Letter Reversals…Does my child have dyslexia or a vision problem?

When a child confuses and reverses letters, such as “b’s” for “d’s” and “p’s” for “q’s”, parents often wonder, “does my child have dyslexia?”. This is largely due to the fact that the media has drawn public attention to a problem in visual perception where the person who reverses their letters or numbers usually has trouble reading effectively. However, dyslexia is a broad term that indicates an unexpected reading disability that exists in a person who otherwise has no cognitive impairment and has had adequate educational instruction. The causes can vary as outlined in Wikipedia’s review of dyslexia. A more general overview of “Vision and Dyslexia” has been written in a White Paper by the College of Optometrists in Vision Development.

Letter reversals are developmentally normal up to age 7, however several other developmental factors must be considered before assuming that a child is experiencing normal letter reversal tendency’s at a younger age. When a child is behind in their visual processing it is referred to as a delay in visual spatial orientation or visual directionality. A child who is developmentally delayed in visual directionality will exhibit confusion in reading simply because of the letters that are symbolically the same, have a different meaning because of their visual spatial orientation, ie,  “b”, “d”, “p” “q”…same symbol different meaning!

Delays in the visual brain’s ability to process information, such as letters, numbers and words, based on visual-spatial orientation,  will indeed complicate reading, writing and other learning activities. As a result, a child or adult who has this form of visual processing problem will also have a vision related learning problem. And yes this can be one of the causes for a reading disability or dyslexia…visual spatial dyslexia.

What should you do if you suspect your child has a problem with visual spatial orientation skills? Seek out help from a Doctor of Optometry who is Board Certified in Developmental Vision and Vision Therapy. Those doctors skilled in the diagnosis and management of a patient with these problems will utilize a complete battery of visual perceptual tests and be able to offer treatment, in the form of office-based vision therapy to treat and remediate the patients delay in vision.

To help doctors with the best methods of practice in treating patients with learning related vision problems, the American Optometric Association has published an evidenced based Clinical Practice Guideline entitled:Care of the Patient with Learning Related Vision Problems (CPG20)

The best treatment for a child (or adult) with a vision related learning problem is office-based vision therapy. An example of one of our patients success, ie “no more reversals”,  can be seen at Hannah’s Story.

Dan L. Fortenbacher, O.D., FCOVD

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