DIFFERENTIAL DIAGNOSTIC QUESTIONS
TO BE ANSWERED TO DETERMINE THE ROLE OF VISION AND PERCEPTION IN THE EFFICACY OF LEARNING
REFRACTIVE STATE – Is there an error in the optical system that raises barriers to effective learning? While some eye “problems” are genetic, evidence now suggests that more are not. Stress causes at least 75% of all disease and eye problems do not seem exempt. Refractive error is, for the largest part, probably the outer manifestation of the physiological and neural distress of life upon the eye and of the demand upon its functioning. Genetics would determine and limit the type of refractive changes that would occur. The importance of any lens correction seems to be in its neurological effect more than the optical effect, and some learning problems respond very dramatically to the trial and use of the correct stress-reducing lenses.
OCULOMOTOR SKILLS – Can the eyes track the printed page smoothly? Pursuing the track of a moving target is a primitive, natural skill, present to the infant as soon as several hours after birth. Word attack problems, skipping and rereading, number and word reversals, and word calling errors often stem from nothing more mysterious than tracking and scanning problems.
FOCUS PROBLEMS – Can the subject focus for the entire work or study period? Momentary reading tasks are inadequate tests for the endurance challenges that reading and writing present. Word calling and letter substitution problems result from inaccurate or rapid fatigue of focus abilities.
FUSIONAL SKILLS/STEREOPSIS– Can the child maintain single vision easily for the entire study period? Momentary convergence tests or cover/uncover tests are not valid measures of the classroom challenge. Nearpoint stereopsis and visual suppression problems have been HIGHLY correlated with learning problems in various studies, including ophthalmological research (Curtis Benton, in Dyslexia, by Sweeney and Sweeney, 1968).
GENERAL AND MOTOR SKILLS
GROSS MOTOR SKILLS – Can the child move his or her body without overt attention to balance and accuracy? All learning is based in movement, and the brain must be able to handle more than one task at a time reasonably well in the classroom. (Multi-tasking, or cognitive loading are various terms for this ability.)
FINE MOTOR SKILLS – Among other areas of fine motor skills, can the child manipulate a pencil and paper efficiently? A child whose ability to control his digital skills will lose control of his writing, thinking, or both.
BODY CONCEPT – Is the child aware of his body parts? A child needs to be able to relate the physical parts of the body to the labels of each and those individual parts to the whole of his or her body to ultimately know who (s)he is and where (s)he is in space. This is also a test of receptive language, to an extent.
LATERALITY/DIRECTIONALITY – Can the child operate spatially? Is the child automatically able to label the “leftness” and the “rightness” of the body and extend that organization out into the world? Almost all, if not actually all, of “mirror writing” and reading stems from this. [It’s not possible for a child to see in mirror fashion, because all words would be mirrored, not just certain ones – I have yet to hear a child say “ton” for “not”, or “tar” for “rat” or “retfa” for “after”.] Children need to be shown right, shown left, and then practice using the labels until we can see that they have fully internalized — digested — the meaning and can act on them appropriately.
GESELL COPY FORMS – How does the child organize a blank sheet of paper and can they reproduce simple geometric figures? Younger children start centrally and may “collide” figures together. Somewhat older children may keep to the edge of the paper to have a guideline to organize their space on the paper. Poor arithmetic concepts have long been associated with poor visuo-spatial skills.
RUTGERS COPY TEST (STARR) – What is the child’s copying age? This test is one of several popular tests that allow us to derive a “drawing age” for each child. This test is preferred because it requires the child to analyze and reproduce more diagonal lines than the more popular DVMI or Bender-Gestalt. Preliminary research being conducted shows that the Rutgers correlates quite strongly with reading and math achievement. Diagonals require a higher order performance than verticals or horizontals alone. When a child’s drawing skills demand too much concentrative effort, writing and composition abilities are directly affected. Visuo-spatial skills analytical problems can be detected on the test, as well, and relate to math problems as noted above. The ability to analyze and reproduce letters originates in visual analytical skills. Drawing tests probe the expressive side of visual perception.
SEGUIN FORM BOARDS – Is the child visually directed in solving visual-motor tasks? The child who randomly tries piece after piece or who “scrubs” the surface of the board with a puzzle piece is telling us that he’s lacking the developmental skills of a child who studies the pieces and picks the most likely ones to match to the board before placing them. The use of vision with the motoric demands of a task may put too much cognitive demand (or loading) for the performance and the child may slow down dramatically. These children may not have made the transition from touch to vision yet, and this skill of concrete to abstract substitution (being able to visualize what has previously been dealt with tactually) is needed to deal readily with arithmetic concepts.
MOTORFREE VISUAL PERCEPTION TEST – How well does the child decode visual perceptual tasks? This tests the receptive side of visual perception. A child may do well on this but poorly on the copying tests, indicating that the child’s problem is more than likely a motoric one, not a sensory decoding one. Children with these problems frequently know the answer, but can’t get it onto paper properly or in time (i.e., knows math flash cards, but doesn’t test well; does well in spelling tests, but is a poor applied speller, etc.).
WORD REPETITION TEST (Echolalia, Slingerland) – How well does the child receive and mimic English words? This is not a probe of articulation or receptive language per se, but a test of sequencing of polysyllables that requires phonemic decoding and encoding skills.
AUDITORY ORGANIZATION TEST – Can the child repeat sequences of information that carry no language clues? By having the child repeat a sequence of claps, we begin to analyze auditory perceptual problems to see if there is a breakdown in non-phonemic sequencing and rhythm abilities. This test is easily affected by emotional distractions, since the signal is lost, due to the momentary inattentiveness caused by inner conversations being carried on.
AUDITORY ANALYSIS TEST– Can the child visualize and manipulate phonemic pieces? The inability to manage this easily has been proven to relate very highly to the prediction of reading failure in nine years of basic research. We must be aware of the auditory pieces as we decode what we’ve listened to and then code that input into written language.
ARTICULATION-INDEPENDENT AUDITORY PERCEPTION TEST – (Experimental: in development) – This enables us to answer the question of whether an auditory processing problem is centrally sensorally or motorically based. This tests the child’s decoding processes for auditory input independent of vocalization, and articulation. It is intended to probe a child’s central auditory analytical abilities for difference, sequence, closure, length, and memory. It has a number of subtests to probe all of these skills.
BILATERAL INTEGRATION TEST – Can the child rhythmically interweave the motor actions of the right and left body halves? Previously thought merely a motor skill, tempo and rhythm have been associated with reading achievement in the literature and research (Kephart, 1962, Dunsing, 1968). Clinically, the practice of this skill doubles the rate of change of other skills.
TACTUAL-VISUAL TEST (STEREOGNOSIS) -Can the child build mental images of tactually received information? Kinesthesia is the most primitive manner by which we explore our world. The correlation of touch to mental images is the first step of being able to search for, identify, and label objects that are out of arms’ reach. It is an essential primitive stage of development of visualization and conceptualization.
AUDITORY-VISUAL TEST (BIRCH-BELMONT)– Can the child remember auditory sequences and relate them to visual representations? This is the most basic auditory-visual coding of the sort we use in language: coding of graphemes to phonemes. This skill is very easily affected by emotional distractions.
LINDAMOOD AUDITORY CONCEPTUALIZATION TEST – This powerful test asks if a child can discriminate auditory input, conceive a demand, code, and spell in a motor-independent task. It probes auditory analysis, auditory-visual integration, auditory sequences, receptive language, and concept formation. It probably taps an important aspect of intelligence.
STROOP COLOR-WORD TEST – Is there right/left brain integration interference above the expected norms? Words – in the form of color names – are processed by the left brain, are then compared to the ability to name the color of inks, a right brain function. The difference in the rate predicts an expected confusion when the person is asked to name the ink color of color names printed in non-corresponding inks. The actual rate is then timed and compared to norms. Severe disparities may indicate minimal brain damage or developmental lags. This significance is being explored clinically, but for pragmatic reasons, we are currently using the changes in this rate to indicate changes in mental processing efficiency. The results thus far are very encouraging.