Thursday, August 20, 2009

Oddly spaced handwriting could indicate a visual perceptual developmental delay

When a student has a delay in the developmental visual perceptual skill of visual figure ground, they may not be able to space the letters within words adequately. First graders whose letters vary widely in size may not be aware of how their work differs from the model because of delays in the development of their visual processing skills. Students who put extra wide gaps between letters within words or between words within a line may also be attempting to cope with an underdeveloped set of visual perceptual skills.

Vision is much more than the ability to see clearly at near and in the distance. It involves gathering visual information, intake skills; interpreting visual information, processing skills; and responding to visual information, visual motor integration skills.

The root of a student's difficulty, frustration, dislike of, and inaccuracy with reading or writing could be their visual skills. In fact, even when a student passes a vision screening, they could still have undetected learning-related visual challenges.

If they do not have independent, automatic, voluntary control of their eye muscles, they will have difficulty with gathering visual information. This aspect of vision can also be impacted by poor eye teaming skills.

If they do not have effective strategies for processing the visual information that the eyes send to the retina, they will have difficulty recognizing, remembering, or manipulating it.

If either the visual intake skills or the visual processing skills are under-developed, they will have difficulty with the motor response such as writing a word neatly, or finding the beginning of the next line, or hitting a baseball.

Teachers and parents are the first line of intervention when a student has a learning-related visual issue. If you notice that a student has a consistent problem with a certain type of assignment, ask the student what they think is going on before you tell them how to fix it. Then make sure to arrange a comprehensive vision examination with a developmental optometrist who is experienced with children and binocular vision. The doctor will be able to recommend an assortment of options for how to address any learning-related visual diagnosis with glasses, in-office vision therapy, or by suggesting activities for you to do with the student at home or in the classroom.

When otherwise healthy, intelligent, articulate, and curious children experience difficulty in academics, suspect that the problem has a visual root. At least, rule out any learning-related visual problem by taking them to a developmental optometrist for a thorough check-up.

Friday, August 14, 2009

Does Your Child Say Reading is Confusing?

Many children with learning related visual challenges describe reading as being confusing. I notice this time and again when working with younger elementary school students with whom I am doing in-office vision therapy. They don't understand how to explain the trouble using other words, perhaps because for them, reading has always been difficult. How inexplicable to be otherwise intelligent, curious, articulate, and wanting to learn but to lag seriously behind their peers in reading! While I have done no statistical survey to correlate the visual diagnoses of these children with their perception of "confusion", my sense is that it most often accompanies a severe delay in the development of the visual spatial skills of laterality & directionality. These children typically make frequent reversals when reading and writing, don't know their left from their right, and often have trouble crossing the mid-line. My theory is that they don't know which side of the page or word to read first - varying their approach without noticing it from line to line or word to word. Children also use the label, "confusing," when the words appear to wiggle or double on a page. This is a classic symptom of an eye teaming insufficiency or excess. Tutoring in phonics or reading comprehension strategies won't solve these problems. A comprehensive eye exam from a developmental optometrist may identify the problem. Once a diagnosis is in place, the options for treatment can be evaluated.

Wednesday, August 5, 2009

Why don't more people know about vision therapy?

I just had a long conversation with the publisher of my Eye Can Too! Read series about why people don't know about vision therapy as a way to improve a child's reading among other things. She commented on the interest the books receive at the various home school curriculum fairs (there's one this weekend in Schaumberg, IL, by the way- my books will be at the Home School Inc booth). She said that when the sign offers "help for struggling readers," parents are not as attracted as when it says "vision therapy workbooks." By the way, Lottie, your eyeball painting attracts A LOT of interest! Here's some of what I said.

  1. Education generally does not consider that other than for low vision issues, vision could be the root of a child's difficulty in learning to read. It isn't profiled in the graduate school reading courses. (I would love to offer such a course at the graduate school level here in St. Louis- I even have a course proposal written!) Vision therapy and binocular vision evaluations are not typically included in an IEP (of course not because then the budget-strapped public school districts might have to pay for the services). The school nurse's vision screening doesn't usually deal with anything other than acuity and obvious ocular health issues. So when a child has received all the reading interventions at school, gets read to at home regularly, is otherwise intelligent, articulate, and healthy, but still cannot read on grade level, he gets labeled learning disabled in reading, given a diagnosis of dyslexia, or placed in still more sedentary tutorials. If these children were to be sent to a developmental optometrist for a binocular vision evaluation and, if indicated, a developmental evaluation of their visual-perceptual skills, and again if indicated, enrolled in a program of in-office vision therapy, many of them would gain the skills they need within 12 to 48 weeks.
  2. Home schooling parents frequently choose to home school because their struggling readers are not well served in a traditional school setting. Then, in their frustrated search for interventions, they end up spending too much money without achieving the result they hoped for. Since vision therapy providers are hard to find, are usually very expensive, and their services tend not to be covered by health or vision insurance, these parents suspect that the prescribing doctor may just be another person looking to separate them from their money without bringing any real change.
  3. Optometry and ophthalmology are not always friends. Optometrists are the eye doctors who generally provide vision therapy services as well as binocular vision evaluations. Ophthalmologists are the medical doctors who specialize in the treatment of eyes. They also do eye surgeries. While there is more than 40 years of documented optometric research to prove that vision therapy works, there is limited awareness about it partly because of the disconnect between optometry and ophthalmology. Since 2008, though, both professions agree that in-office vision therapy is effective to treat convergence insufficiencies. This is real progress. Ophthalmology also agrees that vision therapy is helpful in the treatment of amblyopia.
So much for the big issues that may be slowing down the sale of my "vision therapy workbooks" as the publisher nicknamed them. Really, they are graded academic activities for home-school students in language arts and math that also help parents identify, begin to address, and certainly improve a students efficiency, comprehension, fluency, and speed when reading. In no way do these books attempt to diagnose or prescribe anything for anyone. Rather, they connect the dots I hold because of my background in education, home-education, and as an optometric vision therapist.

One reason that I started blogging about these issues (other than as a marketing strategy for the books, of course) is that I know that a lot of children who don't like to read and who are not "living up to their potential in school" change after their unaddressed learning-related visual challenges get fixed. I see it every day when I work in the vision therapy context. I'd love to be considered a resource for parents and teachers around the issues of vision and learning so please, post your questions as blog comments or on the wall of the FaceBook page. Or email me at I'll answer what I know- probably I'll suggest you schedule an appointment with a developmental optometrist too.

For optometrists, the Eye Can Too! Read series of e-books is a great resource for your home-schooling families. The books work as stand-alone solutions or as resources for home therapy in connection with a program of in-office vision therapy for saccadic deficits, laterality & directionality delays, and visual perceptual delays. Let me know if you are interested in receiving preview copies or in having them available on CD for sale at your office.