How Vision Can Support or Delay Learning in a Child with Down Syndrome: Part 3

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Trisomy 21 Update

How Vision Can Support or Delay Learning in a Child with Down Syndrome - Aadi NOTE: This is the third article in a multi-part series about vision and individuals with Down syndrome. Read part one and two.

Individuals need several important visual skills to navigate their environment and participate successfully in their daily activities at home, school and work. This article focuses on an individual’s visual information processing skills.

Visual information processing refers to the ability to extract and organize visual information from the environment, integrate this information with other sensory modalities and high cognitive function to make a motor response. There is a higher prevalence of visual information processing deficits, in addition to other visual skills, in individuals with Down syndrome. Learn more about other visual skills that impact an individual’s function in Part I and Part 2.

Visual information processing includes two key subdivisions of skills:

  • Visual motor integration and
  • Visual perceptual skills.

Visual motor integration is the ability to integrate visual information with fine motor movement. The most well-known example of a visual motor integration task is handwriting. Children with poor visual motor integration skills would have difficulty with many written academic tasks such as copying from the board, drawing or handwriting that appears sloppy, inconsistent spacing between letters and words, difficultly writing on the line and poor organization of math problems.

Visual perceptual skills refer to a group of visual cognitive skills that are often further classified into these individual skills.

  • Visual discrimination: telling the difference between forms, shapes and designs
  • Visual figure ground: finding an object hidden in a background
  • Visual closure: determining the whole without having all the details present
  • Visual memory: remembering what you have seen
  • Visual spatial relations: understanding how objects relate to one another in space
  • Form constancy: recognizing a form when it is changed, for example if it is smaller, bigger, darker or turned around

Children with visual perceptual skill difficulties might appear inattentive in the classroom due to difficulties with many academic tasks. Children with poor visual perceptual skills may have:

  • Trouble learning the alphabet
  • Make frequent letter reversals
  • Have trouble learning basic math concepts
  • Mistake words with similar beginnings
  • Have trouble organizing items on paper when taking notes
  • Have trouble recognizing words across presentations, especially if in a different font
  • Have trouble distinguishing the main idea from insignificant details

Children with poor visual perceptual skills might also be clumsy and often bump into things, have poor coordination and balance, struggle with rhythmic activities and generally have difficulty with athletics.

Development of visual information processing ability begins in infancy. When infants establish contact with you or a toy, begin to follow your face or a toy in various positions and become interested in visually exploring toys and their environment, they are beginning to develop a foundation for visual perceptual skill development. You can support your child’s visual motor and visual perceptual skill development by working on the following activities:


  • Participating in container play, using shape sorters, simple puzzles, stacking toys, pegboards, large Legos, and/or stringing beads
  • Self-feeding with a fork and spoon, coloring with different materials
  • Encourage your child to match patterns or sequences, sort objects by groups
  • Teach your child prepositions such as up, down, in, out, under, over, bottom, and top
  • Send your child on a treasure hunt for certain objects (e.g., find all the red things, round things) around your house or at school
  • Practice making shapes with pipe cleaners, play doh, popsicle sticks and paint

Children & adolescents

  • Encourage youth to complete connect-the-dot worksheets, seek-and-find books, “find the differences” pictures, word searches, eye spy games, color-by-number coloring books and mazes, or use learn-to-draw pages with step-by-step instructions
  • Standardized tests can help evaluate a child’s visual motor and visual perceptual skills. If your child is struggling with school, especially with handwriting-based academic tasks, there is a chance poor visual motor and visual perceptual skills are negatively impacting their performance. You can ask your school for an occupational therapy evaluation to evaluate your child’s visual information processing skills.

To have your child’s visual motor and visual perceptual skills evaluated or other vision skills screened at Children’s Hospital of Philadelphia, call 215-590-5819 to schedule a remedial vision evaluation with the occupational therapy department, or call 215-590-2791 to request an appointment with the Division of Optometry. Lindsey E. Perno, OD, can provide a vision evaluation that includes assessment of the child’s eye movement skills.

If your child is found to have decreased visual motor or visual perceptual skills for their age, your child’s occupational therapist can provide intervention to improve these skills.

Jordan Porter, MS, OTR/L, is certified in remedial vision and an Occupational Therapy supervisor for the acute hospital team at Children’s Hospital of Philadelphia.