Thursday, July 26, 2012

The Misdiagnosed Child

By Dr. Joel Warshosky, author of How Behavioral Optometry Can Unlock Your Child’s Potential

Children presenting with behavior disorders often have associated reading/learning difficulties and are commonly characterized as being difficult children by their teachers and parents. ADD (attention deficit disorder), ADHD (attention deficit disorder hyperactivity), LD (learning disabilities), ODD (oppositional defiant disorder) and Dyslexia (difficulty deciphering symbols) are a few of the diagnosis that have been used to identify these children. Typically, it’s the child’s pediatrician, pediatric psychiatrist and/or neurologist who routinely prescribe medications: Ritalin, Concerta, Adderall and/or Prozac to name a few, used to create order and quiet in a child’s behavior.

Understandably, professionals are pressured to find answers for these children with behavioral and associated reading/learning problems. The school system and individual teachers are also pressured to create an environment where these children labeled as lazy, a class clown, day dreamer, slow, or uncooperative, can become socially and academically functional within the mainstream classroom. Medication may promote a child’s behavior to be more predictable and even appear to cause a child to stay on task better. However, if the underlying problems children experience are not medical in nature, these children will not learn or read any easier. In fact, they may become frustrated because they don’t feel right not knowing what’s wrong with them. Side effects of medications may create additional change in how children feel resulting in fatigue, restlessness, loss of appetite and a feeling of despair. Medicating without success reinforces a child to feel unstable about them self.

Medications may seem to cause less disruption in class and children may appear to better stay on level. However, if what was thought to be a chemical imbalance is truly a behavioral vision disorder, he will still not be comfortable processing visual information.

Children suffering from a behavioral vision disorder commonly have difficulty converging their eyes inward (inefficiency turning eyes inward), have difficulty focusing (inefficiency identifying) and are not be able to track (follow from one point to another). Misdiagnosis may not only support visual inaccuracy, it can diminish self esteem and even develop into the “Failure Syndrome.” Children with this syndrome believe that in not being able to perform a task correctly, they are incorrect.

Misdiagnosed children may not be considered “at risk” because medication has appeared to ease the situation. However, they will most likely be affected by a lack of self worth that the misdiagnosis has instilled within them. This may ultimately lower a child’s professional expectation and cause him to accept a vocation or profession lower than his actual potential.

What would have happened had these children been introduced to a behavioral vision approach? Not only could they have achieved success in reading and learning but they may have actually reached their life’s potential and subsequent joy.

Parents and child study team members may feel a false sense of security believing that they’ve taken the child to the eye doctor who said, your child’s eyes are fine, they see “20/20.” Seeing with clarity is important and yet a child’s visual concerns may have nothing to do with eyesight and everything to do with efficient, effective and effortless eye coordination, focus and tracking ability.

A lack of visual coordination results in two sets of eye muscles not working together.  One muscle system controls focus, for clarity, while the other system controls seeing single, not double.  These two systems are linked. Inaccuracy in one system will typically create a mismatch in the other creating inefficiency between the two.  Classical symptoms of a motivated  child trying to overcome visual dysfunction is eye strain associated with excessive eye rubbing/burning, headaches after visual activities and blurred vision during near activities. Symptoms of eye avoidance, typical of an unmotivated child, are double vision, omissions, or substituting words while reading, difficulty finishing school work and the most common symptom loss of place while reading.  Nonreaders have no symptoms at all simply because they avoid any situation which calls for them to read for any considerable length of time.

The success of vision therapy depends on the motivation of the team: inclusive of the child, parents and Behavioral Optometrist.  If the condition is recent and academic lags have not yet occurred, the program is quite simple often resulting in complete remediation.  When the condition is long standing, academic and/or emotional concerns can become secondary problems which must be addressed along with the primary visual. The more complex the situation the more involved the treatment strategy.  When secondary issues are evident the team must include the appropriate professionals. With academic involvement, reading, learning and special education professionals need to be resourced.  Social workers/psychologists consulted if emotional concerns have surfaced. Occupational and Physical therapists utilized for the development of fine and gross motor skills and Speech and Language therapists responsible for treatment of receptive and/or expressive language delay.

Parents, teachers and school administrators have the power to advocate for our children especially when they realize that symptoms of these labeled children can mimic behavioral vision dysfunction. Throw open your child’s door of opportunity and success and advocate for your bright and intelligent child’s ability to read, write and learn accessing the freedom of visual self-discovery through the benefits of a vision therapy program.

One of the most common and enthusiastic statements parents in my office make is “guess what, my child just picked up a book to read all by herself.”

Early and appropriate intervention is essential when changing a child’s course of development from one of frustration and lack of ability to one which encourages belief in oneself through success in a task.

About Dr. Warshowsky:

Joel H. Warshowsky is a behavioral and developmental Optometrist. He is Associate Clinical Professor and founding Chief of Pediatrics at SUNY State College of Optometry, where he has taught for over 35 years. He served as Optometric Consultant to numerous schools for child development throughout New York and New Jersey. Dr. Warshowsky has lectured internationally and is published widely in the field of optometry, and is a Fellow of the American Academy of Optometry and College of Optometrists in Vision Development. He maintains two pediatric practices in New York and New Jersey.

Dr. Warshowsky is available for speaking engagements


How Behavioral Optometry Can Unlock Your Child’s Potential: Identifying and Overcoming Blocks to Concentration, Self-Esteem and School Success with Vision Therapy can be purchased from,, and through all major booksellers.

1 comment:

Unknown said...

While of course it can be frustrating not to know the cause of problem behavior, some doctors are too quick to jump to conclusions, delaying the truth and potentially causing unnecessary suffering and expense in the meantime. In some cases, there may even be grounds for contacting a medical malpractice lawyer. Something needs to put a stop to this epidemic of misdiagnosis.