Vision Therapy - Helping Kids Succeed in School

One of the best things about being an optometric vision therapist is seeing the kids, who are my patients, become convinced that they can succeed at school. Often this doesn't happen until more than 4 or 5 weeks of therapy has occurred. Then, when I ask, "Are you noticing any changes when you do your school work or reading?" Usually they volunteer something like, "I don't lose my place as much." or, "I read quicker" or "the words don't go double anymore." Of course, when and what a child notices is totally related to the diagnosed deficit or learning-related visual challenge. Many times kids respond when I tell them that they need to learn to be the boss of their own eyes but that until that happens their eyes are taunting them by saying that they don't have to obey and, in fact, they can do whatever they want. After a few giggles, the kids begin to take a more active role in their own vision therapy.

Why a VT Patient Plans to Get Married

A high school patient with severe developmental delays came to vision therapy yesterday. My colleague was doing a perceptual activity using attribute blocks which was frustrating our patient. His way of distracting us away from vision therapy is to chat about anything and everything -usually sports, video game releases, and television programs. Yesterday, though, he was complaining that he had done poorly on a test at school. "What subject was the test in?" the therapist asked. "Personal finance," the patient answered. "Isn't that where you learn to balance your check book?" asked the therapist. "That is a really important class for you to do well in, right?" "No, I don't like doing it," said the patient. "What will you do when you grow up? How will you know how much money you have?" "That's why I'm going to get married so my wife can balance the checkbook," he responded.

Miss Mary Mack.....

Remember the clapping games from elementary school recess? You had to clap a partner's hands in rhythm to the poem following a pattern. You had to cross the midline, remember the words to the rhyme, think ahead and respond to your partner. This little game builds bilateral coordination, laterality & directionality, visual motor integration, all of which are visual skills that contribute to a child's ability to succeed in school. If your child can't do a simple game of patti-cake without mixing up which hand goes where in the rhyme, don't allow them to forget about the game. Slow it down. Do it again and again. Simplify it by using just one or two elements in the sequence until they are mastered. This kind of game is really important especially if your child has trouble with reversals when reading and writing or gets confused about which side of the page to read first.

Rice, Tweezers, and Dot-to-Dot Books

One easy to do fun activity that helps individuals strengthen their lazy (or amblyopic) eye is to fill in the gaps between the numbers in a preschool dot-to-dot book with grains of uncooked rice.

Directions: Put about a tablespoon of rice into a small saucer. Tape a dot-to-dot page to the table so it doesn't wiggle. Put a patch over the better eye. Using a regular pair of tweezers, pick up one grain of rice at a time and place it carefully down between the numbers in order. Continue laying down grains of rice one at a time until the entire puzzle is complete.

Why is this an effective monocular activity?

1. Because the page is likely to be the same color as the rice, seeing where each piece of rice should be placed depends on good visual acuity
2. It also requires good visual-motor-integration skills to manipulate the tweezers, isolate just one piece of rice and maneuver it to the paper

Our Amblyopic Intern is Getting Better

This morning our 4th year optometry intern told me that yesterday she asked our senior doctor to refract her and guess what? After four weeks of doing vision therapy activities with our patients - she has been wearing red and green glasses to "wake up" her amblyopic eye when facilitating activities with anti-suppression targets and wearing a patch over her "good" eye when facilitating monocular activities....her best corrected visual acuity in her amblyopic eye has improved significantly. She is surprised and thrilled.

Jigsaw Puzzles Develop Visual Perceptual Skills

Children who hate doing simple jigsaw puzzles should be encouraged to do a simpler similar task so that their visual perceptual skills will improve. What visual skills are involved in doing a jigsaw puzzle?

1. Visual spatial relations is the ability to recognize patterns between the puzzle pieces. In a jigsaw puzzle you must recognize that some pieces have a straight edge, for example. Thus, they produce the outer frame of the puzzle. 
2. Visual closure is the ability to predict what an image will look like when you only see a portion of it. To solve a jigsaw puzzle you have to be able to visualize which pieces fit into openings made by the other pieces.
3. Scanning the array of unused pieces is an eye movement skill. People with saccadic deficits will have difficulty finding the right jigsaw piece.
4. Visual memory is the skill that allows a person to create a mental image and then refer to it. This skill must be in place when searching for pieces and when returning to the incomplete puzzle to place the selected piece.
5. Visual attention is a basic skill that must be in place before the simplest puzzle can be completed. People who do not value the information received by their eyes will not do well at jigsaw puzzles. They tend to try to locate things by touch instead of by sight.
6. The ability to transition between a central fixation with peripheral vision is necessary to complete any jigsaw puzzle. This skill is often very under-developed in individuals on the Autism Spectrum

Each of these visual skills must be developed and in place in order to enjoy and be successful at doing jigsaw puzzles. Academic success also depends on each of these visual skills. So, if your children do not like doing jigsaw puzzles, do not allow them to avoid them. Try using simple preschool puzzles and time how long it takes to complete them. Challenge your child to beat their previous time. Go to a teachers' supply store and purchase parquetry blocks or tangram workbooks. Even inexpensive dot-to-dot books will help to develop a child's visual closure and scanning skills while the hidden picture puzzles in Highlights or the I Spy book series will also improve a child's puzzle solving skills. 

Remember to schedule an annual eye exam with an eye doctor who incorporates vision therapy into their practice. These developmental optometrists routinely examine children's visual perceptual development and can prescribe in-office vision therapy activities to help.

In addition, the Eye Can Too! Read series of e-books contains helpful home-based activities and resources that you can easily adapt for any individual child or classroom.

Our Intern's Emerging Binocularity

Today I asked our amblyopic intern whether she has had any more results from doing simple binocular activities in our vision therapy room. Yes, she is aware of depth in a new and not terribly comfortable sense now that she can see two strings on the Brock string. She also had a terrific headache last week and attributes that to the emerging use of her right eye. Not only is she providing clear language about the disruption that becoming binocular is making for her otherwise reliable visual world-view, she is gaining empathy for all the patients for whom she will recommend vision therapy once she is a fully licensed board-certified optometrist. I hope to convince her to blog about her journey towards binocularity.

Can You Do This?

Hold your thumb out at arm's length in front of your nose. Look at it. It should look like a normal thumb. How do you have to change your eyes to make the thumb double? If you can make the thumb double, what do you need to do to make it single again?

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.

What's So Good About Recess?

Recess, that endangered but kid's favorite part of the school day, could be key to a child's academic success. No, not because they need a break - but they do! And, not because it's fun - but it is! Recess is where the gross motor bilateral coordination building laterality & directionality eye movement visual perceptual and visual motor integration skills all get exercised on a daily basis without anyone realizing it. That's the problem. So many educators insist that the reason children are not making more consistent progress learning to read and write is because they don't spend enough time in the classroom that many (especially inner city) schools are doing away with recess. My next Eye Can Too! Read book will be about recess games that actually will make it easier for children to learn to read. These include hopscotch, jump rope, ball games, aiming/tossing games, running games, and clapping games. I'm going to provide the directions and then explain the learning-related visual skills involved as well as connect those to how they are critical to developing adequate reading and math skills. Want to help? Add a comment here or on FaceBook or Twitter about your favorite recess game when you were a kid. If there was a type of recess game that you just never were able to do well, let us know that also. And, more than anything, make sure that the children you know, love, and work with have plenty of opportunity to be outside playing the games that build the skills they need in the classroom.

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.

Hope for an amblyope

We have a new intern in our office, a fourth year optometry student who, as I am fond of saying to the therapy patients, is just a minute away from becoming an eye doctor. As I was introducing her to the various activities that we use in therapy, she disclosed that she is not binocular. In other words, she does not see in three dimensions because her eyes do not team properly together. She is also an amblyope. One eye has an acuity that is at least two lines on the Snellen Eye Chart worse the other eye. This is probably why she is not binocular - she opted to pay attention to the information coming into her brain from just one eye - actually, she did not do this on purpose, it just happened and therefore she does not experience double vision. You need two eyes to point to the same place in space AT THE SAME time in order to experience three-D vision. Since we deal with binocular dysfunctions a lot in VT (vision therapy), she and I began to talk about what her goals were for this rotation. Binocularity has been an abstract concept for her, not ever having experienced it and she hopes to understand it better. As I showed her patient histories that demonstrated how we can stimulate the emergence of binocularity in patients with similar conditions as her own, she became more and more intrigued with the possibility that she, like "Stereo Sue" Barry, could actually achieve a different visual outcome. That was last Monday. I only work on Mondays and Saturdays so when I saw her today she greeted me with the news that she is beginning to be able to do very simple binocular tasks. Later this morning, she was wearing a patch over her better eye to make the amblyopic eye work. I love when people unexpectedly gain hope for what they thought was a forever condition to change. I'll keep you posted.

Can't cross the midline - Rake my yard, please!

Children who cannot cross the midline have lots of problems in school. They don't easily form letters like X, V, W, M, N, or Z because these letters require them to draw a line that moves across a diagonal. These kids have trouble finishing worksheets where they have to connect a selection on the left side of the page by drawing a line to its match on the right side even when they can demonstrate mastery of the information orally or in other kinds of written assessments. Regular playground activities like skipping are also very difficult and the most delayed children may not be able to alternate their feet when climbing up or down a flight of stairs. These same children probably do not know their left from their right and may become confused about which side of a word or line of text to read first. By providing lots of gross motor experiences that require a child to cross their physical midline during a program of in-office vision therapy, we can often help them to form the neural pathways that allow them to understand where they are in space. Then we can assist them to apply that knowledge to directions outside of their body. So, it's fall. I spent much of the afternoon raking leaves. It is a perfect chore to give to a child who needs to learn to cross the midline. You hold the rake with both hands and sweep it across your body again and again. Of course, the satisfaction of creating a huge pile of crispy leaves to jump in and hide beneath provides most of the motivation needed. Even very small children can rake if you buy them rakes with shorter handles.

If you suspect that your child may have delays in the development of laterality & directionality, make an appointment for a comprehensive eye exam with a developmental optometrist who incorporated vision therapy into the practice. The doctor may decide to administer a series of normed tests to learn whether your child's visual perceptual skills are developing on schedule.

If you would like to have a set of original activities that assist children to grow in the development of the visual spatial skills of laterality & directionality, consider buying the Yellow Book of the Eye Can Too! Read e-book series by Lesley Barker

Before you Medicate, Investigate- ADHD & Vision

Clinical research has established that there is a link between a diagnosis of ADHD and certain vision deficits or delays in children. Many children with ADHD also test positive for a saccadic eye movement deficit. This means that they have difficulty moving their eyes efficiently and accurately from one fixed visual target to another as in going from one word or line to the next on a page of text. Many children with ADHD also test positive for a convergence insufficiency (CI). This means that they are unable to cross their eyes or team them appropriately and may experience words moving, blurring, or doubling on a page. They may get headaches when reading or they may, without ever being aware of it, suppress the vision in one eye. Many children with ADHD also test positive for accommodative infacility (AI) which means that they have trouble adjusting their focus when looking from a near image to a different image in the distance.

The good news is that all three of these visual diagnoses can be addressed with a program of in-office vision therapy under the supervision of a developmental optometrist. So, if your child has been diagnosed or if you are being encouraged to obtain a diagnosis of ADHD, don't stop there. Arrange an appointment for your child to receive a comprehensive eye exam by a developmental optometrist who incorporates vision therapy into their practice. If the eye doctor finds that your child has any of these visual problems, follow through with the program of vision therapy. To find a developmental optometrist in your area, plug your zip code into the search box at www.covd.org.

You can read more about this in: Borsting, Eric; Michael Rouse, and Ray Chu. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. "Optometry", Volume 76. Number 10. October 2005

Learn to Be the Boss of Your Own Eyes

A first grader came to his 15th in-office session of vision therapy today. His parents brought him to the developmental optometrist in the first place because they noticed one eye shifting in whenever he got tired. They feared he would be teased for having crossed eyes and wanted to try to avoid surgery. Not only did the doctor concur that he has a strabismus- an eye turn, she discovered that he did not use both eyes as a team. Like many other children, he suppressed the vision in one eye to avoid seeing two images when his eyes were not aligned at the same time on the same visual image in space. This unconscious strategy made him unaware of any visual problem. He had good grades, was a good athlete, and had no intrinsic use for coming to see me every week. It has taken all sorts of monocular, and binocular activities disguised as games to coax him to begin to experience binocularity. Last week it started to make sense TO HIM. I asked him to watch a bead approaching his nose on a long string (the Brock String - magic to many patients but key to learning to use two eyes together). Whenever the bead got within about six inches of his nose, his left eye swooped in towards his nose and he reported seeing two balls. Had his eyes continued to be teamed on the in-coming bead it would have remained single. Finally he was able to connect the feeling of that eye moving in with the sensation of double vision. "You need to be the boss of your own eye," I suggested, "but it keeps saying: 'I don't have to obey you - I can do anything I want.'" That apparently was enough motivation to make the child take charge. Today I could push the bead within two inches of his nose without the eye wigging out and he could switch between that bead and another bead about eight feet away on the same string without any problems at all except that it made him very tired. By next week he should be able to do more repetitions without fatiguing. As long as he is the boss of his own eyes, he will make them mind. Of course, this activity correlates with the ability to read for extended periods of time without fatigue, double vision, headaches, or the words wiggling on the page. It also solves the cosmetic problem that his parents were so (justifiably) worried about.  I can't wait for his re-evaluation appointment with the doctor who will be thrilled at the emerging binocularity and independent control of his eye movements both when using one eye and two.

Your Child Can't Keep Their Eye on the Ball?

Just because a child has difficulty aiming and catching a ball does not necessarily mean that they are not athletic. It might mean that they need to see a developmental optometrist for a comprehensive eye exam. Children with poor ocular motility skills do not know how to control their eye muscles. The same kids who can't catch may also move their heads from side to side across a page when reading instead of moving just their eyes. This may result in frequent losses of place or skipping little words and lines of text. Why is this? Because each eye is equipped with six muscles that serve to coordinate to physically point the eye towards a visual target when used efficiently. However, children who don't know how to make automatic voluntary eye movements may have difficulty tracking the flight of the ball (and finding their place in a book.) Children can also have a visual-motor mismatch that makes it hard for them to discern where something is in space. This can impair a child's visual-motor integration skills- not just in sports, but in handwriting and other fine motor skills as well. Every child should receive an annual eye exam and if your child exhibits any of these problems, ask about a comprehensive evaluation of their binocular skills when you talk to the doctor. These problems are routinely addressed with just a few weeks of in-office vision therapy.

By the way, the activities in the Purple Book of my Eye Can Too! Read series of e-books all can be used as an addition to a program of in-office vision therapy to improve a child's eye movement skills. Written for homeschooled families, these activities are easy to do and appropriate for elementary school children.

Strategies to Develop Visual Memory Skills

Today, after eight weeks of seeing me for in-office vision therapy, the optometrist discharged a high school sophomore patient previously diagnosed with a delay in the development of the perceptual skill called visual memory. She attends an elite parochial school with high standards and hard tests. Because it has been so difficult for her to remember what she studies, she has struggled with both her grades and her self image. Last week I introduced tangram puzzles as a way to help her discover meaningful strategies to remember complex material. This week she reported that it was the most significant activity of all the ones we did in therapy because it helped her approach her homework differently. Instead of becoming overwhelmed at the many individual words or concepts she had to remember, she began looking for and sorting the work into chunks and patterns that made sense. Even remembering the verb conjugations in her Spanish 2 class became so much easier.

Here is the sequence we came up with to remember a block design so that, without looking at the model, it is easy to rebuild it from memory:

• Start with a simple block design that you want to remember

• Build it 

• Analyze it by making associations and by dividing the larger design into manageable chunks

• See if you can close your eyes and see the design in your mind
  

• Practice referring to the mental image and drawing or assembling it on paper or in space

• Do something else for a while

• After several minutes, hours, or days, see if you can still access, refer to, build, and use the visual image stored in your mind

Shameless self-promotion: For home-schoolers (and vision therapy patients who need home therapy activities), I created the Green Book of the Eye Can Too! Read e-book series. All the activities require the use of visual perceptual skills to accomplish academic activities - I indicate the expected grade level for each activity as well as tips for parents to observe while their children attempt the tasks.

Eye Movements & a Struggling Adult Reader Who Has an MBA

I recently did a very simple eye movement activity with a friend who reads very slowly. It has always been a problem for her from the time she was in elementary school. In fact, she chose her high school and college courses to avoid reading so she became good at math and ended up with an MBA in finance. It remains agonizingly difficult for her to find the energy to tackle reading even a few pages. When she reads aloud, she lacks fluency, obviously struggling to keep her place while decoding the words and trying to process their meaning. So, I suggested that she might have some basic eye movement deficits. Now, I am not an eye doctor. Nor do I play one on TV but I am a skilled observer of a person's eye movements because of the work I do as a vision therapist. I asked my friend to cover one eye and to follow my pen as it moved in a slow arc in front of her eyes, up, down, across, and circling in toward her face. Then she covered the other eye and we repeated the activity. She had no problem making smooth eye movements to track the moving pen so her ocular pursuits look fine. She could even maintain a conversation while doing this activity. Next, one eye at a time again, I asked my friend to look at one pen and then, on my signal, jump her eye to another. She could not keep her fixation on the first object, nor could she accurately locate the second. When she visits a developmental optometrist for a thorough eye exam, I predict that she will receive a diagnosis of saccadic deficits. This is the result of poor control of the six muscles in each eye and can be addressed through a program of vision therapy. (In fact, just as a side note, the Purple Book of the Eye Can Too! Read series of e-books that I wrote has a lot of activities that rely on and can improve these eye movement skills). Next I asked my friend to use two eyes and focus on the #2 written on the side of a pencil that I was holding about a yard away from her face so that the eraser was facing up. I asked her to keep the #2 single and clear and to tell me if it got blurry or doubled. Slowly I pushed the pencil towards her face watching her eyes to make sure that they were converging. They did get closer and closer to her nose which is appropriate. However, when the pencil was about a foot away, my friend said, "That hurts!" She did not look away right then but I could see the stress that she was under. I repeated the activity and she repeated her report of discomfort at about the same place. So, when she visits the developmental optometrist she will likely receive another diagnosis related to her eye teaming skills.She should have been able to track that pencil in to three inches or nearer to her nose without pain, blur, or double vision. No wonder reading has been so difficult in spite of her willingness to tolerate significant discomfort in order to succeed. No matter your age, if you have difficulty reading, see whether there is a visual issue that can be resolved with a few eye exercises. Locate a developmental optometrist by going to www.covd.org and plugging in your zip code. Make an appointment and see what the doctor discovers.

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

Peripheral Awareness & Autism Spectrum Disorders

If you stare in front of you at a small visual target like a sticker or a spot on the wall you are using your central vision. The longer you maintain that fixation, the more you should become aware that you can also see objects in your peripheral field of vision. The ability to coordinate between your central and peripheral visual systems is very important. Athletes depend on it to sense when an opponent is approaching from behind. Everyone relies on it to remain aware of cars or other potentially dangerous obstacles that should be avoided. Peripheral awareness can actually be improved with practice and certain activities.

For individuals on the Autism Spectrum, however, coordinating and transitioning between the central and peripheral visual fields may be their most significant visual challenge. Many people on the Autism Spectrum repeatedly focus on spinning objects, or on moving lights and shadows. These are enjoyed via the peripheral system. Other people on the spectrum fixate on a pen or pencil that they hold and rotate right in front of their eyes or they cannot be pulled away from small objects or details. These are enjoyed via the central visual system.

As Patricia S. Lemer explains in her helpful book, Envisioning a Bright Future: Interventions that Work for Children and Adults with Autism Spectrum Disorders, learning to coordinate central and peripheral vision may improve a child's attention, focusing, and visual perceptual skills. It may even reduce toe walking and the need to hold onto a wall when walking. Dr. Melvin Kaplan (www.autisticvision.com) wrote a book, Seeing with New Eyes, that explains how these issues can be addressed using therapeutic prisms.

Children who are on the Autism Spectrum may have other visual challenges that can be addressed with the help of a developmental optometrist and a program of in-office vision therapy. They may need glasses to see clearly. You can easily locate an experienced developmental optometrist in your area by plugging your zip code into the search box at www.covd.org. Even if your child is not on the Autism Spectrum, it is important to schedule an annual eye exam with a developmental optometrist and to follow up with the treatment, prescriptions, or therapy that the doctor advises.

Find out why a child is a struggling reader by asking the right question

In my opinion, one of the most common reasons that parents and teachers don't bring their children to the optometrist when they first start having trouble learning to read is that the grown-ups don't ask the children the right questions. So, they never hear what the child is really experiencing.

The adults who probably learned to read early and always performed at the top of the top reading group when they were in grade school often declare that the reason a child is struggling to read is that they are just lazy, do not want to work, don't pay attention, or don't want to learn.

Why don't the well-meaning but demotivating dissing grown-ups ask the child a simple question like: what makes reading hard or frustrating?

Instead of trying to put words in the child's mouth, the next thing to do is wait quietly until the child answers.

Perhaps the child will say that they can't tell where the letters are because the lines are always moving or they are on top of each other or look too blurry to read. Maybe the child will say that reading always gives them a headache. Any of these answers should send you to the optometrist immediately. They are classic symptoms of a binocular dysfunction like a convergence insufficiency. Research indicates that most patients diagnosed with convergence insufficiency resolve the problem after an average of twelve weeks of in-office vision therapy.

Other children may say that they keep losing their place when trying to read which may indicate a deficit of their eye movement skills. This condition, which is often accompanied and/or masked by a diagnosis of AD(H)D, can also be addressed by some guided vision therapy activities (And, if I do say so myself, by the activities in The Purple Book of the Eye Can Too! Read Series that I wrote- but that is shameless self-promotion, after all, so hurry and click on the link to that sale page.) Seriously, not being able to control their own eye movements is a common reason that otherwise healthy, obviously intelligent and articulate children do poorly in school.

Finally, the child may say that reading is confusing or they can't remember how to figure out the words. These answers should prompt you to have your optometrist schedule a developmental evaluation of the child's visual perceptual skills (And check out the other two books in the Eye Can Too! Read Series. The Yellow Book provides activities to improve dyslexia-like symptoms and The Green Book provides activities that rely on visual perceptual or processing skills.)

But, whether you buy my books or never look at them ever, take the advice of this mother of seven, grandmother, master teacher, and optometric vision therapist, please.

Children want to please there parents and teachers for the most part but when they don't know how to tell you why they are struggling and when you don't ask the right questions, they can only respond by resisting, refusing to cooperate, getting angry, or passively avoiding the dreaded school work.

Ask what makes it hard.

Don't put words in their mouth.

Respect their answers.

Believe what they say.

Be their best advocate.

Find real help and keep hunting if the first helper turns out not to work after all.

If you still don't know how to help your child or student, why not post your question or tweet it or Facebook it to the Eye Can Too! Read page's wall - I'll try to put in my two cents but I'll bet that the optometrists, vision therapists, parents, and educators among us will weigh in.

On behalf of all the children who went to bed tonight angry and confused about why reading is hard for them, thank you for reading this.

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.

School-induced Headaches- What should you do?

Students with some learning-related visual problems tend to complain that school or reading gives them a headache. This makes them dislike school and reading even when they initially looked forward to it. What could really be going on? The student may have an undiagnosed, unaddressed learning-related visual problem. For instance, if the teacher projects material on a smartboard or writes on a blackboard expecting the class to copy information from the board into their notebooks at their desk, students have to adjust how their eyes are focusing from near to far and back again. This is the visual skill called accommodation. Children with inflexible accommodation skills often cannot handle that kind of classroom activity without getting a headache. It takes a skilled developmental optometrist to identify the problem. Sometimes the appropriate treatment includes glasses. It can also be addressed through in-office vision therapy using various near/far activities and special lenses. Headaches can also be caused by the eyes failing to team well together. A child diagnosed with a convergence excess may be unable to relax their eyes when they get tired from reading because when the look away they may not be able to return to the word without it seeming to blur, wiggle, or double. On the other hand, a convergence insufficiency diagnosis may indicate that the child cannot coordinate the eyes well enough to keep a word in focus when reading. These children may also complain of having headaches at school and when reading. Many of them suppress the vision from one eye without even being aware of it which, unfortunately, can cause additional visual problems to emerge. So, if your child has frequent headaches at school or when reading but is otherwise perfectly healthy, here's what you should do. First, believe that your child is telling the truth. Second, make an appointment with a developmental optometrist to have a comprehensive binocular vision examination. Third, follow your eye doctor's recommendations regarding glasses and vision therapy. Fourth, make sure that your child understands that the condition is not permanent and they should optimistically participate in the work it will take to overcome the problem. Don't ignore the complaints until you find a caring professional who doesn't quit until the correct diagnosis and treatment plan are made.

3-D Vision Therapy

Some people whose eyes do not team properly don't see in three dimensions. In other words, they may lack stereo vision (stereopsis). The cause may be an eye turn (strabismus), the suppression of one eye, or some other condition to be identified by an optometrist. Until recently the experts believed that unless the condition was addressed in a young person, either by vision therapy and/or surgery, it would become "hard-wired" in the brain. In other words, no one even held out hope for an adult to obtain stereopsis. That began to change with the experience of psychologist, Dr. Sue Barry, now nicknamed "Stereo Sue." Check out how she explains what happened to her on her website, www.fixingmygaze.com, or in her book by the same title. You can also watch her on You Tube:

http://www.youtube.com/watch?v=m2YqVLARZOM

http://www.youtube.com/watch?v=P9afrMMsh2w

http://www.youtube.com/watch?v=aUzJogvB0Hc

http://www.youtube.com/watch?v=CP8SsUl5wb0

http://www.youtube.com/watch?v=_c010cP8sKo

In the vision therapy context, I have worked with quite a few adults who had never experienced seeing in 3-D. When it begins to emerge, the delight they express is amazing- in spite of the headache that seems to accompany the adjustment to true binocularity. It takes time but to enrich the way the world looks is a reward that is truly worth the investment of time, money, and discomfort.

Now Available

All three Eye Can Too! Read books by Lesley Barker are now directly available at Team Lesley's Store. Just click on the links to the left here or go to www.teamlesley.com. Then click on the button to take you directly to the store. The books are e-books sold in PDF downloads. First, you buy a copy. When I get the notice of your purchase from Paypal, within 24 business hours, I'll send your copy attached to an email for you to download.

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.

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 asklesley@teamlesley.com. 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.

Surprises

Between patients at the optometry office where I work as a vision therapist, I browsed through the most recent edition of the COVD Journal. Imagine my surprise when I came across a link to my blog - this one! - in the last article. Here are the other optometry related blogs that you might be interested in following:

• http://covd.typepad.com/visiondevelopments/
• http://covd.typepad.com/visionu/
• http://mainosmemos.blogspot.com
• http://brighteyesnews.com
• http://wowvision.typepad.com/the_wow_vision_blog/
• http://petesaoablog.wordpress.com
• http://janetsjournalblog.com
• http://blogs.psychologytoday.com/blog/eyes-the-brain/feed

I also discovered that www.homefieldadvantage.org, a great home school resource also decided to link to my website.

If you are a homeschooler, a member of a home school support group, or an optometrist with a vision therapy practice that services homeschoolers, let me know, please. Follow me at @eyecantooread on Twitter or "fan" the Eye Can Too! Read page on Facebook.

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.

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.

Eye Hand Coordination as Demonstrated by Kindergarten Students 100 Years Ago

These are three scans taken from kindergarten albums from my family members. The first is carefully woven paper. It was made by Mary Edwards at Froebel Kindergarten in St. Louis City in the 1907-1908 school year. The other two scans were done by a boy, Albert Edwards, who attended kindergarten in the 1899-1900 school year, also in a St. Louis public school. The portrait of George Washington is a printed picture over which Albert has sewn very tiny neat straight stitches - the blue is a coarse thread and the white is a very fine thread. The holes are different sizes denoting that the needles were too. The third scan shows a series of folded origami.


Why did I include these scans in the Eye Can Too! Read blog? I wanted to make a statement about what kinds of activities were done at the reading readiness, preschool level in the eras before television, plastic playgrounds, and Game Boys. The eye-hand coordination required to do any of these crafts is far more mature than we expect from fifth graders today, let alone from five year olds. Not only did these children have to demonstrate very fine motor control, this kind of close work would have strengthened their eye movements so that they could gain experience converging on near point images long before they were expected to use those eye movements to decode the meaning of text.

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.

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.

Does Your Child Have a Head Tilt?

This could be a sign that your child favors one eye over the other. She may tilt her head because each eye may have a different visual acuity at near or in the distance. Perhaps she sees better and clearer with one of her eyes.

Another cause of your child's head tilt could be the result of a convergence insufficiency or a convergence excess. These conditions may indicate that she is having difficulty teaming both eyes together without experiencing blur or double vision. Her coping strategy could be to suppress the visual information received by one eye, shutting it off, in effect, by tilting her head.

If your child has always experienced these visual conditions, she may not even realize that it is abnormal.

So, if your child has a head tilt, don't scold her about her posture until after you take her to a developmental optometrist for a comprehensive eye exam. She may need glasses or a program of professionally supervised in-office vision therapy. You can find a developmental optometrist in your area at www.covd.org by plugging in your zip code.

Comprehensive Free Eye Exams for Infants

Do you know a baby who is under 12 months old? A comprehensive absolutely free grant-funded eye exam is available from optometrists nation-wide under the InfantSee Program. Check out www.infantsee.org. At the top of the home page there is a link to help you find a participating optometrist in your area. This is a much more extensive vision evaluation than your baby's pediatrician will conduct. Not only a check of the baby's eye-sight and ocular health, the exam investigates whether your baby's functional vision is developing properly. Optometrists who are participating in the InfantSee Program are likely to also incorporate vision therapy in their practice or else know a colleague who does. This is a wonderful program that no one should miss.

All 3 Eye Can Too! Read books are available as of this week

Just in time for the St. Louis Home School Expo this weekend, the Green Book of the Eye Can Too! Read book series by Lesley Barker, became available from the publisher. This book provides a set of academic activities for home schoolers (and others) which also gives students practice using their visual perceptual skills. There are several different visual perceptual skills that are important to efficient learning: visual discrimination, visual memory, visual form constancy, visual figure ground, visual spatial relations, visual sequential memory, and visual closure. The book introduces you to each skill, how it is used to process visual information, and how to promote your student's visual perceptual development. There are standardized tests that can assess an individuals visual perceptual development given by developmental optometrists, educational psychologists, and neurologists. Even without a diagnosed visual perceptual developmental delay, this book will give parents and educators a tool to use to identify and improve areas where a student may be struggling. Besides, everyone's visual perceptual skills can improve with the experiences in this book. The three Eye Can Too! Read books are available in their prefered format: a PDF download, or as a printed text from the publisher, Home School Incorporated. You are welcome to browse the sample pages at the publisher's website or, if you are in St. Louis, visit the Center For Vision & Learning booth at the Home School Expo tomorrow between 9-5 at the First Evangelical Free Church on Carmen Road in Manchester. We'll also be doing a workshop at 10:30 and a clinic at 3.

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.

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.

Does your student make frequent reversals when reading or writing? Here's help!

If your student makes frequent reversals when reading or writing or gets confused about left and right, the second book, The Yellow Book, in my three book series: Eye Can Too! Read ...Better, Faster, Without Making Reversals or Getting Confused may help. These behaviors are often due to a delay in a student's development of the visual spatial skills of laterality and directionality. Sometimes students who make frequent reversals when reading or writing are labeled dyslexic even though there is no consensus among the various disciplines on a definition for dyslexia. However, many of these students who receive vision therapy designed to address the visual spatial developmental issues overcome them. They often make significant gains in their academic performance as a result. The Yellow Book contains a series of activities like the ones we use in the vision therapy context which are designed to help students improve both of these visual spatial skills. Created with home-school families in mind, each activity identifies the visual skills used, the academic objectives and appropriate grade or ability level, a list of materials needed, clear instructions, and a set of observation guidelines to help you to understand what your student's performance may indicate. The book is available at http://www.home-school-inc.com/store/p-15-item-000014.aspx as a pdf download or as a printed spiral bound text. The Purple Book (the first in the series) is also available online at Home School Inc- it gives similar activities designed to help students improve the eye movement skills that must be in place for a student to be able to read efficiently without skipping words, lines, or losing their place. In a few weeks, the third book in the series, The Green Book, will also be available. That book provides academic activities designed to improve a student's visual perceptual skills. Each book contains graded activities for Pre-K through 8th graders. While they are all written for a home school audience, classroom teachers will find the activities easy to adapt for their class either as whole group or learning center activities.

Do words on the pages you read seem to wiggle, double, or blur?

If you can easily coordinate both of your eyes to point to the same place at the same time, you are unlikely to have this problem. However, if you can't, you may find reading very frustrating because the words may appear to wiggle or double up on the page so that it is very difficult to decode them. When this happens to beginning readers, the situation is more difficult because these very young children do not usually have the experience of normal single vision so they don't know that what they are seeing when they read is abnormal. They also don't have the language to explain what is happening. It is especially difficult for very bright, obviously articulate children who cannot counter the grown-ups' assertions that they are not trying hard enough.

Here is a simple test that anyone can do at home to check how well their eyes can team. It is called a pencil push-up. Hold a pencil in front of your face about arm's length away and slightly below your nose. Try to focus both eyes on the writing on the pencil keeping it clear. Slowly pull the pencil towards your nose, keeping the letters clear. Can you pull the pencil to within an inch of your nose without it becoming blurred or doubled? That is normal. If the pencil doubles or gets so blurry that you cannot see the writing, you should go to a developmental optometrist who specializes in binocular vision and who incorporates vision therapy into their practice.

If you sit opposite the person who is doing the pencil push-up, watch their eyes. You should see them move closer and closer towards the nose as if they are becoming "crossed." You may notice that one or both eyes suddenly stop crossing and bleep out towards the ears. When this happens, the person will probably report that they see two pencils. That is because the eyes stopped teaming to point to the same place in space at the same time so the brain received two separate visual images instead of one fused image with depth and detail.

This could be due to a condition called convergence insufficiency. Recent research demonstrates that it takes an average of 12 in-office sessions of vision therapy to address a convergence insufficiency. There are even some computer programs that can be purchased to address eye teaming problems at home which can be used in conjunction with in-office vision therapy with some patients who have adequate stereo vision.

So, don't accuse your child of being lazy if they report that the words wiggle or look double or blurry. Take them to a developmental optometrist who will be able to provide therapeutic interventions to address the problem in a few short months afterwhich reading should become much more efficient and enjoyable.

Tossing Bean Bags Can Improve A Child's Reading

Children who struggle with reading because they keep losing their place, skip little words, or miss entire lines may have deficits of their eye movement skills. Since there are three pairs of muscles connected to each eyeball, (that's 12 muscles in all), the eye can be accurately pointed towards an exact point in space often without the need for the head to move at all. Of course, if a child's eye movements have not developed to a place where she can control them automatically and efficiently, she will find reading difficult or frustrating. Tossing bean bags can help her control her eye movements. Here's how to give directions for the activity for which you need nothing more than two bean bags:

• Hold a bean bag at waist level, palm up in one hand
• Hold the other hand also at waist level, palm up
• Toss the bean bag from one hand to the other in a large soft arc
• Watch the bean bag from the time it leaves the first hand, following it constantly until it lands in the second hand
• Toss the bean bag back and forth without taking your eyes off the bean bag

If it is difficult for your child to catch the bean bag, suggest that he make sure to look at the hand with which he needs to catch the bean bag right before the bean bag lands there. You may need to issue the same cue with every new toss at first.

When this becomes easy for your child, make the activity more difficult.

• Hold one bean bag in one hand as before with the other hand at the waist, palm-up, in order to catch it
• Toss the bean bag as before
• When the bean bag is flying, clap one time. Then, catch the bean bag
• Toss it back, clapping and catching with the other hand

When this becomes easy, make the activity even more difficult.

• Hold two bean bags, one in each hand at waist level, palms up
• Toss one bean bag in an arc
• Watch the bean bag that is flying
• When the bean bag is in the air, mid-flight, clap the other bean bag into the hand that threw the first bean bag (DO NOT Throw the second bean bag - CLAP It!)
• Catch the first bean bag with the now empty hand
• Continue for as many repetitions as possible

As your child masters these simple and quite entertaining activities, she will become more aware of how to direct her eyes. The longer she can sustain the activity, the more she will exercise her eye muscles. While this activity alone will not remediate a severe eye movement deficit, it will begin to give your child experience using and developing their ocular motilities.

If your child has difficulty reading because he loses his place, skips words or misses whole lines you should not assume that he will grow out of it. Instead, schedule your child for a complete eye exam at a developmental optometrist who has experience with binocular vision and who incorporates vision therapy into his practice. Click on the link (at the top right of this blog) to the College of Optometrists in Vision Development to find a member eye doctor in your area.

You may also be interested in purchasing the first book (the Purple Book) in my Eye Can Too! Read series because it provides a series of academic activities for elementary school students which rely on the eye movement skills of saccades and pursuits. All of these activities are designed to be done at home facilitated by a parent. Every child can improve their eye movement skills just like every athlete can improve their strength and dexterity. To purchase your copy of this book, just click on the link at the top right corner of this blog.

What if your 3-D glasses didn't work?

Did you put on a pair of 3-D glasses to watch the special Super Bowl commercials yesterday? At least 4% of you probably did not notice any difference in the picture after you put on the glasses. This is the percentage of the American population that has a strabismus or an eye-turn. Even more people have difficulty teaming their eyes together whose conditions may involve a convergence insufficiency, convergency excess, or other problem that involves binocular function and would also have found the commercials less impressive than they had been led to believe. Other people probably were able to appreciate the added depth and detail in the commercials with the 3-D glasses at first, but then their eyes began to hurt or the special effects seemed to fade away. Still others, who have amblyopia, commonly called a lazy eye, tend to suppress the information gathered by the weaker eye, so they would also have had difficulty using the 3-D glasses.

3-D glasses work by providing the right eye with different visual information than the left eye so that a more complex image will be perceived when the two pictures are combined in the retina. ( See http://www.3dglassesonline.com/how-do-3d-glasses-work/ for a discussion of how 3-D glasses work.) For them to work requires that the individual has good binocular vision. Strabismus, eye teaming disorders, and amblyopia all correlate with reduced or absent binocularity. People who have these conditions usually have difficulty with depth perception. Some of these conditions also impair the individual's ability to read efficiently because, with a convergence insufficiency, for instance, the words may seem to be unstable on the page. They may also get headaches or report seeing double when they read.

Fortunately, with appropriate diagosis and vision therapy, these conditions can be helped. New research demonstrates that convergence insufficiencies can be addressed with a program of in-office vision therapy. Children who have been diagnosed with other binocular disfunctions have the best prognoses but even adults can be assisted to gain ground as has been demonstrated by the experience of Sue Barry, dubbed "Stereo Sue". (See ttp://www.newyorker.com/archive/2006/06/19/060619fa_fact_sacks for her story.)

What is my point? If you or someone at your Super Bowl party was unimpressed by the 3-D glasses because they didn't seem to change anything about the picture, or if anyone found wearing the glasses uncomfortable or intolerable, it probably means that they need to schedule a comprehensive eye exam with a developmental optometrist who specializes in binocular vision and who also is a vision therapy provider. Then, if there is a diagnosis that can be helped by vision therapy, know that the benefit of seeing in stereo is worth the investment of time, money, frustration, and effort.