Category Archives: Vision Training

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:


Can vision problems affect my child’s life outside of school?

While many vision problems are first suspected in a school setting or learning environment when a child has difficulty with reading, writing, math, or engages in disruptive classroom behavior, vision problems can also significantly affect the child’s life outside of school.

If a child has a visual processing issue, seemingly simple tasks may be more difficult for him than other children. He may struggle to learn how to tie his shoes, match his socks, or follow demonstrated instructions. You might notice that he has trouble remembering his own address, phone number, or retelling stories about something he watched on television or experienced.

Vision problems also affect social interaction. Your child might appear awkward, clumsy, or other children may complain that he is invading their personal space, because he has trouble with spatial and body awareness and depth perception. The other children might treat him differently because he has developed coping habits, such as constantly rubbing his eyes, squinting, or tilting his head, or because he often complains of headaches or nausea. He may become distracted while talking or ignore the rhythm of a conversation and other social cues. Children or other parents might unfairly judge this behavior as unmannerly or inconsiderate.

In addition to learning difficulties, vision problems can affect physical activity as well. A child with an untreated vision problem may perform poorly in sports due to clumsiness, poor hand-eye coordination, inability to focus, or skewed depth perception. They may be picked last for teams; or the the other children may leave them out of games or tease them.

At home, a child’s untreated vision problems may contribute to stress in the household. Homework can consume hours of family time. Parents often become frustrated or angry with a child if he keeps getting in trouble at school or ‘acting out’ with friends or siblings. Particularly if parents did well in school or sports, they may not be able to relate to their child’s struggles and suspect that their child is not trying or that he’s just ‘bad.’

Dealing with difficulty in school, awkwardness in social settings, poor performance in physical activities, and strained relationships with parents is a lot for a child to handle. While children with other learning disabilities may excel in sports or sociability, vision problems interfere more often beyond the classroom. Falling behind academically and being treated differently by peers and adults can lead to low self-esteem and withdrawal.

Fortunately, a personalized vision therapy program treats visual processing problems. Vision therapy, also known as vision training, is likely to significantly improve performance in academic, athletic, and social settings. In fact, one of the first benefits of vision therapy parents often report is that their child’s self-esteem improves dramatically shortly after starting a vision therapy program.

Dr. Philip Nicholson’s Visual Learning Center treats visual processing problems with individualized vision therapy programs in our Olney, MD office, convenient to Silver Spring. Contact us today to schedule a comprehensive exam and consultation.

Teacher Appreciation Week: How Vision Therapy Can Help Teachers

It’s Teacher Appreciation Week, and we want to express a big thank you to all of the teachers who support students in the classroom. At the Visual Learning Center, we work daily with children who have struggled in school due to learning-related vision problems, sometimes for years before receiving a diagnosis; and their caring, patient, and skilled teachers deserve appreciation for their dedication to each child’s success.

Classroom teachers serve as our allies and partners in vision therapy, so we wish to celebrate their service to the community and welcome the opportunity offer our support in return.

When a child has difficulty in school — particularly if parents feel confident that their child is smart — teachers sometimes endure undue blame. Parents are understandably frustrated when a child performs poorly and may assume the teacher should know what to do to improve their child’s performance.

Teachers are educated in a wide variety of subject matter, teaching methods, and classroom management skills; and they receive training in detecting possible learning disabilities and special needs. However, the majority of teachers are unaware of how common learning-related vision problems are, and most teachers simply do not know how to recognize the symptoms.

Once teachers learn about how vision affects learning, they begin to recognize vision problems in their classroom right away and realize this is something they have been dealing with for years.

So, how can teachers get the help they need?

First, they have to be able to recognize vision symptoms that may affect learning, such as:

  • Squinting while reading near or far
  • Rubbing eyes continuously throughout the day
  • Rubbing temple or forehead and complaining of headaches
  • Complaints of dizziness or motion sickness
  • Skipping words or losing place while reading
  • Confusing similar words
  • Reversing letters
  • Easily distracted, inattentive, unable to stay on task
  • Disruptive behavior, especially after expressing frustration with work
  • Poor hand-eye coordination, depth perception, or awkwardness and clumsiness
  • Performs noticeably better orally than written

As you may recognize, many of these symptoms can also indicate learning disabilities, dyslexia, ADD/ADHD, or even health problems; and consequently, misdiagnosis is common. A possible vision problem is often overlooked.

If you are a teacher, you can expect that parents may dismiss your suggestion that their child has a vision problem because he or she has “20/20 eyesight.”  It is important for teachers to understand that the vision problems that affect learning are not usually detected during routine vision screenings at school or typical vision exams with the family’s eye doctor.

Typical vision exams only test for eye sight, or vision clarity at a distance. However, vision involves an entire vision processing system — the coordination of eye muscles and the brain.

A healthy vision system can function well over prolonged periods of time in a classroom setting; but if the child has a vision problem, he will grow tired and frustrated, not understanding why he has so much trouble doing tasks that seem easy for his peers. So a child with vision problems might seem to give up, have low self-esteem, or act out as a result.

Once a child is properly diagnosed by an optometrist who specializes in functional and developmental vision care, he can take part in an intensive individualized vision therapy program, which is likely to bring about remarkably fast and long-term results.

To learn more about vision and vision therapy, download our free guide, watch our webinar, and see our resources for teachers and parents.

If you are a teacher in Olney, Silver Spring, or the surrounding area, invite Dr. Philip Nicholson to speak at your school or association. Click here to learn more.

What Appears to be Attention Deficit Disorder Could be a Vision Problem

Have you received a note from school saying your son or daughter is having difficulty paying attention? Did your child’s teacher or counselor recommend testing for attention deficit disorder (ADD/ADHD)?

Teachers might describe your child as distracted or antsy, report that your child daydreams in class, stares out the window, or looks around the room when he should be focusing on his paper or the board. You may have noticed that your child has a short attention span, trouble reading, and difficulty staying on task or following instructions.

Your pediatrician or a pediatric psychiatrist might have diagnosed your child with attention deficit disorder and prescribed medication, such as Ritalin or Adderall.  No parent wants this diagnosis for their child or to medicate their child unnecessarily. But if a child truly has attention deficit disorder, caring parents want what’s best, so the child can improve, learn, settle down, behave, feel more in control, and get along better with peers. If a child does have ADD/ADHD, proper treatment can work wonders.

However, some children are misdiagnosed with attention deficit disorder, when the symptoms they are experiencing are actually related to a vision disorder. Many parents only learn that vision can be at the root of the problem when a child’s behavior and attention does not improve with treatment for attention deficit disorder.

Vision is not usually suspected. Suggestions that a vision problem could be to blame are often initially dismissed; because after all, most children undergo vision screening at school or have an annual exam by their family eye doctor. The child either has “20/20 vision” or he already wears corrective lenses.

However, “20/20 vision” is not enough, as it simply indicates that a patient can see clearly at 20 feet of distance. It does not test how well the child can see close up, how eyes function when they move across a page or from a desk to the board and back again. Screening for 20/20 eye sight also does not assess how well visual processing works, meaning there is no measurement of how well the child is able to remember or make sense of what he sees.

In fact, the eye chart test only catches a small percentage of vision problems. Unfortunately, screening for distance only is outdated and inadequate, considering the tasks and learning activities children need to complete in school.

When a child has a learning-related vision problem and his visual processing skills are weak, he must put forth a tremendous amount of extra effort just to keep his eyes turned correctly, focused, aligned, and recall or process what he is learning. This extra effort can cause fatigue, headaches, and unease.

As a result of experiencing visual difficulties, the child may choose to stare into space, respond to irritability by moving around or choosing an activity that does not cause as much stress on his visual system, or react to his frustration with disruptive behavior. What appears to be daydreaming, distraction, or ‘acting out’ may simply be avoidance or coping behaviors. He does not understand that something is wrong; he is simply adapting to his environment and expectations as best he can.

If your child’s attention or behavioral problem is resulting from a vision deficiency, the good news is a personalized intensive vision therapy program can result in significant and lasting improvement within a relatively short period of time.

To be clear, not all attention problems are related to vision. A child may be dealing with neurological, psychological, nutritional, environmental, auditory processing, or any number of factors. Vision therapy only helps with attention and behavioral problems if a child has a vision problem.

To determine if your child has a vision problem that may be affecting his attention or behavior, he should undergo a functional vision exam and through vision assessment by an optometrist that specializes in functional and developmental vision care.

If you suspect a vision problem, or you want to rule out a vision problem in your child, and you live near Olney, MD or Silver Spring, MD, contact us to schedule an appointment with the Visual Learning Center.

Is vision therapy a “proven therapy” or is it “quackery”?

Vision therapy is a proven therapy that is well-documented in medical journals, scientific literature, and supported by the National Institutes of Health (NIH) in Bethesda, MD, not far from our center.

Despite vision therapy’s solid reputation in the scientific community, awareness about learning-related vision problems and vision therapy’s effectiveness is not widespread. Lack of familiarity sometimes creates a healthy dose of skepticism, which we discuss regularly with parents.

When you learn about something new that challenges previously held beliefs, it is natural to view it with a critical eye. If a child has considerable difficulty reading or writing, your first thoughts are likely to suspect a learning disability or dyslexia. If a child has attention or behavioral problems, popular opinions point to attention deficit disorders (ADD/ADHD).

Learning-related vision problems may be new on your radar; and as a parent, caregiver, teacher, or pediatric occupational therapist, it is your duty to scrutinize new information and work in a child’s best interest.

Obviously no doctor or practice ever wants to be accused of quackery or placed in the same category as a snake oil salesmen. Vision therapy is sometimes confused with “the Bates Method” or the “See Clearly Method” which do not have the same scientific basis or reputation as vision therapy, which is known in the medical literature as Orthoptic Therapy.

Rest assured, vision therapy has been proven effective in treating visual processing problems.

The NIH published results of a study, which proved vision therapy’s efficacy for the most common problems we find in students struggling in school. The Journal of the American Optometric Association has published articles about vision therapy’s effectiveness citing more than 260 peer-reviewed journals.

The reason you are not more familiar with vision therapy is simply that you have not read the studies and journals, and the information has not been picked up by the media or distributed through other outlets. As practitioners of vision therapy, it is our job to inform you about it, and you will find many helpful resources on our website about it.

At the Visual Learning Center, our vision therapy program is based on the latest scientific studies, and we have a proven track record of vision therapy success. Learn more about visual processing skill deficiencies and vision therapy by downloading this guide and watching this webinar.

We offer vision therapy to children and adolescents with learning-related vision problems in our Olney, MD, office, which is convenient to families in Silver Spring.

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.

Do the improvements achieved in vision therapy last?

When a patient undergoes vision therapy, families often recognize remarkable improvement in a rather short period of time. Within a matter of a few weeks or months, many children are able to make significant progress.

Noticeable improvement early in the vision therapy program instills confidence in patients and provides hope for families that their child will overcome the learning-related vision problems that have caused so much frustration and struggle. Because the child’s vision skills develop through vision therapy exercises, activities, and practice, parents often wonder if the effects will last beyond time spent in the program.

Because your child has not undergone surgery and was not prescribed new corrective lenses or medication, you may suspect that vision therapy is not a permanent solution. Often parents wonder if the effects are a quick fix that will fade away with time. You may question whether your child will require vision therapy throughout his lifetime, become dependent on a lifelong costly treatment, or risk reverting to the problems experienced prior to participating in the vision therapy program.

Not only do we expect the results your child experiences from vision therapy to last, we also expect improvements to continue.

Your child will continue to use the new skills learned on a daily basis. Just like fitness and exercise, as long as she continues to use skills regularly, those skills will continue to function and even develop further.

When your child learns new visual processing skills, these new skills will be used repeatedly, become habitual, and the visual system will begin to work correctly and more efficiently.

In vision therapy, also known as vision training, your child will learn meaningful skills that are used in daily activities, so there is a high level of retention. You should notice continued improvement in your child as he or she progresses throughout the school year.  Many of the skills we work on in-office during vision therapy will continue to strengthen as they are put to the test in a school environment.

At the Visual Learning Center in Olney. MD, we stress the importance of having progress checks at 6 or 12 months after a child has completed a therapy program. This will ensure that the gains we made while in therapy are still holding strong, and we will make recommendations for continued improvement. Schedule an assessment appointment today.

eye with earth reflection

How are “Visual Skills” related to learning?

Discovering that your child is struggling to learn, not because of a learning disability or lack of classroom skills, but instead a problem with their “visual skills” can be confusing for parents.

If a school screening or an eye doctor’s exam indicates that your child has no trouble with her eyesight, it can be even more confusing. You might ask yourself, “If my child can see just fine, how can there be something wrong with her vision?”

You might wonder how a child with 20/20 eyesight can also have a vision problem that is so significant that her learning is delayed or disrupted.

Most people think that vision is the same as sight. So if that’s what you thought too, you’re not alone.

However, sight simply provides the input for a child’s learning, while vision represents a complex system. When a child’s vision system is working efficiently, that child can process, understand, and relate new information to knowledge he or she already has.

On the other hand, when a child’s visual system is not working as it should, visual skills deficiencies can contribute to learning problems. If children experience a lag in their ability to recognize what they see, and relate it to what they already know, and then use this information as a basis for future understanding, the learning process can become frustrating.

For the learning process to work as it should, your child must first be able to see, then use what he sees to understand. The ability to see letters on a chart for an eye exam is not enough — 20/20 vision is not enough.

What developmental optometrists know is that there is a very important relationship between vision and the brain. The two work together so closely that vision and intelligence and understanding are almost synonymous

Sound complicated? It is. But the good news is, many children with low visual skills are often quite bright, or they may have little enduring learning problems with proper vision therapy. Also known as vision training, vision therapy can improve visual skills significantly and quickly.

A child’s ability to perform visual tasks (such as reading and studying) depends on the ability to synchronize thinking and seeing. The processes of thinking and seeing work together to give a perceptual and conceptual understanding of the material. The full spectrum of seeing and thinking needs to run smoothly for a child to gain meaning from what is taught.

Vision therapy exercises improve the integration of seeing and thinking.

Visual skills such as focusing, following moving objects, aiming, turning the eyes together as a team, visual processing and other abilities can be inefficient or poorly integrated, which can put great strain on a child.

Vision training allows a child to practice and strengthen vision skills, lessening the strain and effort they will have to put forth.

Experts have found that when anyone’s attention is spread between a number of tasks, it reduces the efficiency of the tasks. Think of the last time you tried to do two things at once. Was it easy? Did you do both as well as you wanted to? Or did one (or both) tasks suffer

When a child’s attention and efforts are spread between trying to make the visual system work physically and understanding the material, attempting to learn anything new that requires visual skills can be discouraging. A child who does not have deficiencies in visual processing can simply focus on understanding the material, without the interference of trying to get their system to function as it should.

Vision therapy serves to help children strengthen the link between vision and intelligence. Once visual skills are improved through vision therapy, it frees up energy and focus for actual learning. The less stressed mind is freed to focus on the task at hand.

Vision therapy in Olney, MD, and convenient to Silver Spring, MD, is provided by Dr. Philip Nicholson, O.D. and his staff at the Visual Learning Center. Call 301-570-4611 for a comprehensive assessment and to see if your child might significantly benefit from vision training.

Can an attention problem actually be a vision problem?

Many parents question their child’s attention span. When a child will not sit still, stay focused on a task long enough to complete it, stares into space too often, hops from subject to subject, jumps from activity to activity, or simply appears to have too much energy, the child’s spirited behavior can go from charming to concerning to, in some cases, alarming.

Could there be a problem with your child’s attention span?

You may wonder how long a normal attention span is, begin to compare your child’s attention span to those of their friends, and you may even start to suspect that your child has an attention problem, such as Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).

Attention disorder diagnoses have become commonplace. However, most parents, teachers, and even trained psychologists and other professionals are unaware that childhood behavior that appears to be an attention problem could actually be caused by a vision problem in disguise.

Unfortunately, many parents only begin looking for alternative causes to attention problems when diagnosis, treatment, and medication for ADD/ADHD does not improve a child’s behavior or performance in school. This is because awareness about learning-related and behavioral-related vision problems is not as widely spread as knowledge of attention deficit disorders.

Attention is the ability to focus consciousness on a task. Studies show attention is the most essential factor for academic success; and in order for a student to be successful, he or she must first come to attention and then maintain attention on the task at hand. In school, these attention requirements largely involve strong visual processing skills.

What does attention have to do with vision?

The ability to stay on a task is often adversely affected by poor visual processing skills. If a child is unable to keep his or her eyes aimed properly, for prolonged periods, comfortably and easily, this deficit in the functioning of their eyes and visual processing system can interfere with their ability to maintain attention.

When visual processing skills are weak, the effort a student must put forth to keep their eyes turned correctly, aligned, and focused can cause unease, fatigue, and headaches. It’s easier and more natural for the child to give up on a task that requires sustained focus and move on to an activity that allows for more sporadic and unfocused eye movement. Talking in class and moving around the room causes far less frustration for them than aiming their eyes at the text on a paper in front of them, on a screen, or on the board.

Unable to enjoy the ease many of their peers experience in remaining focused on a visual task, a student may choose to doodle, talk in class, act out, or cause disruptions. So what looks like ADD/ADHD could very well be the result of a vision problem.

Research shows visual attention skills can be dramatically improved with intense, one-on-one vision training, also known as vision therapy.

In Olney, MD and convenient to Silver Spring and surrounding areas, Dr. Philip Nicholson, OD’s Visual Learning Center provides comprehensive evaluations to determine if your child might significantly benefit from vision therapy.

girl reading

How will vision therapy help my child in reading?


Although it may not seem apparent at first, reading can be extremely difficult for a child with visual problems. When learning-related vision problems go undetected, a child might seem to be picking up on words and demonstrating comprehension initially, but overall performance and literacy will suffer.

Studies have revealed that the greater the amount of effort a child must put forth to read, the lower the child’s overall reading performance and comprehension will be. Reading requires prolonged fixation on reading materials, so the effort necessary to read is particularly challenging if the child has visual deficiencies, such as oculomotor and binocular weakness.

For a person to read, it is necessary for the two eyes to be properly aimed at text, so the eyes must turn inward. For some children, the eyes will naturally turn outward; and this deviation — even if slight and unnoticeable to parents or teachers — means that the child must use excess effort and energy to maintain fixation on the reading material.

If a child is unable to aim his or her eyes inwardly easily, he or she may not see every word in sequential order.  Instead, the child’s eyes may skip words or phrases, bounce around the text, and land at words sporadically.

A parent or teacher might notice that a student omits or adds words to make sense of a sentence, without actually seeing those words.

A child may be seeing double due to overlapping vision and experiencing headaches and eye fatigue as a result. But the child is often unable to express “seeing double” because he or she is unaware that the way they are seeing is not the correct way to see.

Vision therapy or vision training treats and quickly improves eye disorders by facilitating exercises and activities that strengthen existing weaknesses within the visual processing system.

Many children who participate in our vision therapy programs in Olney, Md. come to us having tested far below their current age levels in sensory skills, such as those related to oculomotor or binocular weakness.  Upon completing therapy, they retake the initial screening tests with impressive results.

Read some of our vision training success stories to learn more about how vision therapy can help your child in reading.  Contact us to learn more about how vision training can improve speed and accuracy of eye movements, visual concentration, letter reversals and other skills, making learning easier, faster, and more enjoyable.