Category Archives: Letter Reversals

children with visual discrimination problems

Poor visual discrimination skills are often mistaken for symptoms of dyslexia

The Visual Learning Center offers 
developmental optometry & vision therapy
near Silver Spring, Maryland in Olney.

Does your child struggle with reading? Have you noticed your child reversing letters? If so, you and your child’s teachers may suspect dyslexia. However, an undetected vision problem that can be treated with vision therapy could actually be to blame for letter reversals and other common learning problems.

Download our free guide: “10 Things You Need to Know About Vision” here.

Dyslexia is a language-based learning disability that causes difficulty with reading, writing, and spelling. Reversing letters is one of the most familiar tell-tale signs of dyslexia, but letter reversals are common among children with treatable vision problems too.

People with dyslexia learn differently, and while they are often able to adapt and overcome the challenges they face, it is a condition that can’t be reversed.

Visual discrimination is a perceptual process involving our ability to correctly identify distinctive features of a visual stimulus, such as text. Visual discrimination skills enable a child to see and identify size, color, shape, and orientation.

Poor visual discrimination skills cause a child to have difficulty with directionality or laterality. With poor directionality or laterality skills, a child is unable to distinguish left from right on themselves, which causes them to have trouble distinguishing left from right on other objects, including letters and numbers.

For example, they will confuse b with d or q with p. They may also confuse b with p or d with q.

You will notice young children having trouble determining left from right, which is a normal phase of learning; but by the time a child reaches second grade, this skill should be fully developed. For those of us with a normal healthy visual processing system, this skill develops early and naturally. So if the child continues to confuse directions and reverse letters beyond second grade, they may need to undergo vision therapy to further develop the skill.

When visual discrimination isn’t functioning properly, similar letters and words will continue to be confused. In addition to directionality, they may confuse words that appear similar, such as “want” and “what.”

Without addressing this problem, deficient visual discrimination functions can be a lifelong challenge.

The good news is, unlike dyslexia and other learning disabilities, poor visual discrimination skills can be treated and improved significantly in a short period of time with vision therapy. Vision Therapy is a treatment program that includes exercises and procedures that are designed to enhance a child’s ability to control eye movement and visual processing.

View demonstrations of vision therapy exercises to improve visual discrimination skills here.

Register for an upcoming webinar here.

If you suspect that your child might have a problem with visual discrimination, contact your nearest developmental optometrist who specializes in functional vision care for a comprehensive vision exam.

For vision therapy in Silver Spring or Olney, Maryland, contact Dr. Philip Nicholson’s Visual Learning Center to schedule a comprehensive vision exam today.

letter reversals

Letter Reversals: Is it dyslexia or something else?


When parents notice a child reversing letters, they often suspect that the child could potentially have dyslexia. Dyslexia is a language-based learning disability that causes difficulty with reading, writing, and spelling.

Writing letters in reverse is one of the most well-known and recognizable signs that a child may have dyslexia. So when a child is experiencing difficulty learning to read and also reverses letters, it’s reasonable to speculate that dyslexia could be to blame.

However, many parents and educators are unaware that letter reversals are also a common symptom of vision problems, such as eye movement disorders and visual processing deficiencies.

Click here to learn more about how vision problems interfere with learning.

If you notice that your preschooler through first grader is reversing letters, there’s no reason to be concerned. When a child is learning to read and write, confusing left with right and writing letters backwards is a perfectly normal part of the early development process. But if you notice that your child is still reversing letters in second grade and beyond, it’s time for a proper evaluation — a comprehensive vision exam by a developmental optometrist who specializes in functional vision care and vision therapy.

Typical vision screenings do not test for the learning-related vision problems that have similar symptoms to dyslexia. An exam by your family eye doctor usually only evaluates clarity of vision at a distance. So it is important to note that children with 20/20 eyesight may also have a vision disorder.

In addition to reversing letters, children with learning-related vision problems face many of the same challenges as children with dyslexia. They may confuse left with right and transpose words, have messy handwriting, experience and experience difficulty with peripheral vision and depth perception. Many struggle with reading comprehension. Some also have trouble staying on task and paying attention.

transposing letters and letter reversals


There are subtle differences between the symptoms of some vision disorders and dyslexia. Even a professional trained to recognize dyslexia may not suspect a vision deficiency without specific awareness.

Whereas dyslexia is a lifelong learning disability that many people learn to cope with successfully, functional vision problems can be treated and overcome. That’s why if you suspect dyslexia, it would be in your child’s best interest to rule out a functional vision problem that can be treated successfully with vision therapy.

To be clear, vision therapy does not cure dyslexia, but learning-related vision deficiencies that have symptoms similar to dyslexia can be improved and even eliminated by vision therapy. 

See our vision therapy success stories.

This video demonstrates a vision therapy activity that can improve letter reversals in children with vision problems:

Click here to learn more about this vision therapy activity.

To schedule a comprehensive functional vision exam and to learn more about vision therapy in Olney Maryland or Silver Spring, Maryland, contact Dr. Philip Nicholson’s Visual Learning Center.

Vision Therapy Exercise: Stickman Activity Packet

When a child has difficulty with reading, concentrating, confusing their left and right sides, or reversing letters, their challenges may indicate an undiagnosed vision problem. He or she could be struggling with eye movement skills or visual processing skills due to an underdeveloped ability to move or coordinate their eye muscles or an inability to process visual information through the brain efficiently.

A functional vision exam by an optometrist who specializes in developmental vision care can either rule out or diagnose a learning-related vision problem. If a child is found to have a vision problem that cannot be corrected with eyeglasses, a comprehensive, individualized vision therapy program often leads to significant improvement in a relatively short amount of time.

Eye movement skills or visual processing skills can be trained and developed through practicing a prescribed set of activities that a child will undergo with the guidance of a trained vision therapist. At the Visual Learning Center in Olney, MD, we suggest students supplement their in-office therapy with practice at home.

The Stickman Activity is one such exercise, designed to improve eye movement skills and visual processing skills. Working through and practicing this activity can improve the following skills:

  • Laterality and directionality — required for writing and recognizing orientation and direction
  • Figure ground — required to distinguish an image relative to its background or context
  • Visual concentration – required to fixate attention long enough to complete tasks and for comprehension

The vision therapy stickman activity is simple but effective. The person doing the activity is instructed to view a sheet that contains simple drawings of a figure wearing one glove or shoe, then say which hand is wearing the glove or which foot has a shoe on it. The goal is to first reach accuracy, then enhance difficulty by increasing speed or including rhythm elements.

Download your activity packet here.

Watch the video below for a demonstration:


Vision Therapy Exercise: Discrimination Orientation Arrows Activity

If your child struggles with determining the correct letter orientation — or reversing letters when writing — due to a visual processing skills deficiency, vision therapy exercises can help.

Discrimination Orientation Arrows (DOA) is a vision therapy activity that develops visual discrimination, which is a skill essential in determining correct letter orientation and preventing letter reversals among students with learning-related vision problems.

In this activity, students work with a sheet of paper that contains a series of arrows, which are pointing in various directions. The vision therapist asks students to look at the sheet and indicate which direction each arrow is pointing, by saying “left” or “right” while the eyes are moving across the page.We encourage students to start slowly and allow for mistakes and self-correction to build their confidence.

This activity seeks to mimic the process of selecting a direction for each letter while writing.  “Should d point right or left? Should b point left or right? Which direction should I write q? Which direction should I write p?”

With practice, the outcome children enjoy is that they begin to catch their mistakes faster, reduce the frequency of errors, and dramatically boost their self-esteem. As the student improves, we incorporate a metronome into the activity and they use the beat to enhance deeper comprehension of discrimination orientation skills, until they become second nature. Soon, they will be writing b, d, q, p, etc. correctly, and with confidence.

Watch this video to see a demonstration of the Discrimination Orientation Arrows activity in progress and download a Discrimination Arrows activity packet here.


Should you wish to learn more about this vision therapy activity for letter reversals or schedule an appointment with Visual Learning Center in Olney, Maryland, contact us today at (301) 570-4611.

child reverses letters while writing at a desk

Common Causes When a Child Reverses Letters

When parents notice a child reversing letters, they often assume that what they are observing is a sign or symptom of dyslexia.

Dyslexia is a language-based learning disability that causes difficulty in writing, reading, and spelling. Children with dyslexia often reverse letters; however, while letter reversal in writing can be a symptom of dyslexia, this does not mean that every child who reverses letters has dyslexia.

A child may reverse letters in the early stages of learning. As a child begins to practice writing, they will make mistakes or their motor skills might not be well developed yet. Parents and teachers should continue to observe and see if the child makes improvement with guidance and practice.

Children who do not improve letter reversals within the first two years of schooling should be watched more closely and evaluated by a professional. The child could be dyslexic or have another learning disability.

But there is also a another lesser-known cause that could explain the child’s tendency to reverse letters, such as ‘p’ and ‘q’ or ‘b’ and ‘d’ when writing. Learning-related vision problems interfere with the visual processing system and cause affected children to reverse letters. Without detection, diagnosis, and vision therapy, the child will continue to reverse letters and struggle with reading, writing, and spelling.

Research indicates the major causes of letter reversals include the following:

  • Poor visual memory:  the ability to recall a visual image
  • Poor visualization: the ability to create a mental image
  • Poor visual-motor integrations:  the ability of the visual and muscular system to reinforce each other
  • Poor visual association: the ability to link what you see with something you saw, heard, or felt in the past.

If a child is lacking ability or skills in the areas of visual association, integration, visual-motor, and recall skills, he will be more likely than his peers to continue reversing letters when writing. Intensive vision therapy will strengthen visual skills, and with training and practice, letter reversals can be eliminated.

“Parents are often told the child will outgrow it. And this can be true. Continued exposure to letters and numbers will reduce reversals; but if the underlying causes are left untreated, learning will still be slow and school performance will suffer.” – Dr. Philip Nicholson

Without knowing and addressing the cause of letter reversals beyond the initial stages of learning development, a child will not automatically improve.

Assuming the child is dyslexic may not help, unfortunately, because the methods used for helping a dyslexic child learn are different from the methods used to improve visual processing in a child who has learning-related vision problems.

If your child is reversing letters beyond second grade or 8 years of age, we recommend screening for dyslexia and vision problems. Learn more about learning-related vision problems by downloading our free guide here and watching our webinar here.

If you live near Olney, MD, schedule an appointment with the Visual Learning Center for a thorough vision assessment.