Introduction to Learning and Vision Therapy: Opinion Part III

Elephants in a Small Room


There are two parts to this opinion piece. The first considers the very important role of exposure to nature in a child’s development. The second describes the need for effective standards in vision screening.

A – By Any Other Name: Nature Deficiency

B – The Need for a Common Standard

A – By Any Other Name: Nature Deficiency

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Nature deficiency is not a disease, but it’s a real problem. Regardless of the professional paradigm you adhere to for a living, the consequences of inactivity and a detachment from the many lessons nature teaches us has a profound impact upon how children develop and what they can achieve as a consequence.

From (July 30, 2012) describes Nature Deficit Disorder thus

“A lack of routine contact with nature may result in stunted academic and developmental growth. This unwanted side-effect of the electronic age is called Nature Deficit Disorder (NDD). The term was coined by author Richard Louv in his book Last Child in the Woods in order to explain how our societal disconnect with nature is affecting today’s children. Louv says we have entered a new era of suburban sprawl that restricts outdoor play, in conjunction with a plugged-in culture that draws kids indoors. But, as Louv presents in his book, the agrarian, nature-oriented existence hard-wired into human brains isn’t quite ready for the overstimulating environment we’ve carved out for ourselves. Some children adapt. Those who don’t develop the symptoms of NDD, which include attention problems, obesity, anxiety, and depression.”

“Nature-deficit disorder is not a medical condition; it is a description of the human costs of alienation from nature. This alienation damages children and shapes adults, families, and communities. There are solutions, though, and they’re right in our own backyards.”

From Wikipedia (July 30, 2012):

“Nature Deficit Disorder, a term coined by Richard Louv in his 2005 book Last Child in the Woods, refers to the alleged trend that children are spending less time outdoors, resulting in a wide range of behavioral problems. This disorder is not recognized in any of the medical manuals for mental disorders, such as the ICD-10 or the DSM-IV, neither is it part of the proposed revision of this manual, the DSM-V. Evidence was compiled and reviewed in 2009.”

“Louv claims that causes for the phenomenon include parental fears, restricted access to natural areas, and the lure of the screen. Recent research has drawn a further contrast between the declining number of National Park visits in the United States and increasing consumption of electronic media by children.”

It seems intuitive that the more children are exposed to electronic media, the less they are inclined to spend time interacting with the physical world or seek the outdoors. We can all attest to this through our own experiences and knowledge of the children and clients we deal with. Between automation, centralized food processing, digital media, and limited availability of outdoor education and experience, we are raising a generation of sedentary children who are virtually disconnected from and unaware of the natural world.

This last statement is significant for three important reasons, all of which are relevant to the discussion of childhood academic and behavioural concerns. The lack of DSM classification notwithstanding, practitioners must recognize that full and complete child development requires nourishment through an environment and experiences that produced this current model of human. This includes the full gamut from healthy food from natural sources, to open spaces for running and obstacles for climbing, and a vast laboratory for making messes, dropping things, and most certainly breaking things. The nervous system learns to integrate sensory, motor, and cognitive functions only by experiencing physical experiences that provide multimodal interactions with the physical world – there is no virtual reality alternative.

Firstly, a sedentary lifestyle is clearly not a good health indicator, and a poorly maintained engine will simply not perform as well in the classroom. Poor diets and sleep habits contribute to irritability, poor tolerance of sustained tasks. Growing vegetables and turning them into culinary delights not only teaches children respect for the land and how to eat well, they learn important visuomotor skills that prepare little hands for the finer motor control required for writing.

What is most important with respect to reading, learning, and vision, is that children have a diminishing/diminished exposure to the physical world, and this prevents full development of spatial awareness, locomotor control and integration, and balance. These elements are critical for development of fine motor control and visual targeting. We are, in effect, over-loading our children visually on the one hand, then removing their chance of developing strong vision on the other. This is why locomotor, spatial awareness, and balance training are critical to learning therapies – and why most text-based learning therapies are of limited value.

In the Children and Nature Network report “Children’s Nature Deficit: What We Know – and Don’t Know”, the authors report a number of observations regarding children’s health, knowledge of nature, and relative exposure to the outdoors. The main findings and the full report can be found HERE.

See Also:

For more information, read the pdf or go to

B – The Need for a Common Standard

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Research in optometry and medicine has shown that the only way to determine whether a child has a sufficiently robust visual foundation is to assess very specific elements of visual health and function that represent potential obstacles to reading, and by extension, learning. The Orinda study of 1959 (Blum, 1959) was the progenitor of the ‘Modified Clinical Technique’ (MCT) which provides an economical means of determining gross risk by including assessment of refractive error and detection of strabismus. The MCT does not, however, require assessment of rapid motor skills, phoric posture, or other essential elements of muscular control such as vergence that can have a great negative impact on reading performance. (Basics elements of visual behaviour are covered later.)

While not all elements of the comprehensive examination are practical for on-site assessments of large groups, detailed assessment of refractive error, nervous function, and ocular motilities can be obtained in a relatively brief time and should be considered compulsory. When problems arise, gathering of more detailed information is warranted on an individual basis.  Refraction with cycloplegia (‘dilated’ or ‘drop’ examination) for borderline cases is an effective means of increasing reliability of referrals and reducing costs overall. Use of more recent autorefractor technology combined with cycloplegia in school screening is a powerful tool in accomplishing this.

In order to ensure all children are properly assessed for potential significant VIL, all should be assessed periodically following the guidelines in the table below, beginning shortly before Grade 1. In Alberta, these services are available to all parents, but accessibility is a problem so that a mere 15-20% of children are ever checked.

Table 2: Recommended Elements in Assessing Visual Readiness for Early Elementary.
  • Visual Health: Eyes, visual nervous system.
  • Refraction: Retinoscopy or Autorefraction, cycloplegia recommended for borderline or clinically significant cases.
  • Ocular Range of Motion and Alignment,
  • Visual Acuity: At near distance, observing strain.
  • Pursuit movements and fixation as indicators of visual developmental status.
  • Saccadic behaviour for potential impediments to rapid automated sequential targeted movements required for reading.
  • Colour
  • Stereopsis

Comprehensive assessment programs, as compared to current screening methods, are prudent fiscally and with respect to health and education outcomes. Still, tightening school and health budgets encroach upon school nursing and monitoring programs, and more effort is now spent on making vision screening faster and more efficient. But this comes at the price of increased numbers of false negatives and higher costs for intervention for academic, behavioural, and health concerns resulting from unchecked VIL over the child’s lifetime. Abbreviated screening protocols then, such as simple sight tests administered by untrained personnel, may well represent false economy while providing little to no benefit to those who need the help most.

Learn more through this draft paper: VIL Draft Aug 2012


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