THE EYE AND LEARNING DISABILITY
2
ANNOTATIONS THE EYE AND LEARNING DISABlLlTY A recent number of the Journal of Learning Disabilities highlighted the dissension which exists about the two rales of vision and visual disorders in learning and of differently qualified practitioners in identifying and treating such disabilities as may be interrelated or co-exist. Leaving aside the somewhat passionate attitudes expressed by FLAX* in phrases such as ‘unscholarly and dishonest presentation’, we can consider how this very confused topic should be approached by the unbiased doctor, if such exists, who wishes to think and act constructively. There is really no need to go into the minutiae of the debate merely to score points, nor- except from a minor semantic aspect-do they merit consideration in defining an attitude to the problem of treatment of reading disabilities. Vision, visual acuity and visual skills have parts to play in learning. The visual apparatus exists to present information to be decoded and acted upon by the subject. This is the object of the whole complex. If there are defects in the transmission of the message to be decoded, then the interpretation is liable to be affected. If there are defects in those areas of the brain which perform the decoding then, however good the information, the message may be garbled. Lastly, the action which results depends upon the subject grasping the meaning, significance and implication of the information, and on his understanding that this implies a need for action. Looked at from this standpoint it becomes clear that no one speciality can shoulder the task of planning remedial processes without assistance and contribution from the others involved. The ophthalmologist can contribute information about the normality or otherwise of the visual apparatus, including important differential diagnoses of medical and neurological bearing, and he can compare the nature of, say, a squint in one child with no learning disability with the squint in another child with a learning disability, and so on with all varieties of peripheral eye disorders. What strikes an ophthalmologist is the frequency with which comparatively gross eye disorders appear to have no commensurate effect on a child’s general progress. It is not quite true to argue from this that, because many children learn well with imperfect eyes, a child with some peripheral or neurological defect of the eyes won’t be bmefited by ‘visual training’ in the broadest sense. Almost everyone’s experience and skill can be improved by visual training, such as the type of programme a hunter would have to go through to match the ‘innate’ skill of an Indian following a trail and obtaining visual clues which to the hunter were ‘invisible’; that is, unnoticed and unperceived. It would be useless to give the amateur ‘hunter glasses’. Their provision would be an un- warranted expense’ and cause delay in ‘proper instruction’. How much more serious this becomes in educating a child. When we specifically consider retardation in reading, the bulk of the evidence indicates that this has a very mixed aetiology, not the least of which is the genetic endowment and culture of the home. The reading difficulty may present as a delay by comparison with the standard of ‘normal reading age’, and may rectify itself with the passage of time. These children need to be sorted out from those with developmental delays of more complex origin, very often in association with other quirks and individual anomalies such as speech defects or minimal neurological deficits of any sort, right the way up to major organic lesions such as cerebral palsy. G 95
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Transcript of THE EYE AND LEARNING DISABILITY
ANNOTATIONS
THE EYE AND LEARNING DISABlLlTY A recent number of the Journal of Learning Disabilities highlighted the dissension which exists about the two rales of vision and visual disorders in learning and of differently qualified practitioners in identifying and treating such disabilities as may be interrelated or co-exist.
Leaving aside the somewhat passionate attitudes expressed by FLAX* in phrases such as ‘unscholarly and dishonest presentation’, we can consider how this very confused topic should be approached by the unbiased doctor, if such exists, who wishes to think and act constructively.
There is really no need to go into the minutiae of the debate merely to score points, nor- except from a minor semantic aspect-do they merit consideration in defining an attitude to the problem of treatment of reading disabilities.
Vision, visual acuity and visual skills have parts to play in learning. The visual apparatus exists to present information to be decoded and acted upon by the subject. This is the object of the whole complex. If there are defects in the transmission of the message to be decoded, then the interpretation is liable to be affected. If there are defects in those areas of the brain which perform the decoding then, however good the information, the message may be garbled. Lastly, the action which results depends upon the subject grasping the meaning, significance and implication of the information, and on his understanding that this implies a need for action.
Looked at from this standpoint it becomes clear that no one speciality can shoulder the task of planning remedial processes without assistance and contribution from the others involved.
The ophthalmologist can contribute information about the normality or otherwise of the visual apparatus, including important differential diagnoses of medical and neurological bearing, and he can compare the nature of, say, a squint in one child with no learning disability with the squint in another child with a learning disability, and so on with all varieties of peripheral eye disorders. What strikes an ophthalmologist is the frequency with which comparatively gross eye disorders appear to have no commensurate effect on a child’s general progress. It is not quite true to argue from this that, because many children learn well with imperfect eyes, a child with some peripheral or neurological defect of the eyes won’t be bmefited by ‘visual training’ in the broadest sense. Almost everyone’s experience and skill can be improved by visual training, such as the type of programme a hunter would have to go through to match the ‘innate’ skill of an Indian following a trail and obtaining visual clues which to the hunter were ‘invisible’; that is, unnoticed and unperceived. It would be useless to give the amateur ‘hunter glasses’. Their provision would be an un- warranted expense’ and cause delay in ‘proper instruction’. How much more serious this becomes in educating a child.
When we specifically consider retardation in reading, the bulk of the evidence indicates that this has a very mixed aetiology, not the least of which is the genetic endowment and culture of the home. The reading difficulty may present as a delay by comparison with the standard of ‘normal reading age’, and may rectify itself with the passage of time. These children need to be sorted out from those with developmental delays of more complex origin, very often in association with other quirks and individual anomalies such as speech defects or minimal neurological deficits of any sort, right the way up to major organic lesions such as cerebral palsy.
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DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1974, 16
A number of children appear in infancy to see little or nothing, but eventually see normally. Some may take as long as 10 years before reaching normal acuity. This delayed visual maturation appears to right itself spontaneously. There seems no a priori reason why the interpretation of symbols involved in learning to read should not be subject to similar delay or similar resolution. That an intensive programme of eye training may be running concurrently is no reason to attribute improvement to the training. I know of one case of a headmaster’s son who was thought to be dyslectic who only learnt to read fluently at about the age of 16 years. He claimed that the method of primary education confused him and that he ‘suddenly’ understood how to read in his early teens. This obviously suggests a spontane- ous process. This is supported by BETTMAN et af.2, who claim that 75 per cent of the children they treated improved whatever method was used. They also claim that any programme which includes individual attention, sympathetic understanding and parental involvement --in short, counselling-will help.
There is an accumulation of evidence that the education (in its widest sense) of all handi- capped children benefits from this sort of programme and that, given the interest of the staff (which it is hoped can be taken for granted) the best way of ensuring such a programme is a high teacher/pupil ratio in school. For instance, the achievements of partially-sighted children in special schools where the ratio is about 1 : 2 are thought by the teachers themselves to depend on exactly these factors, which would not be so easily obtained in larger schools without making special allowances.
I t is right to accept the statement that ‘eye care should never be instituted in isolation when a patient has a reading problem’’. It should equally be stated that a remedial education or psychological programme should never be constructed in isolation. My experience in- cludes knowledge of a psychologist endeavouring to educate a totally blind retarded child to make eye-to-eye contact with her.
For those who wish to get away from enthusiasm to understanding the many aspects of this problem in a balanced and thorough manner, GOLDMAN and SCHIFFMAN’S~ excellent contribution will supply their needs.
Research Felow in Ophthalmology, Guy’s Hospital, London SEI 9RT.
PETER GARDINER
REFERENCES 1. Plax, N. (1973) ‘The eye and learning disabilities.’ Journal ofLearrring Disabilities, 6, 328. 2. Bettman, J . W. Jr.. Stern. E. L.. Whitsell, L. J . , Gofman, H . F. (1967) ‘Cerebral dominance in develop-
3. Goldberg. H. K . , Schiffman, G. B. (1973) Dyslexia. Problems of Reading Disabilifies. New York: Crune mental dyslexia: role of ophthalmologist.’ Archives of Ophrhalmology, 78, 722.
and Stratton.
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