Behavior Problems and Poor School Performance Linked to Vision

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By Dr. William Moskowitz

OK, you say. I get the connection between doing poorly in school and being able to see the work. If you can't see, you can't work. That's obvious! But, behavior problems - that's something else. That's just a matter of consistent discipline and parenting. Right?

Well, you might be surprised at these statistics. According to the National PTA, "About ten million children in this country suffer from undetected vision problems that may cause them to fail in school." Over eighty percent of the children with diagnosed learning problems have undiagnosed vision-based learning problems. And, sadly, up to fifty percent of youngsters who find themselves entangled with the criminal justice system have vision problems that were undiagnosed prior to their run-in with the law.

Right about now you're going through your mental Rolodex, thinking about all those "bad boys" - and girls -you remember from your own classroom days, or those who are currently destroying the learning environment for your own kids. And what about those truly hard-working kids who always struggled for their grades? Did anyone ever say , "All that kid needs to straighten/help him out is a good eye exam" Probably not. Then, why not?

First, it must be understood that vision is more than 20/20. What does that mean? 20/20 is simply the ability to see at 20 feet what a person should be able to see on an eye chart at 20 feet. This is what most people think of as "perfect vision". And, this is what the typical school vision screening program tests for. However, it is just one of the many visual skills required for optimum learning.

Think about the classroom environment. A child sits at a desk, writes, alternately reads from a textbook and from the chalkboard, and visually follows the teacher's movements around the room while listening to the lesson. Visual skills required?: being able to see the board (distance vision) and the book (near vision); being able to maintain clear vision while shifting focus from a distant object to a near one (accommodation); being able to aim both eyes accurately and move smoothly across a line of print or from object to object with ease (eye movement skills); being able to use the eyes to guide the hands (eye-hand coordination); being able to coordinate the two eyes together so that they are precisely directed at the same object at the same time (eye teaming); maintaining, for long periods of time, completely clear vision while looking at near or distant objects (focusing).

If any of these skills is inadequate or lacking, imagine how much harder it is for a child to be an efficient learner. Imagine, too, the frustration; and, if the child has poor coping skills, behavior problems may emerge, at home and/or in the classroom. Why, then, don't all these children scream for help - "I can't see!"?

The answer may be as simple as the fact that they don't know they aren't viewing the world the way everyone else does. They (or their parents, or teachers) may think they are lazy, stupid, clumsy, slow - you name it. They see; they just don't see correctly; their vision is compromised; the information they take in through their eyes is not processed normally. Squiggly lines, print that splits into double images, or words that don't stay in one place, for example, are just some of the roadblocks to learning that these children might face - and no one knows about it.

So, if you have a child who is struggling, you might just ask for a description as to how he/she sees.

Some of the most obvious symptoms of which to be watchful, and which might indicate that a child (or even an adult!) has a visual problem include:

  • Poor concentration, comprehension and attention span
  • Fatigue
  • Squinting
  • Complaints of double vision or blurring
  • Loses place while reading
  • Points to words while reading
  • Avoids close work
  • Rubs eyes or blinks a great deal while reading
  • Nausea, dizziness, and/or headaches after close work
  • Reverses letters or words in reading and writing
  • Omits small words or makes substitutions while reading
  • Clumsiness on the playing field, when ordinarily well-coordinated
  • Homework takes FOREVER when its shouldn't

Do you know a child who is bright and has no physical problems, but dislikes reading, struggles with math, or spelling, or writing? Or, perhaps, that child is restless, can't focus on tasks for any length of time, or seems frustrated with fine motor tasks. He/she may have an undiagnosed learning related vision problem.

A developmental optometrist can help make things better for those children when it seems that everything - counseling, tutoring, medication -has already been tried? In addition to testing acuity (clarity of sight), he/she will assess all the visual skills required for learning: eye movement control, eye focusing at distance and near, depth perception, visual motor integration, visual memory, form perception, and eye teaming ability. When insufficiencies are uncovered, therapeutic lenses and/or vision therapy are prescribed which are designed to remediate the problems and enhance the child's ability to understand and apply the information which comes through his/her eyes.

Let's return, for a moment, to those children who find themselves before a judge in juvenile court. According to a national organization called P.A.V.E., Parents Active for Vision Education, several studies over the years have found a high correlation between juvenile delinquency and vision problems. They cite San Diego Judge Lawrence Kapiloff, who noted that many children who get into trouble with the law have problems in school; they have school problems because they can't do the work - an inability to read is often the major offender; they can't read because they have vision problems. In fact, there are judges, such as Judge Kapiloff, who order these children to be evaluated by behavioral optometrists. If vision problems are found, they must then receive vision therapy (individually prescribed eye exercises designed to develop and enhance a person's visual performance). In many of these situations, once the therapy takes place, these teens find that their grades improve, their self-esteem and self-confidence rises, and their run-ins with the law decline significantly. Sounds like an idea whose time has come!


Dr. William Moskowitz is a board certified developmental/behavioral optometrist who has been in practice for over forty years, providing specialized services for children with vision-based learning problems, as well as adults. He trained at the Gesell Institute at Yale University and is an expert in pediatric developmental optometry. He has lectured internationally and was a contributor to a textbook on pre-school vision. Dr. Moskowitz, whose practice specializes in the diagnosis and treatment of vision-based learning problems, is a popular speaker with parent and professional groups. Individuals and groups can contact his office, the Park Vision Therapy Center, at (908) 725-1772, or his Vision Education Coordinator, Nan Miller, at (609) 882-6987.