Paul Harris, OD
For many years I have used the toolbox analogy as a way to share with others one way of viewing the relationship between the services offered by a behavioral vision care optometrist and education. I share the analogy here with the purpose of facilitating an understanding of how the services of both professions are needed in order to serve the needs of many of the children who are failing to perform in the educational system.
Imagine that we have delivered to a plot of land all of the necessary raw materials needed to build a house. Piles of wood, nails, screws, drywall, cinder blocks, plumbing supplies, electrical supplies, cabinets, doors, windows, roofing materials, etc. are all present in abundance.
The child brings to that work site each day their toolbox. The tools in that toolbox have been acquired over the years based on the life experiences that child has had. Some children enter the worksite with a rather complete set of tools to cover most needs, while others have only the essentials or may in fact be missing even a core or fundamental tool. Fundamental or required tools might be considered to be a hammer, a saw, a screwdriver, or a tape measure.
In general, schools assume two things. The first is that most children enter with the set of tools that will carry them through their academic career and that the fundamental set of tools that a child brings to school is fairly set or immutable.
The child is placed into a series of courses such as Carpentry 101, Plumbing 101, and Electrical Systems 101. In Carpentry 101, they may begin with the simple tasks of measuring and marking lumber to be cut to length, how to start, drive, and set a nail, and making a cross-cut saw cut safely, accurately, and square. To a child coming to the workplace with a basic framing hammer, a handheld crosscut saw, and a Stanley 25 foot tape-measure, these beginning classes may come rather easily. To a child missing one or more of these basic tools, failure to achieve basic "educational" goals may become evident rather early on.
Generally, in the education system, a child comes to the attention of their teacher before testing for a problem is initiated. To qualify for services, their performance must have fallen to a certain measurable amount.
Many resourceful and smart children, who are missing fundamental tools, may find ways to get the job done although they are not using the proper tool. They might find a rock to use as a hammer or they might use a monkey wrench to hammer in the nails. The job gets done but it takes longer, the job isn't done as well, and there may be some wear and tear on the child that would not have been present had the child used the proper tool for the job. However, the child, due to a lack of the appropriate developmental experiences, is/was lacking the tool. This degree of compensating can often serve to mask the discovery of a missing fundamental tool for quite a while in a resourceful child.
Once the teacher realizes the child is having a problem, the school system will initiate a series of tests to identify the problems. Psychological educational testing often correctly identifies the general category of the problems, such as carpentry or plumbing, but may fail to recognize that the lack of a tool may be the source of the problem. Here is where a false assumption dooms the child to an intervention program that will actually work to embed the problem even more. How?
A hammerless child is labeled as "hammerless" or "hammer compromised." The system then looks for special education materials that have been shown to be able to be mastered by those without hammers. The idea has been that the child who does not have a hammer should not be penalized for not having a hammer and we should not ask them to do things that require hammers. Therefore, a program has been conceived and produced in, for, and by the school, which addresses hammerless children's needs.
The hammerless child will be given activities, which will not require them to use a hammer. Either they will now use screws and screw guns for everything, or they will switch to learning to assemble prefab home kits. The child will advance through the rest of their courses, but a fundamental tool and basic skill necessary to nearly any home building project will be missing—the ability to use a hammer. The false assumption was that once hammerless, forever hammerless.
The education system is not in the business of tools. They are in the business of tool usage. "Missing tool? Oh well, you'll just have to learn to accept your hammerless condition and arrange things differently so that you don't encounter hammering demands in school life." Real life then becomes another matter.
The key factor in optometric behavioral vision care is that our assumption is that the presence of a missing tool is only evidence of not having had the appropriate meaningful experience to have developed or acquired that tool. We are in the business of identifying the missing tools and then putting together treatment protocol. The purpose of which is to provide the child with the necessary meaningful experiences to acquire the tool.
In essence, we take the child shopping. We know that hardware stores exist. We know the fundamental classes of tools. We know the order which people generally acquire tools.
One would not start their saw collection with learning how to use a coping saw or a compound miter saw. One starts with a handheld crosscut saw and learns by cutting basic lumber to length. A rip saw may follow. Then a circular saw, jig saw, table saw, band saw, coping saw etc. with each experience being built on the prior knowledge base which all came from the handheld crosscut saw.
This process of tool acquisition and attaining fundamental competence in the use of the skill is the domain of optometric behavioral vision care.
We turn over to the school system a child who now possesses the correct array of tools to perform the tasks required of them. When the school system moves on to fundamentals of balloon framing houses or the proper method of trussing up a floor, the child will have the tools necessary to execute the demands of the class, understand the concepts, and to use the proper tools for the proper job.
Behavioral vision care optometrists do not teach carpentry, plumbing, or wiring. Behavioral vision care optometrists do not teach reading, writing, or mathematics. Behavioral vision care optometrists do identify missing tools and take the child shopping to acquire and gain competency with the new tools.
Then, and only then, will the school system find a child who is ready to be taught using conventional methods and who will achieve in a variety of educational settings by following a variety of teaching methods.
Reprinted with permission from Dr. Paul Harris by Vision First Foundation. Copyright © 2002 Paul Harris, OD. All rights reserved.