Fact or Fiction? Determining the Truth Behind Two Common Treatments for Attention and Learning Challenges
Anecdotes of how something helped “save a child’s life” or recommendations from someone you trust (doctor, psychologist, optometrist) can easily sway concerned parents wanting to help their child. The best advice is to ensure that you’re getting evidence-based programs and supports in place. But what does the evidence say about two popular treatments parents are choosing: Brain-Training Games and Vision Therapy?
Over the last few years, brain-training programs have become widely popular and made multi-billions of dollars for their creators. The advertising would have you believe that these computer-based games will increase your memory, your level of attention, your reaction time, and even your overall IQ. Some even suggest reduced symptoms in children with ADHD. However, how trustworthy are these claims?
The Facts: In 2014, over 70 psychology and neuroscience experts signed an open letter warning that brain training companies were exaggerating the benefits of their products. More recently, one game-making company was fined for making unsubstantiated claims about the benefits of their products. Reliable research shows that playing these games simply helps you get better at those games or very similar tasks. There is little evidence to suggest that these improvements will transfer or generalize to other areas of your life, such as academic achievement or work performance. And unfortunately, it won’t stop the mental decline of aging!
In order to experience improvements in abilities, we need to encounter practice and experience in the real world. The time spent on such games would be better spent “… learning things that are likely to improve your performance at school (e.g., reading; developing knowledge and skills in math, science, or the arts), on the job (e.g., updating your knowledge of content and standards in your profession), or in activities that are otherwise enjoyable.” (Simons et al, 2016). As for treatment of ADHD, research consistently shows that psychostimulant medication (alone or combined with behavioural strategies) administered and monitored carefully, shows the largest improvement in symptoms related to inattention and hyperactivity/impulsivity symptoms. Approximately 80% of individuals respond positively to such medication.
When a child is presenting with learning challenges, the first course of action should be to get vision, hearing, and medical checks to rule-out issues in these areas that may present themselves as reading challenges such as dyslexia. Many people think that dyslexia means that a child reverses letters or skips words or lines on a page, and therefore must be a vision problem. But, is this correct? Does vision therapy help?
The Facts: Dyslexia is a phonologically based disorder, meaning that it involves the understanding of, and the ability to break down, the sound structure of language. While we need vision to see what is on the page, the act of reading is a higher-level process that occurs AFTER the visual signals are sent to the brain.
Research suggests that children with dyslexia or other related Learning Disabilities have the same visual function and ocular (eye) health as other children. Thus, eye exercises or vision therapy are not effective direct or indirect treatments for Learning Disabilities. They do not improve the decoding or understanding of reading. Similar to brain training research, the research that shows support for vision therapy as a treatment for Learning Disabilities has been poorly designed. A joint statement from the American Academy of Pediatrics, American Academy of Ophthalmology, the American Academy of Pediatric Ophthalmology, and the American Association of Certified Orthoptists (initially put out in 2009 and then supported in 2011) urges their members not to recommend vision therapy for the purposes of treatment for Learning Disabilities including dyslexia. Referring to dyslexia and ADHD, they state: “Scientific evidence does not support the efficacy of eye exercises, behavioural vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioural vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended.”
What the child needs is to learn how to read rather than control their eye movements because visual problems do not underlie dyslexia. Research for decades has consistently shown that children show improvements in their reading with intensive, phonologically-based remedial instruction that is multi-sensory in nature. Difficulties in maintaining proper directionality and even saccades (quick movements/jumps of both eyes together to another location) are symptoms, not causes, of reading disorders. The reversals and skipping of words are related to linguistic deficiencies rather than visual deficiencies.
Additional note: If a child is complaining of blurry vision, it could be the case that they are struggling with a visual problem such as convergence insufficiency (a condition in which the eyes are not efficient in how they are working together to look at nearby objects). This can make reading hard and should be treated with vision therapy.
Vision therapy can also address other visual problems related to visual acuity, eye tracking, ocular alignment, and other issues such as strabismus (eye turn) or amblyopia (lazy eye). Children with suspected Learning Disabilities who appear to also have a vision problem should be seen for a thorough evaluation by an experienced ophthalmologist as routine vision screenings may not pick up on these treatable visual problems that can contribute to learning, and particularly reading, problems. If you suspect this, ask for a referral from your family physician. When no such problems are found, no further vision-related assessment or treatment is required. If vision therapy is recommended for treatment of a vision problem, parents should understand that it will not fix the reading problems; reading instruction will still be required after (or during) the vision therapy is completed.
Treatment recommendations for children with learning and attention challenges should come from evidence-based practices to ensure that the learning difficulties are being addressed in the best way possible. Treatments that do not have research support behind them can delay proper treatment of a child’s difficulties. Furthermore, they can waste valuable time, energy, and of course money, as well as produce a false sense of hope. However, as I said to a set of parents recently regarding their son’s use of ‘Dyslexic Font’ (a letter font developed to help dyslexics read easier but is not supported by research (because dyslexia is not a vision problem)), if the tool is allowing the student to have enthusiasm towards reading and keeps his interest, then, by all means, keep it in place. Such tools won’t do any harm, except perhaps to your wallet. Just remember that they likely won’t make much of a difference. Thus, such treatments should not replace traditional, evidence-based treatments. If you’re wondering whether a treatment is an appropriate choice for your child, feel free to question the professionals, including school psychologists, in your child’s life.