Understanding Visual Processing Disorder and Midline Crossing

Visual processing disorder and midline crossing delays can each have a different impact on a child's learning. There is sometimes an overlap between the two.

A concerned parent, Katie from Montrose, reached out about her 9 year old son's struggles with reading and math. He mixes up letters like p, d, b and q, as well as numbers 9 and 6. He struggles with spelling and loses his place when reading. The teacher suspects a visual processing disorder combined with delays in crossing the midline as her son was unable to visually track a moving object, especially across the midline, and Katie asked for more clarification on these issues.

visual processing disorder and midline crossing - a parent's concerns

The advice and activities on this website are NOT a replacement for evaluation and treatment by an occupational therapist. If you are concerned about your child, please seek a professional opinion.

What Is Visual Processing?

Visual processing is about how the brain processes what it sees. It is not about how clearly you can see (visual acuity) but about how you make sense of what you see.

A disorder in visual processing means the brain is not making sense of what it sees.

The different visual perception skills such as visual discrimination, visual closure, figure-ground perception etc, can all be affected by poor visual processing.

making sense of what you see - visual processingMaking sense of what you see

A child may then struggle to see subtle differences between letters and numbers, or to find their place on the page or board. This can affect a child's reading, writing and math.


What Is Midline Crossing?

The ability to move one part of the body over to the other side to work there, is called crossing the midline.

Children need to be comfortable and adept at coordinating their body movements, and midline crossing is an important part of their natural gross motor development and coordination skills.

child reaching across the midline to pick up a cardReaching across the midline

The eyes also need to be able to track smoothly from side to side across the "midline". If a child struggles to get the eyes to track smoothly from one side to the other, this could impact reading and writing skills as well as effective participation in sports and other childhood tasks. This is possibly what the teacher had observed in Katie's son.

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Katie's Son's Symptoms

The teacher is right to express concern about these issues. Katie's son is showing the following symptoms that necessitate getting an assessment and support from qualified professionals:

  • Letter and number reversals - could be a sign of poor visual perception skills such as visual discrimination (not being able to see the difference between them)
  • Losing his place when reading, and skipping words - could be owing to poor figure-ground perception skills and also owing to poor visual tracking skills
  • Spelling difficulties - could be owing to difficulty processing and retaining visual information
  • Difficulty with visual tracking - functional eye movements (focusing, tracking) are really important for reading, sports and many other daily tasks
  • There may possibly be midline crossing delays that show in other ways, so an assessment of his gross motor coordination and midline crossing would be recommended

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What To Do?

I advised Katie to have an assessment done with a developmental optometrist (behavioral optometrist). These vision specialists are able to diagnose and treat functional visual skills, like coordinated eye movements, eye tracking, convergence etc with vision therapy. A child may struggle with functional visual skills even if they have perfect 20/20 vision.

I also advised Katie to consult an occupational therapist to assess and treat any visual perception delays that may be affecting her son's progress.

Visual perception activities and midline crossing activities from my site could be used in consultation with these therapists, to supplement whatever treatment her son receives. 

a range of visual perception activities for kids to help your kids develop visual perceptual skillsVisual perception activities
activities and tips for crossing the midlineMidline crossing activities

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What Is Vision Therapy?

Vision therapy, conducted by a developmental optometrist, uses targeted activities and exercises to improve eye tracking and eye coordination skills. Children learn to focus the eyes properly, and to develop the visual perception skills needed for reading and writing.

Organizations like the College of Optometrists in Vision Development (COVD) offer resources to locate qualified professionals in your area.

If you don't have access to these qualified health professionals, perhaps consider getting Eyes On Track#Ad, which is a manual developed especially for parents to help their kids develop functional visual skills at home.

Eyes on Track book to help kids develop functional visual skills

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Frequently Asked Questions

Is it necessary to see a specialist if my child already passed an eye test?

Yes. Most regular optometrists only check whether your child is near or far sighted. They don't usually check eye movements and other functional visual skills. A developmental/behavioral optometrist will provide a more comprehensive evaluation.

What are some other signs of poor functional visual skills?

Frequent headaches, watering eyes, covering one eye while working - these are all signs that your child's eyes may not be working together well. For more details, read this article.

Are visual processing and midline crossing always connected?

Although they overlapped in Katie's son's case, they are actually two distinct skills. Both can be symptomatic of other underlying developmental issues, and should be addressed in order to improve a child's progress.

As a parent, it is hard to see our kids struggle. Seeking to understand the issues your child is facing is a positive step - well done!

Although the challenges of visual processing disorder and midline crossing may seem complex, they can be addressed with the right support.

Seek support from your health professional if you are all concerned about your child's development.

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visual processing disorder and midline crossing - a parent's concerns

If you want to support your child's normal development, then try these easy, hands-on, screen-free activities on my site!

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