I'm a bit concerned local COVD is giving friends false hope

[Soror]

I have a friend whose son was diagnosed as dyslexic by a NP. She took him into the local COVD and the COVD has told her yes, he is dyslexic there are 3 different kinds and he has all 3. 2 of which they can do therapy for and 1 of which they cannot. Now, I've not researched extensively but I've read some about dyslexia due to my suspicions and concerns about my own son. From everything I've read, she is not able to diagnosis dyslexia and she is presenting dyslexia as a vision problem and it is not, it is a processing problem. I understand it that sometimes there are vision issues that can cause dyslexia like symptoms but it is not dyslexia. When I mentioned to her that the COVD cannot make that diagnosis she said well her recommendations were similar to the NPs. Am I misunderstanding dyslexia and vision? Would you be concerned? Any quick links to send her? This info makes me very leery of this particular COVD and her therapy, I know there is some controversy over COVDs in general but this seems to go even beyond that to me. I have another friend who is deep into therapy with her with her own son after I recommended she look into dyslexia and testing based on how she described her son, well she decided to go with this dr. for all her tests. I don't want to be a jerk and I want to to be supportive but I also don't want my friends to waste their money on false hope.

[Lecka]

I took my son to a COVD eval, and he did a phonemic awareness screening with my son.  It was at a point in time after I had already done a massive amount of work with him on phonemic awareness, and he passed it, but made two mistakes still that surprised me, I would have expected him to get those two questions right.  

 

I would be skeptical, too.  

 

And, I don't know what the COVD would recommend to people who did poorly on the phonemic awareness screening.

 

But -- I do not think it is that difficult to do a phonemic awareness screening, I think a COVD could do one.  

 

I am just throwing it out there.  

 

My son's private OT did a lot of "connecting the two hemispheres of the brain" stuff with him (which I think actually really helped him in a lot of ways) and then told me another mom whose son had similar issues had used Barton with him, and wondered if I had heard of it (at the time I had already been doing OG-style remediation with him).  (She wrote down all the materials I had used with my son, too.)

 

I would be concerned, too, but also open to the possibility that maybe the COVD is going to make a good recommendation to her, too, if her son does need work on phonemic awareness.  I mean -- it is possible.  But, I would be concerned.  

[wapiti]

I agree, that would really rub me the wrong way.  However, as much as it makes me twitch, historically, the term "dyslexia" had a broader meaning than it has among most psychs currently, and my guess would be that this ambiguity may play a role in the covd's use of the term, so I'm not sure whether I would automatically reject the covd for using it without knowing more.  Ultimately my opinion would depend on some specifics.  For example, there are COVDs that offer a more multi-faceted therapy shop (e.g., ours has a full time OT) so I can easily imagine the possibility that a SLP could be part of a team, in which case a discussion of dyslexia might make a little more sense.  Mostly, what I would be asking for is the report listing the specific, measurable vision issues (convergence, tracking and the like) rather than "dyslexia."

 

I think what would bug me the most is the conjunction of "diagnose" with "dyslexia" as when I hear "diagnose" I think of the DSM, which obviously requires a psych's involvement in the testing process somewhere.  (Then again, "dyslexia" isn't in the DSM... so it depends on what the doc meant.)

[PeterPan]

Well here's my opinion.  You should let them go forward utterly unchecked by any negative comments from you, and then let US know what happens.   :D  Because, frankly, our COVD doc has done something pretty similar and I'd be interested to hear how it turns out for them.  When you dig into the literature (this thick, boring Learning Disabilities book I've been reading), they parse dyslexia as phonemic or orthographic, and then they look at RAN/RAS.  Well frankly VT *can* address 2 of those three.  So the real question to me is whether that visual processing issue is something that is NOT going to respond to VT (which is true in some cases of VT, we've had people on the boards here where this was the case) or it IS going to respond to the VT.  

 

That would NOT be VT for convergence, focusing, tracking, etc., because in those kids there might *only* be visual processing issues. And you know that would be an interesting conversation to have, asking her whether her COVD doc found the physical problems (convergence, focusing, tracking, etc.) or only visual processing or both.  She'll hopefully know which.  It's not unreasonable to say someone has physical vision problems like convergence AND dyslexia, and I don't think any of us would be so crass as to say a kid with convergence problems shouldn't get them treated just because he happens to have dyslexia as well.  

 

But once you get into treating visual processing problems only, that's another situation and more controversial.  There's no controversy over whether VT works for convergence, etc.  The data shows it does, fine, bam, done.  The question is whether it works for people who *only* have visual processing problems.  That's more hairy.  That's where my ds is it seems, and frankly *my* decision at this point was a financial one.  I've got the therapy stuff and I'll do it with him myself.  But that doesn't mean someone else is WRONG to make the decision to TRY to let the COVD doc work on it, kwim?  They might actually make some headway in some kids.

 

There are also scenarios you don't anticipate.  For instance the lead doc at our COVD practice brought in PACE/Learning RX, because her own kids were struggling to learn to read despite proper interventions and VT.  There was something about what they did in PACE that got the working memory and vision and whatnot working together and the reading started.  I've said before my dd spontaneously started sounding out words at age 11, after 2 months of VT.  You just can't assume that EVERYONE'S causes of their symptoms are the same.

 

So I would ask very reasonable questions, not so much to dissuade her but just to help her think.

 

-Did he find physical symptoms like convergence, focusing, depth perception, saccades, accommodation, tracking, etc. or was it all visual processing symptoms?

-How does he track progress?

-What is his payment structure?

-How will she assess progress and know if she's satisfied?

-Has he given her a written time estimate on therapy?  

-Has she talked with other people who've used him for this to know how satisfied they've been as to promptness, results, etc.?

-What psych does the optometrist refer to for people who realize they have a learning disability on top of the vision problems?  (That will tell her a LOT.)

 

As a customer, I would also compare prices to other docs in the area and yank his chain a bit by asking about more homework with less frequent sessions.  Sort of ways to gauge if you're his cash cow...

[Lecka]

OhE -- Is your son having an OT eval?  Visual processing is also something OTs work on.  

 

I do not know if my son's vision tracking was really a physical problem or a processing problem -- it was related to him not crossing the midline.  

 

OT helped for it, and at the vision eval he thought it was worth trying OT, and coming back to him if OT didn't turn out to work for him.  The OT also was not positive she could help him to the point he wouldn't need VT.  He had other things to do in OT, though.  It was not something where he needed VT first and then OT.

 

Some of my son's vision processing scores increased a tad with OT, some more than a tad.  None of them were brought up to average, but they were brought up to a point where I saw real-world improvement.  

 

I am not taking him back to the COVD in our town.  I am in a smaller town and I do not think he offers everything that is available in other practices.  But -- he did not think he could help my son in any area besides the tracking.  

 

My impression from talking to just a couple of people -- if there was more he could do, he would have said so.  If it was something where my son was one who was going to make progress with him in other areas, he would have said different things than what he said to me.  B/c -- he really was more like "you are in here looking for some solution for your son's handwriting, and I cannot provide you a solution."  

 

At this point he is fine for everything, but not the fastest swimmer or best at steals in soccer.  He is pretty mediocre, but he is good enough to be able to participate and have fun, and not be embarrassed.  Everything except handwriting, which is unforgiving in its way.  

 

But -- there are vision processing skills that are on a testing battery my son son has done for OT.  

 

So -- I do not know how they interact, but it is something where you can also ask about it in OT, it is not something where the only choice is VT.  

 

Just to be informative -- this is the test he has done.  http://www.healthofchildren.com/B/Beery-Buktenica-Test.html  The person watching him do it can tell things by how he copies these shapes.  My son comes up low on the "visual perceptual" side.  He made enough progress that you can tell just by looking at his booklets, that he has come a long way, but still it is low for his age.  As far as I know the "visual perceptual" is OT-speak for visual processing -- but I don't know that for sure, and I would be interested to hear if that is not the case.  

 

But -- at a certain point, I have just come to believe, that like it says in one of the Eide books, there is a large percentage of kids who have problems with phonemic awareness and also with visual skills -- and I think my son is one of them.  Or -- at least, that is what I think at this point.  He has come a long way in both areas, though  :)  With his formal therapies -- 4 years of school district speech, one year of awesome private speech, 2 years of school OT, and one year of private OT. But I think -- in another place -- the OT he did, could have been the same things that are done by VT in other locations.  

 

So overall -- maybe ask the OT what he/she has screened for, and see if there is anything they can suggest or rule out.  Mine was pretty honest, I thought, about saying that for some things, sometimes she refers on to VT, she just has to work with kids and see if they progress with her, she can't predict if they are going to be better off with her or VT.  The VT told me the same thing about his own services.  They were both like -- try about 2 months/6 sessions, and at that time, we will know if we are getting anywhere or not.  I had a good impression of both of them, they both seemed up-front with me I thought.

 

Also overall -- they get how it is hard to have a hard time with handwriting, but my strong impression is that their perspective is -- most of the kids they are working with who have these issues, have way more challenges than my son, so I should look on the bright side.  Not in a bad way -- but just comments were made that came across that way by multiple people at the time of him doing these evals and stuff.   

[PeterPan]

Lecka, I guess we're rabbit trailing, lol, but yes the OT did check his eyes.  And yes, she found what you're saying, that his eyes jump for tracking *just* at the midline.  In general (what the VT doc was screening), fine.  (That was a year ago at his last annual eye exam.)  But at the midline, jumps.  

[Lecka]

Same thing, then.  

 

I had a choice between OT and VT and for various reasons (including insurance coverage and thinking the woman did better with my son) and went with OT, but could have gone with VT.  He did not make progress for a little bit, I was just about to call the VT back (the OT telling me she was not seeing progress).  Then two weeks later -- he started to show progress with her, and I called and cancelled the appointment.  Then he made a lot of progress on that in a few months.  

 

It really helped him, though.  

 

It is great you have found out so early.  I didn't find out with my son until he was most of the way through 2nd grade.

 

For me -- it was good for me to find that the VT was telling me the same thing as the OTs.  It seemed like a bizarre thing to me at the time.  

 

[SandyKC]

This is the sort of confusing issue I address right away in the opening of my book. People use the word "dyslexia" based upon the word's definition almost interchangeably with a dyslexia diagnosis.  

 

The word's definition is basically, "difficulty with reading" --and so that covers just about any condition that would cause difficulty. People use the term "dyslexia" to describe problems with ocular motor development, scotopic sensitivity, visual perception, etc., but none of these are TRUE Dyslexia by diagnosis.  It really irks me that professionals use the word "dyslexia" as a catch-all for all kinds of reading problems because that just serves to confuse parents. Often, the professionals want parents to think their solution for "dyslexia" is a cure for most reading problems, but it seldom is.

 

So, the COVD doc is not necessarily "wrong" in referring to the visual problems as dyslexia based upon the definition of the word, but he sure is muddying the water for a parent to be able to sort out the problems and issues her child has.  It would be better to say the child has ocular motor deficits, visual processing deficits and clinical dyslexia (the diagnosable, neurological learning disability).  Then the parent could understand that she is dealing with three separate conditions, not "three types of dyslexia."  When it comes to "types" of dyslexia--there is only one, and it is a neurologically-based learning disability!!

 

Putting my soapbox away now. ;)

[geodob]

I would ask if the local COVD looked a bit like a duck?

As it sounds like quack to me?

[PeterPan]

Ok, so which is more quack, the COVD doc who calls everything dyslexia, diagnoses what he shouldn't diagnose, but has a track record of treating and GETTING PROGRESS in a percentage of kids... Or the psychologist who calls everything that scores lowly dyslexia/reading disorder, doesn't refer off to COVD, and doesn't own up when that kid then goes to a COVD doc, gets the physical problems treated, and has his skills go up enough that he loses the reading disorder label?   ;)

 

We've had BOTH happen here on the boards.

 

Our COVD doc is totally legit, and I don't think she'd be recommending we do VT with her for visual processing if she didn't think she could get it to budge.  And our VT work *did* include things that I think probably bumped dd's RAN/RAS score.  And some dyslexic kids WILL have both convergence/tracking/focus issues (which VT is quite effective for) and the dyslexia.

 

I don't have any reason to *doubt* my COVD doc when she says their work on visual processing improves visual processing, kwim?  That's all she's saying.  Can it improve on *all* kids or is it intractable in some?  I've heard enough to know the latter is true for some kids.  That doesn't mean they aren't able to get it to budge on ANYONE, mercy.  And she DOES tell you to be doing OG, which means she's acknowledging eyes are NOT the total sum of it, even though she makes these loaded statements.

 

Medical care is totally pigeonholed.  Psychs aren't qualified to diagnose eyes, and eye docs aren't qualified to be psychs.  Add to that SLPs make lousy psychs and OTs aren't qualified as psychs either. But all these people are MORE than willing to cross over their specialties.  I think it's just the medical arrogance.  So deny them that and use your head, since they don't seem to be able to restrain themselves from opinions that can be inaccurate and misleading.  

[Tokyomarie]

I like Sandy's explanation regarding vision and dyslexia. Vision Therapy is a valid treatment for ocular motor deficits and certain visual processing deficits. But these things are not the underlying cause for dyslexia as it is currently defined in the dyslexia research and intervention community. They may exist in some people who also have dyslexia but they are not dyslexia.

 

The written language difficulties in dyslexia are just that: difficulty in processing language that results in difficulty with word level reading and spelling. Other aspects of written language can also be challenging for people with dyslexia , but the word level difficulties must be present. These are not issues that can be addressed through VT.

[PeterPan]

I like Sandy's explanation regarding vision and dyslexia. Vision Therapy is a valid treatment for ocular motor deficits and certain visual processing deficits. But these things are not the underlying cause for dyslexia as it is currently defined in the dyslexia research and intervention community. They may exist in some people who also have dyslexia but they are not dyslexia.

 

The written language difficulties in dyslexia are just that: difficulty in processing language that results in difficulty with word level reading and spelling. Other aspects of written language can also be challenging for people with dyslexia , but the word level difficulties must be present. These are not issues that can be addressed through VT.

I'm trying to think through what you're discriminating here, because these are the issues we're sorting out with ds.  So you're saying if the psych says dyslexia, it's the connection of the LANGUAGE to visual that is glitchy, not just any old visual processing...  That's interesting to ponder.  So then you could have the inverse, someone who has no problems with other forms of visual processing (visual memory, etc. etc.) but *does* have issues with how they connect language to written?  Interesting.  But then how do you account for the reversals and transposing common in dyslexia?  Are you saying a student could theoretically have spatial/reversal/transposing issues in written language tasks but *not* other things (say building with legos) and they *don't* benefit from VT; however if the student has spatial/reversal/transposing issues with language to written AND non-language tasks (say building with legos) then he DOES benefit from working on the visual processing?

 

Dunno, just trying to think this through the way you're saying...

 

 

[Julie of KY]

I also try to remember when someone tells me that their doctor said something that this is secondhand. I know I sometimes can go to a doctor with a friend. I listen with a medically trained ear and my friend hears the some thing. However, friend's interpretation of what the doctor "said" is vastly different from mine. Therefore, when someone tells me that their doc said something, it has been filtered through their interpretation and may be significantly different than what the doc actually meant.

[Lecka]

It is not really "language to visual" in my understanding.  It is more "language to language."  It is not hearing how the sounds in words go together, and then having trouble with going from the sounds in words to the letters on the page.  But it is more that the problem with the sounds in words, shows up as a problem with reading, b/c it is a basic requirement of reading (assuming we are not memorizing literally every word we will ever read, assuming we will ever read by sounding out words, assuming we will be able to read "nonsense words" like "flept" and be able to sound out how we will say it).  It is really a language-based thing, that shows up in reading, but it is really not about the visual at all.  

 

It is about not being able to blend or segment, b/c you do not really get that words are made up of individual sounds.  

 

So -- no, I would not say it is "language to visual" at all.  That is just not what it is at all.  

 

All the problems with phonemic awareness are pre-reading skills and the tests for them are oral only (that I am familiar with), and do not require any visual element at all.  

 

There is just no "visual" to it.  

[Heathermomster]

OP, It would be nice if the COVD could clarify what they stated by writing down specifically what they hope to address and how.

 

I was speaking with a gal locally. Her DD has some sort of strabismus thing going on, and one of the local COVDs wanted some obscene amount of money for services followed by a hard sale. The hard sale would bother me. In that instance, I'd want everything in writing so that I could get a second opinion. All I can say is if your friends are concerned, they should request that services be spelled out in writing, and then she should seek another opinion.

 

Thus far, I've been very fortunate with the COVD that I met. She listened, saw DS, and then sent us to OT. I don't believe all COVDs are snake oil salesmen. Her money seemed to be made in the frames and lenses department.

[PeterPan]

 

There is just no "visual" to it.  

But they are diagnosing "surface" dyslexia, which I think, from what I'm reading, is visual, no?  I've just been trying to wrap my brain around it, reading this book on Learning Disabilities by Mather.  They said orthographic (sound to written) and surface (visual like spelling issues).  So Mather says they're looking for one or both of those and a low RAN/RAS.  We've had people come on here saying they were told surface dyslexia, so it is a term being used.

 

Just trying to understand!   :)

 

Adding: I had to return Mather to the library, so I don't have it handy.  I guess where this is going in my mind is:

 

-is "visual processing disorder" a term that is used by neuropsychs or only more in the education field?

-is VPD permanent or does it respond to therapy for visual processing?

-how does VPD discriminate from surface dyslexia?

 

Bonus: do some psychs *only* consider phonological issues for dyslexia/reading disorder and *not* surface dyslexia?

 

Coming back to this.  I found this, not sure it's particularly accurate.  It seems to be a mom's take on everything.  http://www.dyslexia-reading-well.com/types-of-dyslexia.html  She mentions surface dyslexia and says it's only acquired (ie. through brain damage or trauma), not genetic/developmental, so that means it *wouldn't* account for visual issues with most kids.  She does banter about some numbers on % of dyslexics helped by VT, overlays, etc.  

 

So then why have I seen people equating "stealth" dyslexia and surface dyslexia?  Or am I crazy and that's not what happens?  I thought I had seen people saying that they were equivalent...

 

She suggests that issues with telling time on a face clock are a reliable symptom/indicator of dyslexia, but why is that if it's primarily a phonological and LANGUAGE based disorder?

[Incognito]

This is all purely from my experience, but the reason that reading a clock and letter reversals are an issue isn't necessarily that they aren't seeing things well, it is that they are so extremely good at manipulating things in the 3rd dimension in their heads that they don't have an anchor point for which way is left/right/up/down and things that are the same but in a different position are the same to them.  

 

As far as the language stuff goes, I see a few elements working in tandem to make reading harder - the words/letters are not predictable because the child doesn't have their orientation cemented in their mind, so they are always struggling to see if it is deb or bed or ped or qeb or whatever.  For my child, longer words are easier (but that is because of memorizing shape, I think).  Then there is the phonological bit.  They also don't seem to be able to heard the individual sounds of the word as well either (or to hear the divisions of syllables or the rhyme or whathaveyou).  So even if they can "see" the word as it should be (say, bed), they have a hard time taking the sounds of the letters and being imprecise enough to squish them together into a word.  And there is the memorizing issue of phonemes.  

 

Additionally, in our case, there is the mind working so very much faster than the rest of it all, so there is guessing and zooming by words and the painful forced slowing down to really attend to the ciphers on the page.

 

ETA: There can also be tracking issues and other visual problems with trouble reading, but the things you were talking about relating to the actual dyslexia that had to do with letter reversals and clock troubles were what I was addressing.

 

[Lecka]

I am not really familiar with surface dyslexia at all.  From looking at the link -- I don't know much about it.

 

I don't think that stealth dyslexia is necessarily a phrase that everyone uses the same way.  I think in general it just means -- the person appears to read well in many ways and may have good comprehension, but either words are missed, or words are mis-read.  The child fills in the blanks from context and from reasoning abilities and background knowledge -- such that a child who is gifted and has superior reasoning abilities, will be able to perform at a higher level, than they really should from their word-for-word reading.  Or -- it means they are doing good at reading, but it is hard for them and they are slower, compared to where they should be.  But -- if you didn't know they should be doing better, you wouldn't realize there was a problem.  They are not kids who are obviously struggling.  

 

But it seems like there could be various reasons for that to happen.

 

But -- I do not know all the different terms.  However -- I think the phonological dyslexia is the most common/mainstream, and I think it is what a lot of us consider to be the official definition of dyslexia.  For example -- if you look at the IDA website (International Dyslexia Association) -- this is what they mean.  This is what the Barton website means.  This is what Overcoming Dyslexia means.  

 

I do NOT know why there would also be difficulty with telling time with an analog clock.  My son has trouble with that.  He has reversals when he writes.  I don't know at all, from my experience, why this is.  I just know it is difficult for him.  I agree -- it does not seem like it fits in with the "language-based" side.  I still am a user of the term dyslexia to mean -- a language-based disorder, based in trouble separating apart the sounds in words.  It is a contradiction I just live with at this point.  There is still research being done and I don't think there is a consensus at this time, or a full amount of knowledge, so I think for some things it is just something where I may not be able to find out for a few years, and that is okay.   

 

http://www.interdys.org/EWEBEDITPRO5/UPLOAD/DEFINITION.PDF

 

I just searched for the IDA definition of dyslexia -- and they have put the word "typically" in there -- that "these difficulties typically result from a phonological component of language."  They do not mention anything visual.  That is the kind of definition that is, to me, the definition of dyslexia. 

 

I do think there are things that are just unknown.  But, I think there are things that are known, and a thing that is known is that certain kinds of reading remediation are effective for children who have this kind of dyslexia.  And since the deficit is in phonemic awareness type stuff, that is a skill that needs to be worked on. 

 

But it seems like there could be various reasons for that to happen.

 

But -- I do not know all the different terms.  However -- I think the phonological dyslexia is the most common/mainstream, and I think it is what a lot of us consider to be the official definition of dyslexia.  For example -- if you look at the IDA website (International Dyslexia Association) -- this is what they mean.  This is what the Barton website means.  This is what Overcoming Dyslexia means.  

 

I do NOT know why there would also be difficulty with telling time with an analog clock.  My son has trouble with that.  He has reversals when he writes.  I don't know at all, from my experience, why this is.  I just know it is difficult for him.  I agree -- it does not seem like it fits in with the "language-based" side.  I still am a user of the term dyslexia to mean -- a language-based disorder, based in trouble separating apart the sounds in words.  It is a contradiction I just live with at this point.  There is still research being done and I don't think there is a consensus at this time, or a full amount of knowledge, so I think for some things it is just something where I may not be able to find out for a few years, and that is okay.   

 

http://www.interdys.org/EWEBEDITPRO5/UPLOAD/DEFINITION.PDF

 

I just searched for the IDA definition of dyslexia -- and they have put the word "typically" in there -- that "these difficulties typically result from a phonological component of language."  They do not mention anything visual.  That is the kind of definition that is, to me, the definition of dyslexia. 

 

I do think there are things that are just unknown.  But, I think there are things that are known, and a thing that is known is that certain kinds of reading remediation are effective for children who have this kind of dyslexia.  And since the deficit is in phonemic awareness type stuff, that is a skill that needs to be worked on. 

 

Btw, here is the top hit for stealth dyslexia on google: http://www.davidsongifted.org/db/Articles_id_10435.aspx  It is pretty interesting, and written by the Eides.   And here is a quote: "The reason is that these children are able to use strong higher-order language skills to compensate for the low-level deficits in auditory and visual processing that cause the reading problems in dyslexia."  See -- the Eides mention "auditory and visual processing."  They do mention visual, too.  So -- it is just something where it is different or they are not looking at things the same way.  I honestly think, in this case, a lot of it is people who are looking purely at reading and teaching kids to read, vs. people looking at more than reading.  Reading is pretty important to me, but notice in this article, a lot of it is about handwriting.  A lot of people who are doing reading programs, just are not including the other things in their scope, and I think that is okay, that is how they are looking at.  I don't think it is worth it to me to try to pick it to death -- I try to get useful information however I can.  But -- overall, I totally do go with the more "language only" type of use of the word "dyslexia," even though my son has turned out to have commonly associated visual processing issues, in addition.  It makes sense to me ----- because he learned to read with OG-style remediation, before he ever started OT for his visual processing issues.  

 

I do not know a lot of things, though.  I actually went to an OT workshop today, for my younger son, and had a chance to talk to an OT there, and I need to look into some more things for my older son, and I am going to be working on that.  

[PeterPan]

This is all purely from my experience, but the reason that reading a clock and letter reversals are an issue isn't necessarily that they aren't seeing things well, it is that they are so extremely good at manipulating things in the 3rd dimension in their heads that they don't have an anchor point for which way is left/right/up/down and things that are the same but in a different position are the same to them.  

 

As far as the language stuff goes, I see a few elements working in tandem to make reading harder - the words/letters are not predictable because the child doesn't have their orientation cemented in their mind, so they are always struggling to see if it is deb or bed or ped or qeb or whatever.  For my child, longer words are easier (but that is because of memorizing shape, I think).  Then there is the phonological bit.  They also don't seem to be able to heard the individual sounds of the word as well either (or to hear the divisions of syllables or the rhyme or whathaveyou).  So even if they can "see" the word as it should be (say, bed), they have a hard time taking the sounds of the letters and being imprecise enough to squish them together into a word.  And there is the memorizing issue of phonemes.  

 

Additionally, in our case, there is the mind working so very much faster than the rest of it all, so there is guessing and zooming by words and the painful forced slowing down to really attend to the ciphers on the page.

 

ETA: There can also be tracking issues and other visual problems with trouble reading, but the things you were talking about relating to the actual dyslexia that had to do with letter reversals and clock troubles were what I was addressing.

See that's so interesting.  I was rereading Shaywitz last night, since Lecka likes it so much, trying to see if more of this would sort out for me.  If dyslexia is *primarily* the phonological defect in almost all cases, then WHY the spatial problems?  

 

Btw, it was interesting to me that Shaywitz's MRIs showed that the Broca area in the brain controls both articulation and that early decoding.  Hmmm...

[PeterPan]

Btw, here is the top hit for stealth dyslexia on google: http://www.davidsongifted.org/db/Articles_id_10435.aspx  It is pretty interesting, and written by the Eides.   And here is a quote: "The reason is that these children are able to use strong higher-order language skills to compensate for the low-level deficits in auditory and visual processing that cause the reading problems in dyslexia." ...

 

...I actually went to an OT workshop today, for my younger son, and had a chance to talk to an OT there, and I need to look into some more things for my older son, and I am going to be working on that.  

Just for you, I pulled back out Shaywitz, because I KNEW you'd be referring to her.  :)  I only got through a few chapters (4?) so I need to keep going.  As you say, no mention of surface dyslexia.  So if that other website is correct and surface dyslexia is *only* caused by brain damage, then it's *not* equivalent to stealth dyslexia.  

 

That's a good find on that Eides quote!  So do I understand that correctly to mean that "stealth dyslexia" actually means sub-clinical or asymptomatic dyslexia?  I guess my issues are showing up here, lol, because "stealth" means NOTHING to me.  I see a ninja.  Doesn't get me anywhere.  In that quote they're saying low-level deficits, so does that mean CTOPP scores that are low relative to IQ, definitely low, but not *quite* as low as what would get you a traditional dyslexia label?  Remember the DSM has gone absolute, not relative.  Well I say that, and our *very well-respected* np said mentioned low relative to IQ in our talks (quick, nothing official, just him glancing at things).  So "stealth dyslexia" = high ability to mask plus relatively low but not necessarily absolutely low CTOPP?

 

So here's a question.  What happens to the CTOPP scores on a student who gets effective interventions over a number of years?  Do the CTOPP scores go up or do they stay down?  Then how do they continue to diagnose the dyslexia/reading disorder at that point?  It then shows up in reading speed and RAN/RAS?

 

So then for purposes of the DSM, reading disorder does *not* attempt to explain or include the visual symptoms AT ALL.  That's just this bonus weirdo thing that happens to happen from the perspective of the DSM?  So then you get the broader picture thinking people (Eides, the right-brain camp, Brain Gym, etc.) who are looking at the broader picture...  

 

I don't know, the whole thing is screwy.  

 

But DSM does *not* include VPD at all, correct?  I have some friends in special ed who were taught VPD as part of the labels in college and told it was an LD.  So who is it an LD according to and why is it not in the DSM if it's an LD?  Or is it just from the school's perspective and not from your double-blind, show it on an MRI, psych, or whatever perspective?  

 

Ok, I'm looking over this chart again that was on that Dyslexia Reading Well site.  She's got this venn diagram saying you have to have the phonological deficit PLUS the ran/ras PLUS the comprehension deficit to get to dyslexia, that just the ran/ras and comprehension alone don't get you there.  But then if you remediate the phonological with Barton, the CTOPP scores go up and you have no way to diagnose?  Or they still remain suppressed?

 

Sorry, I just haven't figured out these things in my mind yet and they actually come up in conversations with people.  I've had people equating VPD and dyslexia so the term is out there and being used by people.  And the confusing thing to me is that if VPD is *not* dyslexia, then doesn't it basically just mean get your butt to the developmental optometrist?  

 

Anyways, that explains the snarls from the np, hehe.  If he's looking ONLY at phonological, ran/ras, and comprehension to slap on the reading disorder label, then saying an optometrist can help is odd.  But clearly because two of those three involve actually using the eyes with the text, anything that IS going on with the eyes would affect them. 

[PeterPan]

I know I'm working this hard, sorry.  I'm googling VPD and dyslexia with my oh so stealth ninja google-fu skills...  I see sites calling VPD an LD that is not federally recognized.  Referral to COVD.  More reiteration that VPD is *not* dyslexia because it's not a language processing disorder, only a vision problem.  So then one could conceivably have BOTH, yes?  So if my ds' visual processing is off, even without convergence, focusing, etc. problems, then we have to intervene because a reading disorder/dyslexia label has no explanation for it, right?

 

So are there dyslexics WITHOUT visual processing problems and dyslexics WITH visual processing problems?

 

So if someone has visual processing problems, irrespective of the language processing, convergence, etc., then they need the intervention for the visual processing?

 

Or is the assumption that VT for VPD alone is bogus?  Or is the assumption that what is commonly called VPD is actually caused by convergence or part of the unacknowledged total package with dyslexia?  And is it then considered treatable or intractable?

 

Adding: found sites calling VPD "visual dyslexia" which of course is not in the DSM at all.  

[PeterPan]

This is sort of geeky/technical, but it goes through a bunch of terms and discusses the possibility of physical vision problems in dyslexics.  Apparently it's all locked up in theory right now and not quite as b&w either/or as the DSM makes it sound.  http://www.hindawi.com/journals/crinm/2013/406861/

 

And a slideshow that has a bunch of info nicely presented.  Seems to line up with Shaywitz, showing brain diagrams of the MRI research and areas affected, and discussing how vision connects.  Explores the magnocellular pathway theory.

‎www.oxfordkobe.com/VisualProblems.pdf

[PeterPan]

So if the evidence is that a percentage of dyslexics will have physical vision problems, then why are we so huffy about referring them?  I agree it's not EVERYTHING.  But to paint it like there are NEVER any physical (treatable) vision problems in ANY dyslexics doesn't seem to fit the evidence either. I was just surprised not to see more discussion in the books I've been reading showing these stats on how often the treatable vision problems WILL be comorbid.

 

To look at the MRI scans in that presentation, it looks like the vision issues and the decoding/phonological issues are in two separate parts of the brain.  So you have comorbid issues, not the one explaining/eliminating the other.

[wapiti]

I know I'm working this hard, sorry.  I'm googling VPD and dyslexia with my oh so stealth ninja google-fu skills...  I see sites calling VPD an LD that is not federally recognized.  Referral to COVD.  More reiteration that VPD is *not* dyslexia because it's not a language processing disorder, only a vision problem.  So then one could conceivably have BOTH, yes?  So if my ds' visual processing is off, even without convergence, focusing, etc. problems, then we have to intervene because a reading disorder/dyslexia label has no explanation for it, right?

 

So are there dyslexics WITHOUT visual processing problems and dyslexics WITH visual processing problems?

 

So if someone has visual processing problems, irrespective of the language processing, convergence, etc., then they need the intervention for the visual processing?

 

Or is the assumption that VT for VPD alone is bogus?  Or is the assumption that what is commonly called VPD is actually caused by convergence or part of the unacknowledged total package with dyslexia?  And is it then considered treatable or intractable?

 

Adding: found sites calling VPD "visual dyslexia" which of course is not in the DSM at all.  

 

These are very important questions!  I have always assumed that VT would be the (only) way to try to improve VPD, *but* that many COVDs do not handle that, though some do (I think this has come up over the years on the boards?).

 

The rub may lie in the meaning of the term "visual processing."  Is it a term of art?  Is there more than one possible scope to the term?

 

I come at these questions having kids who are not dyslexic, as in, have no phonemic issue whatsoever, but are very VSL, "dyslexic processors," as the one COVD put it (one who is in contact with the Eides), with dyslexic-style strengths as described in DA.  They also have slight motor glitches.  Looking way back when dd13 was in K/1st, dd could not blend three-letter words.  Then she had VT for tracking and viola, she could blend and naturally her reading took off - what's up with that?  I still don't get what VT and blending have to do with each other.  Then there's the separate language processing glitch with inferences and comprehension generally - I guess none of that is pigeon-hole-able.

[Lecka]

I think the vision stuff is just newer information, maybe.  It is still a very new field in a lot of ways.  

 

Briefly, though, I do not think you are looking at the Venn diagram the right way.  It does *not* say "and" "and."  It says -- definitely phonological, maybe also ran/ras, maybe also comprehension.  It says that ran/ras by itself is not dyslexia (which -- I think is not necessarily a decided thing, but that there are people saying that if this is the problem, it does not make sense to do a reading program focused on remediating phonological problems).  It says comprehension only is not dyslexa -- this is pretty accepted.  

 

The whole point of dyslexia, is that comprehension is not a problem, only the physical act of reading.  If comprehension is low, it is b/c of reduced access to learning b/c of a reduced opportunity to read.  Pretty much everything says that.  

 

Edit - -going back to re-read and look at other things.  But wanted to let you know -- I think the little arrows on that venn diagram are not the most clear, but I am not looking at it and seeing the same thing you are seeing.  

 

Also -- as odd as it seems, in my little town, it is actually OTs who do a lot of the visual processing stuff.  B/c -- I think the COVD here is more about the convergence/tracking type of stuff.  I do not really know.  But -- as counterintuitive as it seems, here it seems like it is an OT thing and not a "take them to VT" thing.  I do not really know.  There may be more overlap, I have only been to the one COVD for an eval.  I also have a name now, for another one who is a reasonable drive, but at this point I really think my son has made the improvement he is going to make.  Except -- I have plans to start looking at that next week and asking some more questions.  Last year we were very burned out and it was time to let things be, now it is time to look a little more.  But I do think, maybe my son is as far as he is going to get, it just is what it is.  While with reading -- he really has gotten to be a good reader.  

 

At the same time though, with personal circumstances and our location, we may not have access to the most cutting edge stuff out there, and he is doing well enough, that if that is the case, it is fine.  

 

Edit again:  locally the OT people do not call it vision processing, they call it "visual perceptual skills."  From reading I have done about autism, the "visual perceptual skills" my son has identified in OT, are under lists of visual processing possible problems, in some books I have read about autism.  But -- I do not know why there are the different terms, or what they mean, really.  (And both OTs my son has seen also suggested I take him to a VT b/c they said they have had kids with similar issues who are really helped by it, some who have not been really helped by it, but they can just tell me -- I should check it out, it is not their area of expertise.)

[Lecka]

Also, I think stealth dyslexia just implies -- the kids are not getting identified as having dyslexia, b/c they are compensating.  Like -- they are flying under the radar, people don't know they need help.  It is the opposite of my son, who was not making it in Kindergarten.  These are kids who are making it in Kindergarten, but maybe b/c they are guessing answers or because they have memorized a lot of words, or for other reasons.  Or -- maybe they are reading low-average or average, but their intelligence is much higher, so they should be reading at their intelligence level.  Why aren't they?  B/c of stealth dyslexia making it harder for them to read.  But their hard is hard for them, but still good enough to be average.  

 

It is not really the type of dyslexia, just that it is not noticed.  

 

It is not the same as having a dyslexia processing style but being a good reader.  I think that is a thing, too, but not the same thing as stealth dyslexia.  

 

Also -- in Shaywitz style, any problems with comprehension or inferences would not be considered part of dyslexia.  There is supposed to be no reason for those to be impaired in dyslexia.  

 

I think it is all just very individual, and that there are differences, but a lot of kids may have various differences but also have the phonological processing problem.  

 

I have read The Autistic Brain recently by Temple Grandin, and it is a lot about how not everyone with autism has the same brain structures or the same things going on.  It makes sense for the same to be true with dyslexia.  I don't know.  I do agree that Overcoming Dyslexia probably does not include everything that it could/should, but at the same time, I think it is a great book about the phonological model.   But it is also getting to be an older book, as time goes by.  I think a lot of research may not have even been done when it was first published.  I don't think that takes away, I still think it is a good book. But I don't think it is the final answer.  But I think -- it is not the book to answer some questions, it is the book to explain the phonological model, and that if you are reading it and looking for something else, it is going to be disappointing, but if you read it looking for that, then it won't be.  But -- you may have gotten all the information you want about the phonological model from the website, and if so, there may not be new information for you in Overcoming Dyslexia, and that is okay.  It is just "the book" about the phonological model. When I read it I don't know if all these websites were available, I was not finding stuff that was helping me on the Internet like I can find now (partly probably b/c I know more about what all the words mean and stuff like that).  

 

Oh, and I am not even sure my son has a dyslexic processing style.  It makes sense to me -- that there are kids who have it, but no phonological processing problems... my son could have phonological processing problems, and not have a dyslexic processing style.  He is still on the young side, I am not sure, I do not quite place him when I read Dyslexic Advantage.  But I still got some great ideas from that book :)

 

I do not have time to look at the links right now, but I am interested, it might take me a couple of days though.  

 

Edit:  It does make so much sense, for the the two things to be co-morbid.  I think -- maybe it was just not all put together, maybe it is just new information.  I don't think it is because this information was available and people chose to ignore it because they just like to have turf battles.  The phonological model is not that old!  It is not like -- "oh, well we have all the answers, this is from 100 years ago, we have had the technology to do these studies for 100 years."  

 

I got to a point a year or two ago, where I just had to say, okay, I am going to do the best I can with the information available now, what is in books and the Internet now, what is in my community now. B/c it is stuff that can drive you crazy for sure. But cool to think I will get more answers as time goes by, maybe even when I have time to check out the links :)

[geodob]

Dyslexia is a generic term for difficulties with reading and/or writing.

Where it plays an important role as a generic term, in developing broader community awareness.

Which has been successful, given that most people have at least heard of Dyslexia, and know that it effects reading/writing.

Where it can also be used to separate this difficulty, from general intelligence.

'Not stupid or lazy, just Dyslexic'.

 

But the other side of Dyslexia, is as a Marketing Term?

Where Dyslexia is also a multi-billion dollar Industry.

With a multitude of companies trying to claim ownership of this generic term?

But an alternative industry approach, is to invent sub-generic terms.

Where these fictional terms of Stealth Dyslexia and Surface Dyslexia?

Are good examples of this.

 

Though in regard to Visual Processing Disorders, this is something that I have discussed with board members of COVD?

Who have admitted that they really know little about this.

As they have little understanding of how the brain actually processes vision.

How vision disorders actually effect brain development?

Where currently their are no effective tests of Visual Processing Disorders.

 

But also in regard to difficulties with reading analogue clocks?

This is nothing to do with Visual Processing?

But rather, it is a Spatial Processing difficulty.

Which gives time a quantity.

Gives meaning to the numbers and hands on a clock.

With divisions of hours, minutes, seconds.

 

But we really need to understand Dyslexia as a generic term.

[Lecka]

Just out of curiousity --- a test of visual perceptual skills my son did, had him look at a shape and figure, and then do his best to copy it.  He would copy some of the shapes good, and some he copied in very odd ways (a part too big, a part too small, two parts not touching that are supposed to touch. things on top of each other that are supposed to be next to each other).  This is the kind of thing I think he did for "visual perceptual skills." Is this the kind of thing that would be meant by visual processing?  I assume it is very broad and this is just one part, but do you think this is in the category of visual processing, or really a separate thing?  

 

When he did it, they told me it could be caused by a vision problem and he should see a developmental optometrist.  

 

When he can copy some of the shapes accurately, it makes it not seem like it is just a motor control problem, you know?  But I can also see -- maybe this is not what people are talking about when they are talking about visual processing disorder, I don't really know.  

 

Edit: my understanding is that the test where he copied shapes, was the test of visual perceptual skills. It is a normed test the OT uses at his school.

 

It is all confusing to me, I am just wondering if you know how this fits in?  

 

[SandyKC]

Just for you, I pulled back out Shaywitz, because I KNEW you'd be referring to her.   :)  I only got through a few chapters (4?) so I need to keep going.  As you say, no mention of surface dyslexia.  So if that other website is correct and surface dyslexia is *only* caused by brain damage, then it's *not* equivalent to stealth dyslexia.  

 

That's a good find on that Eides quote!  So do I understand that correctly to mean that "stealth dyslexia" actually means sub-clinical or asymptomatic dyslexia?  I guess my issues are showing up here, lol, because "stealth" means NOTHING to me.  I see a ninja.  Doesn't get me anywhere.  In that quote they're saying low-level deficits, so does that mean CTOPP scores that are low relative to IQ, definitely low, but not *quite* as low as what would get you a traditional dyslexia label?  Remember the DSM has gone absolute, not relative.  Well I say that, and our *very well-respected* np said mentioned low relative to IQ in our talks (quick, nothing official, just him glancing at things).  So "stealth dyslexia" = high ability to mask plus relatively low but not necessarily absolutely low CTOPP?

 

So here's a question.  What happens to the CTOPP scores on a student who gets effective interventions over a number of years?  Do the CTOPP scores go up or do they stay down?  Then how do they continue to diagnose the dyslexia/reading disorder at that point?  It then shows up in reading speed and RAN/RAS?

 

So then for purposes of the DSM, reading disorder does *not* attempt to explain or include the visual symptoms AT ALL.  That's just this bonus weirdo thing that happens to happen from the perspective of the DSM?  So then you get the broader picture thinking people (Eides, the right-brain camp, Brain Gym, etc.) who are looking at the broader picture...  

 

I don't know, the whole thing is screwy.  

 

But DSM does *not* include VPD at all, correct?  I have some friends in special ed who were taught VPD as part of the labels in college and told it was an LD.  So who is it an LD according to and why is it not in the DSM if it's an LD?  Or is it just from the school's perspective and not from your double-blind, show it on an MRI, psych, or whatever perspective?  

 

Ok, I'm looking over this chart again that was on that Dyslexia Reading Well site.  She's got this venn diagram saying you have to have the phonological deficit PLUS the ran/ras PLUS the comprehension deficit to get to dyslexia, that just the ran/ras and comprehension alone don't get you there.  But then if you remediate the phonological with Barton, the CTOPP scores go up and you have no way to diagnose?  Or they still remain suppressed?

 

Sorry, I just haven't figured out these things in my mind yet and they actually come up in conversations with people.  I've had people equating VPD and dyslexia so the term is out there and being used by people.  And the confusing thing to me is that if VPD is *not* dyslexia, then doesn't it basically just mean get your butt to the developmental optometrist?  

 

Anyways, that explains the snarls from the np, hehe.  If he's looking ONLY at phonological, ran/ras, and comprehension to slap on the reading disorder label, then saying an optometrist can help is odd.  But clearly because two of those three involve actually using the eyes with the text, anything that IS going on with the eyes would affect them. 

I could just about respond to every post on this thread since I was last here, but that would take me ALL DAY and it looks like you all have done a great job of covering the bases already.  SO, I will start here and try to answer a few of the other questions too.  I think it's the next message I'll reply to too.. with what I know that doesn't seem to be covered here yet. ;-)

 

""stealth dyslexia" actually means sub-clinical or asymptomatic dyslexia?" - 

Not totally "asymptomatic" because it often is "noticeable" by those who know the child best, particularly in the realm of writing.  Since writing is such a neurologically intensive process, that's where observers can see something isn't quite up to par with the child's clear cognitive capabilities. Thus, it is stealth in the sense that it is not blatantly obvious, but it is present nevertheless.

 

This goes hand-in-hand with your other question, "if you remediate the phonological with Barton, the CTOPP scores go up and you have no way to diagnose?  Or they still remain suppressed?"  and now that we have fully traveled this road with my son, I can tell you that the scores go up some, but not entirely.  My DS, who had severe and obvious dyslexia (nothing stealth about his), who is now fully remediated in his ability to read and write (well), still scored in a clinically diagnosable range.  However, since a casual observer wouldn't know, but our neuropsych can test and determine the presence of dyslexia, I'd say that a person goes from having full-blown, obvious dyslexia to a form that is more "stealth" in nature.  

 

I think, therefore, that is part of where the dyslexia is never "cured," but its affects can be ameliorated through robust remediation.  It allows the person to function a lot better academically--kind of like a person with stealth dyslexia already can.  There will still be issues and problems here and there, but at least the student can perform functionally in the academic setting.

 

We worked on reading speed /fluency, cognitive enhancement, etc. and all of those areas are still markedly low as compared to DS' IQ and cognitive functioning--everything is just higher now!! His IQ measures a good 20 points higher NOW than it did when he was very first tested and heavily affected by his cognitive profile.  Did he get "smarter"? NO, Because he was already one smart cookie!  I do think, however, all of the remedial work lifted his ability to demonstrate his functional abilities much better across the board.

 

"She's got this venn diagram saying you have to have the phonological deficit PLUS the ran/ras PLUS the comprehension deficit to get to dyslexia, that just the ran/ras and comprehension alone don't get you there." I don't think that is accurate.  DS's reading comprehension has always been excellent for whatever bit he could read at different points in our testing, yet he's always had the neurological diagnosis of dyslexia based upon his phonemic awareness and working memory deficits.  In the dozens of neuropsych reports I've read at this point, I would even go as far as to say that **most** of the kids who are diagnosed with clinical dyslexia do not have issues with comprehension--it is far more to do with the reading decoding and phonemic awareness than it has to do with comprehension, and to a degree fluency.  Virtually all of the kids' whose reports I've read, including my own boys', have significant reading fluency deficits and those go hand-in-hand with the inability to decode well.

 

On the remedial end of that, my son's reading "fluency" is in a normal range now, but his phonemic awareness issues are still "measureable" (not that they're big, but they can be seen through neuropsychological assessments).  

 

I'm going to talk more about the visual processing end of dyslexia in response to the next post in this thread where I feel I'll be able to add something to the conversation...  but did want to answer this question here quickly too:

 

" I've had people equating VPD and dyslexia so the term is out there and being used by people.  And the confusing thing to me is that if VPD is *not* dyslexia, then doesn't it basically just mean get your butt to the developmental optometrist? "  I'd say if a child has reversals, loses his place frequently, complains of his eyes hurting, or displays any other VISUAL issues--YES>> GET yourself to a COVD too!!  The visual issues are a different issue, but they do OFTEN co-exist with clinical, neurological dyslexia, as I'll discuss in my next response. ;)  Off to that one now! :D

[SandyKC]

So if the evidence is that a percentage of dyslexics will have physical vision problems, then why are we so huffy about referring them?  I agree it's not EVERYTHING.  But to paint it like there are NEVER any physical (treatable) vision problems in ANY dyslexics doesn't seem to fit the evidence either. I was just surprised not to see more discussion in the books I've been reading showing these stats on how often the treatable vision problems WILL be comorbid.

 

To look at the MRI scans in that presentation, it looks like the vision issues and the decoding/phonological issues are in two separate parts of the brain.  So you have comorbid issues, not the one explaining/eliminating the other.

 

I think the "huffiness" comes from people not being told by the professionals, or the professionals not educating themselves enough to know, that there are co-morbid conditions and both need to be addressed.  Parents MUST understand that there are comorbid conditions because treatment falls short when they don't.

 

SO, if you have a COVD doc that says they 'cure dyslexia' (I've heard that one before), but the kid has vision-based issues comorbid with neurologically diagnosable dyslexia, the parent will believe the COVD doc.  The parent takes the child through the vision therapy and lo and behold, the child still can't read.  That's because the visual issues are NOT the "dyslexia." 

 

On the other side of the coin, you have the neuropsychologists who poo poo vision therapy.  The NP says the kid has neurological dyslexia and needs a phonemic awareness-based reading program.  The parent thinks that's the answer, provides the program, but the child makes little to no progress because the visual component isn't in sync yet.  

 

SO, YES, you have to address them both --or "all" because you have scotopic sensitivity (Irlen institute) and visual perception "anchoring" (as addressed in the Gift of Dyslexia) that are other visual perception/visual processing issues that can cause issues TOO.  

 

A parent really has to become a detective and nail down ALL of the conditions affecting a child to be successful in fully remediating a child.  That's why I wrote my Dyslexia Help Handbook for Parents because there is so much more to the picture than JUST clinical dyslexia as addressed by Shaywitz or visual processing addressed in the Davis program.

 

As for the f-MRI's (Functional MRIs) and the comorbid presence of conditions.. You are RIGHT ON TARGET there!!  The key, I think, is found in the f-MRI's as they image the brains of kids with dyslexia.  Their brains process differently.  Words that should be processed in the language center of the brain are processed in the frontal lobe, where cognitive processing usually takes place.  There are functional differences in the processing centers of the brains for kids with ADHD, Dyslexia, etc., which leads to common co-morbid issues.  

 

The problems come in when people try to box the problems into one nice little slot--phonemic awareness only, Or vision therapy only, etc.  Or when professionals aren't CLEAR about the co-morbidness of the conditions and leave parents thinking it is a convoluted soup of conditions that can't be sorted out.  I think that is where most SCHOOL personnel have their brains--they think it "can't" be sorted out, so they don't even try.

 

The thing is.. Each condition CAN be independently identified and addressed.  When each independent condition is identified, and an appropriate program is put into place and used properly, then kids can make awesome progress.  

 

In my book, I explain why it is important to work on the physical (visual) and cognitive enhancement components FIRST so that the child has more ability to learn to read through the phonemic awareness programs and other academic programs that will be used.  

 

This thread is soooo totally WHY I wrote my book!!  I've been there, trying to sort everything out, and my son had multiple comorbid conditions.  We did vision therapy, occupational therapy, speech-language therapy, a specialized reading program (Orton-Gillingham), and cognitive enhancement.  We had to address EACH component to build the academically successful package that is my son today! :D

 

It was HARD WORK.  It was hard to be the detective and ferret out each component that needed work, but doing so was critical to our success.  We'd already been floundering for five years in public school--teachers thought my son "cried" when they wanted him to read because it was so hard for him, but I knew my son's personality better than that! When we began homeschooling, I could see first-hand that his eyes watered and bothered him. He had convergence insufficiency, so he needed vision therapy.  He had pervasive reversals (you can see those here), so we worked with Ron Davis' program from The Gift of Dyslexia. I went and got trained in Orton-Gillingham methods, which equipped me WELL for teaching my son. 

 

It was all WORTH IT!! SOOO WORTH IT!! SO you all KEEP ASKING QUESTIONS and you will find answers!! Keep searching for causes and solutions and you will find them.  Knock and the door shall be opened unto your child's academic potential. ;) (Sorry, couldn't resist the reference to Matthew 7:7 ;) ) 

 

HUGS TO ALL! :D  Keep on being the rockin' moms that you ARE! :thumbup:

[SandyKC]

Just out of curiousity --- a test of visual perceptual skills my son did, had him look at a shape and figure, and then do his best to copy it.  He would copy some of the shapes good, and some he copied in very odd ways (a part too big, a part too small, two parts not touching that are supposed to touch. things on top of each other that are supposed to be next to each other).  This is the kind of thing I think he did for "visual perceptual skills." Is this the kind of thing that would be meant by visual processing?  I assume it is very broad and this is just one part, but do you think this is in the category of visual processing, or really a separate thing?  

 

When he did it, they told me it could be caused by a vision problem and he should see a developmental optometrist.  

 

When he can copy some of the shapes accurately, it makes it not seem like it is just a motor control problem, you know?  But I can also see -- maybe this is not what people are talking about when they are talking about visual processing disorder, I don't really know.  

 

Edit: my understanding is that the test where he copied shapes, was the test of visual perceptual skills. It is a normed test the OT uses at his school.

 

It is all confusing to me, I am just wondering if you know how this fits in?  

That was probably the The Rey-Osterrieth Complex Figure Test which measures visual memory, visual processing, visual-spatial awareness, etc.  It has copy, immediate, and delayed recall components which help assess how well a child stores visual information in his brain.  This is one test my son performed virtually perfectly--at the 99th+ percentile.  He missed ONE line's placement.  He had the line, but it just wasn't accurate.

 

It's important to note this too because this is the same child whose handwriting is in the sample I use on my website. You will see there is only one word in the whole thing that doesn't have a misspelling or mis-orientation of some letter. The problems he had were due to his visual processing giftedness.

 

My son's EXCEPTIONAL visual processing meant he could visualize anything in 3-dimensions.  We had to use the visual-perception training in Ron Davis' book to train my son to manage his visual perception abilities when it came to writing. With my DS, this test was a clear indicator that teaching him everything VISUALLY was a huge key to his ability to remember it too.  

 

When he was young, he had a bunch of boys over once.. They dumped out a bunch of Legos, and my DS built an aircraft carrier and helicopter out of his mind. One of his buddies said, "HOW'D you do that??? I can't even build things when I have instructions!" My son says, "Who needs instructions?"  For my DS, this was an area in which he was exceptionally gifted, but it also adversely impacted his academic abilities when it came to writing. 

 

So the basic answer to your question is that YES, the test does measure visual processing components, including visual memory. If you son had problems and couldn't reproduce the drawing, the "issues" would be diagnosed or revealed out of whether his difficulties occurred at the copying, immediate, and/or delayed recall portion of the test.

 

The delayed portion assesses visual memory--the child does other activities between the initial copying and the delayed recall.  If the child can store the information in long-term memory and access it later to reproduce the drawing, it shows the visual processing occurred properly and visual memory is intact.  The delayed recall was the one virtually perfectly produced by my DS... and that performance was after he had completed vision therapy.  Makes me think.. I need to go pull our NP reports from our early to our later testing where the near perfect performance occurred and see what the first performance was.  I truly don't remember the Ray-O at the earlier testing--and maybe it wasn't done, but it'll be interesting for me to check out! ;)

[PeterPan]

Sandy, this is totally expanding the way I think of dyslexia!  (or narrowing??)  :)  It's the MRIs that make it make sense, because when you that things are happening in different locations in the brain then they really are separate things.  So then why are sites saying difficulty reading clocks is dyslexia?  Why aren't they teasing things apart?  Because I guess it's complicated, oy.

 

Thanks for those explanations.  I guess we're waiting to hear what the psych says.  He'll probably say something that totally surprises me or have some mixture of labels (or lack of labels) I had never thought of.  

 

You know the confusing thing then is what are the implications for teaching if the CTOPP isn't likely to go up that much?  Is it that the OG methods don't actually focus on the specific CTOPP skills?  Or does it mean you shouldn't push *so* hard but should just get function?  I'm just saying I'd feel really guilty if I assumed my need was to push for a certain level of whatever and then it turned out that was NEVER going to happen...

 

Your comments on the Rey-Os are fascinating!  Now I'll be interested to see what happens!  Yes, I'd be VERY interested to hear your before and after Rey-Os test results...  

[summerreading]

 

-Did he find physical symptoms like convergence, focusing, depth perception, saccades, accommodation, tracking, etc. or was it all visual processing symptoms?

-How does he track progress?

-What is his payment structure?

-How will she assess progress and know if she's satisfied?

-Has he given her a written time estimate on therapy?  

-Has she talked with other people who've used him for this to know how satisfied they've been as to promptness, results, etc.?

-What psych does the optometrist refer to for people who realize they have a learning disability on top of the vision problems?  (That will tell her a LOT.)

 

As a customer, I would also compare prices to other docs in the area and yank his chain a bit by asking about more homework with less frequent sessions.  Sort of ways to gauge if you're his cash cow...

 

:iagree:  These are excellent questions. The second VT doctor we saw for an opinion offered answers to all these, with a signed contract with an estimate of therapy time and explaining how evals would be and when. The first one we saw charged twice as much without including perceptual eval in that price.

[SandyKC]

You know the confusing thing then is what are the implications for teaching if the CTOPP isn't likely to go up that much?  Is it that the OG methods don't actually focus on the specific CTOPP skills?  Or does it mean you shouldn't push *so* hard but should just get function?  I'm just saying I'd feel really guilty if I assumed my need was to push for a certain level of whatever and then it turned out that was NEVER going to happen...

 

Your comments on the Rey-Os are fascinating!  Now I'll be interested to see what happens!  Yes, I'd be VERY interested to hear your before and after Rey-Os test results...  

 

FASCINATING!! WOW! I never realized this before.. 

 

SO, on the Ray-Os for DS.

 

Early admin before VT and home-based cognitive enhancement: "Performance on the two recall trials of the complex figures showed standard scores of 69 on the Immediate Recall and 64 on the Delayed Recall trials. The problems ------ had with being able to organize the copy of the complex figure resulted in him not being able to remember very much of it.  He was not able to keep the Complex Figure in his visual memory as a whole object, rather it was disintegrated as a collection of pieces.  In the Delayed Recognition trial, he performed in the average range in the Trial when the examinee is required to look at 24 geometric shapes, half of which were in the original figure and half of which were not.  This trial showed he had stored a large amount of the complex figure in his visual memory, and he could recognize the components. However, when he tried to recall this information spontaneously, he had significant difficulty."

 

---Note: It got into visual memory, but he couldn't find it or use it when he needed it.

 

High school admin after all therapies and remediation:  "----- performed strongly on all three trials of the Complex Figure, earning Superior Scores on the Immediate and Delayed recalls and in the High Average range on the Recognition Trial.  This performance shows ----- has a strong implicit visual memory and procedural memory..." He had a 58 point increase on the delayed recall!! WOW!

[Lecka]

I think of course it is worth working on CTOPP skills to get an increase.  It is like -- you might get to 50th percentile, but in other areas, your son is way higher.  So don't just pooh-pooh 50th percentile, when it used to be 12th percentile.  Or going from below 10th percentile to 30th percentile.  That is a jump that is like -- wow, you are going to see a big difference in how a kid is doing.  It is still on the lower side and it is still maybe not as high as other scores.  Does that mean just don't work on it?  

 

I think it is not the right way to look at it.  An increase is great.  If his other scores are 90th percentile, then maybe the will not get to 90th percentile in that area.  But that is not like -- "oh, he is doing so bad" necessarily.  It is lower than his other scores, though.  

 

It is just -- it is the weaker area, you still just work on it and hope he can do as good as he possibly can.  

 

My son's visual memory iirc is one of his lowest areas, and did not improve much at all in OT.  At the COVD eval, he did not say it was an area he could work on.  Do you happen to know off the top of your head, that for someone who has done 2 years of school OT and about a year and a half of private OT, if there is still more I should look at for visual memory?  I am just curious.  

 

I looked back, and before OT his lowest area was motor coordination at 81.  It is the area where he made the most progress in OT.  (However at one time he had a 63 in articulation that was pretty depressing at the time, now he still might get a lower score on an age-normed articulation test, but he talks just fine, it is no problem.  I think he scored right at 100 last time.  But -- his verbal IQ is a lot higher.  But he talks well enough, that is all that really matters.)  

 

I need to get my act together wrt his handwriting, though.  I am going to see if I can get some information from school.  I feel like I do not know what to do locally, even though I have been asking around for a long time.  No one seems to really know.  But -- I have been recommended to start by talking to the school psychologist and ask him for information.  He seemed very helpful when I met him the last time, so I am optimistic.  I am not optimistic about getting testing through school, but I think I can at least get information.  

 

I was talking to someone at an OT workshop yesterday, and it is to the point, it is ridiculous I don't know if my son has working memory problems or not.  I have been asked before, and I do not know one way or the other.  But at the same time -- if I can't find anyone vaguely local, I don't know how I am going to find out.  I almost did this all last summer and then it just seemed like it was going to be too hard to do the driving.  

 

[SandyKC]

My son's visual memory iirc is one of his lowest areas, and did not improve much at all in OT.  At the COVD eval, he did not say it was an area he could work on.  Do you happen to know off the top of your head, that for someone who has done 2 years of school OT and about a year and a half of private OT, if there is still more I should look at for visual memory?  I am just curious.  

 

I looked back, and before OT his lowest area was motor coordination at 81.  It is the area where he made the most progress in OT.  (However at one time he had a 63 in articulation that was pretty depressing at the time, now he still might get a lower score on an age-normed articulation test, but he talks just fine, it is no problem.  I think he scored right at 100 last time.  But -- his verbal IQ is a lot higher.  But he talks well enough, that is all that really matters.)  

 

I need to get my act together wrt his handwriting, though.  I am going to see if I can get some information from school.  I feel like I do not know what to do locally, even though I have been asking around for a long time.  No one seems to really know.  But -- I have been recommended to start by talking to the school psychologist and ask him for information.  He seemed very helpful when I met him the last time, so I am optimistic.  I am not optimistic about getting testing through school, but I think I can at least get information.  

 

I was talking to someone at an OT workshop yesterday, and it is to the point, it is ridiculous I don't know if my son has working memory problems or not.  I have been asked before, and I do not know one way or the other.  But at the same time -- if I can't find anyone vaguely local, I don't know how I am going to find out.  I almost did this all last summer and then it just seemed like it was going to be too hard to do the driving.  

 

Truthfully, Lecka, I'm surprised by an OT working on visual perceptual skills of the kind that would be addressed through developmental vision therapy.. I haven't known any OT's who focus on that as a skill area, but that's not to say they don't.  I am just thinking it probably isn't a substantial part of the overall therapy plan. OT's definitely work on visual-motor integration (handwriting, copying) and that is a typical area for an OT to work on.

 

To me, I would think these would be two different fields where the COVD doc would be the one more skilled and trained for working on Visual-perceptual needs and the OT would be the one more skilled at working with visual-motor integration and fine motor skills.

 

I could totally be misunderstanding the therapies since you have seen a COVD and have been going to an OT... I'm just feeling a bit confused about the question of OT in regard to visual memory.  An OT would not typically work on visual memory at all.

 

Since you have difficulty acquiring a working memory eval, you might try this online tool: http://www.workingmemory.com.au/free-memory-assessment-quiz/.  The other thing I have recommended to parents before is to play some of the memory-matching card game with your child and try to determine if your child is good at it or has exceptional difficulty.  That can be a "hint", but it is by no means a "reliable" assessment. ;-)  You could also sign him up for something like BrainBuilder and see how he does as he works through the different portions of the program.  If he has a lot of difficulty with the memory sections, that could provide insight too.  I've been known to tell parents who can't get or afford evals to just use the "cover it anyway" approach and just go ahead and provide a program to make sure you do what you can.. There isn't any harm in doing it (except maybe a dent in the budget), so it can be worth doing.

[wapiti]

Lecka, FWIW, my understanding (from our OT) is that, usually, VT works on skills that are downstream from the central nervous system SPD issues that an OT would address. With regard to visual memory, that may be particularly downstream, as in one of the later skills to be worked on during a course of VT.

 

Eta, if it helps, visual memory of the sort measured during my kids' developmental vision eval was totally different from working memory (WM measured on the WISC). (One of my kids was low in visual memory but very high in WM)

[Lecka]

Thanks. 

 

I have just been to one COVD eval, and he was only going to be able to do the tracking. 

 

The OTs definitely work on more than VMI and handwriting here.  They do some things for some kinds of visual processing, at a minimum.  I do not know to what extent they do it.

 

The COVD here I think only does the things like tracking, convergence, and whatever else is more in that category. 

 

I think I am going to have to research this and find out what is available in our area. 

 

Right now, in 4th grade, the *only* real-world problem is with handwriting. 

 

I do not want to give up on his handwriting if I don't need to.  I am coming off about a 6-month period where I had given up and thought the important thing is just if he is successful anyways, which I still think, but I also think, if he could have more functional handwriting I want that for him. 

 

I wonder too, if I went back to a vision therapist now, if I would get different answers if I got then.  Maybe his tracking kept him from getting the results on the eval that he would get now. 

 

 

[PeterPan]

 

We worked on reading speed /fluency, cognitive enhancement, etc. and all of those areas are still markedly low as compared to DS' IQ and cognitive functioning--everything is just higher now!! His IQ measures a good 20 points higher NOW than it did when he was very first tested and heavily affected by his cognitive profile.  Did he get "smarter"? NO, Because he was already one smart cookie!  I do think, however, all of the remedial work lifted his ability to demonstrate his functional abilities much better across the board.

 

I was thinking about this some more this morning.  Was this higher IQ the 2nd time around the GAI or the unaltered?  And which cognitive therapies did you do?  You list a bunch on your site, right?  You did them all or some?  

 

 

Truthfully, Lecka, I'm surprised by an OT working on visual perceptual skills of the kind that would be addressed through developmental vision therapy.. 

I'm not.  There is an OT around here who will do it and advertises it, and well Lecka regularly alters the Laws of the Universe with the wonderful people she finds.   :D

 

Now Sandy, I want to keep this going with a weird question, since we're discussing fMRIs, etc.  What is your take on how the current brain research (like in Shaywitz, showing each problem to have a spot in the brain and not necessarily putting all problems in one spot) to connect to the popular term "left brain" or "right brain" for thinking process and issues?  I know there are things they can clearly demonstrate, like how issues with in determinant hand dominance connect to certain language parts in the brain not being picked and solidified, and that when you get the hand dominance consistent, the brain picks the side and the language improves.  Our SLP has an OT who has gotten MARVELOUS results improving language function (expressive language, retrieval, etc.) by doing OT.  It seems screwy, but the evidence is there.  

 

What I stumble over and what doesn't make sense to me (mainly because I'm a seriously dense, literal person who also couldn't accept basics like the definition of a logarithm without rehashing it in my mind EVERY TIME), is this whole idea of putting tons of DSM labels under the popular label of "right-brain dominant" and just landing everything to there.  Is there any MRI evidence of that? See they get all excited when someone fits their predictions (which my ds seems to) and huffy when I say my dd (who also has her labels) doesn't.  

 

I know it's a can of worms.  It kind of goes back to our discussion though which is the way the DSM teases everything apart vs. the way, in reality, they're sort of broader, with things often going together, co-morbid.  The DSM never tries to wrangle with those patterns but just isolates all the (what to me are) SYMPTOMS without seeing the CONNECTIONS.

 

So do you have any comments on that?

[wapiti]

I know it's a can of worms.  It kind of goes back to our discussion though which is the way the DSM teases everything apart vs. the way, in reality, they're sort of broader, with things often going together, co-morbid.  The DSM never tries to wrangle with those patterns but just isolates all the (what to me are) SYMPTOMS without seeing the CONNECTIONS.

 

Can of worms indeed.  FWIW, the way I see it is the opposite, that the DSM tries to make far too many connections (or maybe just the wrong ones??) between symptoms in order to pigeon-hole the problem.  My guess is that leads to a lot of misdiagnoses.  (e.g. in the old DSM - I haven't seen the new one - criteria for a certain spectrum issue included "stereotypical" behavior - pathetically circular)

 

(As you know, I've been reading a lot lately on how the rest of the body impacts the brain.  There are more connections there than docs of all stripes are ready to deal with...the science is only half way, if that, though the big picture makes some amount of sense.)

[SandyKC]

I was thinking about this some more this morning.  Was this higher IQ the 2nd time around the GAI or the unaltered?  And which cognitive therapies did you do?  You list a bunch on your site, right?  You did them all or some?  

 

 

I'm not.  There is an OT around here who will do it and advertises it, and well Lecka regularly alters the Laws of the Universe with the wonderful people she finds.   :D

 

Now Sandy, I want to keep this going with a weird question, since we're discussing fMRIs, etc.  What is your take on how the current brain research (like in Shaywitz, showing each problem to have a spot in the brain and not necessarily putting all problems in one spot) to connect to the popular term "left brain" or "right brain" for thinking process and issues?  I know there are things they can clearly demonstrate, like how issues with in determinant hand dominance connect to certain language parts in the brain not being picked and solidified, and that when you get the hand dominance consistent, the brain picks the side and the language improves.  Our SLP has an OT who has gotten MARVELOUS results improving language function (expressive language, retrieval, etc.) by doing OT.  It seems screwy, but the evidence is there.  

 

What I stumble over and what doesn't make sense to me (mainly because I'm a seriously dense, literal person who also couldn't accept basics like the definition of a logarithm without rehashing it in my mind EVERY TIME), is this whole idea of putting tons of DSM labels under the popular label of "right-brain dominant" and just landing everything to there.  Is there any MRI evidence of that? See they get all excited when someone fits their predictions (which my ds seems to) and huffy when I say my dd (who also has her labels) doesn't.  

 

I know it's a can of worms.  It kind of goes back to our discussion though which is the way the DSM teases everything apart vs. the way, in reality, they're sort of broader, with things often going together, co-morbid.  The DSM never tries to wrangle with those patterns but just isolates all the (what to me are) SYMPTOMS without seeing the CONNECTIONS.

 

So do you have any comments on that?

It was the calculated composite, Full Scale score on the Wechsler IQ test--first admin was probably for Children and the last was the adult version.  I don't have my reports in front of me to check right now.  I'd think the scales would be similar, but some of the difference might be accounted for by test differences.

 

We did not do all the therapies by any means!  We used Brain Gym and both of my boys went through the entirety of the Lexia Cross-Trainer programs twice. I also had my boys use Omega-3s daily (Nordic Naturals), and we did a TON of cross-body patterning types of activities--Swim League and Sprint Kayaking were our ongoing activities with lots of practice every single week--for years. ;-)  The boys also went through Earobics twice and we worked with Audiblox some (but I can't say we did that diligently--no one really liked it, including me).

 

Honestly, I don't know enough in depth about the fMRIs to have much of an opinion on the left-brain, right-brain aspects of thinking processes.  With typical readers and readers with dyslexia, the word processing is shifted from the language center of the brain to the frontal  lobe (where the processing is "central", so to speak).  Some of the functional brain imaging shows that some people have language dominance on the right side and others have it on the left side, and that dominance is different in children than it is in adults! (see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464420/) -- It says:

 

"The influence of age on language lateralization is not completely understood. Increasing left lateralization of language with age has been observed in children while the reverse has been noted in healthy young adults. It is not known whether the trend of decreasing language lateralization with age continues in the late decades of life and at what age the inflection in language lateralization trend as a function of age occurs."

 

Soooo, my opinion is basically that right versus left brain "thinkers" is probably popular psychology rather than a researched based fact of where processing actually takes place in a person's brain.  I think we don't really know enough, fMRI-wise, yet to know how the processing develops as a child's brain matures.  Questions I have:

 

-- Is language processing centered in the "language center" from birth, or does it start in the frontal lobe and shift to the language center sometime in infancy or toddler-hood?

 

--For kids with dyslexia, is the shifting of language processing delayed in moving to where it is supposed to be, or are they born with language processing occurring in the frontal lobe?

 

-- Is the frontal lobe processing present in all kids with phonemic awareness-based dyslexia? Or do some kids process the language in the language center and still have problems?

 

-- What other differences exist between LD brains? -- Executive functioning--are there fMRI differences there?

 

MOST interestingly, the studies show that as a child's phonemic-awareness based dyslexia is remediated, the processing of the words being read shifts from the frontal lobe to the child's language center of the brain.  At that point, the child's brain begins to demonstrate "typical" brain patterns when reading that are similar to good readers.  That opens the question for me, especially in regard to my DS, as to whether that shift frees up the frontal lobe to more properly develop executive functioning?

 

It's an interesting, convoluted world with all of the different LDs, etc.  Have you seen the MRI images of Temple Grandin's brain (Asperger's) compared to a typical brain?? CHECK That OUT! (http://karenweintraub.com/KW_home2/Journalism/Entries/2013/5/1_USA_Today__Temple_Grandin_looks_at_how_The_Autistic_Brain_sees_world.html) -  To me, it is just fascinating!! Is that why language skills are difficult for kids with Autism? Their brains are super-duper wired for processing everything visual that comes their way.

 

I guess I've asked as many questions and not really answered much of anything! :o  It IS an interesting topic!

[PeterPan]

Sandy, I totally had not thought of the brain as a SSD that was moving information around!  Fascinating!!!!

 

Those scans of TG's brain are interesting.  See some of the VT (or is it LMB? I forget) theorize that missing social cues is a visual problem, basically visual processing, because they were noticing the correlation between developmental vision problems and people with ADHD, ASD, etc.  But these scans would tend to indicate the total opposite, that typically the brain will be super-wired for visual and that they are noticing MORE!  And that might lead into what some MIT research was showing, that it's not so much what they see as how the *predict* and that ability to *predict* is the brain function connecting the deficits...

 

Autism Symptoms Result of Inability to Make Predictions ...

[Lecka]

Yeah, our town is odd.  Some things are way better than they have any right to be, and then other things are just missing, gone, absent, not available within 2 hours drive. 

 

There are OTs and SLPs and autism specialists who go to national conferences and are very up on things, and who go out of their specialties in efforts to help the kids they work with, and bring new approaches into our area. 

 

Then -- there are just not things that you would think we would have, and people just shrug their shoulders. 

 

We are a smaller town, but a college town, but not near any urban center.  So -- there are people here who are very interested in doing their jobs really well and helping kids, but then we are also just not that big of a town.