Vision Therapy: difficult at home but not so at VT office

[DeniseF]

My DS-7, who has attention issues but I haven't had a formal evaluation of that, started VT about 4 weeks ago.  He loves going to his appointment time but getting him to do the work at home is excruciating.  For example, the Marsden ball....he swings his arms, picks at his buttons/snaps, tells me his tummy hurts (really every single time), falls down on the floor, complains the height of the ball is incorrect, complains about how I'm moving the ball, scratches his head, fidgets with the eye patch endlessly, takes off the patch to scratch his eye, pulls his eyelid away from his eye (usually the one under the patch)...etc.  It takes a half hour at least to get through the 10 minute exercise. I get very frustrated and am not patient. Similar thing with the jump saccades between two pencils.  But he does the computer program PVT-iNet, which requires focused attention, without much difficulty.  And he will do paper exercises such as circle-E and mazes without complaint.  He also looks forward to the appointments with the vision therapist and seems to do pretty well when he is there.

 

A friend suggested having my husband do some of this with him.  So he did the jump saccades using pencils and it went much better than it did with me, though he did exhibit some of the same behaviors, he didn't carry on endlessly.  

 

Maybe it is obvious that the problem is me, but the reality is that he will work quite a lot harder for someone else than he will for me. 

 

Any advice?

 

 

 

 

 

[krismoose]

I did VT with my son when he was newly 7, and he was dreadful to work with, and It was very. very. hard. for me to be patient. Definitely better at the VT office. For reference, his past year (9yo) he has received diagnoses of ADHD and Autism (high functioning, Aspergers type). Lego rewards were what got us through, earned after a certain number of days of practice marked on a chart. Smaller monthly rewards and a larger set as the final jackpot. It was worth it, though. The VT made a huge difference after a couple of months - he gained depth perception and was no longer carsick, as well as improving other targeted skills by the end of he 6 months. It was not easy! Best wishes to you!

[PeterPan]

Yup, horrible here too.  Worth it, but horrible.  

 

You know, if you're open to meds or biomedical for the adhd, you might consider it.  Obviously wear him out a bit first so it's easier to focus.  (Go to the park and play hard for 40 minutes, then come home and feed him snacks, one bite for each thing he does.)  But yeah, if you know you're going to do meds you might as well.  

 

My dd had some OT issues that they said were making the VT go rougher.  Sensory is sort of the 4 alarm fire siren going off all the time.  You chill the sensory and it doesn't make the adhd go away but it does give them a fighting chance.  So an OT eval, if you have any indication, might be good.

 

And yes, if he gives Dad less grief, let Dad do it.  :D

[kbutton]

Agreeing. I called my DH in at some points. We did reach a point each week where we got over the hump for a day or two, and then it was back to the resistance with the new material. We did bribe as well. At some point during the therapy, it all got much easier, and now we have no fuss (almost done, and he responded REALLY well from a therapy point of view). Not everyone reaches that point, so I don't want to encourage you falsely, but yes, everyone meets resistance, and Mom always gets the brunt of it. For us, this is true for everything, not just VT, but VT was the worst for that so far.

 

One thing you could mention to him is that the homework is what helps him get through it faster and have better results. Our therapist had a bunch of kids all start around the same time this summer, and even with taking into account the level of their problems, she said kids who do the homework get through it faster and with better results. She found it really striking when she had such a big comparison group.

[clemota]

Yes, we've found that letting Dad handle the VT at home made it less painful for all of us.  She still acts out, yells, tells us she hates it, can't do it, etc; but it's less intensive than it is with me.  I get it: VT  is difficult and can be challenging depending on what she's working on.  And she is NOT a patient girl and wants to be done ten seconds ago. 

 

Then she acts just fine at her appointment.  They love her there.  But I do have a weekly report sheet that I turn in, and I let them know when some part of her homework caused more frustration than other parts.  Sometimes they just tell her to push through it.  Other times they find a way to make it slightly easier, so that she can work her way up to it.  I guess it depends on what they are seeing during the appointment.

 

I hadn't thought about the sensory component, OhE; thanks for that reminder...I wonder if starting up our brushing again would help...

[Lecka]

Escape or avoidance behaviors!  My old friends....

 

There are some strategies, you can google to look for some.

 

Some main things to remember (not that anyone ever does manage to be perfect):  if he succeeds in delaying doing the task by sidetracking YOU by getting you to go into a lecture or something -- he has succeeded in his desire to postpone doing the unwanted task (if this is really why he is doing the delaying behaviors -- it may not be, it just sounds like it might be).  This is not necessarily conscious on his part, he is probably not consciously doing it.  But it may be something he just feels like trying to see if it will work.  So, try not to let yourself be sidetracked.  

 

But also, ask the doctor's office if you can reduce anything -- that way you could start lower and work up.  It could be too much for him starting out.  If you dropped it down maybe he could work up to adding stuff in.

 

You want to try to end of success -- and a common way to do that is to cut the time or difficulty down until he is able to end on success. Then he associates the task with success, instead of with failure or discomfort.  

 

He may be motivated by a reward.  If you do a reward -- try to make it easy for him to earn the reward.  Make a reward be something you are happy for him to earn -- where you won't feel like he is not being good enough to get it.  Make it come soon enough for him to not feel like it is not worth working for.  Maybe have two tiers -- where he earns some smaller rewards very often, maybe even within an exercise or between exercises.  Then a larger reward that takes more than one session to earn.  

 

See if you can find something he really likes that can be done or had right after his exercises.  It can help with motivating him.  

 

If he likes the attention from his dad, of his dad being involved with the exercises, but the set-up is "give mom a hard time and then get attention from dad" then if he wants attention from dad -- he may see it (in an unconscious way, not purposeful) that if he gives you a hard time, he can get to do it with dad.  One option is to have dad do it.  Another option, if that is not possible, is maybe let him earn doing it with dad -- if he cooperates with mom for two days, he can do it with dad the 3rd day... will only work if he is motivated by that, but maybe he is.  

 

For you to be patient -- some strategies.  Read the Bible or daily reading right before doing it.  Have a nice snack during or right after.  Reward yourself for being patient, realize it is NOT easy.  If he does not act this way at any other time ---- this is a sign that these exercises or the whole VT thing is difficult for him, and that is how he is showing it.  It is NOT a sign that you are a pushover or that he is a bratty and disrespectful child.  

 

I would also consider asking the VT what his/her tricks are.  It sounds like he/she has tricks.  Your child is eager to go there?  But despises the actual exercises involved?  To me -- this implies that they have got some serious tricks up their sleeve.  Are they super positive?  Do they have special toys or food or video games?  Do they have a chart that measures progress that makes your kid feel proud?  Do they give movement breaks?  I do not know what their tricks are -- but they may be intentionally doing some things to help make it enjoyable for kids and help kids to feel motivation to work hard.  Maybe they can tell you some tricks of the trade, or even know what seems to work with your son.  Then you can steal that.  But -- don't steal it too much, you still want him to do well there, so sometimes you have to let some things be "the VT clinic's" so that they will still work at the VT clinic.  

 

You can also ask the VT to speak to your child about the importance of the home exercises, or ask them to comment that they can tell the exercises were done.  That can really help sometimes.  It works with dentists a lot.  The VT might be a better person to explain how the child's effort impact the child's result than the parent, if they would seem more impartial.  My kids really are like that with the dentist, but it is not like I don't say it also.  It just helps when they hear it from more sources than me.  

 

But the main thing is -- it is hard for him, he is not bratty, it is hard for the parent to be patient, you should be getting a certificate of appreciation or at least time to do something you enjoy afterward (or something).  It is not easy, but it is also not that your son is trying to be this way.  It is just what kids do when things are hard and they want to avoid them.  And if things are too hard or they fail -- then it is going to be harder next time -- so try to be reasonable.  You may need to talk to the VT if it is possible that it is not reasonable, if you need to slow things down and just accept that it will impact the rate of treatment -- b/c it is better to do that than get a kid who will not do anything -- and a lot of kids will go to that level, so I think it is worth trying to avoid it if possible.  

 

My kids do not seem to have any anxiety, but I have two who do have escape/avoidance behaviors, and there is a reason for it, but I also need for them to do things anyway, so it is just something to work through and try to make the best of it.  But there is not always an answer of "he will have a great attitude if you just do this."  It could be "he will sullenly comply" but that is an amazing result compared to "he will manage to not do what he is supposed to" (but hopefully over time it would get better and better - it just might take a really long time, and in the mean time be happy with baby steps towards that, and being a little better than the day before with attitude).  

[SandyKC]

When my DS had his vision therapy, his doctor told me my only job was to force DS to do the therapy every day!!  He warned me that DS would hate it, complain, whine, avoid it, battle, etc., because it is painful and difficult for the child.  SOOOO, it sounds like your DS is doing his best to get you to relent from the therapy!  Hang in there.. I pointed out every day that we;d keep working until it's done, so DS could do it quickly and get it over with, or he can fight it, but it will get done.  After awhile, we'd have some feet-dragging getting started, but he'd do it without any major battle. Like Oh E said, it's worth it.. Horrible, but worth it! ;-)  HUG!

[DeniseF]

This input has been so helpful...the specific ideas and the support.  Thanks!

Based on a post, I tried a reward for the first time...one dried cherry every time we switched directions on the Marsden ball (so 8 cherries for the 10 minute exercise) with 2 chocolate chips when he finished the whole exercise.  It made a huge difference the first day, and less so today but it made it possible to get it done with some happiness mixed in, which is valuable.  I'll think of a longer term Lego goal because he loves Legos but it will be interesting to see if that keeps him going...not sure about his ability to work for delayed gratification but it might work when mixed with immediate rewards.

 

I am new to this board and am still trying to get my sea legs with the different types of evaluations and help that are available so I appreciate OhE's suggestion to look into things such as OT (I'm not really sure what it is), sensory issues (not sure if he has them), the whole ADHD question of whether we even have him tested, is the testing worth it or do you just proceed on the assumption he has it...the whole question of meds feels like a gigantic one...I'm sure I can read a ton on this board.  I really need to grapple with the question of how to proceed...up until now I was just hoping it would all get better as he got a little older and matured.  Lurking on this board has given me a better picture of the likely reality.

 

I will talk to the VT about explaining the importance of homework, and love the idea that he has to earn time to do it with Dad...that is a huge motivator for him.

 

I will consciously try to read the Bible and/or give myself a motivational talk before beginning with him so I can keep the bigger picture in mind, and give myself a reward at the end...yes I need rewards too!  

 

I will avoid my own avoidance!  I keep putting off the VT while I "finish up a few things" and instead should do VT first thing in the morning, top priority because my DS will do much better in the earlier part of the day and both of us will feel better if it's not hanging over our heads.

 

Thanks!

 

[PeterPan]

Glad you're getting breakthroughs!  I agree with you, the immediate gratification thing is better.  I tried lego sets and the earn at the end of the week thing didn't really work for us, sigh.  If you're going to do it, maybe go through the instructions for the kit (yes, I know this will take time) and break the kit into 15-20 baggies in order.  Then each day that he completes his VT *without whining* he gets the kit. That way when he sits down with the baggie of legos he'll be able to do steps 1-7 or whatever and be left wanting to keep going. Or let him pool his food treats and decide whether to eat them or trade them all for the bag of legos.  Or something.  I'm just agreeing with you (in hind site) that immediate benefit will help more than a theoretical reward later.

 

LOVE the food.  The dried cherries and just a couple chocolate are a great idea!!!  My ds goes for pistachios right now.  Sounds like you're doing great.   :)

 

On evals, well this is just my hind site, but we waited WAY too long.  My dd was 12 when we finally got her evals, and I consider it probably the SINGLE HUGEST mistake in my entire homeschooling waiting that long.  I had the questions when she was 6 and I didn't.  Actually I called, talked with a receptionist, and let them blow me off.  

 

When we went, we ended up with a very good neuropsych, and it was this huge, pivotal moment for us.  He gave us advice that helps to this day.  We learned tons about how she thinks, her weaknesses, and got counsel specific to her.  We found things we weren't expecting and some of the things TOTALLY CHANGED how I teach.  Some of the things he was able to help us with made radical changes in our school day WITHOUT MEDS.  

 

You don't have to decide the med question to ask for help.  You don't get the meds through the psych anyway but through your ped.  If you just go to a ped and get the meds, you totally miss the benefit you'll get from a neuropsych (or whatever psych) spending time and digging in on your situation.  I learned a TON that improved how we work together and gave us peace.  Do you ever see me freaking out on the board about my 15 yo anymore?  I used to before meds. Now I just go "This is the principle the psych told us.  Apply it to the situation and problem solve."  

 

Look for a good psych who digs in, spends time, does lots of testing (more than a clinical psych will), and who is known for giving helpful advice.  

 

Yeah, some people figure it out on their own, and good for them.  For me, that thorough eval was radically helpful.  It's why, from the day we found out about ds' apraxia (and that there are learning things that usually go with it) I told him we'd be getting evals, whether he thought they were necessary or not.  I'm NOT making that mistake again.  It is so NOT fun to teach someone when you don't know WHY things are happening or what to do about it.  Take for instance processing speed.  Your ped can't tell you that, because it requires proper testing.  Processing speed and word retrieval scores answered so many questions for us and let us radically change some problem areas.  There is just no need to teach without this information and be tortured.  Good evals will help you be a better teacher, and that's all you really want, is to know how to work with him better.  Then LATER you'll decide about meds, when you know what you're working with, whether those changes can take care of it, etc.

[Lecka]

Personally with foods, my kids will get tired of the same food very quickly, so I need to change it.

 

There are some foods that I just do not buy, but my kids love, and they can be possibilities.  

 

Also, don't forget, it doesn't have to just be naturally small foods.  You can take any food and cut it into little pieces.  You can take any candy and cut it into little pieces.  

 

My kids really like flavored water squirts into regular water -- I do not get them often, so they are a big deal to them.  You could let him have little drinks and pick the kind.  

 

Not like I am saying "this is the best."  It is more -- a possible reason it was not as good the second day.  But that also might not be the reason the 2nd day didn't go quite as good.  Kids have off days, and sometimes just the novelty wearing off can do it, too.  

 

I also get good results if I can say "if we finish by x time, we have time to do y."  That is something my older son will work hard for, provided it is something he wants to do and not something he gets to do all the time anyway.  That is a major one for my older son, but I have to think and plan for it, and it does not always work out the way I would like.  But often it works very well.  I also will say I will have time to make him something he likes better for supper (like tacos -- he loves tacos) but if I don't have time it will just be spaghetti -- this is something that motivates him, and it is no problem for me either way.  It can also be going to a park further from home with the extra time, or to have time for him to wander around the video game section when we go to Target, vs. not having time.  That is the kind of thing my older son buys into.  My younger son -- he is more about food, drinks, riding his scooter, getting bounced on the bed (he loves this), and things like that.  Also, there are some DVDs I usually don't get down, and I might get one down for him to watch.  Once in a while he likes that.  

 

With my older son, he did reading remediation, he could have longer swimming if he finished earlier.  In our case it was not worth it or necessary to take away swimming totally -- would not have worked for either of us (I want my kids to get exercise, too!!!!).  But -- he could earn extra time by having us leave earlier, if he worked hard on reading.  

 

I think it is often counter-productive to take anything away.  But, you can make your baseline of what they get lower, and that can make it easier to add in extra time or whatever, without the kid feeling like you are mean.  I planned for that for our summer with the pool... really I wouldn't mind taking him early every day, but I thought it would be a good way to get him to do his reading, if I pretended I didn't like to go before 4:00 (b/c the sun in my eyes) but then could get talked into going at 2:00 when he did so well in the morning.  I let it be known he could earn it, and he really wanted to go earlier.  It does, also, irritate me to have the sun in my face, but it is not that big of a deal, either.  

 

Oh, another idea, not something I would do, but I know someone who did this.  Their child had a chart, and the parent filled it out, but the chart was all about the child.  The child really liked the therapist and wanted to be able to take the chart in filled out every week, and get a prize and kudos.  It was working out for them.  But there overall situation was not one I liked, and I think a lot of the reason it worked was that the parent was not consistent and the therapist was.  But -- I can see it working in ways I would like, too.  But I am not crazy about having my authority with my child bypassed like that -- but at the same time, if it worked I don't think I would knock it.  

 

And natural reinforcement would be, to some extent, measurable progress, or the VT saying "I can tell you worked hard this week."  Where there is a cause and effect related to him actually doing the homework.  But sometimes kids don't care or the progress is infinitesimal over the course of a week - -and that is where it can fall down.  But that is always something to look towards, b/c it is kind-of the best.  It is the best in the long-term but not always practical in the short-term.