First VT progress eval - wondering about perceptual issues update #18

[summerreading]

I'd like to say I'm so grateful for the help I've gotten on this forum with my son's reading issues. I'm really happy with our COVD doctor treating my 7 year old (8 next month, God willing). I'm so glad I went for a second opinion as this woman is warm, friendly and patient with my son. He has his first 13 week progress eval. His depth perception increased and he is up to age level on some other measurements. He is now starting to work both eyes together, so she said in this next session is when we would see progress in reading skills. He is also being treated for perceptual issues.

 

The perceptual issues (right-left confusion, reversals, flips) raises a flag for me, should I also go get an NP eval? She showed me a list of the symptoms of dyslexia vs vision issues and showed me the large overlap. Has anyone gone through VT, it worked but the child still has another issue? I'm wondering what to look for, as in VT helped with x but not y. Not trying to over think it, but just worried about missing an opportunity early. 

 

Thanks

[PeterPan]

You want the long answer or the short answer?   :)

 

The short answer is the VT is going to fix whatever is caused by vision, and what's left you take to the neuropsych.  VT made huge changes for us, but it didn't eliminate the need for a psych eval.  In fact, it made it all the more obvious because we had eliminated the physical causes and KNEW she was trying and KNEW things still weren't right.

 

What do you have symptoms of?  What's going on? 

 

If you're seeing symptoms of phonological problems (difficulty sounding out words or sound to written correlation), working memory problems (dropping steps, forgetting instructions, etc.), impulsivity, working like molasses (processing speed), meltdowns, anxiety, inattention, etc. etc. etc., those aren't going to change with VT, sorry.  A lot did change for us, but those kinds of things don't.  

 

It's kinda like wondering if your OB will do your dental work.   :D

(sorry for the bad imagery, hehe.  I'm down with a bug and my humor has gone really WRY. )

 

And yes, just the fact that you're having that conversation on what symptoms are dyslexia and what are vision probably means you should start looking for a psych.  You can always cancel in a month if things miraculously change.  Took me a long time to choose a psych and then they have a waiting list, so this isn't some fast process.  You might as well find someone, get on the list, and cancel if you no longer need it.   :)

 

PS.  Come read this thread and see if Sandy's answers to my questions make anything gel for you.   :)       I'm a bit concerned local COVD is giving friends false hope    

[summerreading]

You want the long answer or the short answer?   :)

 

The short answer is the VT is going to fix whatever is caused by vision, and what's left you take to the neuropsych.  VT made huge changes for us, but it didn't eliminate the need for a psych eval.  In fact, it made it all the more obvious because we had eliminated the physical causes and KNEW she was trying and KNEW things still weren't right.

 

What do you have symptoms of?  What's going on? 

 

If you're seeing symptoms of phonological problems (difficulty sounding out words or sound to written correlation), working memory problems (dropping steps, forgetting instructions, etc.), impulsivity, working like molasses (processing speed), meltdowns, anxiety, inattention, etc. etc. etc., those aren't going to change with VT, sorry.  A lot did change for us, but those kinds of things don't.  

 

It's kinda like wondering if your OB will do your dental work.   :D

(sorry for the bad imagery, hehe.  I'm down with a bug and my humor has gone really WRY. )

 

And yes, just the fact that you're having that conversation on what symptoms are dyslexia and what are vision probably means you should start looking for a psych.  You can always cancel in a month if things miraculously change.  Took me a long time to choose a psych and then they have a waiting list, so this isn't some fast process.  You might as well find someone, get on the list, and cancel if you no longer need it.   :)

 

PS.  Come read this thread and see if Sandy's answers to my questions make anything gel for you.   :)       I'm a bit concerned local COVD is giving friends false hope    

 

Thanks as usual for your great answers. I asked the VT doctor is she knew of an NP and said the mother of one of her patients is an NP and the doctor had advised her on a test to differentiate between just vision issues and I don't know whatever else they are looking for. So I have her number, just putting it off to see how he does and also because we are paying for VT ourselves and affording another eval seems difficult.

 

He does have some anxiety but meltdowns have gone way down since we started VT. He does work slowly, but says he's thinking it out. The main symptom I see from him is a lot of guessing and not stopping at all to sound it out, looking at me or the picture for clues. I guess that's just habit. I'm a little on hyper alert b/c my husband's dyslexia and/or vision issues are so difficult for him (and us) to deal with that I want DS to get any help as young as possible.

 

I'm off to read that thread, thanks.

 

[summerreading]

I just found his paperwork from the first eval. Here are his diagnoses: Binocular instability, accommodative insufficiency, accommodative infacility, oculomotor dysfunction, visual motor deficiency, visual processing speed deficiency, lateral/directionality deficiency

[hearts4homeschooling]

My daughter has recently been diagnosed with alternating esotropia with the recommendation given for vision therapy to the tune of $4000 over six months which is not covered by insurance.  

 

I happened to be reading the book Why Isn't My Brain Working?, and one of the patient testimonials in it mentioned fish oil helping vision, eye turn, in particular, which is what my daughter has.  A 14-month-old girl was given a special formulation of fish oil, and her vision problem went away in a week and returns if she doesn't take it for a few days.  The oil is a ratio of at least 10:1 up to 20:1 of DHA to EPA to help mental and visual function.  There are many different ratios of fish oils out there with different types of oils based on the fish it comes from.  Metagenics has an oil that meets the criteria.  I am now giving this to my daughter in hopes that it is of benefit to her eye turn.  It hasn't been enough days to say yeah/nay yet.  She has been on a different formulation of fish oil for several months, and this has helped the bumps on the back of her arms but not the eyes.  

 

Fish oil might be a consideration to boost his brain overall even if it doesn't solve the eye symptoms.  Remember that the different formulations of fish oils treat different things and may be worth researching further.

[SandyKC]

The perceptual issues (right-left confusion, reversals, flips) raises a flag for me, should I also go get an NP eval? She showed me a list of the symptoms of dyslexia vs vision issues and showed me the large overlap. Has anyone gone through VT, it worked but the child still has another issue? I'm wondering what to look for, as in VT helped with x but not y. Not trying to over think it, but just worried about missing an opportunity early. 

 

Thanks

My answer would be a definitive YES on the "Has anyone gone through VT.." although we KNEW DS had neurological issues before we went for VT.  We didn't find out about the need for VT until after our NP evaluation.  Our son needed both. I just posted over on another thread that you might find interesting to read through...http://forums.welltrainedmind.com/topic/531357-im-a-bit-concerned-local-covd-is-giving-friends-false-hope/ that is all about VT & Neuropsych needs.

[PeterPan]

Thanks as usual for your great answers. I asked the VT doctor is she knew of an NP and said the mother of one of her patients is an NP and the doctor had advised her on a test to differentiate between just vision issues and I don't know whatever else they are looking for. So I have her number, just putting it off to see how he does and also because we are paying for VT ourselves and affording another eval seems difficult.

 

He does have some anxiety but meltdowns have gone way down since we started VT. He does work slowly, but says he's thinking it out. The main symptom I see from him is a lot of guessing and not stopping at all to sound it out, looking at me or the picture for clues. I guess that's just habit. I'm a little on hyper alert b/c my husband's dyslexia and/or vision issues are so difficult for him (and us) to deal with that I want DS to get any help as young as possible.

 

I'm off to read that thread, thanks.

 

The meltdowns and anxiety would concern me.  If they don't go away when you get the vision fixed and if the processing speed extends beyond vision into how he works, it would be nice to get evals just to have the right words for things and stop wondering.  It might change how you approach some things or help you connect dots on things you didn't even realize were related.  

 

I just found his paperwork from the first eval. Here are his diagnoses: Binocular instability, accommodative insufficiency, accommodative infacility, oculomotor dysfunction, visual motor deficiency, visual processing speed deficiency, lateral/directionality deficiency

It will be interesting for you to see how much progress he makes with therapy.

 

He's 7.  There's no extreme rush unless you're hitting a wall and not moving forward.  I'm getting my ds eval'd, but that's because we're at a standstill where I literally can't teach him without more info.  When I got my dd eval'd at 12, same deal, we had hit a WALL.  So I wouldn't consider it some extreme rush.  You're just going through the steps.  

 

A couple suggestions to make your money go farther?  Option one, consider asking for more homework and stretching sessions.  You'll accomplish more in a session, yes, but if he's compliant and working well with you it can work to stretch them and do a ton more homework.  Option two, go through the ps for evals.  You'll need to have things that actually impact his education, something concrete, not just a wish list.  If you have direct symptoms impacting his education when your VT is over, you can go through the ps, do the formal written request, and get that rolling.  

 

Honestly, I find choosing a psych very nerve-wracking.  It costs $1-3K in our area, depending on who you go to, and it's something you only do once, twice... (more with more complex situations)  So I think it's a great idea to take the name of that psych, listen to the word on the street, get a list of names going, and then when it's time see what you think.  And you know your sense of what's going on might improve as he ages too.  Certain things might become more obvious.

 

I hope his anxiety improves with the VT and that that's all that was causing it.  If it's enough that you're having meltdowns *and* learning symptoms *and* trouble getting work done due to how slow he is, it would be really nice to get the right words for that and good advice.  Our psych was pretty blunt about dd.  He said to get off the curriculum rat race, assign less work, and leave her with energy for her creative stuff.  We all SAY we want to work with our kids, but it's REALLY hard to be confident about that without some numbers and professional counsel, kwim?  At least it made me a lot more confident.   :)

 

Good for you for doing so much legwork and being on the front end of these things!  Plow on!  Sounds like you're doing great! :)

 

PS.  On the suggestion of fish oil, it is true omega 3 can affect a number of things.  I give my ds 1T. flax oil a day (he gets fussy with fish) and it dramatically improves his speech.  My dd takes it and it seems to help somewhat with focus.  So sure, omega 3 in some form is just one of those generally good things to try.  We use Spectrum organic soft gels except for my ds who gets Barleans (I think? it's at Krogers in a black bottle, I never look at the label, I'll bet it's Spectrum too).  The cheaper brands like Walmart's didn't work for us.  Spectrum works for us.

[geodob]

The way that vision works?

Is that each eye sends images to its own side of the brains, visual cortex.

Then another part of the brain, in the mid-brain.

Merges the images from both sides together, to form a whole left to right image.

 

But with the vision difficulties that detailed?

This presents a problem for the mid-brain?

As the images from both sides don't match up?

 

To cope with these mis-matched images?

The brain shuts down one side of the visual cortex.

Which removes the confusion, as only the vision from one eye is processed.

 

But then when VT gets both eyes working together, and looking at the same focal point.

 

The problem is that the side of the Visual Cortex that has been shut down?

Needs to be activated again.

So that it is processing visual images.

But it doesn't only involve activating that side?

It also requires the mid-brain learning how to merge the images from both sides, to form a single left to right image.

 

But it is only when both sides are merged, that left and right can be located as opposing points?

We can only concieve of 'right', if we can locate the opposing point of left.

 

With 'reversals?

Both sides of the brain work in a mirror relationship with each other.

For example, if you hold both hands out?

You will find that you can then move both hands in mirror movements to each other.

 

So that while the eyes can be trained to work together as a team?

The next stage is to firstly reactivate the unused side of the visual cortex.

Then to merge both sides together, to form a single left to right image.

[Rod Everson]

 

 

To cope with these mis-matched images?

The brain shuts down one side of the visual cortex.

Which removes the confusion, as only the vision from one eye is processed.

 

In an older child, the above describes what probably happens eventually.

 

However, in a younger child attempting to read, the brain will generally first attempt to resolve the problem by means of "alternating suppression" where first the input of one eye is suppressed, then neither is suppressed, then the other eye is suppressed, then neither again, and continuing on like that.

 

When neither eye is suppressed the result is visual confusion if the eyes aren't properly aligned. When one eye is suppressed vision is clear whether the eyes are aligned or not. I think possibly this is the brain's attempt to right the ship, so to speak. That is, here's what print is supposed to look like, here's what you're seeing with both eyes, here's what it's supposed to look like, here's more confusion, and so on, until at some point the child manages to get his eyes working together on his own. That's called development, and all kids go through it, but most of them at below reading age. Some believe the crawling phase is important for this type of binocular vision development, for instance.

 

If you think about it, when a struggling reader suddenly skips a word or two, or even drops down a line of print midway across the page, that could easily be because that's where the other eye is aimed when the first is suppressed.

 

The reason I bring this up is that the visual cortex issues you raised are probably not relevant as long as alternating suppression is still underway, as both sides would be used alternately. Once total suppression occurs and has persisted for some time, it's possible some old synaptic connections have to be reconnected I suppose, and even new ones made.

[Rod Everson]

I'd like to say I'm so grateful for the help I've gotten on this forum with my son's reading issues. I'm really happy with our COVD doctor treating my 7 year old (8 next month, God willing). I'm so glad I went for a second opinion as this woman is warm, friendly and patient with my son. He has his first 13 week progress eval. His depth perception increased and he is up to age level on some other measurements. He is now starting to work both eyes together, so she said in this next session is when we would see progress in reading skills. He is also being treated for perceptual issues.

 

Thanks

 

I've no problem with a vision therapist working on perceptual issues. What I want to warn against is expecting vision therapy to teach reading skills. In my experience, during vision therapy most children will become more visually comfortable with print and will begin to read more fluently, but if they don't know how to read, they still won't know how to read. That goes double for the phonological issues like blending, segmenting, phoneme manipulation, which vision therapy doesn't cover.

 

So if, after vision therapy, anxiety issues are still present, that could be due to the child still struggling with reading, and all that entails in dealings in the classroom and with peers.

 

My suggestion is to first address the vision needs and then, before spending the time and money on further evaluations, to hit the reading instruction hard for a time. Once a child is visually prepared to read, a good reading curriculum that works on both phonemic skills and code knowledge can remove some of the anxiety as the child begins to realize that his reading is finally improving. 

 

Having tried that second step, reading instruction, if issues still remain I would then seek further evaluations and help. But you might find that no further help is needed.

[Cheryl in CA]

.

[summerreading]

Thank you for all the additional replies. I can say he is a much happier child since we started VT. The anxiety level has gone down a lot. I really don't see much from him now and that is a big relief. The past few weeks I have seen improvement with him. He just started this month playing the Wii with his brothers. He said that before that certain games were "too 3D". His handwriting is getting smoother and he goes through the warm up drills in Recipe for Reading pretty quickly now. So I'm relaxing a bit, finally!

 

We are stuck a bit on identifying right and left. I mentioned to the VT that we just introduced "b" and he is confusing b and d in print and reading. She said it is because of right/left confusion. So we have lots of homework for that.

I do notice towards the end of his reading lesson he starts to read a few words backwards. I'm chalking this up to his eyes are getting tired and doing all the things we are in VT for. He no longer has trouble identifying the sounds letters make and I'm guessing it's because he can actually see what letter it is!

 

Really, this stuff is so confusing until you just get started on fixing it and either see results or don't.

[PeterPan]

Congrats on your progress!!!   :hurray:  :hurray:  :hurray:

[OneStepAtATime]

b and d were a huge issue here.  Barton addresses this issue very systematically and it has cleared up nearly any problems in this area, including reading and writing, for us but we had to use the method in Barton every single day for weeks before it did.  Now it is usually a non-issue though.  You may need to be very systematic and come up with something that helps him remember and visualize, something you can use with him every day until he internalizes the difference.  Maybe google to see if you can find something for free that could help?

[Rod Everson]

I mentioned to the VT that we just introduced "b" and he is confusing b and d in print and reading. She said it is because of right/left confusion. 

 

I'm reasonably sure that if you try this method you'll see results quickly: Telling b from d

 

I borrowed it from Spalding's Writing Road to Reading and it usually works well, plus it's fast and easy to teach. If you teach him to form the b "line first" and the d "circle first" when writing it will work for both writing and reading. And as long as he's going left to right when reading and writing, right/left confusion shouldn't make a difference.

 

By the way, I'm glad you're seeing some good results from VT. You're right, it's a confusing issue all around and most people aren't really convinced until they see what it can do for a child. This is why I advocate tackling the vision side first, before getting too nervous about all the other issues. They might exist, but it's surprising how many behaviors change once vision skills are in place.

 

Rod Everson

OnTrack Reading

[Guest jennas_mom]

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[summerreading]

Thank Rod,

The order of introducing letters is how they are introduced in Recipe for Reading. I have made sure he starts d with the c shape and the b as a line. I like this idea of asking him to notice which shape his lips are making. That's not something we've been doing and it may help.

 

 

 

I'm reasonably sure that if you try this method you'll see results quickly: Telling b from d

 

I borrowed it from Spalding's Writing Road to Reading and it usually works well, plus it's fast and easy to teach. If you teach him to form the b "line first" and the d "circle first" when writing it will work for both writing and reading. And as long as he's going left to right when reading and writing, right/left confusion shouldn't make a difference.

 

By the way, I'm glad you're seeing some good results from VT. You're right, it's a confusing issue all around and most people aren't really convinced until they see what it can do for a child. This is why I advocate tackling the vision side first, before getting too nervous about all the other issues. They might exist, but it's surprising how many behaviors change once vision skills are in place.

 

Rod Everson

OnTrack Reading

 

[summerreading]

I think it's time to move on with an NP eval. We were doing our lesson on letter e yesterday and in dictation he spelled every word with an e. "did" was "ben" huh? and he didn't know why it's wrong. Couldn't wrap his mind around the word "not" even through he's been very good in identifying the short o sound. He inserted every vowel before hitting the right one. He is just guessing sometimes, like his mind forgot every thing he learned.

 

Last VT appointment was canceled, so I haven't been able to run by her the blocking out one eye during math. Today he sees her again.

 

So my next questions are, do NPs have a way to ID that some issues are visual and some are not? I mean with it skew the results to have him get an eval before graduating VT?

 

And I simply can't afford a private eval at the moment. It's a few thousand dollars isn't it? What is is it like to go through the school disctrict? What kind of experience has that been if you've gone that route?

[OneStepAtATime]

A very good NP should be able to determine that some things are more vision related than others but I don't know if waiting until your child has completed VT before getting one is the way to go or not.  I guess you could call and ask?

 

Prices for a private evaluation are going to vary.  You could ask around, see what the cost is.  This will really vary by practice and general location, as far as I can tell.

 

As for what it is like going through a school district, that varies widely as well.  Cost is usually none, as far as I can tell, or very low cost compared to many private practices.  But the quality of the evaluation varies tremendously.  If you were living where I live I'd say don't waste your time.  I don't know a single parent that got good answers, irregardless of if their child was actually in the school system or homeschooled.  The school district fights even giving evals.  I mean they will dance around the process as long as humanly possible.  

 

My SIL sought evals for my nephew starting in 2nd grade.  She is a teacher in this same area.  They came up with every excuse under the sun not to test.  Testing didn't occur until 5th grade when she finally had to get really ugly about it.  And then the results gave her very little information beyond what she already knew and the program they had her put him in to "help" was utterly useless.  

 

Although we didn't have to fight as hard to get an eval (different school), certainly, I would categorize our own eval through the school as truly useless, waste of time, sent us in the wrong direction, etc.  The person doing the evals just did not have any of the latest data and they only really knew how to do a surface eval to determine if a child was far enough behind that they might need a bit of extra help to pass standardized tests.  Absolutely did not care about evaluating the whole child, finding strengths as well as weaknesses, digging deep and wide for the big picture, or how to help the kids not only limp along to the next grade but actually thrive for the short and long term.  Those things just weren't on their radar or in their training.

 

But there are others on this board and elsewhere that have reported really amazing experiences that provided a ton of information and help.  It you have that type of resource in your area it would definitely be worth pursuing, absolutely.  Ask around, try to find other parents that have gone that route and see if they got any truly useful info.  Were they supported?  Did they feel like it lead them in a positive directions for getting answers?  If so then you may be in a great district.  If not...

[PeterPan]

I think it's time to move on with an NP eval. We were doing our lesson on letter e yesterday and in dictation he spelled every word with an e. "did" was "ben" huh? and he didn't know why it's wrong. Couldn't wrap his mind around the word "not" even through he's been very good in identifying the short o sound. He inserted every vowel before hitting the right one. He is just guessing sometimes, like his mind forgot every thing he learned.

 

Last VT appointment was canceled, so I haven't been able to run by her the blocking out one eye during math. Today he sees her again.

 

So my next questions are, do NPs have a way to ID that some issues are visual and some are not? I mean with it skew the results to have him get an eval before graduating VT?

 

And I simply can't afford a private eval at the moment. It's a few thousand dollars isn't it? What is is it like to go through the school disctrict? What kind of experience has that been if you've gone that route?

When I read this, I had forgotten your initial post and my take was it (your current post) sounds like dyslexia.  Then I read your initial post and saw the VT doc was telling you from the beginning dyslexia.  Get an eval for the baseline, even if it means doing something drastic like oatmeal for a month, and get Barton.  You don't want to screw around with ineffective tools.

 

As far as going through the ps, well it's just going to depend on your area.  In general you're going to get a lot more information to help you as the teacher if you get a private eval.  The schools are VERY amenable in our area and still people go private for dyslexia and ASD evals.  I'm sorry that's not an easy answer.  If through the schools is the way you can make it happen, make it so.  Talk with people and see how it has gone.  

 

Don't waste time on materials and methods that aren't adequate for him.  Call it what it is, get the right word, and get the right materials.  

[PeterPan]

You asked if the np can distinguish dyslexia from vision problems, and the answer is yes.  It's AWESOME that you caught his physical vision problems, but the things you're describing now are language processing problems (the dyslexia), not vision.  Barton would give you fabulous tools to intervene on this.  We're in Barton 2 and it's AMAZING.  I taught through SWR for 8-9 years with my dd, and you'd think there'd be nothing left to learn given that SWR is an OG-spinoff.  Nope, Barton is FABULOUS. Love, love, love.  I'm so over this suffer and wing it through thing.  You're going to love the tools it gives you.  You're going to get into it and just have this huge SIGH OF RELIEF at the things Barton *gets* about your kid.

 

Barton is expensive, so again I'm sorry to be saying that, right at Christmas, right when you were saying there's no money.  And sure you could just buy Barton and skip evals, but then you don't have that baseline, that diagnosis.  You've got to think long-term.  Come high school you're going to want that label to get you out of foreign language.  You also want to know what else is going on.  (adhd, working memory, word retrieval, language processing, motor planning, etc.) But I'm sorry it's so expensive.  

 

What you might do is be pragmatic about it.  Use whoever is respectable who can get you in first.  If the school can get your testing started quickly, do it.  If the private will be faster, go that way.  It will take you a few weeks to buy Barton, receive it, watch the videos, and get ready to blast off.  So if you can get the testing done by some miracle while you're waiting for Barton, that would be fabulous.  I know once I had my label it was like horses at the race, let me out, no stopping us now!  

 

If you have to back off on the VT to afford the psych eval, I would.  You know I'm a HUGE proponent of VT, but you really need the psych eval at this point.  You should have gotten on a waiting list months ago when you started VT and she mentioned the D word.  Our VT doc was the first one to mention the D word with ds btw.  She knew there was no physical reason for the odd symptoms I was describing.  

 

So don't try to sort it out yourself.  Get the evals by whatever means you can.  And not that you have to, but if you end up needing Barton I have my Barton 1 set for sale.  I take exceptional care of my stuff and can give you a good price.  :) 

[summerreading]

I'm sorry OhElizabeth if I confused you. The VT never said he's dyslexic.

[geodob]

I would suggest that you complete the VT, before having an NP evaluation?

As rather than 'skew the results', it would invalidate them.

 

Where an NP can't imagine how the visual issues might affect the tests?

As that this would just produce an Imaginary Report?

 

 

 

[PeterPan]

I'm sorry OhElizabeth if I confused you. The VT never said he's dyslexic.

Well technically they can't, lol.  Even with our VT doc it was sort of side door.  But it was on your mind and something you mentioned in your initial post.  I'm just saying the errors you described sound like language processing, not vision, and dyslexia would explain them.  If his eyes are converging and focusing, what's left is for the psych.  

 

Do you feel there's a different explanation?  What do you think is going on?

[LaughingCat]

Have you done the Barton screening?  Some of the letter confusion was resolved with LIPS here.  The part that is more working memory/recall related was not though.