Introduction to Learning and Vision Therapy: Opinion Part V

A Look At Schools From An Unfamiliar Angle

The following is an excerpt from the upcoming book “Nearsighted White Kids: Why Some Children Will Never Succeed in School”, by Dr. Boulet

Introduction

From the vision science perspective, that is the perspective of physiology and visual function, there is little difference between classes or subjects, such as English, and any other, like History, Science, or Math (though there are differences in the brain areas involved between language-based and math-based activities). If you peer randomly into most neo-traditional classrooms, you will typically see children scanning over text, or copying text from a whiteboard or projection screen to a paper. Physiologically, these are all the same: Using vision to gather signals (that is, visual stimuli) from the environment, then to process them mentally somehow, and finally to reproduce them on the page before them.

Vision is the primary portal for gathering information in the classroom, and the main driver of visual-motor integration. Because of this, if vision is difficult, inaccurate, or overly strained, it will impact upon most of what a child is expected to accomplish in the classroom. Furthermore, difficult vision, in as much as hunger, can be a great distraction, even painful, and this can and will lead to inattention and other behavioural concerns that are easily interpreted as other developmental concerns.

Visual skills and performance are as variable between children as is height and athletic ability: Some children are simply better suited to different tasks than are others. This mismatch of abilities versus demands causes or contributes to some of the academic and behavioural challenges we see appear in children with reading and learning challenges. The focus of this chapter is to explain why visual demands in the classroom have changed over time, and how these increased demands place additional burdens on those children who are not well suited to the task.

The First Classrooms

To be sure, the first classrooms were not ‘rooms’ at all, though the concept of a ‘class’ can be ascribed to any group of people gathered to learn from a more learned person. Perhaps this was around a fire to describe and demonstrate the fabrication of hunting implements and how to capture certain animals, or on a hillside to hear a sermon, or on sandy ground learning about and engaging in discussions of philosophy and logic. Through our evolution, we have tended to be a creature of the outdoors, and much of our learning took place with the great outdoors as our ‘classroom’.

When you compare the human animal to other animals, there are certain distinctions that are clearly observed. We are, for example, made to be erect, to stand, walk, and look forward into the distance. What is not as easy to see, is what is happening inside the body in terms of the anatomy (our ‘parts’ and how they interact) and physiology (internal functioning of different sensory and organ systems). Our brains, specifically our ‘new brains’ or cortex, relative to our body size is at the top of the evolutionary chain, a position shared by only a few other creatures such as dolphins. Behaviourally, this means that as important, perhaps more important, than the ability to jump far, run fast, climb trees, or crush with our fists, is our ability to think, reflect, and plan.  That is, we have the ability to play with representations of reality, to recreate physical reality in our minds and then manipulate that ‘copy’ of reality without ever touching anything concrete. Evolutionarily, this is a critically important and advantageous thing. We can, for example, ask ourselves what will happen if we follow a herd over a cliff and get a good reliable answer, without having to actually ‘do the experiment’.

Even our sensory systems are specifically designed to support making abstract representations of reality, and they do this in three important ways. To begin with, we have highly acute senses, that is, they are very sensitive. Some might say that perhaps dogs or bats have better hearing, or that hawks have better sight, but there are very few exceptions and the fact remains that we have an extraordinary capacity to distinguish fine detail in virtually all of our senses. Olfaction might be an exception, but it is debatable as to whether we have lost olfactory acuity or have simply forgotten how to pay attention to it. Our sight, hearing, touch, and balance are all capable of extreme performance and we can see this daily through the arts and through sport.

The second way our senses are designed to promote thinking is that they are all interconnected. That is, all of our senses can refer to the others for additional information in order to ‘fill in the gaps’. So, for example, you can observe someone mouthing words to you and, without hearing a sound, ‘hear’ the words in your mind. Our human vision, hearing, and balance are the most complicated and tightly integrated sensory systems in nature. You will learn later on how this simple fact is at the root of many reading and learning problems.

Our senses contribute to thinking by being highly acute on the one hand, and highly integrated on the other. The third way our sensory systems contribute to thinking is in their great individual complexity. So, while we have the capacity for very high visual acuity (the ability to discern fine detail), vision goes far beyond simply what the eyes do, including the power to guide our movement, manipulate things in three-dimensions, plan actions, and recognize and anticipate patterns.

In most respects, we were designed from the ground up for learning in an outdoor classroom. In the outdoors, children feel free to play and manipulate their environment. There are few rules, and the child is free to explore with not fear of making a mess or breaking something. There is always a multisensory element to what is learned, and this mixing of stimuli reinforces what is learned – like hearing a song helps to learn the notes on a page, or watching a dish be prepared is better than reading it from a book. There are a few ways of describing this strengthening of one sense when another sense is added. In behavioural neurophysiology, we might say of neurons – the cells that act as conduits and information processors in our bodies and brains – that ‘nerves that fire together, wire together’. This means that when a new connection is made (call it ‘knowledge’ or ‘skill’), it is stronger when the experience that caused it involved multiple inputs from different senses. You can more easily recall some spectacular event involving sights, sounds, smells, perhaps tastes, and heightened emotions, as compared to what you learned about the Battle of the Plains of Abraham in Grade 8 Social Studies class. This is common knowledge in neural science, that behaviour ‘patterns’ – from how we see to how we move and talk and think and feel – all result from associations that are built between senses as things happen to us while we interact with the environment. So, if I write the words

Flintstones. Meet the Flintstones.
They’re the modern Stone Age family.
From the town of Bedrock,
They’re a page right out of history.

I have very little doubt that by far, most readers will also be humming along to the very familiar tune that is ‘paired’ with them. The pairing of sound with image is critically important in learning, perhaps obviously so with respect to language learning. In the case of the Flintstones’ theme song, there is another element present, that is the association of sight, sound, and emotion – perhaps even motor activity as we sign out loud. Not so obvious, however, are the intricate sensory parings between Vision and other senses and how these are just as important in the classroom. Critically important, these associations and visual function in general are only infrequently studied in the research. (Yes, that is capital ‘v’ Vision, as opposed to ‘sight’.)

These ideas will be explored more in the next chapter, but it is important to also note that vision in particular is, for the most part, not naturally ‘tuned’ for near work and fine detail, though we can see fine detail if our eyesight is good. Most people in just about every ethnicity are naturally better suited to distance vision, as opposed to looking at things up close for extended periods. Again, we were really designed for an outdoors existence, perhaps because of our need to see distant threats, and opportunities for shelter and food. It is also because of our ethnic and genetic root in this sort of an existence that nearsightedness, the inability to see clearly in the distance, has been the focus of most research regarding vision in terms of medicine and pediatric ophthalmology. It seems obvious that if a child squints while looking off to the whiteboard (blackboard, digital ‘smart’ board, projection screen), there is a problem standing in the way of learning and so these children, standing out like nails, get the attention they deserve. However, as will be explained later, these standouts are most often the ones in least need of attention.

The Traditional Classroom

What we now call the ‘traditional’ classroom is anathema to the environment we were arguably designed to thrive in – the very same one we have spent more than 99% of our existence as a species living in: The great outdoors. In the outdoors, the air is fresh, the sun shines down, and all the tools for instruction are readily at hand. The open spaces lend themselves to creativity of thought and expression, and thus allow for greater expression of individuality, which lends to greater self-confidence. An outdoor classroom provides many opportunities for natural, one might say ‘organic’, interaction with objects in the environment.

The outdoor classroom has other advantages as well. In the outdoors, there is no need to worry about dropping things, breaking things, spilling and messing things, and so there are naturally fewer rules. Children can thus engage in many forms of experimentation using a wide variety of living and inanimate things. The outdoors is a natural physics, chemistry, and biology laboratory, with built in ‘equipment’ for play and sport. Simply playing outside – running here, climbing there, and building things – is a natural means of conquering many problems of deficient attention and mental focus. Again, as stated earlier, regardless of ethnicity, most children in any population are more likely ‘visually tuned’ to look at distant objects, say, beyond 20 feet or so. Finally, and of no small importance, the cost of operating this outdoor classroom is a small fraction of the cost of an air-conditioned power hungry villages of classrooms that are today’s modern schools.

Now, take this ideal classroom and add in to the mixture extremes of weather, the need for accessibility, the need for reading and writing supports (work tables), and the additional need to show accountability for taxpayer’s dollars spent year in and year out. These requirements for controlled environments for the instruction of modern curriculum to large groups means we have little choice but to operate schools that are enclosed and protected from the outside. The fact that virtually all subjects are taught 100% in the same environment is, perhaps, unnecessary and misguided.

Our modern traditional classrooms, with rows of desks looking towards a board (whiteboard, digital display, or blackboard) and the intense reliance upon text has its advantages, mostly in that they answer the needs of modern instruction by accommodating large groups and can operate year-round. This does, however, come at a cost. With the move to indoor instruction, there are great gains, but at the same time many important elements are lost, not the least of which are listed in the preceding paragraphs. What was once at hand in the outdoors, must now be manufactured and brought indoors at great cost. There is a need for lighting, heating, ventilation and air conditioning systems, plumbing, increasing demands on electrical service, fire suppression and detection systems, security systems, and forests of trees in annual paper needs.

More importantly with respect to instruction and learning, in the last 40 years especially, there has been an aggressive move to limit time outdoors in exchange for more time spent in artificial environments due to the perceived need to provide countless hours of exposure to computers. In exchange for explanation, demonstration, discussion, and exploration, there is an increasing reliance upon reading, memorization, and regurgitation of what was memorized. This is especially so in the United States, as compared to Canada, where there is an increased focus on knowledge as understanding, and memory as intelligence. While this lends itself to economizing on the preparation and implementation of standardized tests, it reduces the current and potential value of a teacher in the classroom and dilutes learning overall. Text-based learning, or the increasing reliance on it, is a frank mistake in education and has long since hit its maximum return on investment, pedagogically speaking.  Still, we spend more each year to teach using computers, which requires textual representations of things, which in turn require computers for processing. In the end, our systems of instruction seem to be more driven by technology than they are driving it, but either way, there is clearly an increased and increasing reliance on text-based instruction, be it on paper, projected on a screen, or on a computer or handheld display.

This transition from discussion and manipulation in the open air to an enclosed space where instruction is primarily text-based represents an important shift for humans, physiologically speaking.  For example, in stark contrast to a world where, for the most part, our eyes are cast to distances beyond arm’s reach, the modern classroom, even more than early ‘traditional’ classrooms, require an ever more intensifying need to be able to scrutinize sights and sound, in increasing detail, at near distances, and for longer periods of time. This does come at a price for many children. The critical impact of this, and the fact that it is largely ignored, will be described more later. It remains clear that this is one big change in our environment and mode of instruction that is in desperate need of further attention in colleges of education, psychology, and in research. Research and clinical experience show that many behavioural problems in the classroom stem simply from this shift in visual demands we put on children and their relative ability to deal with them. These ideas are simply not taught in colleges of education, medicine, and psychology and so it is simply not even ‘on the radar’ for most of these professionals. While the role of vision is well-documented in the annals of physiological optics, vision science, and developmental/behavioural optometry, there is very little cross pollination between these domains and other therapeutic professions – in my experience, however, I have found that Occupational Therapists in particular have an affinity and innate understanding of many of the core concepts involved. Nowadays, as a doctor, teacher, and student of vision science, I know that damage to children and families simply from unattended visual needs represents a crisis in education and healthcare.

The ‘Traditional’ Approach to Instruction

Beyond the change in environment, the way we teach children is also a great determining factor in their behaviour and how they succeed. Studies will show that more time spent outside, and manipulating (playing with) real objects, has great positive effects on health, but also on a child’s ability to grasp concepts, especially at an early age. Moving to a cloistered and artificial environment takes away from this and adds a new level of stress as children try to manage the changes in demands physiologically. That is, we have changed the ‘game’ in terms of how children’s minds and bodies must respond to instruction, but give little consideration to how this might impact them. We cannot, and should not, expect however that all children will respond equally well to these environmental demands, nor should we expect that these changes would simply be accommodated by all children with no consequences.

As mentioned earlier, there is an ever-increasing reliance on text for instruction, in many forms, and arguably for too many subjects. My sense is that we, educators and the schools we work in, tend towards teaching ‘by the book’, meaning using printed text as the de facto standard for instruction, and this for a few key reasons. Firstly, text-based instruction lends itself to cost-effective delivery of content, especially nowadays in electronic and digital form. Second, teaching by text is relatively simple in that we can direct children to simply read and ‘understand’. Indeed, it is often erroneously assumed that if the text is presented, instruction has occurred. Next, text-based instruction is much better suited to standardized testing in that it is much easier to match the questions on the test to the text all students should have, in theory, received through class. (Not that it is impossible to create standardized examinations for assessment of instruction using other, more discussion- and manipulative-based methods, but it is somewhat more difficult to score and to ensure all children are given an equal shot at understanding to begin with. Text, at the very least, provides some degree of assurance that all children have access to the same material, and it is assumed that text-based assessments keep costs down for Province/State-wide achievement testing.) Finally, text works well with computers, and computers, for the last 20 years anyway, have been strongly emphasized in classroom instruction. These days, computers can bring a world of imagery and sound to the student along with the text they need to study, but when first implemented in classrooms, they amounted to an expensive and time-consuming burden to teachers and schools that provided not much more than the ability to do word processing. Even now, with such great advances in the intervening time such as with high-bandwidth data connections, instant audio, video, countless libraries of data online, and massive search capabilities, computers still have a fairly limited effect on overall quality of instruction. That is, just because a student’s essay is printed by laser and has a nice picture to go along with it, does not mean the student is a better writer.

One surprising impact of computer on language learning, in particular in the early years, is that a child who learns to type does not have the same chance to learn about the sounds of language and the symbols associated with them. As a child’s hands and eyes work together to learn letter shapes and words, there is a cross-sensory integration that occurs – recall that neurons that fire together, ‘wire’ together – so that the hand learns the ‘feel’ of the letter (the ‘somatosensory’ experience), while the eye learns the shape, and the ear hears the sound. Computers eliminate virtually the entire somatosensory element – writing a ‘k’ feels very different from writing a ‘t’, and the hand’s movement to create these letters tells the brain that they are distinct. To the hand, hitting the space bar feels different from hitting a letter key, but the letters and numbers themselves all feel virtually the same.

And so, the bias in methodology of instruction has also changed. Children now, compared to even 30 years ago, spend much more time pouring over material on their own, and the material is largely contained in the printed word. There is little interaction with real world phenomena, and this is still in continuing decline as we favour new technology for its novelty more than it’s proven capacity to reinforce understanding (3D and ‘digital smart’ projection systems come to mind). Printed word, be it on the page or on a screen, has become the primary tool of instruction. When children are taught to read early on, this is not so much to learn to read and to enjoy reading, but is rather done as a means to an end, that end being that the child should be able to be given something to read for the purposes of instruction. In other words, we teach children to read so they can teach themselves. Because this is a primary reason for teaching reading, we are also compelled to teach reading at an earlier age, with formal reading instruction beginning when many students are simply unprepared for it physically and mentally. This is similar to asking a child to perform some feat of athleticism without providing training, except that if the child struggles with the task, we call it a reading and learning disability.

Specific Demands of the Neo-Traditional Classroom

It is not clearly obvious that there is any stress or strain associated with extended chair time studying text, or working with computers. Research does, however, support that such activities are extraordinarily taxing, but especially so for children who struggle against their own difficult vision to accomplish even the most basic tasks.

Some skills and abilities required for managing the classroom environment from a learner’s perspective include:

  1. Sit still and focus attention.
  2. Move sensory and cognitive attention between general awareness to specific focus of attention.
  3. Reading is the primary means of learning. This virtually eliminates the powerful reinforcing effects of multi-sensory learning and restricts learning to primarily visual stimuli.
  4. Effortless eyesight, especially for near targets. This means that it is not sufficient for a child to simply ‘see’ something, vision must also be free of excess strain and effort.
  5. Precise, automatic, rapid targeting at near and far distances, but also while moving between distant and near targets, such as while copying.
  6. Precise and reliable tracking to allow for scanning along lines of text without skipping or re-reading lines.
  7. Easy convergence, for looking at near objects, and divergence, for looking at distant objects.
  8. Easy shifting of focus from near to far objects.
  9. Ability to maintain focus at a given distance, especially at near for working at a desk or computer.

10. Effortless visual motor integration for fine motor movements, such as for printing.

11. Excellent visual perceptual abilities, such as visual memory, figure-ground discrimination, form constancy, and visual closure

These are not always present or well-developed. In fact, some studies show that anywhere from 15-35% of children will struggle with these, depending on ethnicity, access to care, and relative impoverishment. It is a mistake to assume all children are equally prepared for class work. It is a worse error to assume that any significant differences in performance are due to neurological conditions that require invasive interventions. The traditional model is in need of reinvention to accommodate for the protracted physiologic strain it imposes upon learners. Furthermore, the ‘new’ approach to learning has minimized the role of the teacher to the point that a computer could provide a similar level of instruction. Teachers have an important role to play in varying the instruction to allow for broader participation by more children, and not simply those who are physiologically suited to endless hours of near work based on reading alone.

Computers and Other Digital Tools of Instruction

Modern classrooms are becoming increasingly dependent upon electronic media, computers in particular, including desktops, handheld devices, and interactive projection systems. These devices have been shown to pose greater demands on the visual system, and this has been well documented in studies of visual strain since the early 1970s. At that time, it became clear that extended exposure to video display terminals caused excessive strain, even with people who are neutrally sighted and are otherwise healthy.

Farsighted and astigmatic children especially find the fine resolution of computer-based visual stimuli challenging and fatigue quickly. Those suffering with Computer Vision Syndrome (CVS) find that chronic exposure to high-resolution screens (Video Display Terminals, or VDTs), in time, leads to decreased tolerance for reading, in addition to concerns of headache, blurred vision, and fatigue. The need to constantly manage such strong visual demands at near distances can also lead to inappropriate postural adaptations that themselves can cause other musculoskeletal pain and discomfort. Frequently this can lead to medical intervention through medications, but the problems will persist so long as the exposure to VDTs continues with no meaningful remediation or management. A search online for ‘computer vision syndrome’ will lead to more detailed information on the signs and management plans for this condition. In particular, the American Optometric Association’s website at www.aoa.org offers some sound advice.

Use of projection systems can also be problematic in that they typically produce less than optimal clarity and contrast. In most classrooms, ambient light is kept fairly bright to allow children to copy from the screen to their papers, and this further degrades the quality of the image. Those children who are already disadvantaged by difficult vision will find that the degraded visual signals are even more challenging. Like other forms of visual stress, the greater effort required to simply acquire visual signals leads to reduced performance during reading and copying exercises. Children, like adults, have limited cognitive capacity, and when energy is expended to simply see what is presented, less mental energy is available for other tasks, such as interpreting what the visual signals are meant to convey.

Conclusion

Reading and writing in more ancient and traditional classrooms, while important, were not the primary thrust of instruction. Much more emphasis was placed on interaction with instructors and with the physical environment. The neo-traditional classroom, in contrast, relies much more heavily on extensive computer time, near work, and a heavy reliance on text. This shift in instructional emphasis has had an measurable impact on children’s behaviour in some important ways.

Firstly, the elimination of free interaction (constructive play) with the physical world means children no longer have the same opportunity to learn about the physical world and the natural order of things. When considering the foundational role our physical development plays in our higher order physical and mental functions, children lacking in physical experimentation and play will find later more evolved functions more difficult to master. Physical play that engages bilateral movement and integration, and balance, go a long way to averting concerns regarding orientation of letter symbols, for example. Children with good experience with physical interactions and who have more time in physically challenging exploits also tend to have better mental focus and can handle more advanced cognitive tasks.

Importantly, the switch to the neo-traditional reliance upon text and computers also brings with it a great increase in visual strain on children. For those children who are lightly or moderately nearsighted, extended near work in the classroom and at home is physiologically much more approachable than for their farsighted or astigmatic peers. This important distinction is largely ignored in schools, even though we mandate 12 years of public education for most children. Because near-point stress is greater with computers, farsighted and astigmatic children will struggle more than their nearsighted peers, and are, as a consequence, at a measurable disadvantage. In order to ensure equal access to education opportunities, we must first ensure children’s vision is adequately managed.

Differences in ethnicity, culture, and wealth also have a significant impact on relative equality of access to public education. Aboriginal children, for example, are much more likely to show significant farsighted astigmatism than other ethnicities. The consequence, supported in literature and in practice, is that fewer aboriginal children will succeed in academics, and more of them will show medical concerns. It is perhaps not surprising that people with similar visual functional profiles are also much more likely to end up in prison, regardless of ethnicity. Cultural differences and impoverishment can also disadvantage a child when a teacher’s expectation does not take into account limitations of prior knowledge and experience.

Learning and reading disabilities labels are often applied to simplify and expedite the process of management of difficult cases. Labels, however, do not describe the context and do not illustrate other conditions or co-morbidities that are contributing to the problem. Experience shows that children who are physiologically disadvantaged due to vision, or who lack cultural familiarity, or economic resources, will not succeed as well as others who do not have the same disadvantages. These factors must be managed where possible, and taken into account when assessing the need for extraordinary educational, psychological, or medical intervention. To leave obvious and manageable conditions uncorrected, or ignored, such as visual function, not only adds to costs of diagnosis and intervention, but it might well be a violation of the child’s basic rights.

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