The Elephant In The Room: Impact Of Visual-Spatial Deficits In Children With Learning Disabilities And Why It Goes Untreated

Children with visual spatial processing deficits present unique learning challenges that are often undetected by parents and teachers, yet result in significant impairments. Everybody makes sense of information in their world in slightly different ways. For example, some of us depend more on visual processing and need to see a visual chart to understand a complex idea, or can easily construct a piece of furniture by quickly glancing at visual instructions.

Others prefer a verbal approach and tend to read dense written instructions or explanations for meaning. Different processing approaches can even be identified in a verbal activity like reading. Some people revel in books that dedicate entire chapters to describing a rich visual scene or depiction of a character, while others are intrigued by books that present verbally clever banter and witty dialogue.

These different processing styles are nuanced and work under the radar of consciousness to shape the way we understand our world. At conception, a child’s processing style begins to emerge as the building blocks of the brain are assembled and follow the genetic maps set out by their parents. Thus, every child is born with a unique constellation of cognitive capacities, or their cognitive preference. As soon as a child is born, their unique experiences continue to mold their cognitive processing style, which is then applied as a tool of understanding to all new experiences throughout their development.

When a child does not meet certain developmental milestones, it directly affects their cognitive preference. For example, a child who is walking early yet late to develop language will walk over and take the toy or cookie from the table as opposed to asking a parent to get it for them. On the other hand, children who are speaking early, but are late to crawl and walk, find that language is the best tool to understand and influence things in their world. As children continue to mature, they naturally use their stronger cognitive tools when faced with a new experience or challenge. This eventually reinforces that tool and their cognitive preference becomes more pronounced.

All parents have certain expectations of their newborn across the first 2-years of life. These predictable milestones (i.e., generally walking with single words at 12-months) suggest that related cognitive skills (brain areas) are similarly primed to develop. For example, between 7 and 10-months most babies begin to crawl. Although this milestone presents new and exciting physical challenges for parents, it also suggests that visual and motor areas of the brain are now ready to learn about an environment that moves and can be manipulated. In fact, studies have shown that once a baby is able to reach out and grab something in their environment, specific pathways between the visual and motor parts of the brain have connected. If a child is not crawling between 7 and 10-months, or walking before 18-months, visual-spatial and motor areas of the brain may not receive the same learning experiences and subsequent development compared to children who achieve these important milestones.

Children who do not reach expected milestones are at a higher risk for developing learning disorders and processing deficits, despite early intervention (Speech, Occupational, or Physical therapies). For example, children with language delays may also be late to read and write, and they are at risk for learning disorders in reading and/or writing. Similarly, when a child does not crawl and is late to walk, they may struggle in other predictable ways. These include delays in using utensils, difficulty tying shoes, and learning to ride a bike. As a result of delayed motor development, they may present with an awkward and uncoordinated gait, may be described as clumsy, and/or avoid team sports. While the connection between a language delay and problems in reading or writing is quite evident, the relationship between visual-motor delays and related learning challenges is less obvious. Moreover, many children with visual-spatial processing deficits have average to above average language skills. They continue to understand and communicate information using language at exceptionally high levels and approach experiences and challenges in their world with a verbal (language-based) cognitive preference.

Our society values strong language skills. From an early age, children who articulate their thoughts in a clear and concise manner with strong vocabulary are celebrated for their clear communication and early reading and writing abilities. They also receive medals in nationally televised spelling bees and are generally described as intelligent. Therefore, children with a strong language-based cognitive preference and significantly lower visual[1]spatial skills are often not identified as struggling learners. In fact, teachers describe these students as bright, with potential well above grade-level, and are confused when they struggle to meet those expectations.

Many children with visual-spatial deficits, sometimes referred to as a nonverbal learning disorder, struggle in nuanced ways in the classroom. Teachers may find that these students ‘tune out’ when a lesson plan is presented with visual charts and graphs, or they are restless during a video presentation. In later elementary and middle school, they may struggle to copy notes from the board and stay within the margin when writing in-class essays.

Although they are exceptional decoders (fluent readers), many children with visual-spatial deficits can struggle with reading comprehension. These students tend to understand what they read at a superficial level and struggle to ‘read between the lines’ in order to pick up on implicit information that may require inferential reasoning. They may also skip words or entire lines when reading a dense chapter book or misread common words due to their visual similarity (“pan” [ban]; “no” [on]).

Students with visual-spatial weaknesses also struggle with math. They frequently ignore function signs, omit steps, and confuse visually similar formulas. Busy math worksheets are visually overwhelming, and it is often hard for these students to line up numbers when solving longer math problems. Because so many aspects of mathematics require visual-spatial skills, certain topics like using a ‘mental’ number line for simple calculations may be quite overwhelming. In high school, children with visual-spatial deficits may find concepts in geometry to be insurmountable without support.

Organization and planning, otherwise known as executive functioning skills, rely heavily on a child’s ability to use their visual-spatial skills. After a child masters crawling and walking, they begin to think about and plan movement. The visually demanding ability to plan movement allows a child to also visualize consequences or outcomes of their movement and then make different choices which result in desired outcomes. This ability is one of the first executive functioning (planning) skills children develop. Therefore, when visual-spatial skills are underdeveloped or delayed, a child’s ability to efficiently plan and organize is similarly undermined. From an organizational standpoint, children with visual-spatial deficits routinely fail to notice changes in their visual world such as bulletin board displays, signs, or posted notices, or where they last remember seeing their backpack or water bottle. Their desk space and binder are also disorganized as they struggle to line up worksheets and assignments. Many of these students also misplace their materials despite convincing arguments that they remember putting it in their backpack, also known as the ‘black hole backpack’.

Fortunately, there are many ways to support and even treat children with visual-spatial deficits. The first step is for parents and teachers to understand the warning signs: late to crawl or walk, poor coordination, difficulty with math concepts, poor organization, and average to above average language skills. A neuropsychological evaluation will also help identify a child’s cognitive preference and will provide tailored treatment recommendations and school accommodations.

General classroom strategies include reducing the number of visual displays, charts, drawings, and diagrams that could overwhelm a student, and replacing them with clear verbal instructions. Teachers should explain in words all new skills and concepts, and verbally talk through any visual examples in a lesson plan. The more information can be presented in a step-by-step recipe format (Step 1, Step 2), the better these students will be able to learn and engage with the material.

In addition to classroom accommodations, there are ways to strengthen visual[1]spatial weaknesses in children. Think3D is an evidence-based way to improve visual-spatial skills in children through activities related to origami. Children who complete this program improve not only spatial reasoning but also STEM skills and math performance. Adults in the child’s life can also stimulate spatial thinking by asking them questions and engaging them in conversation: Which way does the sheet fit on the bed? Does the left shoelace go over or under—and which one is the left? Will the groceries fit in one bag? Which shapes do I get if I cut my bagel the other way—and will it still fit in the toaster? These questions provide challenging questions to children and provide opportunities for them to learn and think about space.

Strengthening visual-spatial weaknesses in children is a team effort that requires collaboration and cooperation between family, caretakers, and teachers. With the right support these children can overcome their learning differences and achieve their potential.