BLOG: Why ‘minimal brain dysfunction’ is making a comeback

Leonard J. Press

By Leonard J. Press, OD, FAAO, FCOVD

In the 1960s and 1970s, the term “minimal brain dysfunction” was coined by psychiatrist Richard A. Gardner, MD, to describe children of normal intelligence who nevertheless exhibited some deficits in learning, visual processing and memory.

The term minimal brain dysfunction (MBD) eventually fell out of favor; it was viewed as too negative a label and too nonspecific — a “catchall” for possibly unrelated or nonexistent conditions.

However, Gardner may have been onto something. We know that traumatic brain injury (TBI) —whether mild or severe — causes deficits in cognitive, visual motor and visual processing abilities that can affect learning and behavior. The very same assessment and rehabilitation techniques used by practitioners to identify and treat kids with MBD (or visually related learning disabilities) have also been used successfully in rehabilitation environments for adults with TBI.

It seems entirely likely that many children have suffered a “silent,” unremarked, mild TBI (mTBI) during routine childhood play or even a difficult delivery at birth; mTBI events may be more common among boys, who have historically engaged in more sports and more rough-and-tumble play that could lead to injury.

In evaluating children with learning delays or vision-related problems, we as optometrists should consider the possibility that one — or perhaps multiple — mTBIs may be at the root of the problem.

Here are four things you can do in primary eye care practice:

--Ask about a history of concussions if a child participates heavily in sports;

--Ask questions about whether the child is prone to clumsiness, has a history of falls or hits to the head during play (it is important not to imply suspected abuse), or had a forceps or difficult delivery if there are early signs or symptoms suggestive of mTBI;

--Consider the King-Devick test for kids in your practice, both as a baseline and whenever you suspect a TBI. This quick and easy eye movement test is a very sensitive indicator of cognitive function. Originally developed as a test for reading problems, it is increasingly used as a sideline concussion protocol screening test; and

--Don’t hesitate to refer children with suspected mTBI to a neurorehabilitation specialist for further evaluation and treatment (visit NORAVisionRehab.org for a directory).

For more information:

Leonard J. Press, OD, FAAO, FCOVD, is editor-in-chief of Vision Development & Rehabilitation and wrote the primary textbook used to prepare for board certification in vision therapy from the College of Optometrists in Vision Development. He was recently awarded the 2018 William & Diana Ludlam Educators Award from the Neuro-Optometric Rehabilitation Association. He works and consults from Lakewood, N.J.

Disclosure: Press reports no relevant financial disclosures.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.