Tuesday, December 30, 2008

Seeing Through New Eyes, By Melvin Kaplan

This book that promises to be able to "change the lives of children with autism, Asperger syndrome, and other developmental disabilities through vision therapy" intrigued me from a number of perspectives. I am an optometric vision therapist so I work with this patient population on a regular basis. I found Kaplan's clinical notes and case studies to be rich with insight as well as technique that I can adopt with some of my patients immediately. I am the aunt of 3 children whose symptoms fall along the autism spectrum so I was interested in whether Kaplan's material would be presented in layman's language. It is. Recently I wrote a series of three books about learning-related visual skills for home schooling families, the Eye Can Too! Read series and have been asked to consider writing a book in the same series to give the home schooling parents of special needs children a series of visually reliant academic activities that they can use. Kaplan's book would definitely be included on my resource list should I end up writing the fourth book. Kaplan's vision therapy evaluation tools for non-verbal patients are great and his explanation of the therapeutic use of yoked prism glasses (while sounding quite mysterious to the uninitiated) is well documented and easy to understand. My only negative comment is that the book takes a long time to read even knowing the terms and activities as I do. However, anyone who wants to understand why some children rock, flap the air, or utilize other stimming behaviors to make sense of their world will gain both empathy and hope that these socially challenging habits can be adjusted by reading Kaplan's book. Well done.

Kaplan, Melvin. Seeing Through New Eyes. Jessica Kingsley Publishers. Philadelphia, London. 2006

Thursday, December 18, 2008

Why Is Left/Right Awareness Important to Reading?

Since we read from left to right and from the top of the page down, beginning readers who do not know their left and right may experience some confusion. We call the ability to tell left and right on ourself the visual spatial skill of laterality. Laterality is usually developed, according to Piaget's observations, by the time a child is 7 years old. Projecting that knowledge away from ourself into space is the visual spatial skill of directionality. This involves layers of developmental understanding that evolve in most children by the time they are 11.

Children who have delays in the skills of laterality and directionality mix up their left and right. They often have poor bilateral integration. In other words, they tend not to use both hands or feet efficiently to do tasks like cutting, eating, and alternating their feet going up and down stairs. They probably also have difficulty crossing the midline. By this I mean the physical midline, the ocular midline, and the midline on a page of text or on a worksheet.

So, these children will become frustrated by assignments that involve drawing lines to match information arranged in a column on the left side of the worksheet with additional information arranged in a column on the right side of the worksheet. They may know the correct answer but be unable to connect the lines. They may exhibit poor manuscript handwriting- especially when forming letters and numbers which cross the midline like x, y, M, N, s, v, and w.

Sometimes these children make frequent reversals when reading and writing and the children who are the most developmentally delayed in laterality and directionality may mirror write. They are often labeled dyslexic, a condition that has many competing definitions and involves both visual and auditory perception and processing.

It is possible to build a child's developmental skills of laterality and directionality and to increase their left/right awareness. In fact, occupational therapists and vision therapists spend a lot of time in therapy doing just that for our patients. There are normed tests available to measure a student's development in laterality and directionality that are incorporated in the developmental assessment of a child's visual perceptual skills given by developmental optometrists and by educational psychologists.

I believe that one easy to achieve educational goal should be to provide activities in laterality and directionality for every primary student before they fall behind in reading and writing. This can be done via learning center activities in the classroom. To that end, the second book, the "Yellow Book", in the Eye Can Too! Read series, published by Home School Incorporated, (available in the next few weeks on their website) provides an assortment of activities that home-school families and classroom teachers can use. There are clear directions followed by questions to inform your observation of your student as they do the activities.

This blog is intended to give information for parents and teachers about learning-related visual skills. I encourage each reader to become a follower of this blog and also to become a fan of the Eye Can Too! Read FaceBook page. Please use the wall on the FaceBook page to ask your questions about vision and learning. That will help me to select topics for this blog. Thanks.

Wednesday, December 10, 2008

Does Your Child Look With Her Hands?

When my children were small I used to admonish them to "look with your eyes, not with your hands" especially when we were in little boutiques where everything was fragile. This simple reminder helps patients in the vision therapy clinic as well. Often children who do not know how to control their eye movements efficiently explore everything with touch. The seem unable to find anything -even if it is right in front of them- without groping and feeling the array of items. They seem not to value their eyes as tools to gather information about their world even though there is nothing physically wrong with their eyes at all. Getting these children to use their eyes more readily may involve vision therapy to correct a deficit of ocular motilities but it is also possible that the root issue is one of visual attention. How should you begin to build your child's visual attention? Play "I spy" type games where there is no touch allowed. Use rich visual clues to describe the objects you want the child to get for you. For example say, "Please get the large green vase with the pointy handles that is to the left of the dictionary on the third shelf." Then, resist the child's efforts to get you to answer whether they are hot, cold, or if it is "there". Of course, if your child is four or five years old and still does not seem to rely on his eyes to learn about his environment, consider making an appointment with a developmental optometrist for a complete eye examination. It is recommended, actually, that every child receive an annual eye exam.

Tuesday, December 2, 2008

Does Vision Therapy Do Any Good?

The link between learning-related visual skills and juvenile delinquency has been explored in article after article by the American Optometric Association and the Optometric Extension Program since the sixties. In 2000, Stan Kaseno, OD., reported on the results of the San Bernadino Juvenile Hall Vision Clinic after it had been involved in providing vision care and vision therapy to juvenile delinquents for twelve years.* 93% of the juvenile deliquents initially were unable to pass a developmental test of their visual skills. The average recidivism rate for these offenders is 70% but the ones who received 24 sessions of vision therapy had a recidivism rate of just 15%. The youth also made measurable gains in their reading levels and IQ scores. In addition, they began to set goals for their lives. Unfortunately, the San Bernadino Juvenile Hall Vision Clinic closed in 2000 due to a lack of state funds. However, if this is the potential for improvement after just three months of vision therapy, doesn't it make sense to get every struggling student evaluated to see if their academic challenges could be rooted in a learning-related visual issue? Use the links on the blog to locate a developmental optometrist in your area and schedule your child's eye exam today.

*Dr. Kaseno's article is in Volume 41/Number 3 of Behavioral Aspects of Vision Care, c. 2000. Optometric Extension Program Foundation Inc., Santa Ana, CA.

Wednesday, November 26, 2008

Why do some people move their heads back and forth when they are reading?

If you have to move your head to follow the text when you read your ocular motilities may be deficient. When the six eye muscles in each eye move efficiently in coordination with each other, they can make very fine eye movements. The muscles coordinate to point the eyeballs to keep a visual image near and single. People who use their neck muscles to point their eyes don't realize this- it isn't a conscious failure, though. These people may have deficits of their saccadic eye movements, the short little hops that the eyes make from the end of one word or line of text to the beginning of the next. These same individuals may find it helpful to use a straight edge to keep their place while reading. They may also experience frequent loses of place and may habitually skip little words or even whole lines of text. Developmental optometrists often incorporate vision therapy in their practices. Simple activities and exercises can often promote the development of great saccadic eye movements over a period of several weeks.

Tuesday, November 18, 2008

Can a vision problem make reading seem too hard?

Children who are unable to team their eyes efficiently on a near-point visual target may have a condition called Convergence Insufficiency (CI). These children may complain that reading is too hard or that it is boring or that it gives them a headache. They may also complain that words double on the page or wiggle. Recently the results of a randomized clinical trial of treatments for symptomatic convergence insufficiency in children was published in the Archives of Ophthalmology (vol. 126 No. 10, October 2008). The study found that this condition can be successfully treated through in-office vision therapy. You can read the full study online at http://archopht.ama-assn.org/cgi/content/full/126/10/1336. CI is not the only learning-related visual issue that can interfere with a child's reading performance. If your child is having difficulty with school, arrange for a binocular vision examination by developmental optometrist who will be able help if there are any contributory visual issues. To find a developmental optometrist in your area go to www.covd.org and search for members of the College of Optometrists in Vision Development near you. The American Optometric Association recommends that every child receive an annual eye exam. It's important.

Friday, November 14, 2008

What's So Important About How A Student Holds A Pencil?

Many of the patients that I see in my work as an optometric vision therapist do not have good pencil posture. Instead of the relaxed, efficient grip that should be required of each kindergarten student who is learning to write, many students who struggle with learning related vision problems use a fist grip or hold the pencil very close to the tip or do not secure the paper with their free hand. The issue is not limited to poor or illegible handwriting. In an article in the OEP Vision Therapist, Volume 33, Number 1, 1991, therapist Denis Hoover reported on the observations of Dr. Ernest J. Kahn. This optometrist administered the Sentence Copy test (probably by Wold) to his patients and noticed the following three associations.
  1. Most near-sighted children hold their pencil 1/4 inch or closer to the tip.
  2. Most children who also have been diagnosed with a learning disability utilize "bizarre" pencil grips and also exhibit poor coordination in general.
  3. All the children who used nonstandard pencil postures blocked their line of sight with their fingers so they had to adopt an improper reading distance or head tilt.

So, if your student or child does not use a standard pencil grip, first try to retrain the skill. Many teacher supply stores carry soft grip guides that help a child remember where to hold the pencil. These are inexpensive and very helpful. Then, because this behavior may indicate that the child may be struggling with a learning-related visual challenge or may even need glasses, make sure to schedule a routine eye examination with a developmental optometrist who is experienced in working with children.