Drs. Sheree Fetkin Wright and Charles Boulet continue their discussion of Milestones in Visual Development with Part 3, Visual Impediments to Learning.

According to the American Optometric Association, failure to achieve developmental milestones during early years may be an indication of a risk for developing a learning disability. According to data from the National Center for Learning Disabilities, about 5% of American public school students (that’s 2.5 million children!) have been identified as learning disabled. However, the diagnostic process and definitions applied by different school districts results in inconsistency in the classification of learning disabilities and the range in its prevalence. Overall, learning disabilities account for half of special educational services being provided to children.

Learning-disabled children often have a history of overall developmental and visual developmental delays, and the source of these delays may or may not be obvious. However, when recognized, these delays are seen as contributors to the overall learning problem that many children are facing today. Therefore, acknowledging and addressing them should be part of the management strategy.

This third and last part of this series on developmental milestones considers more specifically the role of visual development and functional deficits in the classroom.

Visual Motor Hierarchy

The visual motor hierarchy is a graphical representation of the normal development process during which vision becomes the dominant processing system for learning. The graph describes the transition from motor based learning to visually dominant processing. During infancy, there is a large emphasis on motor dependency and motor experiences for learning. Tactile information is imperative for organization at this time. Young children first learn by navigating through the world with their hands. Infants and toddlers want to touch everything, put things in their mouth, and grab and release things, all in an attempt to extract meaningful information about these objects. As these children mature, their overall dependence on motor related learning begins to decrease and simultaneously their dependency on visually related learning increases. As maturity progresses, the visual system will begin to dominate over the motor system and more attention can be given to cognitive demands in a learning environment. By the time children enter first grade, they should be more capable of manipulating objects with their vision and have less of a need to touch everything. This is essential if children are going to learn to read in a traditional classroom, which is highly dependent upon visual information processing.


Figure 1. – Shifting dependencies in exploration and learning reflect ongoing elaboration and refinement of sensory and cognitive function (adapted from Weinstein, 1967, Journal of the American Optometric Association).

There are two focal deviations that can ensue, which inevitably lead to a mismatch in the available skills of the individual relative to the demands of his or her associated environment. The first deviation is delayed development of vision as the dominant processing system and a greater reliance on motor learning than expected based on age. Visual dominance is expected in a learning environment, but without it, it can lead to behaviors such as the inability to remain seated during academic related tasks, or difficulty in maintaining participation in classroom activities that involve visual dominance, especially tasks requiring extended engagement in reading and writing. The second deviation is a result of the increase in academic demands that exceed the readiness of an individual. The visual “demand” exceeds the visual “supply,” not because of a developmental delay, but because the demand is inappropriately high at that early age.

The expectations for children at earlier and earlier ages is increasing and the demands associated with these expectations are putting an immeasurable amount of pressure on children who may not be equipped developmentally to handle and organize this academic environment appropriately. While learning from a teacher is often proposed to help children get to a specific solution more quickly, it is possible that de-emphasizing motor based learning is hindering their capacity to discover new information and generate innovative approaches to problem solving.

Vision and Learning

“Learning to read” and “reading to learn” are two demands that are being placed on children at earlier and earlier ages. Each of these tasks requires different skills from an individual in order to facilitate achievement. Vision plays a pivotal role in both aspects of the reading process.

Learning to read places a high demand on visual perceptual and processing skills. This process is highly dependent on the recognition and recall of visual symbols and how each of these symbols represents sounds. There is also a large demand placed on the ability to recall how to write letters, spell words, and construct sentences. Directionality becomes imperative in order to avoid reversals when reading and writing and therefore can play a major role in word recognition, and subsequently comprehension. While there is a larger cognitive demand placed on the individual, there tends to be less of a demand placed on the function and sustainability of binocular and visual skills. At the age when children begin learning to read, the text and font of the material is usually large and accommodation and other binocular aspects are less influential. In addition, attention is usually maintained for shorter durations of time. Children at younger ages are generally taught in shorter bursts of time, which reduces the requirement for sustaining binocular function.

Reading to learn successfully places different requirements on the individual. For this process, there is a greater demand placed on the person’s visual and binocular skills. At this age, usually in 3rd and 4th grade, print size decreases. The smaller sized words place a higher demand on accommodative function. The demand for accuracy of oculomotor function also increases when reading and copying from a board in the classroom. Eye movements need to be accurate and consistent enough to facilitate the proper sequencing of information in order to gain meaning from the content. Speed and comprehension of the material is highly dependent on sustainability of these skills.   Deficiencies are likely to manifest as reductions in academic performance.

The implication is that “learning to read” and “reading to learn” both require the child to be at the proper stage in their development. The visual skills needed for both of these tasks must be aligned with what is age appropriate on the visual motor hierarchy, and a dominant visual processing system must be established in order to achieve success.


A significant percentage of school-aged children suffer from learning problems, many of which are related to reading. Since vision development is so strongly linked to overall development, recognition of developmental delays can be a strong indicator for delays and deficits in the visual system. Vision development is essential for a young child to meet the demands of their constantly changing world, especially in preparation for school and other learning environments. As contributors to the overall problems that are manifested in children today, developmental factors should be recognized as part of the treatment plan. Developmental optometrists can play a significant role in the diagnosis and treatment of these visual deficits, and their potential impact on learning.

[Photo credit: Patient Care Technician]

Don’t miss  Part 1 and Part 2 in this series!

Learn more about learning related vision problems.




National Center for Learning Disabilities.  State of Learning Disabilities, 3rd ed 2014.  Available at: https://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf

American Optometric Association. Care of the patient with learning related vision problems. Quick Reference Guide, 2000. Available from: http://www.aoa.org/documents/optometrists/QRG-20.pdf.

Mozlin R. The use of behavioral parameters for a visual perceptual evaluation. J Behav Optom, 1995; 6(5) 115-18, 140.

Weinstein M. A rationale of vision and vision behavior. J Am Optom Assoc, 1967; 38(12):1029-33.

Gopnik, Alison. Why Preschool Shouldn’t Be like School.  Available from: http://www.slate.com/articles/double_x/doublex/2011/03/why_preschool_shouldnt_be_like_school.html.

Mozlin, Rochelle. Dr. Nathan Flax-Vision and Learning. Mindsight April 28, 2011. Available at: https://covdblog.wordpress.com/2011/04/28/dr-nathan-flax-vision-and-learning.

Sheiman M, Rouse M. Optometric Management of Learning Related Vision Problems. St. Louis: Mosby Elsevier Inc, 1994.