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 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.

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.

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.

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

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

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

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

Does Your Child Look With Her Hands?

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

Can a vision problem make reading seem too hard?

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

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

Many of the patients that I see in my work as an optometric vision therapist do not have good pencil posture. Instead of the relaxed, efficient grip that should be required of each kindergarten student who is learning to write, many students who struggle with learning related vision problems use a fist grip or hold the pencil very close to the tip or do not secure the paper with their free hand. The issue is not limited to poor or illegible handwriting. In an article in the OEP Vision Therapist, Volume 33, Number 1, 1991, therapist Denis Hoover reported on the observations of Dr. Ernest J. Kahn. This optometrist administered the Sentence Copy test (probably by Wold) to his patients and noticed the following three associations.

1. Most near-sighted children hold their pencil 1/4 inch or closer to the tip.
2. Most children who also have been diagnosed with a learning disability utilize "bizarre" pencil grips and also exhibit poor coordination in general.
3. All the children who used nonstandard pencil postures blocked their line of sight with their fingers so they had to adopt an improper reading distance or head tilt.

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