Either/Or False Dichotomies

All too often the role of vision in a variety of clinical conditions is presented as non-contributory if not irrelevant.  Typical examples include ADHD, Dyslexia, and Autism Spectrum Disorder.  In each of these instances, even when these conditions co-exist in the same individual, the popular opinion is that vision is bound to be normal or the eyes are fine, because vision is a “strength”.  We all know the routine: 20/20, eyes are healthy, everything’s fine, and your child has a brain problem not a vision problem.  We hear it from patients every day, but the good news is that more and more patients have gone beyond these false dichotomies.  Brain problems and visual problems are not mutually exclusive.

We should also take note of how we shape questions.  “Is it a vision problem or is it ADHD?” might be better phrased as “Do vision problems contribute to ADHD?”. As noted by our colleague Dr. Tannen, when the problem is visual attention we are misled by the question being shaped as a dichotomy.  As noted by our colleague Dr. Mowbray, when the patient presents with dyslexia and vision problems, we shouldn’t overlook the possibility that there are individuals or cases in which both problems exist and need to be treated independently by appropriate professionals.

There is a marvelous new book on the Visual Aspects of Dyslexia edited by John Stein and Zoi Kapoula.  I’ve blogged about the intrigue and application of Stein’s work here and about Kapoula’s work here.  The entire book speaks to the false dichotomy of shaping the question: is dyslexia a visual problem or a phonological problem.  There is irony within the book in that several of the authors address the notion of visual stress as if it were independent of binocular dysfunction, another false dichotomy.  Our patients are best served by a balanced approach in which visual factors may be contributory to their condition, but always holding open the possibility that they are not.  In due time, other professionals will acknowledge this intellectual honesty, and shed their false dichotomies about the role of vision.


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