Visual and Auditory Processing Disorders

Introduction

Visual and auditory processing are the processes of recognizing and interpreting information taken in through the senses of sight and sound. The terms, "visual and auditory processing" and "visual and auditory perception", are often used interchangeably. Although there are many types of perception, the two most common areas of difficulty involved with a learning disability are visual and auditory perception. Since so much information in the classroom and at home is presented visually and/or verbally, the child with an auditory or visual perceptual disorder can be at a disadvantage in certain situations. The following information describes these two types of disorders, their educational implications, some basic interventions and what to do if there is a suspected problem.

For the sake of consistency, the terms used in this packet are visual processing disorder and auditory processing disorder. Other terms that refer to the same set of disorders include visual or auditory perceptual disorders, visual or auditory processing deficits, central auditory processing disorders, and other similar combinations of these terms.

Visual processing disorder

What is Visual Processing Disorder?

Visual processing disorder can cause issues with the way the brain processes visual information. There are many different types of processing disorder and many different symptoms, which can include trouble drawing or copying, inability to detect differences in shapes or letters, and letter reversals.

Visual processing disorders (VPDs) affect many students diagnosed with language-based learning disabilities.

Visual processing or perceptual, disorder refers to a hindered ability to make sense of information taken in through the eyes. This is different from problems involving sight or sharpness of vision. Difficulties with visual processing affect how visual information is interpreted, or processed by the brain.

Common areas of difficulty and some educational implications: Spatial relation

This refers to the position of objects in space. It also refers to the ability to accurately perceive objects in space with reference to other objects.

Reading and math are two subjects where accurate perception and understanding of spatial relationships are very important. Both of these subjects rely heavily on the use of symbols (letters, numbers, punctuation, math signs). Examples of how difficulty may interfere with learning are in being able to perceive words and numbers as separate units, directionality problems in reading and math, confusion of similarly shaped letters, such as b/d/p/q. The importance of being able to perceive objects in relation to other objects is often seen in math problems. To be successful, the person must be able to associate that certain digits go together to make a single number (ie, 14), that others are single-digit numbers, that the operational signs (+,,x,=) are distinct from the numbers, but demonstrate a relationship between them. The only cues to such math problems are the spacing and order between the symbols. These activities presuppose an ability and understanding of spatial relationships.

Visual discrimination

This is the ability to differentiate objects based on their individual characteristics. Visual discrimination is vital in the recognition of common objects and symbols. Attributes which children use to identify different objects include color, form, shape, pattern, size, and position. Visual discrimination also refers to the ability to recognize an object as distinct from its surrounding environment.

In terms of reading and mathematics, visual discrimination difficulties can interfere with the ability to accurately identify symbols, gain information from pictures, charts, or graphs, or be able to use visually presented material in a productive way. One example is being able to distinguish between an /nl and an Imp, where the only distinguishing feature is the number of humps in the letter. The ability to recognize distinct shapes from their background, such as objects in a picture, or letters on a chalkboard, is largely a function of visual discrimination.

Visual closure

Visual closure is often considered to be a function of visual discrimination. This is the ability to identify or recognize a symbol or object when the entire object is not visible.

Difficulties in visual closure can be seen in such school activities as when the young child is asked to identify or complete a drawing of, a human face. This difficulty can be so extreme that even a single missing facial feature (a nose, eye, mouth) could render the face unrecognizable by the child.

Object recognition (Visual Agnosia)

Many children are unable to visually recognize objects which are familiar to them or even objects which they can recognize through their other senses, such as touch or smell. One school of thought about this difficulty is that it is based upon an inability to integrate or synthesize visual stimuli into a recognizable whole. Another school of thought attributes this difficulty to a visual memory problem, whereby the person can not retrieve the mental representation of the object being viewed or make the connection between the mental representation and the object itself.

Educationally, this can interfere with the child's ability to consistently recognize letters, numbers, symbols, words, or pictures. This can obviously frustrate the learning process as what is learned on one day may not be there, or not be available to the child, the next. In cases of partial agnosia, what is learned on day one, "forgotten" on day two, maybe remembered?

Whole/part relationships

Some children have difficulty perceiving or integrating the relationship between an object or symbol in its entirety and the component parts which make it up. Some children may only perceive the pieces, while others are only able to see the whole. The common analogy is not being able to see the forest for the trees and conversely, being able to recognize a forest but not the individual trees which make it up.

In school, children are required to continuously transition from the whole to the parts and back again. A "whole perceiver", for example, might be very adept at recognizing complicated words, but would have difficulty naming the letters within it. On the other hand, "part perceivers" might be able to name the letters or some of the letters within a word, but have great difficulty integrating them to make up a whole, intact word. In creating artwork or looking at pictures, the "part perceivers" often pay great attention to details but lack the ability to see the relationship between the details. "Whole perceivers", on the other hand, might only be able to describe a piece of artwork in very general terms, or lack the ability to assimilate the pieces to make any sense of it at all. As with all abilities and disabilities, there is a wide range in the functioning of different children.

Interaction with other areas of development

A common area of difficulty is visual motor integration. This is the ability to use visual cues (sight) to guide the child's movements. This refers to both gross motor and fine motor tasks. Often children with difficulty in this area have a tough time orienting themselves in space, especially in relation to other people and objects. These are the children who are often called "clumsy" because they bump into things, place things on the edges of tables or counters where they fall off, "miss" their seats when they sit down, etc. This can interfere with virtually all areas of the child's life: social, academic, athletic, pragmatic. Difficulty with fine motor integration effects a child's writing, an organization on paper, and the ability to transition between a worksheet or keyboard and other necessary information which is in a book, on a number line, graph, chart, or computer screen.

Interventions

First, a few words about interventions in general. Interventions need to be aimed at the specific needs of the child. No two children share the same set of strengths or areas of weaknesses. An effective intervention is one that utilizes a child's strengths in order to build on the specific areas in need of development. As such, interventions need to be viewed as a dynamic and ever-changing process. Although this may sound overwhelming initially, it is important to remember that the process of finding successful interventions becomes easier with time and as the child's learning approach, style, and abilities become more easily seen. The following examples provide some ideas regarding a specific disability. It is only a beginning that is meant to encourage further thinking and development of specific interventions and intervention strategies.

The following represent a number of common interventions and accommodations used with children in their regular classroom:

• For readings
  Enlarged print for books, papers, worksheets or other materials which the child is expected to use can often make tasks much more manageable. Some books and other materials are commercially available; other materials will need to be enlarged using a photocopier or computer, when possible.
  There are a number of ways to help a child keep focused and not become overwhelmed when using painted information. For many children, a "window" made from cutting a rectangle in an index card helps keep the relevant numbers, words, sentences, etc. in clear focus while blocking out much of the peripheral material which can become distracting. As the child's tracking improves, the prompt can be reduced. For example, after a period of time, one might replace the "window" with a ruler or other straightedge, thus increasing the task demands while still providing additional structure. This can then be reduced to, perhaps, having the child point to the word s/he is reading with only a finger.
• For writing
  Adding more structure to the paper a child is using can often help him/her use the paper more effectively. This can be done in a number of ways. For example, lines can be made darker and more distinct. Paper with raised lines to provide kinesthetic feedback is available. Worksheets can be simplified in their structure and the amount of material that is contained per worksheet can be controlled. Using paper which is divided into large and distinct sections can often help with math problems.
• Teaching Style
  Being aware and monitoring the progress of the child's skills and abilities will help dictate what accommodations in classroom structure and/or materials are appropriate and feasible. In addition, the teacher can help by ensuring the child is never relying solely on an area of weakness unless that is the specific purpose of the activity. For example, if the teacher is referring to writing on a chalkboard or chart paper, s/he can read aloud what is being read or written, providing an additional means for obtaining the information.

EIGHT TYPES OF VISUAL PROCESSING DISORDER

There are eight different types of visual processing difficulties, each with its own symptoms. An individual can have more than one type of visual processing difficulty.2

1. VISUAL DISCRIMINATION ISSUES:

• Trouble seeing the difference between similar letters, shapes, or objects2

2. VISUAL FIGURE-GROUND DISCRIMINATION ISSUES:

• Struggle to distinguish a shape or letter from its background2

3. VISUAL SEQUENCING ISSUES:

• Find it difficult to see shapes, letters, or words in the correct order; may skip lines or read the same line over and over2

4. VISUAL-MOTOR PROCESSING ISSUES:

• Trouble using what they see to coordinate with the way they move; may struggle to write within lines or bump into objects while walking2

5. LONG- OR SHORT-TERM VISUAL MEMORY ISSUES:

• Struggle to remember shapes, symbols, or objects they’ve seen, causing issues with reading and spelling2

6. VISUAL-SPATIAL ISSUES:

• Trouble understanding where objects are in space; unsure how close objects are to one another2

7. VISUAL CLOSURE ISSUES:

• Difficulty identifying an object when only parts of it are showing2

8. LETTER AND SYMBOL REVERSAL ISSUES:

• Switch numbers or letters when writing, or may mistake “b” for “d” or “w” for “m”1

Visual Processing Disorders: In Detail

By: National Center for Learning Disabilities (NCLD)

There are lots of ways the brain processes visual information. Weaknesses in a particular kind of visual processing can often be seen in specific difficulties with practical, everyday tasks.

Below is an explanation of each of the types of visual processing. Each category also includes:

• Possible difficulties that can occur if there is a weakness in that area
• Possible strategies that may help overcome the difficulties

Be aware that weakness can occur in one or more categories at the same time.

See Visual Processing Disorders - Challenges & Strategies by Age Group for an overview of visual processing disorders through the different developmental stages of life.

It is also important to note that many people without any kind of visual processing disorder experience problems with learning and behavior from time to time. However, if a person consistently displays difficulties with these tasks over time, testing for visual processing disorders by trained professionals should be considered.

Visual Discrimination

The Skill:

Using the sense of sight to notice and compare the features of different items to distinguish one item from another

Difficulties Observed

• Seeing the difference between two similar letters, shapes or objects
• Noticing the similarities and differences between certain colors, shapes and patterns

Types of Helpful Strategies:

• Clearly space words/problems on a page
• Anticipate confusions and point out examples of correct responses

Visual Figure-Ground Discrimination

The Skill:

Discriminating a shape or printed character from its background

Difficulties Observed

• Finding a specific bit of information on a printed page full of words and numbers
• Seeing an image within a competing background

Types of Helpful Strategies:

• Practice with 'find the item' challenges, such as "Where's Waldo?"
• Use an index card or marker when reading to blot out the distraction of other words
• Highlight useful information while reading

Visual Sequencing

The Skill:

The ability to see and distinguish the order of symbols, words or images

Difficulties Observed

• Using a separate answer sheet
• Staying in the right place while reading a paragraph. Example: skipping lines, reading the same line over and over
• Reversing or misreading letters, numbers, and words
• Understanding math equations

Types of Helpful Strategies:

• Combine reading with oral presentation.
• Color code written instruction

Visual Motor Processing

The Skill:

Using feedback from the eyes to coordinate the movement of other parts of the body

Difficulties Observed

• Writing within lines or margins of a piece of paper
• Copying from a board or book
• Moving around without bumping into things
• Participating in sports that require well-timed and precise movements in space

Types of Helpful Strategies:

• Allow use of a computer
• Allow use of a tape recorder for lectures
• Substitute oral reports for written ones
• Provide a "note buddy" to check that topic notes are clear and well-organized

Visual Memory

The Skill:

There are two kinds of visual memory:

• Long-term visual memory is the ability to recall something seen some time ago
• Short-term visual memory is the ability to remember something seen very recently

Difficulties Observed

• Remembering the spelling of familiar words with irregular spelling
• Reading comprehension
• Using a calculator or keyboard with speed and accuracy
• Remembering phone numbers

Types of Helpful Strategies:

• Provide handouts that are clearly written.
• Provide oral instruction to reinforce written directions

Visual Closure

The Skill:

The ability to know what an object is when only parts of it are visible

• Recognizing a picture of a familiar object from a partial image. Example: A truck without its wheels
• Identifying a word with a letter missing
• Recognizing a face when one feature (such as the nose) is missing

Types of Helpful Strategies:

Practice with jigsaw puzzles and rebus-type games

Spatial Relationships

The Skill:

The ability to understand how objects are positioned in space in relation to oneself. This involves the understanding of distance (near or far), as well as the relationship of objects and characters described on paper or in a spoken narrative

Difficulties Observed

• Getting from one place to another
• Spacing letters and words on paper
• Judging time
• Reading maps

Types of Helpful Strategies:

• Practice estimating distance with ball games and using a tape measure
• Create maps and travel logs
• Practice social skills that focus on judging appropriate physical proximity to others