Convergence Insufficiency Diagnosis

[Maria/ME]

First, I have read some of the great posts here concerning various vision issues and VT. I so much appreciate the advice, links and support on this forum!

 

My daughter, who is almost 10, recieved a diagnosis of Convergence Insufficiency last week.

 

Some background: My daughter has never shown a real interest in reading. She loves to draw and is constantly doing so. She began to read when she was around 7 or so, but haltingly. She was never interested in "picking out words" and eagerly figuring out how to read. As she had 20/20 vision and was doing well in other areas I wasn't too worried. I figured she'd explore reading when she was ready. Last year a unschooling friend introduced me to the Spalding/WRTR method. My daughter made some excellent progress but she still wasn't interested and resented when I said "Time to read!". She wasn't eating up Laura Ingalls like I had hoped! She could spell very well, once in awhile she mixed up letters, but not often. She didn't seem to retain the spelling of what she learned, but had wonderful reading comprehension. The only other red flag to me was that she didn't seem to visualize spelling in her head. But once I would prompt she'd sound out and remember the spelling. It never occurred to me that she may have vision issues. Someone from another board mentioned their children and they "symptoms" sounded similar so I took her advice and went to a dev. opt. You could've knocked me down with a feather when she said my dd's eyes weren't cooperating by half. Wow. (As a side point my husband loves to read, but finds it difficult. He can't pinpoint why. Guess who is going to the eye doctor next?)

 

So we are waiting to hear to what extent our insurance will help with VT. I've heard a bit of the pros/cons of VT, but am convinced it could be very helpful. Could someone share their experiences with Convergence Insufficiency? With VT? (I'm looking for the good or not so good stories!)

 

A poster had mentioned to me earlier that beyond just VT I might look into other forms of training such as cognitive. Does anyone have any further input along those lines?

 

We are going back in a month or so to run through a few more tests before VT starts. Any tests I might want to think of specifically?

 

This may be stupid totally, but is Convergence Insufficiency under the umbrella of dyslexia? What is the hard definition of dyslexia?

 

While we are still working with Spalding Method should I continue working with her reading or wait til VT? Is there anything I can do to help and encourage her reading right now? Or is it best on the back burner for awhile?

 

And an off the wall thought: My daughter didn't walk until she was 15 months after 8 mos of PT. Great muscle tone. The Drs did tons of tests and were basically baffled. They came up with proprioception issues with a bit of sensory integration disorder thrown in. Very vague because she didn't have any "red flag" symptoms of either. Separate issue or related to CI? Thoughts?

 

 

Phew. If you have slogged through this far, I thank you. And I thank you for any input you may have.

[Claire]

Vision therapy is usually very effective for convergence insufficiency. If that's your dd's only visual efficiency problem, you are lucky. My dd also had very slow accommodation (focusing speed of a 3yo when she was 8) and severe tracking problems. Her scores on the testing ranged from <1st percentile in some areas to 99th percentile in others. VT was very effective at bringing all of her test scores into the normal range for her age.

 

We did follow up VT with cognitive skills training. Not all children need this, but my dd's problems were severe. Even after her visual efficiency skills were in the normal range, her reading improved very little. We did PACE and got dramatic improvements in reading and other academic areas.

 

If convergence insufficiency is your dd's only vision problem and she doesn't have severe phonemic awareness delays, she may not need cognitive skills training. Convergence insufficiency can make reading unpleasant. That sounds like what's happening with both your dd and your dh. (Visual efficiency problems probably have a genetic component because they tend to run in families.)

 

I would continue with reading instruction while doing VT. Just don't have your dd spend extra time reading until her eyes are working better together.

 

Even the professionals do not agree on a definition of dyslexia. The current common definition is that dyslexia is a neurological disorder that makes learning to read difficult. However, there is no way to definitively identify this neurological disorder except by exclusion of other causes. Having either an auditory or a visual processing problem can contribute to making learning to read difficult, plus a neurological dyslexic can also have auditory and/or visual processing problems. If your dd reads easily once her convergence insufficiency is corrected, she would not be considered dyslexic. My dd needed other therapies in addition to VT to become a fluent reader, and she exhibits traits commonly found in dyslexics -- difficulty with organization, difficulty with parts-to-whole learning (she is a "big picture" learner and needs the concept before she can retain details), difficulty memorizing math facts even though she understood concepts, difficulty with spelling and writing, etc.

[Kathy in MD]

But you mentioned you were looking for VT experiences. My ds's vision was far worse than what you're reporting. He had multiple problems, including convergency, and they generally were severe. His VT did include visual cognitive training. At the end of his therapy, his vision was that of a high schooler tho he was only 10. But he still wasn't reading and comprehending well. The DO was baffled. But the problem was that reading requires far more than just vision to work. My ds's other problems included phoenimes (SP) and memory. These were addressed by a general home administered cognitive program no longer available, but its sister programs PACE and Learning Rx are. This was then followed by REWARDS, a program that teaches in 20 or 24 lessons how to read multi-syllabic words. My ds needed further practice, so I added a month or two of fluency readings. Finally my ds could read at grade level.

 

So VT was not the magic bullet that instantly made my ds a reader. But without it, he would never have been able to read. His eyes jumped and skipped too much to ever allow him to read. Unfortunately, he still avoids reading thanks to his early struggles.

 

One other caution about VT. The opt doesn't do the actual therapy. Instead he'll hire therapists he's trained (as far as I know). Some of these individuals are good at working with difficult children, some aren't. If your dd is difficult to work with at times, ask for the therapist best at working with your dd's personality type. This can make a world of difference in how easily therapy goes.

 

 

....And an off the wall thought: My daughter didn't walk until she was 15 months after 8 mos of PT. Great muscle tone. The Drs did tons of tests and were basically baffled. They came up with proprioception issues with a bit of sensory integration disorder thrown in. Very vague because she didn't have any "red flag" symptoms of either. Separate issue or related to CI? Thoughts?

 

 

A couple of comments here. First proprioception is one of the three major, how can I word this, branches of SID. Based on what you said, your dd had SID, now often called SPD. Second, only a OT, or the rare PT, trained in SID/SPD can diagnose it. The doctor may be suspect it, but can't definatively diagnosis it. But you were lucky, your doctors knew what it was and got you started in the correct direction.

 

But your thoughts about SID being related to dev vision problems is valid. The proprioception issues often affects, among other things, fine motor control. And how are the eyeballs controled? By tiny muscles. And reading requires fine control of those muscles. My ds's OT and I years ago suspected that his vision and language problems were caused by the prop (proprioception) and inner ear aspects of his SID. Since then Carol Kranowitz revised her important book The Out-of-Sync Child and included the possible ties between the three problems. If you haven't read it, I suggest you do. You may not recognise your dd in many things because she had therapy at such an early age.

 

I'll recommend one last thing. Find an OT (or PT) that is certified or at least highly trained in SID to do an eval of your dd to see if there are any SID issues that aren't resolved. Your dd is rapidly approaching the age when therapy is no longer effective (unlike VT, SID therapy is minimally effective if at all once the child reaches puberty). I would think that this is especially important if your first OT was not trained in SID. Be sure to tell the OT about the earlier OT, because that will have cured much of the SID problems/symptoms.

[Maria/ME]

My goodness! Thanks so much to the both of you...I don't know where to start...

 

I do feel lucky that (so far) we have only found convergence insufficiency. Claire, thank you for your input on VT and the definitions of dyslexia. I go to bed, after research, with quotes and facts in my head and they tend to get muddled. You also confirmed my gut instinct on whether or not I should continue pressing reading in school.

 

To both of you, I appreciate understanding that VT may not be the magic bullet. The information will help in my expectations and also in knowing other steps to take, and other questions to ask.

 

Kathy, I appreciate your input on making sure the actual therapist be a good fit for my daughter. I will bear that in mind when we meet her/him.

 

I should clarify that a specialist did diagnose my daughter proprioception issues, not her primary care doctor. I also appreciate very much your explanation of SPD and proprioception issues and how they are related. After my daughter PT and she learned to walk, we basically got a clean bill of health and went blithely on our way. There was never a lot of follow up. My daughter has never had MAJOR issues in any way, but all these little issues that add up. I read The Highly Sensitive Child and said "Oh, yeah..." but we were able to cope and deal with those issues easily enough in day to day life. However, my daughter has always been physically hesitant. She doesn't take chances whatsoever. Again, not a big thing to deal with. I knew it was probably some proprioception issues, but because they weren't overt or interfering extensively with her daily life, we never thought there was much we could do. At one point, as she grew, we went to another specialist. Again, nothing really wrong. I am so glad that you mentioned finding a OT/PT trained in SID issues. Its given me a direction to try. I get frustrated because, again, she doesn't have overt issues, yet can not and will not ride a bike. Or jump from one rock to another (okay that's improving a bit).

 

When I truly see the extent of issues children have with just vision and SID/SPD (what does the "new" acronym stand for? I can't find it on google??)I am very thankful that my daughter has these 'minor' issues. At the same time, very frustrated that they get 'pushed off' into the 'everything is fine' department by most doctors. I think I advocate pretty well for my daughter but always feel like I'm up against a brick wall.

 

Thanks again to both of you!

[Claire]

SPD stands for Sensory Processing Disorder.

 

There is a group called SID_DSI at http://groups.yahoo.com that is very active. Some OTs post there occasionally. If you join, be sure to sign up for web-only though, as the number of emails even in daily digest form could be quite overwhelming.

 

The bike issue definitely sounds like a vestibular system problem or SPD, perhaps relating to balance. A good OT should be able to evaluate this although, as Kathy mentioned, not all OTs are good at treating SPD.

[Rod Everson]

So we are waiting to hear to what extent our insurance will help with VT.

 

This may be stupid totally, but is Convergence Insufficiency under the umbrella of dyslexia? What is the hard definition of dyslexia?

 

 

And an off the wall thought: My daughter didn't walk until she was 15 months after 8 mos of PT. Great muscle tone. The Drs did tons of tests and were basically baffled. They came up with proprioception issues with a bit of sensory integration disorder thrown in. Very vague because she didn't have any "red flag" symptoms of either. Separate issue or related to CI? Thoughts?

 

Claire posted something a while back on getting insurance coverage and it was really good. Maybe she'd repost it? The developmental optometrist I work with said that it's the major medical coverage that usually comes into play when it is covered, not vision coverage.

 

As for the definition of dyslexia, I think that eventually they'll find that a lot of childhood issues, from autism to dyslexia, to vision problems all fall under an umbrella of delayed development, and it wouldn't surprise me to find that the delay occurs in the midbrain, or cerebellum. A lot of interesting work is going on in that area lately, and the common thread seems to be an underdeveloped cerebellum. This is why, I believe, so many dyslexic children also presented with various developmental delays, skipped crawling, etc.

 

You said in a later post that your daughter didn't like to step from rock to rock. If she's dealing with a convergence problem, she likely is having a difficult time with depth perception and can't tell exactly where the next rock actually is, so she is hesitant to take the chance of missing it, knowing that it's difficult for her. A lot of kids have trouble catching a ball, for instance, for the same reason.

 

You might also be interested in learning one possible reason that your daughter takes so readily to drawing. Here's a link to a pet theory of mine on why so many people with vision problems end up as architects.

 

Rod Everson

OnTrack Reading

[Maria/ME]

Rod:

 

Thanks so much for you post! I find what you are saying about the umbrella of delayed development very interesting as that describes my dd well!

 

Thanks for sharing your link. I've already learned a lot from your site and have been interested in the Exercise/Fish Oil aspect to which you refer. Both of which my daughter has been lacking. Naturally, she doesn't like much exercise, she can't see well enough to be confidant in doing anything physical!! Ah, if I knew then what I know now...but as they say, hindsight is 20/20 (pun SO intended) and what I do from here on in, I hope, will make a difference!

[Rod Everson]

Rod:

 

Thanks so much for you post! I find what you are saying about the umbrella of delayed development very interesting as that describes my dd well!

 

Thanks for sharing your link. I've already learned a lot from your site and have been interested in the Exercise/Fish Oil aspect to which you refer....

 

You're welcome. Just be sure and make it a priority to address her vision issues. At her age, that could be the main reason she's struggling, as most of the other delays will have been overcome. The vision issues, however, sometimes persist into adulthood. If they resolve, they don't always do so in the most advantageous manner. A lot of adults are using only one eye when doing close work like reading, for example, though they sometimes don't even realize it.

 

Rod Everson

OnTrack Reading

[Maria/ME]

Update on my daughters OT visit on my blog, if you are interested.

 

Again, I can NOT thank this forum enough!! Your input, even in passing, is invaluable!!

[Claire]

Read your blog. Sounds like you are on the right track (no pun intended! :) ). You probably want to do OT first and then do a re-eval of vision to see if VT is advisable to correct any residual vision problems. Then, if you can handle it, cognitive skills training is a good idea.

 

Children do so much better with bottom-up remediation.

 

I used to do volunteer work in an elementary school. It got so I could identify problems with about one-third of the children in every classroom -- vision, auditory processing, SPD -- but other adults just don't seem to notice. Children are *so* dependent on parents to do the research and get them help......