What do you think about this?

[MicheleB]

I've posted about my 9yo ds. He's had a speech and lang. eval (still waiting on the results), is set up for an OT eval. and now for a neuropsychologist (though that is not until August!!).

 

The last two months or so, I've decided to read everything to him, as far as school subjects go, and I read to him about 2 hours a day usually. That also includes some fun books as well. He LOVES being read to and remembers what I read. I would say his comprehension is about 7-8yo (?). We do read Hardy Boys books but I have to stop often to explain what's going on and who's who. He still likes to read them though.

 

We still work in Explode the Code. He's working in Book 1 1/2 and Book 2. And we're on Lesson 30 of Teach Your Child to Read in 100 Easy Lessons. He likes both those books.

 

Lately, he tries to pick out words from what I'm reading. He can often read a line or two of very simple words. I mean, technically speaking he's still probably reading at a Kindergarten level. But I see him trying more to read and look for certain words. He also looks for things like words with hyphens, or words with "ing", or whatever strikes his fancy.

 

He still reverses a lot. The other day I gave him a paper notebook with 100 pages. He wanted to number every page. He was able to do that, but he probably reversed almost 1/3 of the numbers.

 

My question is: Is the reading he's trying to do just from the constant exposure I give him? Is he finally starting to understand it better (maturing)? I know he still needs evaluations and remediation from whatever the evaluations tell me. I am still kicking around the D.O. idea. Since he still cannot track his reading well, his eyes water and his head hurts when he reads, I think we probably should go that route.

 

I guess one of my main questions always in my mind is: How much is my son "delayed" and how much of it is his supposed low-average IQ? I hope that makes sense and maybe someone will know better what I'm asking than I do. :001_smile:

[NCW]

My personal opinion? He needs the D.O. eval. If you have an OT skilled in vestibular/sensory processing issues, you can maybe wait until you've done some OT treatment (if he has underlying vestibular issues, which is not unlikely).

 

With that many reversals, eyes watering, jumping, fatigue that are all visible to you, he needs the D.O. eval at some point. Those are not IQ issues.

 

NCW

[MicheleB]

My personal opinion? He needs the D.O. eval. If you have an OT skilled in vestibular/sensory processing issues, you can maybe wait until you've done some OT treatment (if he has underlying vestibular issues, which is not unlikely).

 

With that many reversals, eyes watering, jumping, fatigue that are all visible to you, he needs the D.O. eval at some point. Those are not IQ issues.

 

NCW

 

I think I should just throw the IQ score out the window. It hangs me up so much sometimes. He had the WISC done when he was 6yo. He's 9 now. But I guess I have to wonder *how* effective is an IQ test if a child isn't using his eyes properly? KWIM?

 

As for the OT... how does the vestibular issue tie into the D.O. therapy? I'm a little fuzzy here on some terms, but wouldn't vestibular have to do with balance? I'm thinking about how terribly car sick he gets, even after a few minutes and wondering how this all ties together. He's also a "slow mover", and cautious. Though he can be daring. Hmmm.....

[Claire]

I think I should just throw the IQ score out the window. It hangs me up so much sometimes. He had the WISC done when he was 6yo. He's 9 now. But I guess I have to wonder *how* effective is an IQ test if a child isn't using his eyes properly? KWIM?

 

As for the OT... how does the vestibular issue tie into the D.O. therapy? I'm a little fuzzy here on some terms, but wouldn't vestibular have to do with balance? I'm thinking about how terribly car sick he gets, even after a few minutes and wondering how this all ties together. He's also a "slow mover", and cautious. Though he can be daring. Hmmm.....

 

Throw out the IQ score. They are less reliable with younger children, for one thing. Also, when there are unremediated deficits, these will always serve to lower the test result. Many testers are not good at testing around areas of deficit plus, if you didn't know at the time about existing underlying areas of deficit, the tester would have had no idea how to adjust for those. Cognitive skills acquisition is delayed in children with sensory-level deficits (motor, auditory, vision). There is no way to predict where an IQ test score will end up after sensory-level deficits are reduced and cognitive skills training takes place.

 

I know one mother whose son started out with an IQ score of 80. They did a year of NeuroNet and soon after he tested with an IQ score of 101. That particular family did a lot of therapies, including TLP, FastForWord, Interactive Metronome (helped him a lot with writing), vision therapy, and reading tutors. I'm not sure where his IQ score ended up after all of the therapies were completed, but it was certainly no longer in the MR range.

 

Focus intensively on the sensory-level therapies now, and plan on doing cognitive skills training later. Remember that IQ test scores will always be skewed lower; they are never skewed higher! If your child has unremediated sensory and/or cognitive level deficits, there is no way to have confidence in an IQ test result unless you have already reduced those deficits as much as possible.

[Rod Everson]

how does the vestibular issue tie into the D.O. therapy? I'm a little fuzzy here on some terms, but wouldn't vestibular have to do with balance? I'm thinking about how terribly car sick he gets, even after a few minutes and wondering how this all ties together. He's also a "slow mover", and cautious. Though he can be daring. Hmmm.....

 

Hi Michelle,

 

In some vision therapy departments you'll see a lot of equipment for working on balance. The sort of visual skills that we use to read develop later than some of the other motor skills and to some extent depend upon them, so it makes sense to let an OT at your child when very young, and wait on vision therapy a bit in case it's no longer needed after the other motor skills are developed.

 

By age 7 or so, though, I believe vision therapy can be used independently of the other therapies to make certain that the vision skills are in place, even if other motor skills still need work.

 

If I had a 2-4 year old that I was concerned about proper development, I would be working with an OT while also taking the child to a developmental optometrist for annual eye exams, planning on doing vision therapy if the need was indicated at a somewhat older age (basically, when the optometrist felt it was time.)

 

The binocular vision skills essential to reading easily are thought by some to develop during the crawling phase of a child's development, when the child is continually watching the placement of his hands and then looking up to see where he's headed next. This is thought to be why a lot of kids who skipped the crawling phase and went straight to walking end up with binocular vision problems. I'm not sure I buy that explanation, but it's out there. I think though that it explains why some of the crawling programs do get results when applied to older children with developmental issues.

 

Rod Everson

OnTrack Reading

[MicheleB]

Thanks Claire and Rod. Your replies both answered some of my questions about VT and OT, waiting or doing both, etc. I hope to get into the OT in a reasonable amount of time. The closest VT in our area is about 1 1/2 hours away, but I will at least call and get the info from them. How often do kids go to VT, or does it just depend? I know Claire said a while ago there are also VT software programs parents can use at home in conjunction with a provider. If you could choose; time, money and distance were no problem; would you opt to go to the VT, or do you think the home software is just a helpful?

[Claire]

How often do kids go to VT, or does it just depend? I know Claire said a while ago there are also VT software programs parents can use at home in conjunction with a provider. If you could choose; time, money and distance were no problem; would you opt to go to the VT, or do you think the home software is just a helpful?

 

It really depends. The home software is reasonably effective for some of the most common problems, but it doesn't address all possible visual efficiency deficits. A lot depends also on how compliant the child is. Some find the exercises really annoying and may work better for a therapist in-office than at home. Some DOs are reluctant to dispense the software because they have found that many parents do not follow through and make sure the child uses it daily. Some children also may "dawdle" at the computer screen and not work very hard at the exercises.

 

My dd had multiple very severe problems, and home software had not yet come on the market. Our DO suggested a primarily home-based program to keep costs down, but I felt very stressed at the time and did not want the responsibility of making sure that we did the exercises every day. We ended up doing primarily in-office therapy, but we did do color therapy at home. (Dh constructed a light box and he sat with dd every day for the 20 minutes or so it took.) At the time, color therapy was considered a cutting-edge therapy with good theory behind it but very little research that could confirm it was effective. We wanted to do everything that might help, so doing it at home allowed us to do that without wasting a lot of money if it wasn't effective. (I think it was, in fact, very effective because dd tested with normal field-of-vision at the end of therapy. Color stimulation was supposed to help with her restricted field-of-vision problem.)

[MicheleB]

It really depends. The home software is reasonably effective for some of the most common problems, but it doesn't address all possible visual efficiency deficits. A lot depends also on how compliant the child is. Some find the exercises really annoying and may work better for a therapist in-office than at home. Some DOs are reluctant to dispense the software because they have found that many parents do not follow through and make sure the child uses it daily. Some children also may "dawdle" at the computer screen and not work very hard at the exercises.

 

My dd had multiple very severe problems, and home software had not yet come on the market. Our DO suggested a primarily home-based program to keep costs down, but I felt very stressed at the time and did not want the responsibility of making sure that we did the exercises every day. We ended up doing primarily in-office therapy, but we did do color therapy at home. (Dh constructed a light box and he sat with dd every day for the 20 minutes or so it took.) At the time, color therapy was considered a cutting-edge therapy with good theory behind it but very little research that could confirm it was effective. We wanted to do everything that might help, so doing it at home allowed us to do that without wasting a lot of money if it wasn't effective. (I think it was, in fact, very effective because dd tested with normal field-of-vision at the end of therapy. Color stimulation was supposed to help with her restricted field-of-vision problem.)

 

How long was your dd in VT? From your post, it sounds like she went daily, or maybe I misread that. I can't imagine driving 1 1/2 hours a day, five days a week. Wow. I guess it could be worked out if I was told it was only for "x" amount of time, but I'm already feeling the strain. ;) Realistically, though, with three other children I don't know how I would do it (if that were the case).

 

Sometimes I wish we didn't live in such a rural area! At least we have a pediatric OT here!

[Claire]

Not daily. My dd went for in-office visits twice a week for 4 months, and then once a week for an additional 4 months. This would have been shortened if we had done exercises at home but, as I said, at the time I just didn't feel up to handling that.

 

My dd's problems required more therapy than most children would require. However, her particular problems -- although severe -- were ones that tend to respond fairly quickly to VT. It's possible for a child to have more difficult problems to address than she did. That's why I say a lot depends on the individual child, your family's circumstances (such as driving distance to the office, finances, time), exactly what the problems are and their degree of severity, etc.

 

I don't know for sure, but I suspect therapists are more efficient with the exercises than a parent would be. That's why we could get away with two office visits per week. Also, a therapist can more easily get a child to work continuously for 45 minutes or so. I'm quite sure I could not have done that length of time at home.

[Rod Everson]

The closest VT in our area is about 1 1/2 hours away, but I will at least call and get the info from them. How often do kids go to VT, or does it just depend? I know Claire said a while ago there are also VT software programs parents can use at home in conjunction with a provider. If you could choose; time, money and distance were no problem; would you opt to go to the VT, or do you think the home software is just a helpful?

 

Hi Michele,

 

If time, money and distance were no problem, I would probably have a vision therapist do most of the work in office. However, this isn't anywhere near a realistic solution for most families.

 

The VT department I work closely with sees patients once a week for 45 minutes and expects "homework" exercises to be overseen by the parent almost daily between visits. A lot of parents drive over an hour to get to the office, as there are only two VT departments on the west side of the state (Wisconsin.)

 

Unless the developmental optometrist was convinced that a computer program was all that was needed, I would follow the protocol suggested by the optometrist, while making sure that they knew that the 90-minute drive was quite a burden. This might encourage them to modify the program a bit to accommodate your particular situation.

 

Incidentally, there's a pretty good discussion going on a different thread in here that bears on a lot of this (the one titled The Effectiveness of VT) that you should take a look at.

 

Both in that thread, and in the VT department I work with, there's a concern that the computer programs won't get at the entire problem. There's also some concern about the progress sticking once the computer program's use is discontinued, but this could just be practitioner bias. They could also have research to that effect, though. I just don't know.

 

Rod Everson

OnTrack Reading