Specific Learning Difficulties

Question 1

Examples of Specific Learning Difficulties

Answer 1

• Dyslexia
• Dyspraxia
• Dyscalculia
• Dysgraphia
• ADHD
• Autism
• Scotopic Sensitivity Syndrome

Question 2

What standard orthoptics tests would we use for specific learning difficulties?

Answer 2

VA
CT & PCT
OM → Smooth Pursuit & Saccades (speed, accuracy)

Convergence (assess fatigue, smooth and jump)
Accommodation (subj & obj)
BSV
Colour vision
Visual fields

Refraction, Fundus and Media

Ophthalmic imaging?
EDTs?

Question 3

What additional orthoptics tests would we use in Specific Learning Difficulties?

Answer 3

• Developmental eye movement test (DEMs)
• Wilkins Rate of Reading
• Test of Visual Perceptual Skills (TVPS)
• Colourimetry
• Coloured Overlay Assessment
• Developmental eye movement test

Question 4

What’s the developmental eye movement test?

Answer 4

Designed to detect errors of vertical & horizontal scanning
Patient is timed reading subsets of numbers
- Horizontal time
- Vertical time
- Ratio = Horiz / Vert
- Errors
- Compare to normative data
Used to detect problems with scanning or tracking

Question 5

What is the aim of treatment in SpLD?

Answer 5

Aim of treatment = specific teaching / education input to improve individual weaknesses
Treatment is not a cure for the condition itself

• Coloured overlays & tints
  in patients with Meares-Irlen syndrome
• Eye movement training
  exercises to improve the speed & accuracy of eye movements
  tracking exercises (Ann Arbor exercises)
• Visual perceptual training
  hand-eye coordination type exercises to improve ‘visual processing skills’ – often found in Behavioural Optometry
• Advice / strategies
  Font size, position in classroom, aids to keep place on line, referral to specialist

Question 6

What is the Wilkins Rate of Reading test?

Answer 6

Wilkins Rate of Reading
- Contains words in a random order
- Patient reads the words on the page out loud
- Clinician records the time taken & the number of errors made
- Simple words familiar to children age 7 upwards.
- A 5% increase in the score is considered clinically significant (with colours overlays)

Question 7

What evidence is there around treatment in SpLD?

Answer 7

Galuschka et al (2014) → Effect of colour was a placebo effect

Henderson et al (2013) → Improvement in reading speed with an overlay was not reliable and reduced on retesting in dyslexic students

Uccula et al (2014) → Coloured overlays work for some

Conway et al (2016) → Gender influenced choice of tinted lenses (not overlays)

Razuk et al (2018) → Green filters improve reading performance

American Academy of Pediatrics (Handler et al 2011) → The scientific evidence does not support the claims that coloured filters and lenses are effective direct or indirect treatments for learning disabilities

Griffiths et al (2016) → Coloured overlays not effective and any effects are likely to be placebo or practice effects

Evans and Allen (2016) → Coloured filters can improve reading in visual stress, but are not a treatment for dyslexia

Suttle et al (2018) → Evidence not reliable. Coloured filters not effective. Clinicians may choose for the placebo effect

Question 8

What is an example essay question where SpLD can be incorporated into it?

Answer 8

Discuss the orthoptic investigation of a 12-year-old child presenting with difficulty reading at near