March 28, 2024
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The Misdiagnosed Child

Children presenting with behavior disorders often have associated reading/learning difficulties and are commonly characterized as being difficult children by their teachers and parents. ADD (attention deficit disorder), ADHD (attention deficit disorder hyperactivity), LD (learning disabilities), ODD (oppositional defiant disorder), Dyslexia (difficulty deciphering symbols) and CAPD (central auditory processing disorder) are a few of the diagnosis that have often been used to identify these children. Typically, it’s the child’s pediatrician, pediatric psychiatrist and/or pediatric neurologist who routinely prescribe medications: Ritalin, Concerta, Adderall and/or Prozac to name a few, used to create order and quiet in a child’s behavior.

Understandably, professionals are pressured to find answers for these children with behavioral and associated reading/learning problems. The school system and individual teachers are also pressured to create an environment where these children labeled as lazy, a class clown, a dreamer, stupid, or uncooperative, can become socially and academically functional within the mainstream classroom. Medication may promote a child’s behavior to be more predictable and may even appear to cause a child to better stay on task. But, if the underlying true problems these children are experiencing are not medical in nature, these children will not learn or read any easier. In fact, they may become frustrated because they just don’t feel right, not knowing what’s wrong with them. Side effects of some medications may create additional change in how children feel resulting in fatigue, restlessness, loss of appetite and a feeling of despair. The more different medications are tried without success the further a child will get from feeling right about them self and ultimately knowing them self. Without resolve they may enter a downward spiral diminishing their self-confidence. They will continue to know, within themselves, that something isn’t quite right.

So now, because of the medications they are taking, your child doesn’t disrupt in class and he may even appear to be better able to stay on level with the class. However, if what was thought to be a chemical imbalance is truly a behavioral vision disorder affecting your child, he will still not be comfortable integrating and processing visual information.

Children that suffer from a behavioral vision disorder may simply have difficulty converging their eyes inward (inefficiency turning eyes inward together), he may have difficulty focusing his eyes (inefficiency identifying what he sees), or he may not be able to make his eyes track (follow from one point to another). Over time, misdiagnosis can not only create visual inaccuracy, it can diminish self esteem and may even develop into what can be called the “Failure Syndrome.” Children within this syndrome, not knowing what’s wrong within them, can ultimately believe that rather than not being able to perform a particular task correctly, they begin to believe that they are incorrect.

These misdiagnosed children may not be considered “at risk” because medication has eased the situation. However, they will most likely be affected by a lack of self worth that the misdiagnosis has instilled within them. This may ultimately lower a child’s professional expectation and allow him to accept a vocation or profession lower than his actual potential. Ultimately, he would not be thought of as a “learned” individual.

But what would have happened had these children been introduced to a behavioral vision approach? Not only could they have achieved success in reading and learning but they may have actually reached their life potential and the subsequent joy in living their life.

Early and appropriately intervention is essential when changing a child’s course of development from one of frustration and lack of ability to one which encourages belief in oneself through success in a task. Some parents and child study team members may actually feel a false sense of security believing that they have already taken their child to the eye doctor who said, your child’s eyes are fine, they see “20/20.” Although seeing with clarity is important your child’s visual concerns may have nothing to do with eyesight and everything to do with efficient, effective and effortless eye coordination, focus and eye tracking ability.

A lack of visual coordination results in two sets of eye muscles not working together. One muscle system controls focus, for clarity, while the other system controls the function of seeing single and not seeing double. These two systems are linked. Inaccuracy in one system will typically create a mismatch in the other creating inefficiency between the two systems working together. Classical symptoms of a motivated child trying to overcome visual dysfunction is eye strain associated with excessive eye rubbing/burning, headaches after visual activities and blurred vision during near activities. Symptoms of eye avoidance, typical of an unmotivated child, are double vision at any time; missing or substituting words while reading, difficulty finishing school work and the most common symptom loss of place while reading. There are nonreaders who have no symptoms at all simply because they avoid any situation which calls for them to read for any considerable length of time.

Vision Therapy is the preferred treatment for these difficulties. The success of this treatment strategy depends on the motivation of the team which includes the child, parents and Behavioral Optometrist. If the condition is recent and academic lags have not yet occurred, the program is quite simple often resulting in complete remediation. When the condition is of a long standing nature, academic and/or emotional concerns can become secondary problems which must be addressed along with the primary visual. Certainly the more complicated the situation the more involved the treatment strategy. When secondary issues are evident, the team must include the appropriate professionals. Therefore, if academics are at issue, reading, learning and special education professionals should be resourced. Psychologists may be consulted if emotional concerns have surfaced. Occupational and Physical therapists may be utilized for the development of fine and gross motor skills and Speech and Language therapists would be responsible for treatment of receptive and/or expressive language delay.

Parents, teachers and school administrators have the power to advocate for our children. Realizing that symptoms of these labeled children mimic behavioral vision dysfunction cries out for these children to have the opportunity to explore potentially successful treatment strategies. Throw open your child’s door of opportunity and success and advocate for your bright and intelligent child’s ability to read, write and learn accessing the freedom of visual self-discovery through the benefits of a vision therapy program.

One of the most common and enthusiastic statements parents in my office make is “guess what my child just picked up a book to read all by them self.” You can be that parent by exploring the benefits of a behavioral vision approach.

Vision Therapist Dr. Warshowsky has three offices: One in Roslyn, N.Y., one in Ringwood, N.J., and one in Riverdale in the Bronx. His book can be purchased through any of his offices as well as from Amazon, Barnes and Noble, and Jessica Kingsley Publishers. You can also find out more about his practice and find the number to call to schedule an appointment by visiting his website at:http://pediatriceyecare-roslyn.com/contact-optometrist.html.

By Dr Joel Warshowsky, Vision from the Heart

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