St. Louis Examiner Article

Check out this article for more about vision and autism.

http://www.examiner.com/examiner/x-22250-Autism--Education~y2009m9d26-Understanding-the-relationship-between-vision-autism-and-learning

Do You Have Good Eye Movement Skills?

A very common learning related visual problem is poor eye movements. The six eye muscles in each eye should work together to point the eye to a visual target such as a word on a page or a baseball coming towards a bat or glove. There are actually two types of eye movements facilitated by these muscles. Pursuits are the movements the eyes make to follow a moving visual target smoothly. When I am helping a patient develop good pursuits, I often characterize this skill as "ice skating for your eyes." The other type of eye movement is called saccades. Saccades are the short hops the eyes make between two fixed visual targets such as when going from the end of one line of text to the beginning of the next line.

Both pursuits and saccades are developmental eye movements. Like learning to swim or ride a bicycle, once a person knows how to do them, they continue to improve. With experience, the person can coordinate the movement automatically and fluently enough to do other things at the same time like carry on a conversation, for example. However, for patients whose developmental eye movements are delayed, basic tasks like reading, lining up digits in a math problem, or hitting a baseball can be very difficult.

There is a simple test that optometrists use to test a child's eye movements called the Developmental Eye Movement Test (DEM). It is available exclusively from the Bernell company (www.bernell.com). Bernell provides an assortment of tools for optometrists and vision therapists. The DEM can be used for children as young as first grade. First the child is asked to read a column of 80 single-digit numbers arranged vertically. The examiner times the child with a stop watch. Then the child must read the same 80 numbers arranged in rows horizontally with random gaps in the rows. By the time a child is twelve years old, the speed with which they read the vertical numbers should match their speed reading the horizontal numbers. The test has been validated over a period of years so norms for a child's performance scores have been established according to both age and grade. Besides comparing the vertical and horizontal reading speeds, the DEM also measures the number of errors made by the child. It only takes about three minutes to complete the entire DEM but the results may explain why a child is having difficulty in school in spite of having 20-20 vision.

If your child scores poorly on the DEM, vision therapy may be indicated. Your child may also be helped by the activities in the Purple Book of the Eye Can Too! Read Series. While I wrote the series for home-schooling families, anyone can implement the activities which are similar to what we use in in-office vision therapy to address eye movement deficits.

Poor Reading Fluency May Indicate a Learning-related Visual Challenge

Efficient readers move their eyes quickly across a page of text decoding words and processing meaning. The most efficient readers even scan and recognize familiar words by their shapes. It takes more than good phonetic skills and a good visual memory to read fluently though. People who have deficits of their saccadic eye movement skills can't usually do it. Because their eye muscles are not developed well enough for them to control where to point their eyes, they may not be able to maintain a fixation long enough to process the word or its meaning. When they lose the fixation, they also lose their place in the text.

Fortunately, saccadic eye movement skills are fairly straight forward to improve. Starting with monocular activities that exercise each eye by itself, the eye muscles get strengthened enough to become much more reliable within a few weeks. Like I tell my younger vision therapy patients who are struggling with saccadic eye movement deficits, "You are supposed to be the boss of your eyes but they are mocking you and saying, 'We don't have to do what you say. We can do anything we want." After several weeks of consistent practice, most patients gain significantly better skills.

Until they can manage quick and accurate saccadic eye movements while also doing a cognitive task at the same time, though, the optometrist typically will not discharge a patient from vision therapy.

While there are other learning related visual issues which can result in poor reading fluency like a convergence insufficiency or a visual perceptual delay, improving your student's saccadic eye movement skills will usually result in an increase in reading speed, fluency, and comprehension.

The good news is that even if you do not have a diagnosed deficit of your saccadic eye movements, anyone can improve their reading speed, fluency, and comprehension using the activities in the Purple Book of the Eye Can Too! Read series. (Click on the links at the right of the blog to preview the series at Home School Incorporated.) While written with the home school context in mind, the activities are appropriate for anyone and can even be adapted for use in a classroom learning center. The book contains graded academic activities that all also rely on and build saccadic eye movements.

Of course, every child should be examined by a developmental optometrist or other eye doctor once each year to make sure that their vision is developing normally, the eyes are healthy, and if they need glasses, they have the correct prescription. If you are concerned about the possibility that your child has a learning related visual problem, be sure to let the doctor know.

Teaching Students Visual Memory Skills

Do any of your students have difficulty identifying or properly sequencing letters or numbers even though they have been given plenty of instruction and guided practice and seem otherwise bright, articulate individuals? Over the years, several of my vision therapy patients have had this problem and I have discovered that when they learn how to access their visual memory, they begin to have a strategy to solve the embarrassing dilemma.

Here is an activity that can help teach students how to overtly access their visual memory.

1. Have the student close his eyes and describe from memory the items in the classroom.
2. Ask whether there is an alphabet chart posted anywhere in the room.
3. Ask the student to tell you from memory what color the chart is and what color the letters are. If the student does not know, give them an assignment to find out the next time they are at school.
4. Ask whether your student can see a picture of that chart in their mind. Then ask how many "w's" are on it.
   
5. Ask if the student can read the chart by looking at the mental image and find the letter that comes two before "q".

Note that many students who have difficulty remembering visual material have not been assisted to look carefully and analyze the visual images. These students may prefer to learn using an auditory or kinesthetic mode but they can still develop more visual competence with help.

Here is a spelling activity to help students put visual material into their visual memory.

1. Take any word on the spelling list. Perhaps you want to learn to spell picnic.
2. Write picnic in neat manuscript letters as a model.
   
3. Direct the student to trace the word with a pencil five times.
4. Next tell the student to imagine that it is a very damp cold day. There is moisture on the car window. Tell the student to use her finger to write the word picnic on the window.
   
5. Ask her if she can see the word on the imaginary car window. Then ask her to spell it by reading the letters from the window in her mind. Next, ask her to spell it backwards.

Notice that this method does not rely on any phonetic skill at all. It is a visual activity. The most efficient readers mix their ability to remember visual cues with their ability to sound out words. In English, especially, because there are so many equally correct ways to write a single sound, we have to use both our auditory and visual memory to become good spellers and readers.

Learning-related Visual Challenges Can Effect Behavior

Students who get very agitated about doing homework, who do not like reading, or who are having serious challenges learning to read may be responding to an undiagnosed visual problem. I see this in the vision therapy context all the time. Children resist doing certain activities by engaging in all types of behaviors that they hope will distract me from continuing to insist on the task. Some children express anger or frustration, even becoming oppositional or somewhat combative. Other children say that they can't do the activity because it is too hard, too tiring, or too confusing. Still others goof around to avoid actually doing the work. These same strategies happen in the classroom and at home over homework. It can be enlightening for the therapist, teacher, or parent to have a calm conversation with the child. Ask whether the activity is difficult. Then ask why. If the child says that the words move on the page, they can't keep their place, the task is just confusing, or it gives them a headache respect the answer. See if the child can make a distinction between doing the assignment and understanding the material. Don't lead the conversation, though. Just give the child the opportunity to explain the basis for the behavior. Then, instead of making the child push through a task that is overly challenging, give an alternate activity that is more achievable. Talk about better ways to tell the adult that a task is too difficult instead of continuing to utilize the bad behavior as an avoidance strategy. Of course, if your child gives you any indication that their resistance to visual tasks is because of how difficult it is for them to cope with the visual information, make an appointment with a developmental optometrist in your area. First, rule out any need for corrective glasses. Then, rule out any eye movement deficits, eye teaming problems, visual processing delays, and visual motor integration deficits or delays. All of these issues can make school very overwhelming to an otherwise bright child. All of them can be addressed using a specific program of vision therapy under the supervision of a developmental optometrist who incorporates vision therapy in their practice setting.

MidWest Home School Convention in Cincinnati, Ohio

The publisher of my Eye Can Too! Read series of graded academic activities for homeschoolers that are designed to improve a student's learning-related visual skills will be at the MidWest Home School Convention this week. Home School Incorporated will have copies of the books at their booths: #737 and #836. The convention will be held at the Duke Energy Center in Cincinnati starting on Thursday, April 16, and going through Saturday. There is a fee to attend the convention but the vendor booths are worth the trip and the expense because you'll get the chance to look at the curriculum items before you buy them and there are always convention specials and discounts. If you want to learn more about this convention, check out www.cincinnatiHomeschoolConvention.com.

Shameless Self-Promotion: I'll Be at the St. Louis Expo This Weekend

If you're in the St. Louis area, I'll be at the St. Louis Expo from Thursday afternoon until Saturday at 5PM. I designed the booth for the Center For Vision & Learning to have plenty of interactivity for students. I'll have copies of the Eye Can Too! Read series of 3 books - the third book will be out this week. Nicknamed "The Green Book," it provides activities for K-8th graders that require various visual perceptual skills. The second book, "The Yellow Book," is filled with activities using laterality & directionality; and the first book, "The Purple Book," gives students practice using their ocular motility skills. Each book will help a student improve their learning-related visual skills, which, in turn, should help them to make better academic progress. One of the most valuable tools in the books is the set of observation questions to help parents and teachers make sense out of how a student performs an activity. Of course, my message always includes the wisdom of having each child get an annual eye exam by a developmental optometrist who is experienced working with children and who is open to vision therapy as a part of their practice. So, if you are in St. Louis and can get to the First Evangelical Free Church on Carmen Road this weekend, find me. I'll be speaking with Dr. Cheryl Davidson at 10:30 on Saturday morning and then I'll facilitate a session at 3 PM Saturday where participants can ask questions which I'll try to address. The Expo is free on Thursday and there is an admission charged on Friday and Saturday. Find out more about the Expo at http://www.stlhomeschoolexpo.com/index.html. At the Expo, I'll also have a coupon code which you can use on the Home-School-Inc website to save money when you purchase any of my books before Monday, March 30. I'm looking forward to meeting you there.

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.