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  • Vision and Attention Deficit Hyperactivity Disorder - ADHD

    A Developmental Approach

    Attention Deficit Hyperactivity Disorder or ADHD is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that over one million people presently have this disorder.

    The fourth edition of the Diagnostic and Statistical (Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary for diagnosis.

    In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.

    Even though it is generally assumed that people diagnosed as having ADHD evidence a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:

    • Making careless mistakes in schoolwork
    • Difficulty sustaining attention to tasks
    • Not listening to what is being said
    • Difficulty organizing tasks and activities
    • Losing and misplacing belongings
    • Fidgeting and squirming in seat
    • Talking excessively
    • Interrupting or intruding on others
    • Difficulty playing quietly

    These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.

    Physicians often recommend that ADHD be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.

    In addition, many common drugs for ADD, which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self-esteem.

    A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.

    TREATMENT OF ALLERGIES to pollen, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.

    VISION THERAPY improves skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

    OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. This allows them to pay more attention to the higher level senses of hearing and vision.

    The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and the treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.

    When making a choice about treatment for attention deficits:

    • Consult a behavioral optometrist for a developmental vision evaluation
    • Have a child evaluated by an occupational therapist with expertise in sensory processing problems
    • Consult an allergist regarding possible reactions to foods or airborne particles


    American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-lV), 1994.

    Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979.

    Crook, William G., Solving the Puzzle of Your Hard-to-Raise Child, Professional Books, 1987.

    Gesell, Arnold, and Ilg., Frances L., Infant and Child of the Culture of Today, Harper) 1943.

    Goodman, Gay, Poillion, M. J., The Journal of Special Education, "ADD: Acronym for Any Dysfunction or Difficulty," Vol 26, No. 1, l992, pp. 37-56.

    Kavner, Richard S., Your Child `s Vision, Simon and Schuster, 1985.

    Rapp, Doris J., Is This Your Child?, Morrow, 1991.

    Schmidt, M.A., Smith, L.H., Sehnert, K.W., Beyond Antibiotics: Healthier Options for Families, North Atlantic Rooks, 1994.

    Smith, Lendon, Foods for Healthy Kids, Berkeley Books, 1981.


    Vision Therapy

    Optometric Extension Program Foundation, Inc. (OEP Foundation)
    1921 E. Carnegie Ave., Ste. 3-L
    Santa Ana, CA 92705-5510
    (949) 250-8070

    College of Optometrists in Vision Development (COVD)
    215 West Garfield Road, Suite 200
    Aurora, OH 44202
    (330) 995-0718, (888) 995-0719, FAX (330) 995-0719

    Occupational Therapy

    Sensory Integration International
    1602 Cabrillo Avenue
    Torrance, CA 90501
    (310) 320-9986

    American Occupational Therapy Association, Inc.
    4720 Montgomery Lane
    P.O. Box 31220
    Bethesda, MD 20824-1220
    (301) 652-2682

    Developmental Delay Registry
    6701 Fairfax Road
    Chevy Chase, MD 20815
    (301) 652-2263

    International Health Foundation, Inc.
    P.O. Box 3494
    Jackson, TN 38303
    (901) 427-8100

    Pamphlet Copyright © 1994, OEP Foundation, Inc.

    A nonprofit foundation for education and research in Vision

    Permission to reprint the contents of this brochure granted to Visual Edge, Inc. ® - 04/15/09
    by: the Optometric Extension Program Foundation, Inc

  • What is Vision Training/Therapy

    Optometric visual training, sometimes called vision therapy or VT, is that part of optometric care devoted to developing, improving and enhancing people's visual performance. Here is some useful information on vision training/therapy to help you prevent future vision and eye problems.

    Over several decades, behavioral optometrists have developed and used visual training in combination with appropriate, judiciously selected lenses to:

    • Prevent vision and eye problems from developing
    • Develop the visual skills needed to achieve more effectively at school, work or play
    • Enhance functioning on tasks demanding sustained visual effort
    • Remediate or compensate for vision and eye problems which have already developed

    Through visual training, people are able to develop more efficient visual performance.

    Vision: A Set of Abilities

    Nearly all humans are born with the potential for good eyesight, but vision--the ability to identify, interpret and understand what is seen --is learned and developed, starting from birth.

    In learning to walk, a child begins by creeping, crawling, standing, walking with assistance, and finally, walking unaided. A similar process from gross to fine motor control takes place in the development of vision.

    One visual skill builds on another, step-by-step as we grow. But many people miss a step, or do not complete a step, or must begin to perform school or other visually demanding tasks before an acceptable foundation of basic visual skills is in place.

    Science indicates that we do not “see” with our eyes or our brain; rather, vision is the reception and processing of visual information by the total person. Since two-thirds of all information we receive is visual, it becomes clear that efficient visual skills are a critical part of learning, working and even recreation. Athletes, for example performance in their sport.

    Developing visual skills includes learning to use both eyes together effectively. Having both eyes move, align, fixate and focus as a team enhances your ability to interpret and understand the potential visual information that is available to you.

    Intelligent persons who are very highly motivated can be good achievers, even with very poor visual skills and abilities, but at untold cost iii wasted energy and unnecessary effort and stress. For those who are less motivated, even one or two deficient visual skills can produce enough stress and frustration to create a non-achiever.

    What Are the Visual Skills?

    The visual skills which can be developed and enhanced through visual training include:

    • Tracking. The ability to follow a moving object smoothly and accurately with both eyes, such as a ball in flight or moving vehicles in traffic.
    • Fixation. The ability to quickly and accurately locate and inspect with both eyes a series of stationary objects, one after another, such as moving from word to word while reading.
    • Focus Change. The ability to look quickly from hr to near and vice versa without momentary blur, such as looking from the chalkboard to a book or from the dashboard to cars on the street.
    • Depth Perception. The ability to judge relative distances of objects and to see and move accurately in three-dimensional space, such as when hitting a ball or parking a car.
    • Peripheral Vision. The ability to monitor and interpret what is happening around you while you are attending to a specific central visual task; the ability to use visual information perceived from over a large area.
    • Binocularity. The ability to use both eyes together, smoothly equally, simultaneously and accurately.
    • Maintaining Attention. The ability to keep doing any particular skill or activity with ease and without interfering with the performance of other skills.
    • Near Vision Acuity. The ability to clearly see, inspect, identify and understand objects at near distances, within arm’ length.
    • Distance Acuity. The ability to clearly see, inspect, identify and understand objects at a distance. People with 20/20 distance sight still may have visual problems.
    • Visualization. The ability to form mental images in your “mind's eye," retain or store them for future recall, or for synthesis into new mental images beyond your current or past direct experiences.

    Visual Skills/Visual Stress

    If a person's visual skills are not adequately developed, or a person fails to coordinate vision with other senses, vision problems may occur. With poor binocularity, for example, one eye may locate an object in one place while the other eye locates it in another. The confusing signals may result in:

    • Headaches. Especially near the eyes or forehead, or occasionally at the back of the head.
    • Double Vision. Two objects are seen when only one exists.
    • Reduced Performance. Losing your place while reading, rereading words or lines, difficulty with Understanding or recalling what you've read, reading slowly.
    • Discomfort, Fatigue. Body tension, stress or pain; weariness at the end of a school or work day.
    • Suppression. Information from one eye may be blocked or ignored to avoid seeing double. If the visual problem is not corrected, it may get worse.

    Nearpoint visual stress, the result of sustained visual activities done at less than arm's length, may produce most of the problems listed above.

    There are many other common eye and visual problems which can limit the way you live and enjoy life. These include:

    • Nearsightedness. Myopia-seeing more easily at near than at distances.
    • Farsightedness. Hyperopia a-seeing more easily at distances than at near.
    • Strabismus. Crossed eyes.
    • Amblyopia. Lowered visual acuity (clarity), not correctable to normal acuity with lenses.
    • Astigmatism. Distorted vision-interferes with seeing clearly at any distance without effort.
    • Poor Vision-Body Movement Coordination. Clumsiness, awkwardness, inefficient eye-hand or eye- body coordination, poor handwriting.

    Visual training, usually combined with appropriate lenses, may remedy, improve or prevent any of these conditions in both children and adults. Visual training and lenses are intended to alleviate the symptoms and eliminate the underlying cause inadequate visual skills and visual stress.

    Studies show that success in visual training depends on an appropriate program prescribed by your optometrist, and on an individual patient's cooperation, participation and motivation.

    Beyond Visual Performance

    Visual training also has proven to be a remarkably effective tool in helping' people with learning-related visual problems. Many problems in learning to read and write are made worse by poorly developed visual skills.

    Dozens of experimental programs involving thousands of children and adults demonstrate that when visual skills are enhanced through visual training, learning is easier, reading levels rise, and in some cases, IQ scores have increased.

    Building visual skills also increases the ability to visualize, conceptualize and to create. Dr. Johan Pestalozzi, a Swiss educated reformer, notes that “conceptual thinking is built on visual understanding “ visual understandings the basis of all knowledge.”

    What is a Behavioral Optometrist?

    Behavioral optometrists spend years in post-graduate, continuing education to master the complex visual programs prescribed to prevent or eliminate visual problems and enhance visual performance.

    Not all optometrists practice behavioral optometry, which includes developmental and functional optometry. If you do not now have an optometrist who practices behavioral optometry, call or write the OEP Foundation. Or, make sure you receive a yes answer to each of the following questions before you make an appointment:

    • Do you make a full series of nearpoint vision tests?
    • Do you make work- or school-related visual perception tests?
    • Do you provide full vision care and visual training in your office, or will you refer me to a colleague if needed?
    • Will you see me again during the year, and periodically to determine my progress?
    Optometric Extension Program Foundation, Inc.
    1921 E. Carnegie Ave., Ste. 3-L
    Santa Ana, CA 92705-5510
    Pamphlet Copyright © 1995, OEP Foundation, Inc. - A nonprofit foundation for education and research in Vision
    Permission to reprint the contents of this brochure granted to Visual Edge, Inc ® - 4/15/09 by: the Optometric Extension Program Foundation, Inc.
  • Want to be SMART? Here's How!

    There is a common misconception that only "braniacs" that are born with "smarts" excel in school.  If this were truly the case, school would not be an institution where individuals could develop, learn and grow their knowledge.  Though natural ability contributes to the learning process,  exercises, studying methods, hard work, and developing positive habits are the most important factors in a successful academic career.  Here are some simple tips on how to be smart.

    To be SMART in school, be SMART:

    S – Sit up straight in class.
    This will help you stay altert.  Your posture is a reflection of your attitude and will let your teacher know you're paying attention.

    M – Make eye contact.
    When speaking to people, always look them in the eye. They will
    know you are actually interested in what they have to say.

    A – Act interested.
    Even when you are not interested in a subject, act as if you are.
    By opening up yourself to a new subject and giving it a chance, you will be amazed at how you WILL become interested over time.

    R – Remember to ask questions.
    By asking questions your teacher will know you are paying
    attention and interested. Also by asking questions you will learn
    and understand more.  Don't be shy either, often times you are asking questions that many other students may be wondering about as well.

    T – Track your teacher.
    When your teacher is speaking to the class keep your eyes on
    them. This once again lets them know you are paying attention
    and by keeping your eyes alert and observing you will retain more information.

    These five simple steps practiced throughout your educational years will make you a "SMARTER" student and engender positive learning habits and respect from your peers and teachers.

  • Is My Child at Risk of Dyslexia?

    risk of dyslexia

    How to tell if your young child may be At-Risk of Dyslexia
    (Suitable for Kindergarten and 1st Graders)

    Research tells us that approximately 1 in 4 people have some level of a vision-processing problem and 1 in 20 has dyslexia. Dyslexia is a distinct type of Vision Processing problem. This means that there is likely to be at least one child in every class who displays the pattern of strengths and weaknesses characteristic of dyslexia. Do you have a young child who puzzles you, displaying well-developed skills and abilities in some areas and unexpected difficulties in others? Complete this checklist to determine if that child could be at-risk of dyslexia.

    • Family history of literacy learning problems
    • Delay in the onset and/or the development of speech and language
    • Seems bright and capable but not making expected progress
    • Is unhappy soon after starting school

    Compared to their age peers dyslexic children often display difficulties in the following areas:

    Dyslexic children typically have well-developed oral language skills but display specific speech problems, such as:

    • Gets sounds in words muddled up (e.g., says flutterby for butterfly)
    • Mixes up words (e.g., says ‘jungled’ for ‘jumbled’)
    • Displays word finding difficulties (e.g., calls a ‘stamp’ a ‘sticker’ or often uses words like ‘thing’, ‘stuff’ or ‘junk’)

    • Finds it hard to remember the words in nursery rhymes, songs, poems, etc.
    • Has a poor memory for names (of friends, teacher, etc.)
    • Difficulty remembering instructions

    • Has unexpected difficulty developing reading and spelling skills
    • Enjoys listening to stories read aloud but shows little interest in letters or words
    • Has trouble learning and remembering the sounds corresponding to the letters of the alphabet
    • Has trouble learning and remembering common sight words (e.g., you, have, like, come, etc.)
    • Cannot write own name correctly from memory by age 5
    • Has difficulty recognizing numbers after considerable exposure at pre-school/school

    • Displays poor phonological awareness skills
    • (i.e., finds it hard to reflect upon the sound structure of spoken words)
    • Has difficulty analyzing spoken language into its component parts (e.g., sentences, words, sounds)
    • Has trouble recognizing and predicting rhyme (e.g. trouble picking the odd one out of sand/hand/cup)
    • Fails to appreciate alliteration (e.g., trouble picking the odd one out of jam/jug/bed)
    • Confuses similar sounding words (e.g., cone/comb)

    A child who appears bright and capable and displays many of these difficulties may be at-risk for dyslexia. However, it is important to remember that the levels of development and speed of learning in early childhood differ significantly for each child. For this reason psychologists tend not to formally diagnose dyslexia until a child is 7 years of age or older.

    Nevertheless, much can be done at this young age to prevent later difficulties. A good starting point is a comprehensive assessment by an educational psychologist a developmental optometrist who will identify cognitive strengths

  • How to Reduce Stress to Better Reading

    Because there is an intimate relationship between posture, working distance, desk surface the pioneering experiments by Dr. Darrel Boyd Harmon and subsequent research by Drs. John Pierce and Steven Greenspan clearly prove a reduction of stress and improved performance when conditions are arranged properly for near-point visual activities such as reading and writing. The following changes were observed: reduced heart rate, more regular and deeper breathing, and reduced neck muscle and overall body tension.



    Working Surface: A sloping working surface must be used that is tilted between 20 and 23 degrees from the horizontal. The Visual Edge Slant Board is at 22 degrees, which has been found to be the optimum angle.

    Posture: Seated comfortably, relatively erect, feet flat on floor or box.

    Working Distance: The "Harmon Distance" is the optimal distance from the eyes to the working surface. It is the distance from the elbow to the first knuckle. This can only be assured with a proper chair height to desk relationship.

    Near point Lenses: ONLY IF PRESCRIBED BY A DEVEOPMENTAL OPTEMOGIST. A specific, low power prescription not used to correct a defect in the eyes but to put the eyes into better balance for near tasks. This enhances and integrates the posture, working distance, and surface relationship.


    1. Ensure your reading material is at an angle of between 20 and 23 degrees. The Visual Edge Slant Board is at an angle of 22 degree which research has shown to be the optimum angle at which to read.

    2. Do all near point activity at HARMON distance or slightly further. This is the distance from the center of the middle knuckle to the center of the elbow measured on the outside of the arm. Working at the Harmon distance reduces near point visual stress.

    3. Be AWARE of space between self and the page when reading. Also, be aware of things around and beyond the book.

    4. When reading, occasionally look off at a specific distant object and LET its details come into focus. Maintain awareness of other objects and details surrounding it. Do this at least at the end of each page.

    5. When studying, place a bookmark 3 or 4 pages ahead. Get up and move around for at least one minute each time you reach the bookmark.

    6. Sit UPRIGHT. Practice holding your back arched while you read and write. Avoid reading while lying on your stomach on the floor. Avoid reading in bed while lying on your stomach on the floor. Avoid reading in bed, unless sitting reasonably upright.

    7. Provide for adequate general illumination, as well as good central illumination, at the near task. The illumination on the task should be about three times that of the surrounding background. Avoid the use of florescent lighting.

    8. Do not sit any closer to TV than 6 to 8 feet, and be sure to sit upright. Maintain good posture.

    9. When riding in a vehicle, avoid reading and other near activity. Encourage looking at sights in the distance for interest and identification.

    10. Encourage outdoor play or sports activities that require seeing beyond arm's length.

    11. When outdoors, sight a distant object at about eye level. At the same time, be aware of where things are on all sides.

    12. Walk with head up, eyes wide open and look TOWARD, not at, objects.

    13. Become very conscious of the background of the objects you look TOWARD, be it a person, print on a page, an electric sign, the TV, or any other object.


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