How Hopscotch Helps Vision

One of the games I remember playing at recess was hopscotch. My school had a cement playground between the brick building and a twelve or fifteen foot high fence along the back yards of the neighboring houses. There was also a sand lot that did not belong to the school but which we were allowed to use during recess but no girls were welcome on that part of the playground in the early 1960s because the rough wild boys were always playing soccer or softball. And, of course, we were wearing dresses so that wasn't an option for us even if the boys would have tolerated our presence. Since boys have cooties, we didn't mind being excluded because who wants to get cooties. The girls tended to dominate the black-top part of the school yard. We also often played hopscotch - especially if someone remembered to ask the teacher for a piece of chalk from the black board to draw the board. It is too bad that recess is being marginalized because even a simple game of hopscotch relies on and improves the learning-related vision skills that make academic progress easier.

Even drawing the hopscotch board takes a combination of visual skills. First, using the visual perceptual skill of visual memory, the chalk artist checks the mental image of the board. Then, using visual spatial relations, another visual perceptual skill, and visual motor planning, the chalk artist arranges the lines - oops- don't forget to apply good visual motor integration so that the lines meet at good perpendicular corners and the numbers in the boxes are legible.

Applying visual attention and good saccadic eye movements, the kids scan the yard until they locate a rock that won't roll too much, is colored so that it contrasts with the pavement enough to find after tossing it, and is small and light weight enough to pitch.

Again, it takes good eye movements, visual attention, and the ability to team both eyes on a location in the distance as well as great visual motor integration to make an accurate throw so that the rock lands in the next box.

Next, the vestibular system has to coordinate with the visual system with good bilateral integration skills to hop through the board without stepping on any lines.

Finally, visual memory has to remain at work between turns so that the players can keep track of their next goal.

So, if anyone tries to take away your recess - try challenging them to a game of Hopscotch. And, please, post a comment to share what was your favorite recess activity when you were in grade school.

For Teachers About Learning & Vision

Teachers should be the first line of intervention when one of their students has a learning-related vision problem since they get to see the children at work every day. When a student covers one eye or puts their head down so that only one eye points towards the text or paper, the teacher should recognize that this child needs to see an eye doctor to rule out amblyopia, or problems teaming the eyes to keep a word or other image single. When a student squints or complains of having a headache often during school - especially when asked to copy work from the board or smart-board to a piece of paper on their desk, the teacher should suggest that the student's parent make an eye appointment to make sure that the child knows how to accommodate i.e. switch their focus from near to far and back again efficiently. When a student cannot line up the digits in a math problem or appropriately space words on their paper, the teacher should first offer some practical hints but if these do not seem to help, it is time for a referral to an eye doctor to make sure that the child's eye movements and visual perceptual skills are developing on schedule. When a student makes frequent reversals when reading or writing - especially after the second grade, this may be a visual spatial delay in the skills of laterality and directionality. Finally, when a student has trouble in PE or on the playground catching or aiming balls or, in general, has under-performing gross motor skills, the root of the problem could the visual-motor-integration. While each of these symptoms can make success in school very difficult, all of them can be addressed by a few weeks or months of in-office vision therapy under the supervision of a developmental optometrist. No child should be left behind in school because of addressable learning-related vision problems.

Does your student move their head across the page when reading?

Do you notice that one of your students moves their head across the page when reading? The same student probably also struggles with losing their place, skipping lines and little words, and finishing worksheets arranged in rows and columns. Someone who habitually moves their head when reading may be compensating for inadequately developed eye muscle movement skills. However, this strategy ends up hurting their reading speed, efficiency, accuracy, and comprehension. In fact, they are using their neck muscles to point their eyes to the text when each eye has a total of six muscles specifically designed to work together to make very specific, accurately focused eye movements.

Developmental optometrists whose practices include vision therapy have lots of activities that serve to address poorly developed ocular motilities. They usually start as monocular activities so that the student wears a patch over one eye to do the task, switching the patch to the other eye to repeat it. Once a student demonstrates equivalent accurate and efficient eye movement skills with each eye by itself, the therapy advances to binocular tasks. Not only does each eye need to move appropriately to gather visual information, the eyes together have to coordinate to point at the same time to the same point in space. Otherwise the image will wiggle, appear blurred, or seem to be double.

If you have a student who moves their head back and forth when reading, recommend that they see a developmental optometrist for a comprehensive eye exam. They may have a deficit of their ocular motilities which is easily diagnosed by a Developmental Eye Movement Test (DEM). The earlier in a student's academic career that these deficits are identified and addressed, the better that student will do overall in school.

The Purple Book in my Eye Can Too! Read series provides lots of academic activities for the home school classroom which can also be adapted for the regular classroom. Each activity provides review in language arts or math skills for Pre-K through eighth grade. I also included helpful observation questions to assist the teacher or parent to evaluate a student's performance. The activities in The Purple Book will help you identify if your child's eye movement skills are under-developed. They can also be used even by people who do not have eye movement deficits to increase their reading speed and efficiency.

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.

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.

Does Your Child Stand With One Leg or Arm Wrapped Around the Other?

Many of the children whom I see for in-office vision therapy have more than one learning-related visual issue that makes it difficult for them to succeed in school. Sometimes a child presents with a severe laterality and directionality delay. Laterality is the ability to tell left and right accurately on yourself. Directionality is the ability to project the knowledge about left and right away from yourself into space. Both are visual spatial skills, i.e. processing skills or visual perceptual skills. We discover the extent of a child's delays using a combination of tests: the Piaget Test of Left/Right Awareness, either the Jordan or the Gardner test of letter reversals, and a dyslexia screener. Children who cannot cross the mid-line or who make frequent reversals when reading or writing letters and numbers often score poorly on these tests, all of which have age/grade level expected normed scores. Then we use a series of activities in therapy to address any laterality and directionality delays. (The Yellow Book in the Eye Can Too! Read series provides parents and teachers with similar activities and information about how to understand a child's behavior when doing them.) I have recently noticed that many of the children with the most severely delayed laterality and directionality skills stand or sit with one leg wrapped around the other. They often twist their bodies when standing, and seem to be holding themselves together with the right hand grabbing their left side and the left hand grabbing their right side. I think that this postural habit exacerbates the problem by making it difficult for the child to know which body parts belong to the right side and which to the left. I have begun to coach parents to discourage their children from using these positions as another way to address the child's visual spatial problems which they sometimes express as being "confusing." I'd love to know whether others see the same correlations. Feel free to add your comments. Thanks.

How I Got Interested in Vision & Learning

I grew up with great vision - well, I didn't need glasses and was an avaricious reader from early on, loved school and always wanted to be a writer and always wrote stuff I hoped other people would read.

The first place I taught was a tiny church-based school in Santa Ana, CA - in around 1978. I taught first grade. A developmental optometrist pioneer in vision therapy did an inservice training workshop for us teachers and I learned how to recognize when a child's vision problems were at the root of their academic difficulties. We toured his amazing vision therapy clinic. I ended up referring about four students to this doctor and all of them benefited by either a prescription for glasses or a series of in-office vision therapy sessions. Then I forgot all about it.

Until....perhaps fifteen years later. Now I was a home-schooling mom with seven children who also taught students from a total of six families over the course of a 17 year period. One daughter struggled with penmanship and resisted any form of written work in spite of being a very fast reader with great comprehension way above her grade level. Another daughter struggled to learn to read and write, made frequent reversals when writing, and could not progress past the primary readers in spite of an obvious ability to comprehend what ever I read aloud to her, and who had an uncanny gift for organizing people and things.

I took the girls to an optometrist at a major store outlet. Both passed the vision examination as far as acuities and ocular health. So they did not need glasses. Fortunately, the doctor had been a student of Dr. Gail Doell at the UMSL -School of Optometry in St. Louis. She taught binocular vision and owned her own optometry practice where she provided in-office vision therapy. The first daughter was diagnosed with a convergence insufficiency which resolved in about 8 weeks. She went on to be an air traffic controller in the US Air Force. The other daughter's problems were more related to visual perceptual developmental delays - they also resolved enough for her to make the dean's list at college every semester and to become a successful accountant. Of course, Dr. Doell became our family's eye doctor forever.

Fast forward another twelve years to 2004. I was in Gail's office for a regular eye exam. My marriage had failed leaving me the single parent of six (my oldest was grown already). This meant that my home-schooling days were ended. The children, enrolled in public schools, all thrived as top students earning scholarships and awards every year. I went back to teaching - in the St. Louis City public schools. I had also earned a Masters in Teaching. Gail and I were laughing over funny stories about my classroom experiences when she happened to mention that she was hiring a new vision therapist. She wanted someone with a graduate degree either in education or occupational therapy to train in-house. Was I interested? After observing several times, I started working for her as a part time vision therapist. Six years later, I still do that in her pediatric office, the Center For Vision & Learning in Creve Coeur, MO.

Most teachers are never told about how fundamental the development of the visual system is to a child's academic success. Many students who are intelligent and excited about learning but who also have undiagnosed learning-related visual problems lose motivation, engage in deteriorating behavior, and become discouraged about their potential success. It begins in kindergarten for many. In fact, many academic challenges could be avoided if every teacher knew how to incorporate activities to improve eye movements and to build visual perception. Even more students would do better at school if every teacher knew how to recognize the symptoms of convergence insuffiencies or excesses and accommodative disorders so they could refer the students to a developmental optometrist who specializes in binocular vision. Special education teachers could help many of their students who have Autism or Asperger's Syndrome by understanding the visual issues these individuals often face and by collaborating with developmental optometrists and skilled vision therapists.

IT IS NOT ENOUGH FOR A CHILD TO PASS THE VISION SCREENING IN THE SCHOOL NURSE'S OFFICE - THIS JUST DEALS WITH DISTANCE VISION AND WITH OCULAR HEALTH - EFFICIENT READING RELIES ON SEVERAL OTHER VISUAL SKILLS

As I participated in optometry training workshops and conferences I discovered that as much as teachers don't know what optometry has to offer, optometrists don't know how classrooms work either. I have experience in the classroom, the homeschool, and the vision therapy contexts. That's why I wrote the Eye Can Too! Read series of curriculum activities for homeschoolers. Of course, they can be adapted for classrooms too. I'm working on a big book of learning related vision activities for the primary classroom learning center now.

Besides finding it personally rewarding to see my patients advance several reading levels within a few months of starting vision therapy and gain self-confidence so that they can begin to enjoy school, I am passionately convinced that the more than 40 years of optometric research about addressing learning-related visual problems through vision therapy activities should be made more widely available. That's why I write this blog and hope to be a resource to parents and teachers for the sake of the kids.

Please feel free to share the links to this blog. Follow me (@lesleybarker) on Twitter and become a fan of the Eye Can Too! Read page on FaceBook. Leave your questions on one of these sites and I'll get back to you with some kind of response that I hope will help.

Incomplete Math Worksheets May Indicate Learning-Related Visual Issues

Many elementary school math worksheets and tests contain a single sheet of problems arranged in rows and columns. It makes sense. More problems fit on the same page so you save paper. The problems can be solved by working directly on the sheet showing their carries and borrows so that the teacher can easily see if the student knows the concepts and if they deserve partial credit if they got the answer wrong.

But, students whose learning-related visual skills are challenged by ocular motility deficits of either their saccadic or pursuits eye movements may have a very difficult time completing the assignment. Since these students have not yet developed adequate automatic control of their eye muscles (there are six muscles connected to each eye), they may not be able to hold a visual fixation on a single math problem long enough to find it in the first place. So, the paper they turn in may look like a piece of Swiss cheese because so many problems are left undone. In addition, for the same visual reason, these students may start to answer one problem, look away for a second (perhaps to look up while thinking or trying to remember the math fact) and be unable to find the problem again. So the answer to one problem may be written on a different problem nearby.

So, after attacking all the problems (not really) that they perceive, the students assume that they have completed the work and hand it in. "You didn't do all the problems," says the teacher (probably for the 50 thousand time since the year started), surprising and frustrating the student who really really tried. "Go back and finish the paper." A few minutes later, the student returns, again thinking that the whole assignment is done. A few more problems may be, but there are still many left undone, leaving "holes" on the worksheet. Yet, if the teacher points to a problem while the student completes it, or assesses the students' learning another way, these students may be able to show mastery of the mathematical skills that the worksheet was meant to assess.

It isn't that they do not understand how to solve the arithmetic. It could be that they have deficits of their eye movements. They probably are the same students who lose their place when reading, skip little words, and find paper and pencil tasks laborious, frustrating, and terribly time consuming. But, they are obviously intelligent, articulate, and engaged when the learning is delivered and assessed without a need for reading and writing.

These students do not have to spend 12 years of their lives being frustrated and feeling a sense of failure. Recommend that they see a developmental optometrist for a complete binocular vision examination. Then, follow up with in-office vision therapy if it is indicated.

In addition, these students may be assisted to improve their eye muscle control with the activities in the first (Purple Book) of the Eye Can Too! Read series. While the activities are designed with the home school context in mind, many of them are appropriate for use in the regular elementary school classroom. They each serve an academic as well as a visual objective and come with suggestions for what to do when you observe certain behaviors as your students do the activities.

"I like the book...my eyes are not in pain anymore"

Let me tell you about a fourth grade home-schooled boy. We'll call him Charlie (not his real name but he is a real boy). When Charlie's mother first called me she was really concerned about the fact that despite her background and advanced degrees in teaching, Charlie could not read with any fluency. He took forever to do his assignments, made very frequent reversals in reading and writing, and was not advancing at a pace that should have been possible given his obvious intelligence and ability to handle advanced concepts whenever they were presented orally. Charlie's mother agreed to help review the material which would soon become the Eye Can Too! Read series of books because she was ready to try anything. After having Charlie attempt to do some of the activities, she realized that his visual skills were very poor indeed. We helped her to locate a developmental optometrist in her area who concurred, gave appropriate diagnoses, and began to supervise a program of vision therapy to address the various layers of Charlie's difficulties. These included eye movement deficits, convergence insufficiency, and visual spatial as well as visual perceptual developmental delays. Did I mention that Charlie HATED to read? Well, he, like many children with learning related visual deficits, hated to read.

So, here's the good news. Six months later, this week, Charlie's mother told me that she couldn't find him when she wanted him to do something last week until she looked in the living room. Charlie was curled up in a chair reading a Hardy Boy mystery book all by himself. It was the first time that his mother had ever seen him choose to read and also continue to read for an extended period so she left him alone. 40 minutes later she asked him why he was reading.

"I like the book," he answered. "The words do not disappear at the end of the lines [like they used to]. My eyes are not in pain anymore. It doesn't hurt. It's easier."

Once again I conclude that children who resist reading or who seem to find it excessively difficult may have learning related visual issues which can be addressed through a program of optometric vision therapy under the supervision of a developmental optometrist.

K-12 Learning Center Activity - BDPQ Jumps

Learning to tell left from right on yourself is the visual spatial skill of laterality. Extending it into space is the visual spatial skill of directionality. Both are developmental skills that impact a student's ability to learn to read, write, and do gross motor activities. Here is an activity that is similar to one we use in the vision therapy context to assist patients to develop laterality & directionality. It is meant to be used as a K-2 Learning Center Activity.

Title: BDPQ Jumps

Learning-Related Visual Skills: This activity uses the visual spatial skills of laterality and directionality as well as saccadic eye movements, the small hops the eyes must make to go accurately from the end of one word or line of text to the next.

Academic Objective: This activity gives students practice reading and naming lower case b, d, p, and q.

Preparation: Create a chart with 5 rows and 5 columns. Do not put the gridlines in. Randomly arrange b, d, p, and q so that there are five letters on each line. A text size of 42 will be readable at 5-7 feet for most students. Post the chart on a bulletin board. On the floor in front of the bulletin board, use colored masking tape to create a pair of intersecting perpendicular lines 4 feet x 4 feet.

Directions: Show the students that the vertical tape line is analogous to the stick of each letter while the space left by the intersection is analogous to the letter's circle. So, the lower right space is B; the upper right space is P; the lower left space is D; and the upper left space is Q. Students are to work as pairs to jump into the space that matches the letter on the chart which they must read from left to right and from top to bottom as usual. The jumper must also say the name of the letter correctly. Partners observe each other while keeping track of where the jumper is on the chart and watching for mistakes. If a jumper makes 3 mistakes before finishing the entire chart, the roles change. The observer becomes the jumper. How many turns does it take for each partner to jump through the chart making fewer than 3 mistakes? Set a time limit of 10 minutes for each partnership to remain at this learning station.

What Do Children Say When They Have Learning-Related Visual Challenges?

"I shut one eye when I read because it is easier," one second grade boy admitted to me at a recent in-office vision therapy session. His diagnosis includes saccadic deficits and convergence insufficiency. He hates to read. No wonder! The words don't stay put on the page when he attempts to read and he can't keep them single unless he closes one eye. However, that strategy deprives him of some detail and appreciation for depth. Within the next 6-12 weeks, though, he should notice a significant difference. The vision therapy activities that we do together and that he does between the weekly sessions at home are research-based and proven to strengthen the eye muscles as well as to help him realize how to coordinate and team both eyes to point to the same location at the same time, thus keeping the image single as well as 3-dimensional.

The next patient, a first grade girl who is in her eighth week of in-office vision therapy, surprised both her mother and me. Her diagnosis is saccadic deficits. This means that she has difficulty moving her eyes quickly and efficiently from one stationary visual target to another- like what the eyes do when moving from a word or a line of text to the next without loss of place, or skipping. I asked her if she has noticed any changes when she reads since she started coming to vision therapy. She said, "Yes, there aren't two words anymore." While this correlates with some of the anecdotal findings I have recorded about her progress, since she did not have a diagnosis related to eye teaming such as convergence insufficiency or convergence excess, we did not realize that she was suffering from dyplopia, double vision. Children have no other visual experience than their own so frequently they do not identify their visual challenges in language that tips off the adults that they need some interventions. This child has more vision therapy work to do to resolve the saccadic deficits but imagine how much more comfortably and successfully her school days must be now that the letters and words on a page look clear, stable, and single.

Vision therapy is an intervention that works to address quite a few learning-related visual issues. If your child is struggling at school, let me encourage you to schedule a comprehensive binocular vision exam with a developmental optometrist who is experienced with pediatric patients and who also incorporates vision therapy into their optometry practice.

Why Can't My Student Remember How to Read Simple Words After Lots of Review?

As frustrating as it can be for the teacher when a child seems unable to recognize the same easy word in the next sentence, it may be even more difficult for the student. Imagine knowing that you are a very smart person before being confronted with the need to learn to read, and then finding yourself stuck in the lowest performing reading group. How boring! How demeaning! The child cannot figure out how the other students can make the letters stand still on the page, or which of the double lines go with which letter, or which side of the page or word is the beginning, or why the letters and words seem to disappear - that is, if he has learning-related visual challenges. What is even worse, since he has never had any experience of normal vision with which to contrast his own, he cannot explain why he is having trouble. When teachers or parents decide that somehow the problem is related to his behavior or that he is just not trying hard enough or that he is being lazy, the student often responds with even less effort, overt anger, or becomes withdrawn and depressed.

Before assessing that your student is guilty of any of those things, consider that all of these symptoms correspond to a visual condition that can be addressed with simple activities during in-office or home-based vision therapy. Get your child tested by a developmental optometrist who is familiar with vision therapy. Then, follow through on the recommendations that the doctor suggests.

What? Your child passed the vision screening at the nurse's office at school, at the pediatrician's, and, besides, the local eye doctor says he does not need glasses. As the developmental optometrists are fond of saying, "vision is a lot more than 20-20 eyesight." There are ocular motility skills - how the eye muscles work together to point the eyes to a point in space; eye teaming skills - that keep the words single on a page and contribute to an appreciation of depth; accommodation skills - the ability to easily and comfortably change the focus from near to far and back again; a whole cluster of visual perceptual skills - how to interpret the information gathered by the eyes; and visual motor integration - how to use visual information to direct motion. Students can have difficulty with any of these skill sets without needing glasses.

If your student is having difficulty learning to read, if her academic performance does not "match" her expected potential, if school just seems too hard, get a thorough eye examination that considers more than just whether your child needs glasses.

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.

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.

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.

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.