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An expression of this effect can be found in the other reported symptoms of convergence insufficiency; namely, slow reading and difficulty with reading comprehension. The CIRS group found that children with a definitive convergence insufficiency are described as easily frustrated, distractible, with short attention spans and had problems finishing tasks.C. COURSE AND PROGNOSISAlthough some behaviors commonly associated with learning problems may occur before a child enters school, formal diagnosis of learning disabilities usually does not begin until the end of kindergarten or during first grade, because formal academic instruction begins at that time. During the preschool years, failure to achieve developmental milestones may be the first indication of risk for the appearance of learning disabilities. Delays in gross and fine-motor development, visual information processing, receptive and/or expressive language, particularly phonological processing may be antecedents to learning problems. Family risk factors and heredity are also important considerations.^82-83 Letter identification and phoneme identification contribute independently to the prediction of learning problems.⁸⁴ The purpose of early screening and intervention programs is to identify children with developmental delays who may be at significant risk for learning problems. Statement of the Problem 9With early diagnosis and appropriate, comprehensive intervention, the prognosis is good in a majority of cases. Symptoms of learning disabilities frequently persist into adolescence and adult life and rarely disappear entirely.⁸⁵The clinical presentation of persistent visual efficiency problems may change during periods of remission and exacerbation, depending on prevailing intrinsic and extrinsic influences.Visual information processing deficits are usually considered developmental in nature. With maturation and experience there will be increases in performance, but the rate of progression of skill development continues to lag.D. EARLY DETECTIONBecause the evidence that learning related vision problems can be prevented to any substantial degree is inconclusive, the emphasis is on early detection. It is recommended that vision examinations be scheduled at 6 months, 3 years of age, and at entry into school,⁸⁹ at which time the parents should complete a developmental questionnaire. If there is a history of developmental delay, a screening test like the Denver II can be performed. When visual information processing problems are suspected, a more extensive evaluation is necessary for the early identification of the child at risk for the development of learning related vision problems.Most school districts now conduct some form of developmental screening before children enter school. Such screenings tend not to explore visual information processing development as extensively as needed. The majority of school vision screening programs only assesses distance visual acuity. This is woefully inadequate in detecting most learning related vision problems.

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