That is not the case when it comes to having a child's visual skills evaluated, mainly because ophthalmologists, and most optometrists as well, simply don't treat vision skills deficits, and they certainly don't treat them with vision therapy. In the case of optometrists there's also the consideration that vision issues tend to run in families, so a referral to another office that does do vision therapy risks losing an entire family of patients if they then switch optometrists, as they often will be inclined to do. Rather than take that risk, most optometrists (not all, but most) just don't do the sort of extensive and sustained testing required to sort out vision skills issues. Sure, they see the most obvious problems, and might even refer in those cases, but they aren't inclined to diagnose what they don't treat, so the majority of vision skills problems end up going undiagnosed, and therefore untreated. For a longer explanation see: Why Such a Secret?

People tend to hold two misconceptions about vision skills issues: 1) It's not necessarily true that vision skills problems will keep a child from learning to read. In fact, many kids with vision issues can learn to read. However, they tend to either avoid reading, or are uncomfortable when they do read. Nevertheless, a good phonics program can often work with a vision-challenged child. 2) It's not true that vision therapy teaches a child to read. Instead, vision therapy prepares a child to read. The child still has to learn the process. With vision issues addressed, often almost any curriculum will get the job done. After all, as weak as many public school reading curricula are, most kids still learn to read. The reason I bring these up is that you might consider the first one. If your son was struggling, he might still have a vision issue that you'd be better off addressing while he's young. Maybe he doesn't, especially if you see no obvious symptoms (although struggling with early reading is one such symptom), but at a minimum I would get him at least one regular eye exam by a developmental optometrist to see if something surfaces in the exam. In fact, I recommend that to any parent who has a child who is struggling to learn to read. First, have a developmental optometrist rule out vision issues before spending a lot of time and money on other avenues of investigation. Besides, reading instruction will usually go much easier once any vision issues have been addressed, especially if they're addressed before a child has become frustrated by a lack of progress. In case you find it useful, here's a checklist that I put together for parents to use when trying to decide if their child might have vision skills problems: Vision Assessment Checklist And I'm glad you found a program that works for you, by the way.

Elizabeth is giving you good advice, particularly the links to the COVD optometrists. Don't go to an ophthalmologist as they usually have a real distrust of vision therapy. The children's optometrist also won't necessarily be much better unless he or she assesses children for vision therapy. In fact, if the optometrist doesn't refer regularly, you're probably going to be advised that vision therapy is a waste of money, or some such explanation. Assuming you do locate a developmental optometrist here's a page on my website that you should find useful: Find a Vision Therapy Provider. By the way, if none of the COVD optometrists are located near enough to you, try calling a couple of them to see if they can refer you to someone closer who does vision therapy. Also, in South Africa they could be called orthoptists and their specialty could be referred to as orthoptics. (Checking a search engine, it appears that's the case. For example, the Pretoria Eye Institute lists a Kate Housley as an orthoptist who treats eye movement disorders, which is what you're looking for.) Rod Everson OnTrack Reading

Here's a page on my site that you might want to take a look at before you go to the optometrist: Find a Vision Therapy Provider. It will give you some idea what questions to ask and what you're looking for in terms of how they structure the therapy. As for the reading therapist, it would be really helpful if he or she recognizes the value of vision therapy. Otherwise, you might be advised that the problem is unlikely to have anything to do with her vision and might be dissuaded from pursuing that route. I agree with the others' opinions that you're on the right track. Get the vision skills checked out first and address any deficiencies. If you do find she has vision issues and you address them, you might then consider going after the phonics instruction one more time, since a child with poor vision skills often has trouble learning phonics because they can't easily link the sounds to the letters during the lessons. On the other hand, some kids begin to read much better during vision therapy because they actually did learn the phonics (usually due to using an OG-based sort of program of the sort often mentioned in here) and are finally able to apply what they've learned because they can see the print clearly without any sort of confusion. Breaking a well-established guessing habit can be difficult, however. You might also want to check out the multisyllable method I've used with all of the kids I've worked with. It's easy enough for them to apply that they generally dump their guessing habit in favor of decoding longer unfamiliar words. It's also free and you can download all the materials needed from the site. Start at Multisyllable Method Overview if you're interested. All the best, Rod Everson OnTrack Reading

If you continue in this vein, we're done talking, just so you know. No where have I asserted anything remotely resembling a "magic cure" and I don't understand your fascination with saying that I have done so. So, enough already?

First, I don't think I've told you nearly enough about my client base to enable you to make any accurate generalizations about them. ADHD is another one of those diagnoses that is very "fuzzy" because it's made on the basis of subjective observations of behavior. Developmental optometrists often show parents how much the symptoms of ADHD (which is essentially a list of symptoms without a known cause) overlap with the symptoms of vision skills problems (which are observable by objective testing.) So are my clients demonstrating ADHD symptoms, or symptoms of vision skills problems? Based on my experience, it's as likely to be the vision skills as it is to be some ill-defined issue that causes ADHD. Again though, I'm not saying that ADHD is all about vision problems. I'm talking about the huge overlap of symptoms that obviously exists between the two conditions. Second, if you saw the handwriting of a fair percentage of my clients, especially among those who never had vision therapy, you'd question your assumption that they don't demonstrate dysgraphia, i.e., poor handwriting and spelling. (It goes without saying that they also have trouble expressing themselves in writing.) But what's the cause? And why does handwriting so often improve following vision therapy? (Not always, but often.) As far as my not seeing those who've already been sent off to OG tutors, you seem to assume that my curriculum is inferior to an OG curriculum. In fact, it's based on a combination of Spalding and Phono-Graphix, which are both very much phoneme-based curricula. Because I do remediation, rather than initial instruction my approach is faster whereas Spalding is much more comprehensive in terms of teaching writing skills and spelling. However, I'm reasonably certain that the multisyllable approach I use is at least as effective as Spalding's when it comes to enabling a child to decode unfamiliar words. I mention Spalding because Ms. Spalding was quite dedicated to Orton-Gillingham's approach and based her method on much of that work. When it comes to your own child's situation and your description of what you face, and have faced, I agree with you. Dyslexia isn't a teaching problem, and it isn't likely to just go away with maturity although, as you say, with maturity your child's working memory could increase to the point where instruction becomes easier to internalize. Regarding your child's vision, if he's only six now it's possible that he was difficult to diagnose when you had him seen? (Now here I'm the one making assumptions, I'll admit, but I know the very young are harder to assess because of the nature of the testing.) Unless the testing was quite recent, maybe it would be worth having him reassessed again at some point, especially if you notice symptoms of visual stress when he's reading, or confusion that could be explained by poor depth perception. I suspect you're well aware of that though.

Yes, I have helped a lot of children, and also vision therapy is not an "easy fix." Many of the kids I've worked with have been anything but "relatively easy to teach." And, yes, my comments are well meaning. After all, many parents have children who struggle learning to read and, in my opinion, a large portion of them would see their concerns addressed with a combination of vision therapy and good phonics instruction. Not all of them obviously, but a large portion of them. That's been my experience, anyway. All I've been trying to say is that for the vast majority of struggling readers I've seen (I've worked with nearly 200 now, one on one) the phonemic issues have been relatively easy to fix. That doesn't mean that working with the child was easy; it often is a real struggle at first. In nearly all cases, however, they tested 100% after a time on the tests I cited earlier. I also realize there are degrees of "dyslexia," to the point where a lot of kids considered dyslexic by teachers probably aren't even dyslexic; they're just clueless about phonics because no one has taught it to them. On the other end of the spectrum are kids who really, really, struggle. As with the autism spectrum, the degree of reading struggles varies across a wide spectrum. Dyslexia is a fuzzy term. You're defining "true dyslexia" as someone who can't be helped by vision therapy and phonics instruction, at all apparently. Most people, however, refer to dyslexia as a problem learning to read without specifying any particular cause. I've found that the causes vary and often include vision issues and/or phonological issues, but I realize some children's issues go beyond that and I certainly don't claim to be able to teach every child to read. With the kids I work with, even after the vision issues are addressed, and the child tests 100% on the phonological issues I test, some still obviously have more going on that's getting in the way of both fluency and comprehension. I haven't claimed otherwise, and I hope you eventually find the best way to help your own child succeed in learning to read. Also, I apologize for my use of the word "trivial" in this thread. It was a poor choice of words to make the point I was trying to make which was that the vision issues have been more difficult to address than the phonological issues where both are present, yet so much attention is paid to the latter, and very little to the former. I've found this forum to be exceptional for recognizing the existence of vision issues. As I think I said earlier in this thread, Shaywitz, for example, doesn't even discuss them in the context of dyslexia which I feel is a significant, and unfortunate, omission in her book, especially when considering how often people are referred to it for answers.

I would highly recommend a visit to a developmental optometrist to rule out a vision problem. You say that it seems to be something with not being able to connect auditory and visual, and you could be exactly right. Maybe the visual input is confusing to her. I see you've posted a lot in here, so you've likely already had a similar recommendation, and maybe you've already gone down that route, but if not, you should consider it. She might be visually confused whenever she's doing close work like reading or math which would explain a lot of the behavior you're describing.

One more thing. I didn't mean to imply that what I do is done "easily". It is often quite a struggle at first to get a child's attention focused on what I ask them to do. I've often told a parent (who normally sits through every lesson) that I know I only had their child's attention for 40-50% of the session, but to expect better participation as time went on. That usually turns out to be the case. My sessions are normally 75 minute long though, so a lot is expected. Then the parent mostly repeats the same work at home as homework for review. In other words, by the time I'm getting the test results I do, the child has put in 20 to 30 hours of work and I suspect they wouldn't refer to it as an easy time. My results aren't necessarily gotten easily, but they are gotten consistently. And again, bear in mind that I work with Age 7 and up which might explain a lot.

I've no doubt that many of the kids I've worked with would be considered dyslexic, and some were officially diagnosed as such. As I said, I worked almost exclusively with struggling readers. However, I see that your son is only six. I usually would get kids in 2nd-5th grades, and that might explain some of it. I don't have any "magical exercise" although I think I've helped a lot of children just by informing the parents of the existence of vision therapy. To many of them, VT was pretty much a magical experience given the results that followed. I suspect that the reason I get the results I do is partly due to the age of the children I've worked with. They can all write their letters by that age (although not all that legibly in some cases) and my "exercises" depend upon them saying the sounds aloud as they write them while spelling out a word phonetically. Nearly every child I've worked with has already been taught a fair amount of basic code as well, so they at least understand that "t" stands for the /t/ sound, etc., although many will mix up b/d, etc., and they often don't have a good handle on the short vowel sounds when we start. Incidentally, when I started doing this about 15 years ago I was of the opinion that most struggling readers just had a poor understanding of phonics due to the form of instruction they'd received. While it turned out to be true that they did, indeed, have a poor grasp of phonics generally, I found that the reason was more likely to be that they had undiagnosed vision issues than that they had poor reading instruction. Not in all cases, but probably the majority of them. And I'm not saying that dyslexia is all visual in nature either. I think there's a lot of developmental issues going on, possibly even triggered by things we don't yet understand. One more thing, regarding age of the child. The Scandinavian countries recognize that some children just aren't developmentally ready to tackle reading until age 6 or so, and hold off formal reading instruction until around age 7. Again, that doesn't mean that they don't also have dyslexic children in their populations, but it might explain my results in that I don't see children until age 7 or so. That said, they all learn the three phonological skills I test for, which was why I said what I did about them being easy to teach. At that age, they would learn them. The fact that they can learn them, but often still struggle with reading (even after absorbing a lot of phonics information as well) is what made me question the main direction that reading researchers have taken the past couple of decades. Then learning about the existence of vision therapy and seeing a lot of results of it pretty much convinced me that the research was missing a key component of reading.

I'm curious if you're talking a speech issue, or being able to blend, segment, and manipulate phonemes. I was talking about those skills, not speech issues per se, which I don't consider a component of dyslexia. I have hardly ever worked with a child who couldn't be taught those phonological skills and I work mainly with kids who've struggled with reading, some of whom have been formally labelled dyslexic. Maybe we're talking about two different things. All I can say is that after a reasonable number of sessions I would get perfect scores on tests of blending, segmenting, and phoneme deletion. Here's the test battery I use, starting with a page describing my notation: Phonics Assessment Tests I bring this up not to cause any sort of ruckus, but because most reading research highlights the importance of these phonemic skills (actually it highlights their absence in struggling readers), while completely ignoring the visual skills. Yet I've found that when the vision skills issues are addressed, kids are usually relatively easy to teach. And even when the vision skills aren't addressed, the curriculum I use seems to achieve the goal of perfecting the three skills tested above. However, perfecting those three skills doesn't necessarily create a competent reader if the vision skills issues remain. That has led me to wonder whether the reading research isn't overemphasizing the auditory/phonological skills and dramatically underestimating the visual skills. I would also add that I'm not talking about children just learning to read at age 5 or 6. Most have had at least a year or two of formal reading instruction in school, and sometimes considerably more.

Yes, I haven't worked with a lot of kids with speech issues. I was referring mainly to the phonemic skills that are supposedly holding so many kids back. I just haven't had that much difficultly teaching them to blend, segment, and manipulate phonemes. Speech issues are another ballpark though.

From what you said in a later reply, his vision has been corrected. Still, it's very likely a vision issue, but with visual skills, rather than visual acuity. When both eyes aren't working together properly, depth perception can be poor, or in severe cases, even nonexistent. Try closing one eye and navigating for a bit, or try hitting a ball, or catching one, with one eye closed and you'll soon be ducking out of the way because you just won't be able to judge where things are for sure. As others have suggested, you should take your child to a developmental optometrist for an evaluation. Your regular OD is, unfortunately, not as likely to pick up on the problem. Here's a page on my site you'll find useful if you're considering doing that: Find a Vision Therapy Provider All the best, Rod Everson OnTrack Reading

Yes, the reason I asked was so that I could reply to your original question with that information in hand. What I would suggest is that you explain the vision appointment by telling him you're looking for answers as to why he's struggling with reading (and with his penmanship too, for that matter.) Just explain that it's really hard, even for adults, to tell if a person's eyes are working together well, and if they aren't it can cause some serious reading problems, and even other problems, like catching a ball, for example, and that you just want to rule out vision problems as a possible reason why he's finding reading and writing so difficult right now. If nothing of note is diagnosed, you'll have to tell him that, but I'm reasonably certain that they'll find some vision issues worth addressing. Then you have to decide whether or not to address them, of course. Assuming that you do end up going ahead with their recommendations, which could involve a long course of fairly expensive vision therapy often not covered by insurance, you can then tell him that you think you've finally uncovered one of the reasons he's been having so much trouble, but that both of you have some serious work to do before you'll know (if you have vision therapy in the future.) If all goes well, you'll start to see some improvement in his reading, and his penmanship as well. Of course, you'll at some point have to tell him that his hands have been fast enough all along; it was his vision that was messed up.( If you ask him, you'll probably find that he's spent some time trying to "speed up" his hands.) What I'm saying here is that you will hopefully be able to offer him an actual physical reason why he's been having trouble, and that the problem can be addressed, and will be addressed, and that he will notice the difference if he puts in the work (and you do also.) You should also warn him, and also many adults who are confused about vision therapy, that vision therapy doesn't actually teach reading. Instead, it prepares one to learn to read, or enables them to more efficiently implement what they've already learned. If you've taught him phonics already, the phonics information will still be there, but now he'll be more able to utilize it. If he resisted phonics instruction, as many vision-challenged children do, you will have to reteach much of it after vision therapy if he's to successfully catch up to his peers. Again, you should explain why you're doing that, i.e., because you've finally fixed his vision issues, and now he'll find it makes a lot more sense. Ditto for handwriting; it will go much easier. There's also the auditory/language side of things. (That's the side that Shaywitz concentrates on--her book's index doesn't even have an entry for "vision therapy" and I doubt it has one for "vision skills," but I don't have a copy handy to check.) In my reading practice, I've found the auditory side almost trivial to correct, especially blending and segmenting, but even phoneme manipulation can be cleared up in a matter of a few sessions with proper exercises. (I can refer you to those exercises later if you're interested.) As for all the brain scan info out there, ask yourself if your brain would have organized itself normally if your eyes weren't functioning properly. The brain is an adaptable organ; it will find workarounds and those workarounds will, in my opinion at least, inevitably show up on a brain scan somehow. We know that those who lose one sense often sharpen others to compensate. That "sharpening" is essentially the building of new synaptic connections in the brain to compensate for those not being used normally due to injury or a failure to develop properly. It seems reasonable to assume that those new connections will show up as unusual activity on a brain scan. I'm not saying that a dyslexia diagnosis is a misdiagnosis, but I am saying that if you fix the vision issues and then ensure that phonics and phonemic skills are in place, you might then find that you're no longer worried about dyslexia, or at least much less worried. Another thing, if things go as I've described above, it wouldn't hurt to inform his teachers as well, because they've already drawn some conclusions about your son's capabilities and, if they haven't already suggested getting a vision evaluation, some of those conclusions might very well be incorrect. Finally, if the above sounds reasonable to you, I'd suggest reading The Vision Piece of the Dyslexia Puzzle on my website. There's a lot more information there. All the best, Rod Everson OnTrack Reading

Can I ask, have you had his vision evaluated yet by a developmental optometrist? (I haven't been here for a while now and checked a few of your more recent posts, but didn't find an answer there.)

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.

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.

I use the method I describe here, one I borrowed from Spalding: Telling b from d It's easy to explain and I've found that nearly every child I've worked with who had b/d confusion would get over it quickly, to the point where after a few sessions I wouldn't notice it any longer. Also, it works both ways, reading and writing, provided you teach your child to print the letters b and d the way described there (b: line first, d: circle first). You also mentioned open and closed syllables and using other vowel sounds instead of short sounds. I teach the child to first try the First Vowel Sound, hence it's name, rather than calling it a short sound, and then try the Second Vowel Sound (the long sound), and then try the Third Vowel Sound, when decoding an unfamiliar word. The method renders open/closed syllable irrelevant and instills in its place a systematic way to decode any unfamiliar word. It also firmly establishes the vowel sound options in a child's mind because he's continually thinking /a/ae/o/ for "a", /e/ee/ for "e", /i/ie/ee/ for "i", etc. Here's the process and the exercise I use to teach the First Vowel Sounds (short sounds): What Are Vowel Sounds? And here's the description of the entire multisyllable method that I teach, one that I've found works exceptionally well. (All of the materials are included as well.): OnTrack Reading Multisyllable Method I wouldn't expect you to drop what you're using and switch to the multisyllable method I use, but you'll find the b/d page very useful I think, and you'll probably find the vowel sound discussion and exercise interesting as well. Rod Everson OnTrack Reading

Samiam, it would be helpful if you'd chime in here and confirm whether or not any homework was assigned, so we don't have to speculate. I agree with the others though, that if your son only had VT once a week, and only in the office, that you should consider a different therapy department if and when you get the resources to continue his therapy. I realize that in some cases parents have a hard time working with their own children and in those cases they'll often pay more to have all therapy done professionally, but when that is the case sessions usually occur several times a week. The problem with taking up home exercises without professional guidance is that you first have to know whether your son's convergence issue was that he was too "loose" or too "tight". In his diagnosis, "loose" would be described as exophoric, and "tight" would be described as "esophoric" I believe. (I'm not an OD, but am reasonably familiar with VT.) If you do the wrong set of exercises you could be tightening a visual system that's already too tight, and vice versa. I'd talk to the VT and see if you could get some guidance, and two or three exercises that you could do at home. If you can't get that basic information, I'd definitely consider going to a different OD if you take up therapy later. Your present therapist might be great at getting results, but there are more efficient (less expensive and faster) ways to go about it, usually with home exercises interspersed with therapy visits.

It's been rewarding to watch over the years as the WTM boards have logged more and more experiences with vision therapy. When I started advocating VT, over a decade ago now, very few people were familiar with it and skepticism was the order of the day. But many were open-minded about it and over time tried it even though it's usually quite expensive. Congratulations to those of you who've spent the time and money to get your kids the help they needed. I only wish it were more generally available in our schools, as speech therapy and occupational therapy usually are. And for those of you who have kids whose art skills have blossomed following VT, there's a page on my website that you might find interesting. Before VT became reasonably well known, it was realized that a lot of people with untreated vision issues would migrate toward the fields of architecture and engineering. In Growing an Architect, I speculate as to why that might happen. Perhaps spending a few years with a vision problem imparts some advantages to go along with all the obvious disadvantages?

Did you see a developmental optometrist, or were the lenses prescribed by a regular OD? If they were prescribed by a regular OD, that might be all he has in his "bag of tricks" for convergence issues and your son might still need VT. Hopefully it was a developmental optometrist. If so, here's how I view the glasses, which are essentially low power reading glasses (with some experience with this sort of thing): If the glasses do indeed fix the problem, you should see a rapid improvement in your son's response to close work, like reading and writing, because suddenly things start to make sense to him visually. In my experience, parents who are quite reasonably hoping to avoid the expense of vision therapy, don't hear the OD when he says, "Try these, and if they don't help, bring him back for more testing or vision therapy." Instead, they hear, "Here you go, this should fix the problem." A year or so later the child is back at the OD's office with no improvement if the glasses weren't, in effect, the answer after all. That's a year or two wasted in the child's learning to read. So, again, if the glasses are the answer, you should notice that in a short time, and you shouldn't have to take it easy on him either. That advice is for parents of kids who are undergoing VT, because until the VT is well underway, it hasn't begun to have enough influence on his visual system to make reading easier. The glasses should work immediately, so waiting makes no sense. What does make sense, is if he continues to avoid close work, is to conclude that the glasses aren't the answer (although they might well have been worth trying first, as the lowest-cost answer to the problem.) And again, if the OD wasn't a developmental optometrist, vision therapy might never be recommended by him. Here's a page on my website that tries to explain why that is: Vision Therapy: Why Such a Secret? Rod Everson OnTrack Reading

Cases like this are so frustrating. Unless the parents take matters into their own hands, it's extremely unlikely that your student will ever get the vision therapy he probably needs. I would caution you against doing VT on your own without a diagnosis and a prescribed plan because some visual systems are "tight" (the eyes naturally align too closely) and some are "loose" (the eyes naturally align to far apart), and both issues can cause reading problems. But if you do exercises that are intended to correct one situation, and he has the opposite, you could risk aggravating it. If you're going to try eye exercises I'd ask the developmental optometrist who worked with your own child for a list of exercises that could safely be done without a diagnosis. If you get such a list, I'd work from that, but the odds of success are pretty small, I suspect, given the limited time per week that you see him. However, although it can be challenging, a child with vision issues can learn phonics and if you do a good job at that, someday it could be the key to his reading successfully and even relatively easily. At some point his visual system could adjust to the point that he's only using one eye for near work like reading, and at that point the phonics you'd have taught him could be put to good use.

Jenibo, a few thoughts for you to consider: First, regarding the suggestion to patch your son's eye, that might actually enable him to handle reading because it would remove the confusion of getting two conflicting images when he has poor convergence, but vision therapy is far and away the preferred route because VT addresses the underlying problem. Also, don't do any patching while going through VT unless it's prescribed by the vision therapist, or you could be frustrating the therapy in some way. Second, I agree with those who recommend putting off reading instruction for a bit yet. Wait until he's far enough into vision therapy for his comfort level with near work to increase. Preferably, ask the vision therapist if he's at that point yet or if you should wait. Don't be too concerned with his getting too far behind; he'll have a much faster learning curve if his vision skills are improved by VT, and he really is young yet. He's not too young to learn to read, but he's not yet ready visually. In the meantime, read a lot to him so his comprehension and vocabulary continue to improve. Finally, with regard to all the other issues, I have what you might consider to be a somewhat off-the-wall recommendation, but I'd get his vitamin D3 level checked and then consider supplementing him for a while to see if you notice improvement in his other developmental issues. Rather than get into a long discussion as to the reasoning behind that recommendation, take a look at this exchange between the mother of an autistic child and Dr. John Cannell, one of the stronger proponents of vitamin D3, to see if you notice some of the same things, particularly the winter/summer changes she mentions. Here's the link: http://www.vitamindcouncil.org/newsletter/newsletter-another-autism-case-report/. (It's been a while since I've posted here, so I hope the link will work as intended.) In my opinion, having worked with many struggling readers, vision therapy can be the key to getting many of them started down a successful path. As others have also said, consider using a good phonics-based reading program once he's more comfortable visually. Rod Everson OnTrack Reading

Well, this is an old thread, but I feel like writing today... When I work with a young child who is poor at segmenting, or hasn't yet mastered simple blending, I use letter tiles almost exactly as described in the book Reading Reflex, by McGuinness. As soon as the child understands the concepts of segmenting and blending, I would move to my workbook, provided they already had a basic grasp of one-to-one letter/sound correspondences, like the letter "t" represents the /t/ sound, etc. Once in the workbook, I do use "tiles" but they are word tiles, not letter tiles, and the main reason I use them is so I can tailor a lesson to the individual child's present capabilities. In other words, I can use harder words, or skip some of the easier ones, with some children, but with others I progress through every easy word because they need the practice. In the workbook, the words are printed at the top of each page in the order that I found most sensible after using word tiles with a couple of hundred kids. Here are the main problems with today's phonics programs: 1. We have not even settled upon a consistent code to teach. Thus, some programs treat the "gh" in words like "night" as silent, whereas others teach the "igh" as a grapheme for the /ie/ sound. Treatment of the final "e" in words like "are," "come," "save" and "glove" are all over the lot. You won't find any consistency on how to handle them. 2. We have not decided upon a basic set of sounds to associate with each piece of code. For example, some phonics systems teach the schwa sound associated with each vowel letter; some don't. (I prefer not to do so, as it just adds an unnecessary layer of complication.) Some methods never do get around to explaining that the digraph "ar" has more than one sound associated with it (car /ar/, war /or/, dollar /er/, parish /air/) 3. We have not settled upon a consistent marking system for the code, a system that will easily be understood by a child. A marking system should clearly indicate digraphs, for example, and should also indicate whether the letter "a" stands for its short sound, long sound, or another sound (as in "father.") It should also be simple to apply, so any parent can easily figure it out, and should be consistent so that a line or number mean the same thing wherever they are used in a word. Numbers shouldn't indicate a rule here, but a sound there, for example. 4. We have not settled upon a set of consistent phonics "rules" to teach. Other than some spelling rules, the only rule that is consistently useful for decoding is the "rule of c." Beyond that, most of the decoding rules in various phonics systems are worse than useless; they actually mislead. The "when two vowels go walking..." rule is the worst of all. Spalding's five rules for the ending-e also complicate matters unnecessarily. 5. We have, unfortunately, tended to settle upon relatively poor ways to teach multisyllable decoding. The two dominant approaches are the syllable-type approach and the prefix/suffix approach. The syllable types are too confusing to a child, and to most parents, who apparently never had to learn them in order to become proficient readers. And the prefix/suffix approach is a band-aid in English, though quite useful in some other languages that are more root word dependent. Worst of all is the "look for a word within the word" approach, which is little more than a desperate attempt by a teacher to throw a lifeline to a struggling reader, a lifeline that rarely works. So, five problems, all requiring some thought to answer. Here's where I ended up in my advanced code workbook program: #1: My choice was to incorporate to the extent possible every sound in a word into respective letters and digraphs. Thus the "me" in "come" is an ending digraph for the /m/ sound in words like "come" and "some" and the "ve" is a digraph for the /v/ sound in "love," "glove," "have" and "give." #2: Assign as few sounds as possible, but all sounds necessary, to each letter or digraph so that a child can easily learn the options that need to be tried when encountering an unfamiliar word. Primarily, this meant ignoring the schwa sound and teaching a "perfect pronunciation," which also is of immense help later in spelling. #3: Use a marking system where digraphs are underlined, the second, third, and (rarely) fourth options for a letter or digraph are marked with a 2, 3, or 4, respectively, and where the double-underline is used to indicate an unneeded letter, or a letter or digraph that is representing a sound so rare that it should not be considered typical. For example, the ending "e" in "were" is double-underlined. #4: Teach only the "Rule of C." The rest are more or less useless for decoding purposes, but the Rule of c comes in handy when multisyllable words are encountered. #5: Teach a simple system of breaking down words, left to right, and testing the various pronunciation options for the letters and digraphs in a systematic manner. The multisyllable decoding method described here worked spectacularly well with nearly every child I've worked with, and it's free besides. English spelling is a bit of a mess. As a result, it's been difficult for curriculum designers to agree upon a consistent way to teach English phonics. That is unlikely to change in the near future, if ever. I've spent a few years thinking about all this, while working it out in practice with a significant number of struggling readers, and I'm quite pleased with the end result. Rod Everson OnTrack Reading

Yes, that's the intent of vision therapy, i.e., to train, or in his case retrain, the visual skills, particularly his convergence ability. Something knocked his visual system out of whack, and while it would be nice to learn what that something actually was, it's important to try to get his visual system functioning properly again. People often refer to vision therapy as "physical therapy for the eyes" and in your son's case the analogy is even closer, since physical therapy is often used to address a skills deficit resulting from a previous trauma. Another area you might consider investigating, because it couldn't hurt and there's a small possibility that it would help, is diet, especially since your son apparently changed his diet significantly. I'm thinking of two particular aspects of diet, the Omega-3 essential fatty acids found in fish oil, and vitamin D3 (really a sunshine issue more than a dietary issue, but dietary supplements are available.) If you think there's a chance that his change in diet and lifestyle could have dropped his Omega-3's significantly, or especially his vitamin D3 level, you might want to explore that further. Frankly, I doubt that will yield much progress toward solving his vision problem, but there's a chance it could and maintenance of appropriate levels of both D3 and Omega-3 EFA's is good for overall health anyway. Obviously there are other dietary possibilities as well, such as lactose or gluten intolerance, but I haven't looked at them very closely at all, and have no reason to relate them to vision issues, although both tend to suddenly appear in many individuals. Following up on Dr. John Cannell's theory that the recent autism epidemic might be due to a vitamin D3 deficiency, I've speculated on my website about the possibility that a general deficiency of vitamin D3 (due to widespread medical advice to avoid direct sunshine) might be responsible for the increase in other developmental issues in kids over the past couple of decades, but I doubt that a drop in D3 levels would cause an onset of vision issues such as your son experienced. On the other hand, if his lifestyle changes resulted in his getting a lot less sunshine, I wouldn't rule it out either. As for the fish oil, there are some good studies out there that indicate that increasing dietary Omega-3's has an impact on reading ability, but again these seem to apply more to kids who were struggling all along, and not to any sort of sudden onset of symptoms. I personally take both a daily fish oil supplement and a daily vitamin D3 supplement. Those are the only supplements I take beyond my normal diet, and I take both just for general health considerations, and not to address any particular existing health issue. I guess I'm rambling now. Stick with the vision therapy and see if he starts to get some results in time, and do have the discussion with the OD about his/her experience with a sudden onset of convergence insufficiency, as I suggested earlier. Rod