Book Review: Dr. B’s Parent and Teacher Guides on Child Vision, Learning & Development: Fundamentals 1

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After setting up this new website, I sat down to review Charles Boulet’s first ‘Parent and Teacher Guide to Child Vision, Learning and Development’. It had been on my to-do list for some time! The text reflects many of my views on what is going wrong during standard vision screenings (especially as far as farsightedness is concerned), binocular vision treatment and, more generally, in how children with sensory-motor difficulties are being treated. These subjects are close to my heart.

The book provides a nice introduction for uninitiated readers who are interested in understanding normal vision development, developmental vision problems and their effects. In what follows, I will highlight and discuss some of the important topics and lessons which especially resonated with me.

WHAT IS VISION REALLY?

The role of vision in the developmental pyramid

The book provides readers an overview of why vision matters within the global development of a child and why vision is more than just having clear eye sight.

“When speaking of child learning and development, it seems to make sense to pay more attention to the classic ‘senses’: sight, hearing, touch, smell, taste. We now know that muscle development is also an important part of the growth of these senses, but also in our capacity to use the senses and to integrate (combine) these senses for more complicated tasks. Likewise, vestibular sense (awareness of balance and head movement) is a critically binding element that ties other key senses together in the creation of our sense of a three-­‐dimensional world. In addition, body sense (kinesthesis, somatosensation, and proprioception) plays a critical role in becoming aware of space and in the ability to ‘target’ objects; this is critical in gross and fine motor movement, and especially in visual targeting. We can thus begin to see how motor development and experience is critical in visual development. Indeed, we know that children who are more physically active show generally much stronger visual targeting ability.”

In order to properly develop, deploy and integrate the senses and its sensors such as the eyes, the child must thus experience a smooth interplay between motor and sensory development.

“Development of neuromuscular and neuro-sensory systems occurs simultaneously, one supporting the further development of the other.”

If somehow this interaction is interrupted, as for instance in strabismus, a wide variety of skills that are partially or wholly dependent on vision also will be affected.

“The role of vision alone is surprising – it touches everything from hearing, to balance, awareness of space, and awareness of the body in that space. … Vision is a critical element in our physical and mental foundations, and when it is ‘out of tune’, many aspects of growth and behaviour can and will be affected. … Our brains rely on this mapping of space and objects therein, combined with an ongoing awareness of physical orientation and posture, to accurately guide motor movements, to assist in visual thinking, in the anticipation of actions and events, and later higher, more abstract thought.”

The concept of a developmental pyramid completely agrees with my experience. I’ve always felt I was very intelligent but somehow I was lacking this broader sensory-motor foundation to build on due to my strabismus. You can work as much as you like but when you don’t have the tools you will not be successful. Dr. Boulet mentions the concept but does not venture to show us a concrete image of what such a pyramid might look like. I don’t blame him because it’s virtually impossible to get it completely right.

While reading the phrase however, I was reminded of the Pyramid of Learning proposed by Occupational Therapists Williams and Shellenberger. Their Pyramid delighted me when I first saw it. Nonetheless, in reality, I don’t think it is as hierarchical as portrayed in their image. For instance, ocular motor control is a necessary pre-requisite in order to fully develop Visual, Vestibular and appropriate Proprioception which are displayed at the base of the pyramid. Despite its potential flaws, I do nonetheless love this pyramid because it rightly tells us that for Behavior, Daily Living and Academic Learning to be optimized, there needs to be a strong and reliant sensory-motor base.

 

pyramid of learning

This picture is not taken from the Dr. B guide but is used by me to illustrate a concept – Click to enlarge

 

Embodied or grounded cognition

While the idea is not mentioned by name, the author goes on to explain what is often referred to as the theory of ‘embodied or grounded cognition’.

If we are successful in executing the action based on our mental spatial representations and calculations, then our notion of space and motor coordination will be reinforced. Indeed, studies by Sherrington, Hubel, Wiesel, and others have shown that vision and motor interactions are critical to creating this sense of the world around us, and our positioning within it. This system of sensory inputs and motor outputs reinforcing one another is not limited to targeting, but to virtually every mental and physical act we are capable of executing. When we have such a complex interaction of sensory inputs and motor outputs, it becomes clear that when one element fails or functions less than optimally, the entire behavioural ‘structure’ is at risk of failing, or functioning in a less-­than-­optimal manner.”

“It is useful to look at child learning, any learning, really, as a sort of scaffolding structure, where what is built at first will determine the stability of the structure as it grows. Learning, in the sense of interacting with the environment and developing ever more efficient strategies for survival, is a natural and automatic process.

Classroom learning, on the other hand, has become a predominantly symbolic pursuit that relies heavily on more abstract notions that rely on a strong understanding of real experiences. It is the condition of the human motor that underlies learning that makes classroom learning easy or difficult. This is at the foundation of the scaffolding and determines the stability of the rest of the structure, and determines how high a child can climb.”

I learned about ‘embodied or grounded cognition’ in a course called ‘Space and the Brain’ taught by neuroscientist Dr. Jennifer M. Groh from Duke University. She made the astute observation that, “there is an overlap between cognitive and sensory/motor function but solely ‘cognitive’ areas have not been found. … Our cognitive abilities are grounded in sensory and motor processing.” I, and the author of the Dr. B Guide, would certainly agree with that. The disruption of sensory-motor development can lead to cognitive and functional limitations which otherwise would and should not have been there. This is not to say that people haven’t often found ingenious ways to adapt and possibly even enhance themselves in other ways.

“As mature people, we are able to use our physical and mental skills to accomplish some rather amazing feats, and this capacity is all built upon a foundation of strong sensory input, integration of these same inputs with intent, spatial awareness, memory, and coordinated motor output.

Our thoughts (aka ‘mentation’ and ‘cognition’, or simply ‘awareness’) arise naturally from the presence of a brain that is connected to environmental ‘probes’ – our senses. We don’t have to try to think; simply having these mechanical elements in place and being allowed to interact with the environment is a sufficient condition for thought to happen; and it will happen, regardless of whether we want it to or not. Learning, for its part, is simply the reorganization of our brain wiring based on this interaction. At least, this is the case initially: Later on, we can learn without this physical interaction and can move well beyond simply thinking about physical objects ‘in the present’.”

Vision and brain development in children

Aside from broad theories, this first Dr. B Guide dips into some slightly nerdy specifics without causing lethargy on the reader’s part. Just enough for you to get a more profound understanding of what has been discussed earlier and what will be discussed later on. After all, these guides are supposed to be for people who are new to the topic.

“It is important to note that child development occurs in two directions: ‘cephalocaudal’ (sef-­uh-­loh-caw-­dul), and ‘proximodistal’ (prawks-­ih-moh-­dis-­tul). The cephalocaudal growth trend means literally that things at the ‘head’ (cephalo) grow first, then things at the ‘tail’ (caudal). The proximodistal trend similarly means that things develop more at the center (near, or proximally) before the extremities (far, or distal).”

“In (vision) therapy, this has very practical applications: By addressing core (that is, early) systems first, we can often have an impact on later­-evolving systems. Likewise, training later systems and abilities before addressing core needs will have limited benefit.”

Furthermore, the reader gets a chronological overview of early visual development in a fetus, baby and an infant. Next, various categories of visual behaviors are outlined:

- Visual signal acquisition (VSA): mechanical side of vision.
– Visual signal processing (VSP).
– Advanced behaviors that rely in large part upon visual input, such as balance, visual motor coordination, visualization, and reading.
– Other non-visual functions and systems served by vision, such as circadian cycles.

Arguably these skills or behaviors can be classified in various ways and therefore the text also refers to Cook’s 7 visual abilities as a possible alternative. I can reconcile myself with both systems of classification.

“There are many elements in vision alone beyond seeing clearly that, when not working optimally, will affect how a child learns, develops, and behaves. … Given the complexity of vision and hearing/balance (middle and inner ear, respectively) in particular, it is not surprising to know that they are more likely to be affected by defects in the growth process.”

“Sensory and muscle systems work in a similar fashion in that if they left unimpeded and given ample opportunity for practice, they should grow and mature according to the outcomes prescribed by the child’s genetics. Let’s assume there is nothing wrong with genetics and that mom has a supportive, healthy, and safe environment for gestation: The only way to influence development of the baby is to physically intervene or otherwise impair normal growth. For example, in the absence of stimulation by sound, a child will be unable to appreciate language and music. Likewise, in the absence of light stimulation, a child will not learn to perceive faces and shapes (called ‘amblyopia’). Even if a child develops fully, the absence of appropriately varied stimulation, bad sleep habits, visual impediments, and other factors can still add up to create real trouble.”

WHAT CAN GO WRONG?

Having been prepped briefly about vision and the visual process, we get to the part of the book pointing out what can go wrong during vision development. What can be impeding vision development? How does it manifest itself? How easily can it be detected? What can be done about it?

Amblyopia and strabismus

In case sensory-motor development and proper integration of the eyes into the central nervous system is hindered because of optically correctable (farsightedness, astigmatism, nearsightedness) or other environmental obstacles, a detrimental interplay between strabismus (oculo-motor disorder) and amblyopia (visual sensory disorder) can initiate itself.

Amblyopia is often a reflection of a visual system under extreme stress and strain. ‘Lazy’ eyes are actually working harder than normal healthy eyes, but fail to reach their functional goals due to some obstacles beyond the control of the child, like high astigmatism, farsightedness, or strabismus (crossed eyes).

Farsightedness and astigmatism

“For a slightly older child, one who is just learning to reach, grab, and walk, if the farsightedness is strong enough, it can strongly affect emotional, social, and reflex development. If low to moderate, the farsightedness can lie ‘dormant’ until school starts and the child is asked to use their vision for greater discrimination, such as to recognize shapes, letters, or to read. The struggle to manage the excess load impacts on clarity of eyesight, but more importantly on the level of agitation and sympathetic tone of a child – hyperopia (farsightedness) has a very strong psychiatric effect on even the most healthy children. As this visual impediment to learning (VIL) has such broad and apparently ‘silent’ impact, we can say that it is especially ‘toxic’.”

“Many times, subclinical structural impediments such as farsightedness will be present in struggling children: That is, they are there, but go mostly unnoticed. (Likewise, distant eye charts are mostly useless in detecting the more toxic visual impediments: When you point to some object and ask a child ‘can you see that?’, most will report ‘yes’, whether they do or not, or struggle through sheer effort.) But it is also clear that the ‘clarity’ of eyesight is not the issue here, it is more the strain of seeing clearly, and how this is amplified at progressively nearer distances: For the child, these impediments often require adaptations to work around the problem, and these adaptations can reveal themselves in peculiar ways that almost never seem to be related to vision. The low to moderately farsighted child, for example, will show inattention, fidgetiness, headaches, emotional outbursts, but never complain about ‘eyes’.”

Being farsighted myself I can attest to the above and, frankly, I have never seen it described as well as done by Dr. Boulet. Currently I have +2.5 in both eyes and a pinch of astigmatism in my left eye. The values were higher during childhood because as the eye grows bigger the degree of farsightedness often declines. Exactly as described, the farsightedness lay dormant until I had to go to school. At school there was a greater need for discrimination of small objects at near distances which generated a load too heavy to carry for an optically uncorrected farsighted visual system. This ultimately led me to develop alternating strabismus (crossed eyes) and some degree of amblyopia (lazy eye).

My mother took me to see a number of different doctors and ophthalmologists who basically didn’t understand what was going on. The third ophthalmologists finally gave me a pair of plus glasses and tried some patching but that did not restore eye teaming. It was a classic case of ‘too little, too late’, even though my vision development could have been redirected back to normal binocular vision fairly easily. On a cheerful note: because of this whole episode, my younger brother, who is also farsighted, immediately received glasses when needed. His neurological vision development stayed on track and he did not develop amblyopia or accommodative strabismus.

Moreover, I can also testify to the heavy psychiatric effect these uncorrected visual impediments have. Despite being an intelligent and physically strong child who on average performed better than most, everything came at a great cost. To this day my reading proficiency is very limited. There’s only so much you can compensate for with inherent intelligence and will power. Ironically, even back then I realized it had to do with my vision but every eye doctor I met just shrugged his or her shoulders. Who cares, right? Because of that alone, it is very emotional and somehow liberating to read these lines. Finally someone understands how this mechanism works  and poignantly describes the effects of ignoring this crucial component impeding healthy brain development.

“Because vision impacts upon behaviour, visual function matters, even more in the classroom, as does the state of motor and reflex development. As a simple example to go with the story above, a child who is farsighted by 3.00 diopters (D) will almost certainly struggle with reading and show outward signs of a medical nature including inattention, headache, intolerance of reading, and emotional outbursts; and yes, these children often show motor control and even speech problems. This is because farsighted vision is difficult, physically uncomfortable, and impedes our ability to learn more advanced skills; this is especially so when reading and doing near work.”

“Farsightedness and astigmatism, like a number of other visual functional problems, renders the visual portion of learning difficult if not intolerable and this leads to suspected psychiatric and psychological diagnoses due to the child’s means of compensating for the burden. In the presence of unchecked functional or structural obstacles, a child will feel bewildered and stressed, having to overcome additional, often invisible, obstacles before they can even start to address a parent’s or teacher’s demands.”

“I have personally seen cases where very high farsightedness alone has been ‘diagnosed’ as autism and mental retardation. The farsighted child will, for example, struggle to see clearly at any distance, but because he can ‘see’, he is more likely to be ignored. Rebuilding vision through lenses and other therapies completely changed her diagnosis, how she moves about, and how she is able to interact with people. She was most certainly not mentally retarded.”

Statistically it is evidenced that nearsighted people do better in school and generally have higher income. Some research has proposed nearsighted kids might just be smarter. Nonetheless, if you consider nearsighted kids have ‘built-in’ reading glasses whereas farsighted kids are missed in standard vision screenings and left optically uncorrected, you’ll soon understand why reading and academics are generally harder for them.

” The simple answer is that since most classroom learning takes place within near distances, low nearsightedness is best for classroom learning. Research proves this: Nearsighted children are much more likely to succeed in academics than their farsighted peers. This has been at times attributed to the notion that nearsighted kids are more intelligent, but the answer is a lot more simple: Farsighted kids physically struggle with near work. Some visual profiles, then, are much more suited to schoolwork. In short: If you have the right tools, you’re ahead of the game, but if your vision is incompatible with our new traditional model of instruction, you are left behind right from the outset.”

This is true and it stinks. The good news is that this can all be undone if we just re-adjust the way we do standard vision screenings a little bit. Do not just test vision a few meters away with a chart on a wall but also test vision nearby. Measure proper refraction values and give the kid appropriate glasses. Test accuracy and stamina of eye movements and improve through exercise if necessary. You will be putting a vast bunch of kids back into the loop, capture a lot of human potential and save a lot of medical and educational resources while you’re at it. Just by adjusting a standard screening we are already doing. That’s not too hard to do, is it?

Convergence insufficiency

“Convergence is the inability to cross the eyes inwardly, such as required for putting both eyes on a near target. For reading, convergence insufficiency is a disaster: Children will get headaches and double vision when reading, and certainly experience difficulties targeting words on a page as a consequence.”

You can do a basic test for this yourself by bringing a pen or other pointy object up to the face and see whether the person can maintain his or her eyes on the target.

“If the break point is beyond 8 cm (3in) or so, there is cause for concern and a visual rehabilitation specialist should be consulted. There is a good chance this child is struggling with reading, or with endurance.”

“Research shows us that a much better way to address this problem is to increase the range of movement of the eyes through motor and perceptual training, not through surgery, which often makes things worse requiring additional surgeries that will too often leave the child with reduced 3D perception and motor instability.”

Neurologically learning how to control and direct the eyes is better and more lasting than invasive and often damaging eye muscle surgeries.

Retained primitive reflexes

Babies are born with a set of what is called ‘primitive’ reflexes which are usually, if all goes well in development, overwritten by higher-order reflexes that better to address the challenges of later life. In some cases this transition is not entirely successful and some primitive reflexes are not substituted by their more mature counterparts. This can cause functional problems and barriers which make it very hard to perform adequately.

Other times, due to a traumatic injury, the higher-order reflexes get lost due to brain injury and the underlying primitive reflexes reappear. In that case too, the higher-order reflexes have to be restored in rehab to ensure smooth functioning once again.

“If the only tools available to the child are the primitive tools, this not only makes it difficult to make sense of the complex situation, the lack of ability to respond appropriately will also cause the child to react in a (usually) defensive manner: Panic, stress, emotional outbursts, or simply quitting to avoid another failure. Either way, old solutions applied to new problems will always lead to frustrations and inevitably failure.”

In the book, the various types of primitive reflexes are briefly discussed as well as what happens if they are not fully outgrown. References for further reading are indicated.

Dr B Guide Cover

‘Mysterious’ learning disabilites

“This at first seems an odd idea, that vision affects so much of our behaviour, but there is clearly much more to the story than ‘meets the eye’, and certainly much more than simple blur versus clarity in eyesight. Research in many domains, from psychology, vision science, ophthalmology, educational psychology, and of course behavioural optometry, all illuminate for us the pervasive role of vision in development and behaviour, and how much of what we have taken at face value as being mysterious ‘learning disorders’ might not be so mysterious after all. We must also now accept, in light of the vast research available on the topic, that ignoring a child’s visual developmental status may be one of the biggest mistakes we make in the child’s formative years. … Study of a child’s visual function reveals plenty about the status of his neurological development and readiness for school. Often times, this is where the real problems are found and addressed. Remember: vision is not eyes alone, but reflects something like 80% of brain function. “

“So, if a child has trouble reading, it is by far more productive to begin therapy with gross-motor, balance, and manual targeting skills than to simply say ‘if there is trouble reading, what is needed is more reading’. We cannot nor should not by-pass fundamentals in order to rush the more advanced functions.”

“We can also point to trouble in the progression of development of low-level motor systems, like our basic reflex responses (See primitive reflexes). In both cases, the child might adapt to such obstacles in ways that concern us, but that may not point directly to the underlying problem. In the end, the lower deficits occur in the developmental pyramid, the more pervasive the impact will be.”

“Children can be affected by many stressors in life, including social, family, and academic loads to manage. Structural and functional trouble, such as visual impediments or a need for reflex rehabilitation (what are sometimes called ‘Neurodevelopmental Delay’ or ‘NDD’, or more recently ‘DCD’: Developmental Coordination Disorder), will multiply and amplify the normal concerns present for most children. The child will adapt to the obstacles they face, and their level of success will depend on the nature of the impediments they carry and their ability to manage them physically and emotionally.”

“These adaptations may be avoidance of near work, emotional outbursts, intolerance or fear of certain activities, apparent reading difficulties, and so on. Sometimes the adaptation is in the form of muscle tension, for example from adaptation to poor posture, or from squinting to see through astigmatism. Certainly, in many cases, reading success will be limited as will the ability to attend to endless hours of ‘look, copy, repeat’ while sitting at a desk.”

The latter sums up nicely many of the problems and concerns I have experienced throughout my life and am still experiencing. Because my oculo-motor or sensory-motor foundation was narrow and skewed due to early strabismus, it has always been very hard to build on it academically or in any other meaningful way without imploding. It has always been hard to keep everything together, literally and figuratively, because visual capturing and processing was not stable nor integrated. The lack of dependable sensory input made it extremely hard to build lasting brain maps. I still have problems with near work, reading and certain activities due to visual limitations which sometimes lead to enormous frustration and the occasional emotional outburst despite my high level of self-control.

To this day I am working on remediating many of the mentioned suboptimal behavioural and neurological adaptations simply by rehabilitating my oculo-motor and sensory-motor systems. This is gradually opening up more and more functionality and life options. This will take me from perpetually tired and functionally illiterate to strong and able.

WHAT TO DO IN CASE OF TROUBLE?

Uncalled-for, intrusive and wasteful psychological and medical testing

“It is exceedingly rare that a child will have a measurable physical difference in how the brain is ‘put together’ that would explain difficulties in learning and behaviour. It is far more common for differences to occur in sensory inputs (i.e. difficult vision) or in experiences. Belabored sensory inputs and the lack of sensory and motor practice can render even simple classroom tasks overly complicated; the frustration that results from this can and will be expressed as troubled behaviour and will be registered during psychological testing.

“… Testing this way may have extremely limited real value, especially when such testing is done without first assessing visual function, for example, as most ‘psych’ tests rely heavily on visual inputs and strong visual function and visually guided fine motor skills. So, if a child with a visual impediment scores poorly on a test that is assessing something called ‘intelligence’, what is it really telling us?”  

“Often enough, something even more general will be applied such as ‘pervasive developmental disorder, not otherwise specified (NOS)’, a term so woefully inadequate it serves as a white flag of surrender, indicating the assessing doctor has no idea how to describe or classify the perceived problem of behavior.”

“My own sense is that such testing is designed to find areas of relative weakness and will find positive results in most, if not all, cases; this means there will be something there that can be classified as some sort of concern in virtually all kids tested. Still, most psychology reports will never mention status of development and function of vision, and only take a cursory view of hearing: If we are not attending to basics, what conclusions can we possibly draw from testing skills that are heavily reliant on them?”

Having been through the motions of the education and medical system, this again nicely describes my experience. My mother had me do batteries of tests in various offices as a child. Result: nil. Various ophthalmology visits when I started to cross my eyes, as mentioned earlier. Result: belated glasses and patching which did not reinstate proper binocular development. I’ve been going on annual ophthalmology visits throughout my childhood. Result: nil. When I started developing double vision and a host of associated problems, I saw more ophthalmologists, neurologists, physiotherapists, ENT (Ear, Nose and Throat) doctors, etc, etc. Result: An MRI, damaging eye muscle surgeries and some drugs which made me into a zombie. What a waste of money and time.

My ability to take (visual) assessment tests even diminished as I got older. By the time I graduated and had to take assessment tests to apply for a job, there was no way in the world I would attain the minimum standards. In contrast, when I was 16, I still scored 118 on an IQ test. I don’t think I was getting dumber over time. My vision had just been neglected and damaged by so-called eye care professionals. If they had attended to motor-sensory basics and used common sense to rehabilitate them, this down turn should not have been necessary.

“What we do see at the root of many learning concerns is difficulty with vision, hearing, and reflex development. Once these are documented and identified, treatment can proceed from a very practical standpoint. Once these outstanding real and practical issues are addressed, then and only then does it make sense to start additional medical and psychological testing – if it is even required at that point.”

What is going wrong in helping kids with vision problems? 

“Let’s look at the obvious first: Most visual impediments to learning are missed in standard assessments. Next, we take a nearly purely medical view of what must only be a behavioural problem (assuming the child is healthy, that is, free of disease, well-­nourished, and well-rested). Finally, we treat these behavioural problems as though they were based in medicine or psychiatry, even going so far as to create conditions favourable to that conclusion. What do I mean? When a teacher recommends pills for a child’s inattention before an eye exam, the bias is very clearly in favour of a medical preference of diagnosis and treatment: This is not a clinically sound or scientifically-­based decision process, but one that is culturally ingrained – if there’s a problem, there’s a pill for it. Such ‘advice’ to seek drugs for behaviour, destructive as it often is, can and maybe should be considered a form of neglect or abuse. Very rarely are learning difficulties medical concerns, and as a consequence, medical interventions will have little to no impact, and will indeed work against kids in many cases.”

To complicate things, on average, 80% of the children who need help with vision never get it, and still, some 25% of children struggle with manageable visual impediments to learning and development. “

“It’s best to first do no harm, this means avoiding anything that will potentially cause harm to the child. This includes the myriad diagnostic tests from the worlds of education, psychology, and medicine as ‘fishing expeditions’ when nothing is obviously wrong and no clear idea of why the testing is being done. In the absence of data on vision and hearing, there can be many ‘false alarms’ when children behave oddly because of basic sensory impediments.

Practical steps: properly and thoroughly assessing vision, hearing and motor functions first

Ultimately the book culminates in a series of practical steps drawing on what you have learned in previous chapters. As standard eye tests are missing much of the more serious vision development issues, you should start by having a comprehensive assessment done of the child’s binocular vision, hearing and reflex/motor status. “Believe it or not, these alone account for a great number of learning, reading, and attention issues. You have some very concrete answers after very little investigation or cost.” It seems almost too obvious and too good to be true, yet this would have been true for me. It would have saved me much money, time and pain.

“Vision rehabilitation specialists are often seen last in the chain of care because after all the complicated questions have been asked, and the probes and testing finished, there is still need for answers and solutions. As has been repeated: There is no medical solution for functional problems. By far, most of these children have some fairly obvious visual impediment that can be measured and addressed through rehabilitation. Sometimes that means glasses, and most often, the child also needs more active therapy.”

“The principles of strong child development are fairly clear: To raise a healthy, strong, and capable child, it is not sufficient to simply provide the necessities of life; you must also eliminate obstacles to development. This makes intuitive sense – if you want your crop to grow, you must allow it sunshine and provide proper nutrition, but you must also ensure there is nothing weighing it down or covering it. Visual impediments to learning and development are a prime example of such a weight on child growth and are a recurring topic of discussion in the Dr. B Guides. When impediments are in play, one or more cortical regions may not develop, or develop poorly, or not integrate well with other functional areas of the brain and cerebellum. With children, we can also help to move them farther through appropriate and structured, that is ‘scaffolded’, challenges (as in targeted Vision Therapy).

REVIEW CONCLUSION

The first Dr. B Guide on Child Vision, Learning & Development covers a lot of useful, and possibly vital, information which can save many children years of struggle and sorrow. Much is already known about the role of vision in learning and development even though this knowledge often remains a well-kept secret and is frequently repressed by the medical establishment. Hopefully this accessibly written book will help to make the important role of vision in learning more comprehensible for those who sorely need to understand: parents and educators. Teachers and parents should have an elementary knowledge of visual impediments to learning if they really care about children. Aside from the occasional typo, this text does a great job providing that basic knowledge along with practical tips on how to detect and react to functional and developmental vision problems.

I first became acquainted with Charles Boulet’s work when reading his 2013 paper, “Visual Impediments to Learning.” It summarized many of my life experiences while statistically backing up my gut feelings on how Visual Impediments to Learning such as farsightedness are generally affecting people in terms of socio-economic success. It was an extremely emotional experience to finally have this confirmation. I thought it was a brilliant paper which might have the same profound impact on you as it had on me. I recommend it to anyone who has anything to do with children or education. It is freely available and talks about many of the same issues as the Dr. B. guide, albeit in somewhat more academic language.

The ‘Dr. B Guide: Fundamentals of learning mechanics’ is available on Amazon.

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