When I met Daniel, he had an obvious dislike for doctors and testing of any kind. He is in Grade 2, and falling behind rather quickly. This has been going on since he began learning to read last year. Daniel’s teachers noticed that he had trouble sitting still and paying attention in class, so predictably, following an assessment by a pediatrician, he was started on Concerta (ADD/ADHD medication). That’s what it is these days: We discourage ‘drug’ use, but push ‘medications’. It’s a very troubling mixed message to be sure.
Even though Daniel had been assessed by an optometrist and different medical doctors, no one had noticed a very serious problem with his visual function. Daniel can read very small letters on a chart, and, like in so many other cases, this is often taken as sufficient evidence that the eyes are not a problem. Indeed, Daniel’s eye health is excellent, and, with glasses, he can see very well. He is very highly farsighted, which is frequently an undiagnosed problem, but this had been well-managed since he was very young and so he has avoided many additional problems as a consequence.
Daniel’s reading problem, then, is not an ‘eyesight’ or eye health issue. It is, rather, an ‘eye teaming’ issue – this is to say Daniel’s eyes cannot work well together. Specifically, Daniel suffers with rather severe ‘convergence insufficiency’ – he cannot draw his eyes together to look at a near target. This is a simple thing to demonstrate: Get a partner, stand up in front of him and hold a pencil 40 cm in front of his nose. Tell him to look off into the distance – the eyes will spread apart and look as though they are parallel to one another). Then, have him look at the pencil – the eyes will draw together to see the pencil; if this doesn’t happen, send your partner to see me. This is the normal behavior, but Daniel simply cannot do this. Of course, reading requires not only that we bring our eyes inwards (cross them), but this action should also be effortless. Even if a child can ‘cross’ his eyes, if this is with too much effort, it can cause disturbances to reading fluency.
When Daniel’s eyes try to come together, it is so hard to do that one eye simply ‘gives up’ and wanders outwards. In the end, while trying to read, Daniel will alternate between his left and right eyes – going to school and learning to read is somewhat akin to climbing 100 flights of stairs, not by walking, but by hopping using one foot at times, and the other at other times. This becomes excessively tiresome and downright frustrating, especially given his classmates seem to have no trouble at all. As a consequence, Daniel finds reading tasks onerous, and he is smart enough to realize there are differences between him and his classmates. Given that our modern way of teaching relies almost exclusively on reading, Daniel is falling behind. Because reading is a chore, he finds paying attention quite difficult and this translates to distractibility and disruptions in class. When asked to sit and pay attention, Daniel most often obliges at first, but then falls back into the cycle of frustrated reading and distraction.
All of Daniel’s symptoms can be easily explained by assessment of his visual function. In fact, with very little coaxing, Daniel can easily sit still and pay attention to a given task – so long as it’s not reading-based. There are many problems with prescribing medications for what is a behavioral problem, and these relate to health and the fact that they don’t necessarily ‘fix’ the problem. Research and experience shows that Daniel’s visual condition can be treated very effectively and that doing so smooths the road the reading. Not only that, it’s easy to pick up on his condition early, even before a child starts formal reading.
Within 5 months, or so, of the start of Daniel’s visual rehabilitation therapy, which his parents will learn to do at home, he will be well on his way to catching up from what he’s missed. With any luck, he will also be reassessed for ADD/ADHD and his physician will find that in fact the diagnosis is no longer valid, and Daniel no longer needs drugs, that is, medication, to survive in school.