Once you choose a neuropsych, it can be worth the effort to find any information about them. Also if possible to talk to anyone who has used them. As they do vary quite a bit in the quality of their work.

An important thing convergence insufficiency effects, is 'depth perception'. Where it is the convergence of both eyes at a point, that give us a sense of how far way something is. So that correcting convergence can then enable depth perception.

You wrote that she has other areas where she excels, and her twin struggles. Where this could be used as a key? Rather than trying to stop her comparing herself with her twin? Given that each twin has different areas of strengths, this could be highlighted. So that she gains a recognition and acceptance that they each have different strengths. Where they can compare themselves with each other, but not try to match each other in each area. As she understands that they each have their own strengths, and are equally 'smart' in their own ways.

You wrote: 'She's behind in her own head because she has a twin doing the same work-' While children compare themselves to other children and their siblings. This comparing takes on a different level with twins, and even more so with identical twins. Where 'performance' has a direct equivalent to benchmark one self against. So that if one twin has a 'difficulty', then it is highlighted to a greater extent. When you said that she becomes stressed because she's behind and upset because she doesn't want to be behind. Is this behind her twin? So that what might be most helpful, is if she could learn to stop comparing herself to her twin?

It can be helpful to keep a daily diary for a while? Of particular interest you wrote: 'It's like she has no self control, or most the time doesn't.' Which means that some of the time she does have self control. So that it could helpful if you could identify something different about the times when she does have self control?

Does he read much in his own time? As reading is what really builds a visual memory of words.

Amy, perhaps you might like to try one of the tests that Rowe Young has defined? It simply involves having your son place his forearms and hands on the table in front of him. With his palms facing down. Have him to close his eyes, and then ask him which way he feels that each hand is facing? Where it would be interesting to know whether he feels that each hand is facing down? As he may feel that one or both are facing up?

Perhaps you could help him to understand algebraic thinking? Algebraic thinking is a thinking process that extends beyond math. While logical deductive thinking involves thinking through something to arrive at an answer. Algebraic thinking starts with the answer, and then we need to think back and work out how we arrived at the answer? Where the critical factor, is the introduction of the concept of 'variables'? In a logical deductive process, their is no potential for variables. 6+3-2=7. But with algebraic thinking, we explore how we can arrive at the answer of 7, as the outcome. Which gives meaning to the variables. But algebraic thinking is a thinking process that extends beyond numbers? Where we can take any any outcome, and then identify the variables that were used to arrive at the outcome. From a position of understanding the variables, we can then explore changes, that will still arrive at the same outcome? Which is the foundation of innovation.

XR are 'slow release' tablets. The way that this slow release happens, is that the tablet has a coating with tiny holes in it. Where these holes considerably slow down how the tablet dissolves. Which means that it will take a while until enough has been dissolved, to have an effect. So that it's more of a case of identifying when you want it to 'kick in', and taking it long enough before. It can be helpful to observe how long it takes to kick in? Which rather turns around question of whether to take it upon waking or an hour after? To rather a question of what time you want it to kick in? Then knowing how long it takes to kick in, this can be used to define when it needs to be taken by.

It rather presents an opportunity for you to learn ASL along with Jr. Where you'll both become fluent in ASL together, as you both later learn to do basic math in ASL, where you can then 'share mathematical ideas'. You could also gradually develop the ability to think in ASL.

Amy, you wrote: "My son writes all his letters and numbers right to left, bottom to top." Where I think that you are referring to his letter formation? In which case, I wonder he has what is called 'Reverse Position Sensation' RPS ? With RPS, when writing, movement of the hand is sensed in reverse. So that a 'clock-wise' movement to form a letter, is actually sensed as moving 'anti-clockwise'. It is difficult to imagine what this like, where you see your hand moving in a clockwise direction, but it feels like it is moving anti-clockwise? But I wonder if your son's writing letters/ numbers right to left, bottom to top. Is a way to cope with this contradiction? Though I've been in discussion with Rowe Young who has been researching this with a team. Where she has published the research and also made freely available, a guide to diagnosing RPS and remediating it. So if you would have a look at this, I can provide you with links to download it.

Momsuz, you wrote your DD9 has 'no Nystagmus Reflex at all'. Though I would be interested to know what tests were used to diagnose this? This Reflex involves 3 basic regions. Firstly we have the Vestibular canal system, that operates as the sensor. On the other end, we have the Brain Stem, that controls the physical movement of the eyes. In between them, we have a part of the brain that communicates between them. (called the Superior Colliculus) So that it is important to identify where the problem actually is? The test of the Brain stem, uses what is called the Caloric Test. This test involves 'irrigating the ear'? Where a syringe is used to insert water into ear. Which will cause a Reflex eye movement. This test is done with the head at various angles, and on each ear separately. It also done with both cool water, and body temperature water, which elicits opposite eye movements. So this Caloric test will identify whether or not their is an issue with the Brain Stem? It is also a test that it used for people in a coma. Then if we come to the Vestibular System? While this uses semi-circle canals partially filled with fluid, in each ear. It actually has 4 different canals, for horizontal, vertical, front and back. So that each of these need to be tested, as one or more can effected, in either or both ears? But then we come to the thing in between the Vestibular System and the Brain Stem? The Superior Colliculus. Where we have the Superior for Vision and Inferior for Sound. When you hear a sudden sound and turn your head towards the sound as reflex? It is your Colliculus that locates the sound, and directs the turning of the head. The Colliculus is also what the brain uses to represent both internal and external space in the mind. It is also the fundamental control centre for vision.

The eyes have a direct connection to the Vestibular system, which the eyes use as their primary guidance system. Which is termed as the: vestibulo-ocular reflex (VOR). The Vestibular system is simply a curved tube in each ear, with some fluid in it. It works on same principle, that if you tilt a glass from side to side, the fluid in the glass will always remain facing straight up. So that eyes use this fluid, to keep track of where precisely above and below are. So that it can ignore the angle of the head and what are seeing, and just use the vestibular system as a reliable terms of reference. Which is virtually an instant process and is continually updated. But when this isn't functioning properly, the eyes are continually looking around, for where to go to next? So perhaps you can appreciate the fatigue that this would cause with reading, as she looks around for the next word?

In regard to this, I would mention the traditional approach to learning math in Japan? Where children learn to represent quantities and do math on a Japanese Abacus, called a Soroban. But a crucial element, is that they avoid teaching children the name and symbols for numbers, until around 9 years of age. Though 9 years old Japanese children, generally have the math abilities of 12 year old Western children. But the way that 'mental math' is done in Japan is very different, where they don't think of numbers as words and symbols as they do the calculation? Rather, they think of numbers as patterns, which having learned to represent on an abacus. They 'feel' with their hands. So that they 'feel numbers', and feel a calculation. In the same way that people who are born Deaf and learn sign language. Feel letters and words. Then when they are thinking, instead of hearing a word in their mind? They feel the words in their mind, without having to move their hands. So that mental math in Japan is done without using number words and symbols. These are only used to record and communicate an answer. The difference in their approach, is highlighted by their common activity, of racing to do mental math quicker than a calculator.

Hi HejKatt, Quantity is concieved of with Spacial working memory. Spacial w/m can link 2,3 or 4 items together, and instantly recognize the size of each group. This is then associated with a number for each group. But a Spacial w/m disorder, can effect the ability to form and recognize these different sized groups? So that without this, quantities are only concieved of, as 1 or more. 2 is not concieved of as a group, but as the name of the thing next to the thing named 1. This is termed as Dyscalculia. A further indication of this, is a difficulty with 'ordering things in the mind' and following a series of directions.

You wrote: 'my DD has had other delays, predominantly with gross skills.' Dyscalculia isn't just a difficulty with learning math, but a disorder that effects the ability to 'concieve' of numbers. But numbers are just words and symbols that we use to represent different sized quantities. So that a child first concieves of different sized quantities, and then learns to represent them with numbers. Where we concieve of different sized quantities with Spacial thinking. But with Dyscalculia, it is actually an underlying disorder with Spacial thinking, which effects the ability to concieve of different quantities. So that they have nothing to associate numbers with? Which comes back to your DD's delay with gross skills, where she no doubt has some Spacial difficulties? Of particular interest, is her bi-lateral (left-right) coordination? As this left-right coordination is fundamental to concieving of numbers. Where it uses these opposing sides to spacially locate a beginning and an end point.

A basic exercise for palmar reflex, simply involves touching the thumb with the finger-tip. Going from finger to finger. Then 'flicking out the hand', to loosen it. The palmar reflex, is a reflex that is triggered by contact to the palm of the hand. Where if you touch the palm of a babies hand, it will trigger this automatic reflex and cause the baby to form a fist. A baby has no control over this, and also has control over release of the grip. The first stage of developing control of the fingers, is to develop the ability to inhibit this reflex. So that one can gain control over the contraction and extension of the forearm muscles that control the fingers. Crawling plays a role in the final resolution of this, with the hands being placed flat on the ground, as they.crawl. Which further de-sensitizes the palms of the hands. With the 'squeezing the ball' exercise? The crucial factor, is that the ball is being pressed against the palm of the hand. Triggering the reflex. So that exercise actually involves lifting the fingers, one by one. Which gradually develops the ability to inhibit the palmar reflex. But it is notable, that the palmar reflex is mapped in the brain, with oro-facial muscles involved with speech. So that a retained palmar reflex is very often associated with some speech apraxia.

You can scan worksheets and turn them into a writable file. Which uses OCR 'optical character recognition' software. You might check the CD that came with your scanner, as it might have an OCR program on it? My cheap Canon scanner came with the OmniPage Pro program. With that it can save the file in various formats, but the main one is Word. So that you can then open it as a normal Word document. It can also save it as an Excel file. Also with math worksheets. Microsoft has a free Add-in for Word. So that you can scan a math worksheet, and open it word. Where it will recognize that it is a math sheet, and not a text document. As well, it provides extra symbols, for equations and formulas.

Though a problem with Vision Therapy, is that it is unregulated? So that an optometrist who is only trained to prescribe glasses. Can do a weekend workshop on VT and then claim to be a Vision Therapist. But they don't even need to do a weekend workshop, as their no regulation, Where COVD represents an attempt to address this lack of regulation. But the sad consequence of this lack of regulation, is that these false vision therapists have most unfortunately given Vision Therapy a bad name? Though Lecka, with son's 'eyes jumping when they cross the midline'? What would be interesting to know, is if when you 'patch/cover' one eye, if he has a fluid left-right movement ? Which is fluid when either eye is patched? What I am wondering, is if he has a difficult with merging the images from both eyes? Where each eye has a different field of vision. Where vision from each eye, is processed with their own side of the brain's visual cortex. Then another part in the center of the brain, merges these overlapping images, to form a single left to right image. But you might consider the situation, if their is difficulty with merging these images? How the brain would cope with this? One approach that the brain often takes, is to ignore vision from one eye. Which is typical of Convergence difficulties. But another way that the brain could resolve this? Is for the brain to develop a practice of 'switching'? Where the left eye looks across to see the right eyes field of vision? Then the right eye looks across to the left? So that a full left to right field of vision, is formed with each eye. Which would go some way to overcome a difficulty with merging both sides? So that as an alternative to merging the images? It rather tries to form matching images on both sides? Which would appear as the 'eyes jumping', as each looks across, to see what the other eye is seeing?

School evaluations vary in quality. But an important factor, is that after the school evaluation. You are then legally entitled to then immediately request an IEE (Independent Educational Evaluation). Where you can choose a neuropsych, which the school has to pay all costs for. Also importantly, you don't need to prove the need for an independent evaluation. You only need to request it, and they have to comply. Where it is of benefit to have a second opinion. Though a further benefit, is that with the initial school evaluation being a full/ broad evaluation. It will identify some basic areas of difficulty. So that you can take this with you to second neuropsych. Where they can use this to do more targeted tests, to get a deeper understanding of the area of difficulty. But another thing, is that when a school pays for an independent evaluation, they have to recognize it. As they often argue that when a parent pays for an evaluation, that the parent has paid the neuropsych to tell them what they want to hear. So that it's best to let them pay for it.

The real answer is with the coach/instructor and whether they are open to understanding and working with a child's difficulties? Yet this most often relies on an open discussion with the parent, to get a real understanding. So that realistic expectations can be set, which can make it an affirmative experience for a child.

Dysgraphia and hand writing difficulties in our current age, is of great concern to me. Where it needlessly limits students ability, to demonstrate their cognitive abilities. I recently read a small survey of adults functional use of handwriting? When adults were asked how often they hand write a paragraph, or more? Also how long since they last hand wrote a paragraph? Most often the response was many years ago. Then in regard to hand writing a sentence? The main use appears to be for writing Birthday, Christmas and Post Cards. The primary use of hand writing, is for writing down names, addresses and phone numbers. Along with shopping lists. Yet this use is rapidly disappearing, where they are keyed into a cell phone, rather than on bits of paper. The other use is with paper 'Forms'. But these are being replaced with digital forms. So that the future use of hand writing, seems to be for Birthday and Christmas cards? But the crucial issue, is that students with Dysgraphia and hand writing difficulties, are needlessly limited in their ability to demonstrate their cognitive abilities. Being forced to demonstrate their cognitive abilities, in a medium that has become redundant in the 'adult world'? Though I appreciate that our education systems are still trying to cope with the introduction of type writers?

Nita, the TVPS-3 isn't a test of vision, but rather a test of how the brain processes visual and spatial information. Though this highlights the 2 sides of correcting vision. Where the brain develops a way to process vision, to suit what it is recieving from the eyes. So that when vision difficulties are corrected, the brain needs to develop a new way to process vision, to suit what how the eyes now see. So that in regard to questions to ask at the VT appointment? You could ask how his current vision issues would effect each of these sub-tests? Which you could then use as a guide to work on, as he undertakes VT. So that as his vision improves, his brain learns how to process this new way of seeing.

Sunken eyes are sometimes referred to as depressed eyes. Dark rings under the eyes are an indicator of this. Also the skin of the eye lids isn't stretched tight across the eye balls, so that it can sag to some degree.

You wrote that he is very, very mathy and thinks in math problems constantly. But no doubt the math that he does, is a 'question to answer' process? Where you could introduce him to math as an 'answer to question' process? With a basic introduction to algebraic thinking. The difference between 'question to answer' and 'answer to question'? Is that with 'question to answer' it is precisely defined, with no uncertainty. But with 'answer to question', the question can often be defined in a variety of ways, and still arrive at the same answer. Where the variety of are variables. Though a crucial factor with 'answer to question', is that we need to think back from the answer, to work it out? Using what is termed as 'reversability thinking'. So that we can use a combination of 'back and forward thinking', or sequential thinking. Where sequential thinking enables us to recognise a process as whole, We can then go to any point in the sequence, and know what comes next or before. Which comes back to his difficulty with 'simple directions'. Where he quite likely has no sense of the directions as a sequence? Rather he probably has to rote memorise them, and recall them as a script? So perhaps you could explore some 'answer to question' activities with him? So that with the 'huge challenge of getting him out the door, and forgetting things he needs?' The door could be defined as the answer , and what he needs to have when arrives at it? So that he then thinks back from the door, and works out a sequence of activities, to gather what he needs.