuity problems only exacerbate other issues, and too often these children have not received sufficient acuity testing. Sometimes this is because the child has trouble getting through an eye exam as they become distracted, anxious or more easily fatigued. Other times, this is because there may be other processing issues so glaring that caregivers may not even think of visual acuity as a significant issue. However, if a child cannot see clearly, that negatively affects the rest of visual processing.

I have had several instances where I was able to make a positive difference in the lives of special needs children simply by taking extra care and time to gain their trust and make them comfortable during the examination. This allows for more accurate test results, hence allowing for improvements to their eyeglass prescriptions for more precise vision. Helpful adjustments include refining the astigmatism power positioning, balancing the power accurately between both eyes, and prescribing multifocal lenses when needed, as often times one single vision power may not work for both far and near viewing in the classroom.

Step 2: Conducting a binocular vision assessment of your child’s visual functioning abilities – Even if a child has good visual acuity, it is not uncommon for there to be some kind of issue with the function of their binocular system. Examples of these issues include difficulty with tracking a moving object, coordinating the two eyes together causing words to move around on the page, focusing on a single object among other nearby objects, or switching focus from looking at the board to their paper. Any of these can contribute to visual learning disabilities, including those associated with dyslexia, attention deficit disorder, and Asperger’s.

Step 3: Prescribing specific visual exercises for your child to address the particular binocular vision and visual processing issues – Once identified, there is vision training that can often help build specific binocular vision deficits such as convergence insufficiency (difficulty bringing the eyes together when reading), ocular motility inaccuracies, and integration deficits. There are also training activities to help build visual processing skills, including visual memory, visual figure ground, visual discrimination, and visual motor skills. Often times both the binocular vision training and visual processing training will be combined together for certain exercises. Your optometrist may refer you to a developmental optometrist that has their practice specifically designed for these forms of training. These exercises are often fun for the kids, and many will enjoy practicing, particularly when they start noticing the positive results they are gaining.

Step 4: Writing an accommodation letter, so that your child has the best possible classroom environment he/she needs for optimal learning – With a brain that processes things a bit differently, the special needs child is at a big disadvantage in a class setting that does not consider these differences. One thing that can be very helpful is to have an accommodation letter written to the school or program that explains what adjustments to the child’s environment will improve that child’s learning outcomes. This sometimes requires some creative problem solving, but the right set of accommodations can make a big difference in a child’s learning. For example, I have made recommendations for a child to sit on the right side of the classroom to enable them to use their right field of gaze more due to issues with eye muscle issues that affect the left side of vision.

Step 5: Providing the appropriate referrals to other trained professionals to meet the child’s needs that are NOT vision related – While your optometrist will be able to address most of the visual needs for your child, there are many other areas of need that require a multidisciplinary approach to the overall care of the special needs child. This includes guiding and directing the parents to resources that are available within the community to help advocate for the child’s needs.

In summary, children with special needs face many challenges. But with the coordinated efforts of caring professionals, these children can be provided with the best possible environment for them to be able to thrive as themselves and pursue the things that make them feel happy and fulfilled. And ultimately, that is what we all want for our children!

Resource Links:
Decoding Dyslexia:
Autism Speaks:
Attention Deficit Center Association:


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