(Note to parents: Is your child struggling in school or showing signs of other behavior problems? Check vision first before any other testing or interventions. It is the most logical, kindest, and cost-effective place to start. The following story is true, one of many similar stories. Schools and family doctors do not address vision concerns and families pay the highest price. Call us to learn more about your child’s vision. If you’re not in the Calgary/Foothills region, you can try our recommended Providers.)
What would you think if you heard those words from your doctor or psychologist?
Parents are at the mercy of the health and psychology industries when they fear something is wrong with their child. When a diagnosis of ‘mental retardation’ is presented, it can feel at first more like a verdict than a diagnosis, with a lifelong penalty attached. There are many reasons why a child will appear to be abnormal, meaning to say ‘unlike other children’, and unless the correct assessments are done, the true causes will can be missed. Without the true cause, treatment becomes ineffective, if not completely useless and sometimes cruel.
It would be easy to assume that if the diagnosis follows a pediatric medical and psychological assessment, it would be rock solid and incontrovertible. …
The question needs to be asked: What is the basis for the diagnosis? It would be easy to assume that if the diagnosis follows a pediatric medical and psychological assessment, it would be rock solid and incontrovertible. From the perspective of the now traditional approach to assessing child behavior, largely steeped in the religious convictions of western medicine and psychology, nothing else needs to be considered. This was not the case in this instance.
The energetic, smiley, and pretty 5 year-old came to my clinic for review of vision following a diagnosis of ‘mild mental retardation‘ by her pediatrician and psychologist. I’ll call this little cutie ‘Suzy’. The family of four consisted of two parents with more than 30 years of university training combined, the daughter of 5 years of age, and an 8 year-old son who is a stellar student, and in great health. It struck me as odd that this ‘apple’ fell so far from the tree, when she appeared to be in good health otherwise, and from a clearly intelligent pedigree.
Suzy certainly presented with some odd behaviors: Shrill voice, hyperactive, inattentive, with an almost infantile way of interacting socially for her age. Testing also showed significant deficits in language, visual perceptual processing, and intelligence overall. Vision science and clinical experience tells us that these issues, including odd emotional responses, can often result from vision concerns such as high farsightedness, astigmatism, and eye alignment concerns. (See me for the details or read other posts in Views On Vision to learn more.) As expected, the pediatric and psychological assessment made no mention of visual function beyond the observed ‘perceptual’ problems.
As a technically-oriented doctor with a background that includes certifications in IT, I tend to look for simple solutions when advanced diagnostics fail. It seemed there were different opinions as to why ‘the program’ wasn’t working in this case, but no one seemed to be asking the simplest question of all: Is it plugged in, and is the power on? In Suzy’s case, it didn’t take long to find she had a combination of very high farsightedness and what is called ‘convergence insufficiency’. This meant she could neither see clearly, nor align both eyes on any near target. My sense is that smart kids know they are missing something when they can’t see well, but they can’t explain what they’re missing. It’s a constant nagging feeling. They can’t describe it and assume that what others appear to be seeing is simply something they ‘don’t get’. This lack of ‘sensory bandwidth’ leads to odd reactions and compensations, to be discussed in other articles. Long story short: If vision contributes to poor performance and odd behaviors, correcting vision should eliminate these concerns. Such is the case with Suzy.
A few short months after beginning treatment, which includes glasses and visual neurorehabilitation, Suzy is a completely different kid, and most definitely not ‘retarded’.
A few short months after beginning treatment, which includes glasses and visual neurorehabilitation, Suzy is a completely different kid, and most definitely not ‘retarded’ (see below). All those who deal with her are astounded at her flowering personality and improved physical skills. These people include her teachers, nanny, parents, brother, occupational therapist, and relatives. Frankly, I’m a little embarrassed for those who made the initial diagnosis without first checking vision.
It never ceases to amaze me that while pediatricians and psychologists can talk about ‘visual perceptual deficits’, they can neither describe what they mean, what causes them, or what to do about them. In my very practical world, if a child cannot use the eyes to see, anything else to do with vision will suffer. Period. Research and clinical work tell us that when the basic needs of vision are addressed, these so-called perceptual concerns go away. This suggests a major gap in our approach to assessment and care of children with developmental learning concerns. It is odd to me that we do psychology assessments that rely heavily on strong vision, on children of unknown visual status.
It would seem that the description of mental retardation might apply to the current med-psych industrial approach to child care…
As for the parents, they are both elated with the current outcome, and absolutely livid with the expensive assessment leading to such a damaging diagnosis as mental retardation. It would seem that the description of mental retardation might apply to the current med-psych industrial approach to child care: “These (people) typically have difficulties with social, communication, and functional academic skills.” When you disregard basics like vision when leveling such a diagnosis to unsuspecting parents, it certainly points to a dysfunction of some kind.
This is a happy and true story. Suzy will surely go on to become a success with whatever she chooses. She will still need ongoing care and monitoring for previously unmanaged vision concerns. The costs, however, are a very small fraction of the lifelong costs to education and healthcare of caring for a ‘retarded’ child, not to mention the lost opportunities and emotional burden on the family.
Note on the diagnosis of ‘Mild Mental Retardation’: This diagnosis is a DSM-IV diagnosis, a standard preferred in the US. The term ‘developmental delay’ is preferred in Canada, and it is unclear why the term was used with this local family. Neither term provides any insight into the cause of behaviour. The diagnosis of mental retardation depends on many factors, but it must first and foremost exclude any significant sensory deficits and disease. In this case, Suzy had vision severely impacted vision – the most important sense for learning in the traditional classroom. In some cases, a diagnosis can help in that it opens doors for treatment and care. In cases like Suzy’s, her diagnosis became a burden with no way out, and no reference to or solution for the real problem. The parents could have been saved a lot of grief, expense, and anguish. This is a surprising case, but not unlike many other cases of children who are now struggling because we just don’t pay attention to vision.