Wow Vision Therapy Blog

Letter Reversals Indicating Visual Problems?

When a child older than age seven still confuses and reverses letters, such as “b’s” for “d’s” and “p’s” for “q’s,” parents often wonder what can be done to correct this. Letter reversals can be a worrisome sign because it often impacts reading, writing, and learning.

First of all, letter reversals in a child younger than seven years old are not unusual. But in children who have this problem, as they get older, this is a sign that the child is developmentally behind in an essential function of visual processing that has to do with visual-spatial skills. Therefore, letters that are symbolically the same, however different, only based on their visual-spatial orientation, i.e., “b,” “d,” “p” “q” will impact that child’s interpretation and reading fluency when they don’t recognize the spatial difference between the letters.

What to do when your child demonstrates frequent letter reversals?

Quite simply, it’s very important to have testing performed to find out if your child has a visual processing deficit in visual-spatial skills. We often see patients after they visit a child neuropsychologist or educational therapist who performed testing to identify the problem in the visual processing of visual-spatial skills. Other times it is based on a teacher or parent’s observation that raises the red flag that something doesn’t seem right because of frequent reversals.

Within our practice that is dedicated to Developmental Vision and Rehabilitation, we also perform standardized testing for children to assess problems in visual processing and visual-spatial skills. 

Once identified, what can be done?

Parents are often told that their child with letter reversals should learn how to live with it and work around it; in other words, accept it. But that is incorrect. A child doesn’t have to live with this condition. The solution can be found when the correct treatment is applied. Developmental optometric vision therapy is a treatment that targets the visual processing delays in visual-spatial skills. It accelerates the development of these skills to age equivalent or better. The patient can interact with educational therapies for maximum improvement in the shortest amount of time. Therefore, there is help for children who have persistent letter reversals. Most can resolve this issue with the models we use at Wow Vision Therapy.

For more information about our practice, please check out our website at

Dan L. Fortenbacher, O.D., FCOVD
Wow Vision Therapy


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