Still struggling after vision therapy?

[happy-hs]

My 8yo daughter was diagnosed with severe visual delays about a year and a half ago. She did four months of vision therapy and made an amazing amount of progress. She graduated from therapy a little over a year ago.

 

She is doing well in school work, but is still behind in reading. She has such a strong desire to read and she works hard, but it is still a struggle. (She's a second grader, reading at probably a 1-2 grade level. She still stumbles a great deal over her words when she reads aloud. The biggest issue, IMO, is that she gets fatigued after only minimal reading. It makes chapter books a real challenge.)

 

I'm hoping to find out how "normal" this is after VT, what I can expect in the future, and if there's anything else I can do to help her.

 

Thanks!

 

Melissa :)

[RamonaQ]

In our case, normal. Ds was dyslexic before and after vision therapy. I would look into dyslexia -some excellent books are by Sally Shaywitz and the Eides. Next, I would look into Orton-Gillingham based reading instruction-- Barton, Wilson, etc. You can either teach these yourself or find a tutor.

[PeterPan]

Melissa, two things. First, has she had a follow-up annual visit to the developmental optometrist? She may need a bit more work, especially considering where she started. Sometimes when they have growth spurts things get hairy, they need a new scrip, convergence needs a touch-up, whatever. 2nd thing, sounds like it's time for a full neuropsych eval. They can give the CTOPP and everything else and figure out if it's dyslexia or what's going on.

[Lecka]

My son is a little the opposite, I did major dyslexia-style remediation with him and he still has a problem with fatigue that appears to be partly visual (I took him for eval at OT and dev opt and they both could work on it, and I picked OT bc he has other OT issues that are related).

 

So at this point I think there is a big overlap without thinking that there is no such thing as issues related to vision.

 

But if she has problems with sounding out words then it is very possible VT is not the sole solution, even if she did have visual issues that were real and are remediated now.

 

I agree it is time to read Overcoming Dyslexia and see if that fits. (And if not, possibly keep looking.).

 

I also think -- it is possible she needs practice on some other skill. I have found reading rockets .org really helpful in learning about stages of reading. Overcoming Dyslexia is good for that, too. If you can see where she is stuck that is good.

 

I have also talked to people in other circumstances, who have an inflated idea of what reading levels are. Then they have their kids reading books too hard for them, or that is what their kids pick. Really they need to work on fluency at a little lower level than what the parent thinks they "should" be reading.

 

But if she has trouble sounding out words that does sound like dyslexia and she might do really well with a reading program for that (for example Barton). That can help with sounding out words.

 

I have not liked my recent experience of thinking "okay done" bc I didn't know about other issues. But at least you have addressed the vision already (or gotten a start).

 

For warning Overcoming Dyslexia is negative about vision therapy, but I think that is a bias, but it is still a good book. Otoh in The Mislabelled Child they say that 80% of kids with dyslexia also have some kind of visual issue.

[DyslexicParent]

Vision therapy is usually complete bunk and has absolutely nothing at all to do with reading. Seek a full complete eval with the school, which is free.

 

That's I what I read too (except for convergence insufficiency), but it seems to be the most successful therapy for a lot of members here. I haven't noticed any improvement yet from DD's VT, but I'm hoping that I will join the VT fan club.

[KathyBC]

This was our experience as well. Before therapy ds could not track a light in a circle. At. All. Sweeping his eyes along one line of text to the next was overwhelming. After VT, his reading improved and he was able to break some previous barriers (like silent-e words), but he still experienced eye fatigue and had a ways to go before chapter books. IMO, he has classic visual dyslexia and that is something we address, and that will always be part of how he processes the world.

[KathyBC]

 

 

There is a lovely psychology study that confirms that when you pay a lot of money for something you believe its worth it.

 

VT is a scam. See quackwatch.

 

Except that I paid almost nothing for ours. Sorry you or those you know had a bad experience.

[laundrycrisis]

Did the doctor stop after only treating visual-motor issues, ie tracking, accommodation, saccadic control, convergence ? Or did the therapy also include evaluation for visual processing/visual perception issues ? If those were not evaluated and treated, the doctor only did HALF THE JOB. If that is the case, you will need to find a more qualified VT doc to finish what was started. Our son was completely unable to process visual input in a way that allowed him to learn to read until he completed the VT for *visual processing*. IMO 4 months is probably not long enough for this phase of VT to have been done. Here is a website that may help you figure this out:

 

http://www.childrens...com/reading.htm

 

Scroll or search down to the "vision perception" section.

 

Again, VT IS NOT COMPLETE if this part of it has not been evaluated and treated !!!!

 

I feel very strongly that doctors who do only half the job of VT are doing the profession and their patients a HUGE disservice, because the family has the impression that "VT didn't work". Right, it didn't get all of the results it could have because it wasn't finished !!!!!!! If you took a car with two separate problems to a mechanic....and the mechanic said he checked the car out thoroughly, and has now made the necessary repairs, but actually only identified and fixed one of the problems - you would still not be happy with how your car ran, and if you believed that the mechanic really did check everything out, you might have the impression that nothing else could be done. But you would be wrong. You would need to find a better mechanic with the expertise to find the second problem.

 

I am of the opinion that doctors who do not know how to evaluate and treat the problems of visual processing and perception should etiher not be offering VT at all, or if they do, they should be disclosing that they cannot venture into this area, and be prepared to refer patients on to a doctor with more expertise if a patient is still having trouble after finishing the VT for eye teaming, tracking, convergence and accommodation.

[happy-hs]

Thanks for all the great responses! I appreciate it and it gives me a lot to consider and research.

 

I have to chime in on the "VT is bunk" idea. I believe that VT works. My very bright, eager-to-learn child struggled tremendously. She had every symptom of a developmental vision delay. She went from being unable to consistently read CVC words or write legibly, to reading full paragraphs and writing easily. She made tons of progress in a very short amount of time.

 

I do believe that paying money for a product or service might provide a placebo effect, but I don't see how that's possible in this case. My daughter had no idea what her therapy was for and I had no control over her "performance" (for lack of a better word). It's not the same as paying a large amount of money for an energy supplement and then feeling more energetic. The results that I saw were immediate, miraculous as far I was concerned, and certainly not imagined. I DO think that VT is incredibly overpriced, especially considering that insurance didn't cover much of it. But I don't regret our VT experience at all! (I'm not arguing, just sharing our experience.)

 

I'm just not sure where to go next. I think her biggest struggle is fatigue while reading. She just doesn't have the stamina to read for extended periods of time. She has good comprehension of the small amount that she does read. She is spelling relatively well thanks to SWR, and her handwriting seems normal for her age. She loves copywork. Math comes easily to her. She is so eager to learn, and even more eager to really read. I desperately want to unlock that door for her!

 

Thank you again for the responses.

 

Melissa :)

 

She wants to read. She curls up with a novel and tries. She reads a page and then can't continue. We read together, and she loves that, but she really wants to read more on her own. She is beyond easy readers, but can't seem to graduate to chapter books.

[PeterPan]

Melissa, if you work on things that build automaticity (putting words she already knows onto flashcards, etc.), will it ease the processing and result in less fatigue. I taught my dd with flashcards. Might be another angle to look down, the automaticity thing. And of course reread books by the Eides for ideas. :)

[laundrycrisis]

Melissa, if you work on things that build automaticity (putting words she already knows onto flashcards, etc.), will it ease the processing and result in less fatigue. I taught my dd with flashcards. Might be another angle to look down, the automaticity thing. And of course reread books by the Eides for ideas. :)

 

 

Adding on to the automaticity thing - part of our son's problem was that he had almost no visual memory - close to zero. The visual processing/perception evaluation tests for this. Most people have some capacity to remember images. His had not developed normally. The work he did in the 2nd phase of VT built this up from almost nothing - it taught him how to use his brain that way and created neural connections that were not there before. That is what good therapy does.

 

Before completing this, he was a 100% fit for "dyseidetic dyslexia". We do not learn to read by sounding out words forever - after a few times of seeing a word, and learning it by either decoding or being told what it is, we remember it visually. That is the process of building visual fluency. Well, he didn't have this ability. He could sound out decodeable words until the cows came home, but could not visually recognize a simple word like "cat", no matter how many times he decoded it, no matter how recently he decoded it - after a YEAR of sounding out "cat", he still had to sound it out !!!! This is what a total lack of visual memory for symbols looks like. It was truly a disability. The process of learning how to make his brain do this, through VT, has literally changed his life. The specific areas that were a problem for him were form constancy and visual sequential memory/visual memory. Visual closure was also a problem. Just addressing *those three areas* in the second phase of VT changed him from a kid who had to sound out cat, dog, ran, in, on, etc, and made reading a hopeless task, to a kid who was reading chapter books a year later. He didn't just grow into it. It was a heck of a lot of work, with inch by inch progess. But it was so totally worth it.

[Nakia]

For my almost 10 year old, VT is a piece of the puzzle. She's had A LOT of testing, and there's more to come. I'd suggest getting a work-up through your public school system, if that's available and is thorough without too many hoops to jump through. We had a WONDERFUL experience with that. On April 1, we're taking Emma to a developmental/behavioral ped.

 

The neuro-pysch testing hasn't been necessary for us, so far, but it might be in the future. That is something you should look in to as well.

 

I think VT is legit, fwiw. I've seen an improvement with Emma. It's totally inconvenient because it's an hour one way to get there, but our insurance is paying the majority of it. :D We'll keep going. It works.

[laundrycrisis]

BTW our insurance paid for part of our son's therapy for convergence problems, and the testing for those, because that has been accepted as "vetted" by now. This is a "major" medical insurance carrier.

 

Even Mayo Clinic is now on board with VT for convergence problems.

 

http://www.mayoclini...ments-and-drugs

 

This is only the first part of VT to be accepted by the medical community, and it took years to get this through. (With ophthalmologists fighting it all the way. ) I expect more parts of VT to follow with acceptance of their effectiveness.

[KathyBC]

It has nothing to do with experience and everything to do with science.

 

NONE of the major ophthalmologists agree with VT. It is not evidence based.

 

Here's a blog which gives links I am too lazy to provide. VT is a waste of precious time for kids who need real interventions.

 

http://lizditz.typep...ter_is_clu.html

Science is never stagnant. Evidence takes time and study.

 

 

Frankly I dont need to. I am interested in science, not marvelous miraculous pseudo cures. And I just hope to God my posting on this topic saves some poor schmuck thousands of dollars. Because its the perpetual flavor of the month over here.

 

As other posters have mentioned, it has not been a miraculous cure, just a piece of the puzzle. If it had cost thousands of dollars, my son would not have received VT.

[laundrycrisis]

It cost us a lot of money only because when we started it, there was no coverage for it. That is progress that happened 2/3 of the way through a long process, and unfortunately we were beyond the appeal window for the first parts of his therapy when coverage became available. But most of our costs from the time coverage became available were covered. So if we were starting the whole process today, instead of three years ago, it would have cost us a lot less money.

[DyslexicParent]

There is a lovely psychology study that confirms that when you pay a lot of money for something you believe its worth it.

VT is a scam.

Do you have a link to that psychology study? Since four prescribed drugs haven't worked, I'm trying to figure out which "FCU" (fringe/controversial/unproven) therapies are worth trying before giving up.

[herekittykitty]

I am just curious, for those that say it is a scam, how do you explain improvements in children after receiving VT? There are plenty of reports here and on other boards. It sounds like you are saying it is all in parents' heads, and that they are imagining improvements because they paid a lot of money and need to see those in order to feel okay about spending money on VT? I think a better post might be to offer caution to those who want to try it, for whatever reasons you wish to site, but not to discount the reports of those who have found it beneficial. In my experience there is very little that works for ALL of our kids. There are many things I read about that I am not doing for my child for various reasons, but I'm truly happy to read when those things have helped other kids.

[Lecka]

I have been skeptical in the past bc of books that do discount vision therapy, and also hearing of children whose parents don't want to do a reading program and just do vision therapy, and hearing they don't progress. A friend of mine knew someone who did this, and she told me the child never improved in reading.

 

But now I have had 2 separate people with no relationship tell me they see my son's eyes jump when he crosses the midline, and separately had the school psychologist and OT suggest I take him to be evaluated by a developmental optometrist. Still we are not doing vision therapy but I have a good impression of the optometrist we saw.

 

He did screen my son for phonemic awareness also.

 

I have an impression that his eyes are a symptom not a cause, and hope the root cause can be addressed with OT.

 

 

[laundrycrisis]

I have been skeptical in the past bc of books that do discount vision therapy, and also hearing of children whose parents don't want to do a reading program and just do vision therapy, and hearing they don't progress. A friend of mine knew someone who did this, and she told me the child never improved in reading.

 

But now I have had 2 separate people with no relationship tell me they see my son's eyes jump when he crosses the midline, and separately had the school psychologist and OT suggest I take him to be evaluated by a developmental optometrist. Still we are not doing vision therapy but I have a good impression of the optometrist we saw.

 

He did screen my son for phonemic awareness also.

 

I have an impression that his eyes are a symptom not a cause, and hope the root cause can be addressed with OT.

 

Our son was working with a reading tutor (OG trained, although he didn't need the OG approach as he never had any problem with phonics) for a full year of the time he was in VT. It was a good combination. I could take session notes from VT to her and she could tailor her lessons accordingly, and she would observe reading issues beyond what I observed at home, and I could take those observations to the vision therapy session.

 

VT is OT for the visual system. Our kids are both also in OT - two of our son's vision therapists were very much of the opinion that once his visual issues were addressed, he should have an OT eval, so now we are doing that - and the OT practice regularly refers patients to the VT practice we used. He did do some midline work in VT, but those therapists saw a definite issue in that area beyond what could be addressed by VT. So they may both be worth looking into.

 

I am on board with the "peeling the onion" approach, and I think that for many kids, they will end up benefitting from having several different areas of challenge addressed. Complete VT was the main key for our son - without that piece, the other therapies/tutoring would not have helped much - but having those other therapies/tutoring was also important.

[LaughingCat]

I am just curious, for those that say it is a scam, how do you explain improvements in children after receiving VT? There are plenty of reports here and on other boards. It sounds like you are saying it is all in parents' heads, and that they are imagining improvements because they paid a lot of money and need to see those in order to feel okay about spending money on VT?

 

I am not in the group you are questioning but I would assume they mean it is a placebo affect - which means there is actual improvement, but it is just due to your belief that there should be results rather than due to what you are doing. Placebo affect has some pretty darn impressive results so it would not be "all in parents head" at all.

[geodob]

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?

[PeterPan]

Geodob, you've correctly explained why we always mention getting the full dev. optom. eval when people mention tracking issues, because tracking is not *merely* whether the eyes move across the page. As you say, when the eyes are not converging properly, the brain will switch back and forth between eyes to eliminate the double images the insufficient convergence causes. And when the eyes switch, they lose their spot on the page, which results in what LOOKS like a tracking problem but is ACTUALLY at root a convergence problem. VT is well-documented to help convergence insufficiency.

 

As far as what COVD does to regulate them, I really don't know. I've wondered and never pursued it further. Obviously there are levels of training, as they distinguish Fellows from regular members. Also there is a certification program for therapists. However I agree that there's a BROAD range of experience out there and that people should be extremely careful and get feedback. But you know, I feel that way about ALL docs, having been burnt (metaphorically) by some. In every field there are all kinds of levels of experience, a range of quality, and people who might be nice people but who maybe needed a bit more training or experience to be helpful with our particular problem. Nice doesn't = results. That's true of OTs and SLPs and docs and... all of 'em.

[happy-hs]

I don't need my mind changed about VT. I believe it works. As others have said, I think it's a part of a larger puzzle. In my daughter's case, I'm still trying to get pieces into place.

 

OhElizabeth, I think you hit the nail on the head. She can sound out words, but she doesnt have a good base of automatic sight words. So reading a book requires a lot of tedious sounding out. I think I need to improve her recall of words so that she has a larger sight word vocabulary to draw upon. Hopefully this will make reading easier for her.

 

Thanks again for all the input and insight.

 

Melissa :)

[KathyBC]

Melissa, we did shared reading and repeated reading using the Pathways Readers. DS needed so much more repetition than the average kid to recognize words like 'who' and 'the', and because reading had been difficult he was actually reading less than the average kid might. He wanted to get to more exciting stuff, but was willing to spend time every day reading these. I think it really helped.

[Lecka]

Right now we are giving OT a try for a few months and if she doesn't see improvement then that is when we may do VT. So it is still possible but I am not getting messages from anyone that it is the obvious first choice. I don't know if it will end up being a really helpful thing -- it is possible.

 

I am also seeing that he is doing pretty well with reading and using a computer. For example he just read 7 books and took computer quizzes on them when his goal was 6. If there has been any handwriting involved it would have been a nightmare. So I am feeling like -- he has got strengths now, maybe it is time for me to focus more on accomodations than I have so far. I am feeling a lot like he could be just fine if he could go to typing (of course he barely knows how right now, lol, but at least he has a good attitude with it).

 

For OP I have worked a lot with my son specifically with fluency best practices. This is reading easier books, reading out loud together, repeated reading. I have got info from standard library books about fluency, websites for programs designed to increase fluency, and the fluency section of reading rockets .org.

 

This is working for my son, he just needs a lot of extra practice.

 

But for a program where that does not seem to have any results, I see Seeing Stars recommended.

 

For a package fluency program I have looked a lot at oneminutereader but I haven't gotten it (yet).

[happy-hs]

Thanks for the ideas! One minute readers look fun! I also found Sound It Out Chapter Books, which look great. I think she'd enjoy having chapter books to read.

 

Melissa :)

[CraftyHomeschool]

We have One Minute readers and we really like them. They have helped my son with being able to "read" the punctuation and hearing expression. If you do decide to get them I would only get one or two books at the level you child is at and a couple at the next level. Just a quick note that the lowest level they have is supposedly a late K/early 1st but I tend to disagree, I feel it's more of a late 1st early 2nd grade but it may just be me. They have several stories in each book and we do one story each week. Day 1: we do his "cold" timing and then we discus and work through the words he missed Day 2/3: he reads the story out loud with the CD twice (each day) Day 4:I have him read the story to me and we mark the word that he missed and review those then we reread the story chorally (we both read at the same time (me reading a little slow), I run my finger under where I'm reading so he works at reading the same words I am) Day 5: he does his "hot" timing and get a small reward for any improvement.

[ElizabethB]

:grouphug:

 

A friend's daughter worked through my phonics lessons after vision therapy and found them helpful.

 

You can also try working through the program linked at the end of my how to tutor page. The syllable division exercises are especially good for an older child, it gets them reading upper level words quickly and easily, learning how to divide them and sound them out. Webster's Speller is also very motivational, the short course using Webster's Speller Excerpts starts with 4th grade level divided syllable passages and quickly works up to 12th grade level passages. My remedial students enjoy seeing their grade level progression.

[SKL]

My dd also improved greatly in vision therapy, but she still had a lot of trouble building visual memory. I mentioned this to the doc and he said it might improve with time and practice, to give it a chance, but if problems persisted she might need more therapy. It has improved, but is still not where I'd like it to be. She also has some other issues that I think are associated with vision. Last fall the doc prescribed prism eyeglasses which helped. I have also signed her up for some more vision therapy this summer. ... I'm a big believer in VT because I know what I saw in my dd. Interesting factoid. When she was 3.5 she took a sensorimotor test that showed her to be in the 9%ile in visual-motor integration, 0.07%ile in motor coordination, 34%ile in visual form perception. At age 6.5 the school tested her and her percentiles were 42%ile in visual-motor integration, 65%ile in motor coordination, 98%ile in visual perception. ... I also recommended that my sister see a COVD doc when her ophthalmologist diagnosed her 3yo with some vision problems and prescribed glasses. She decided to do VT and within a couple of months, the vision in her dd's "bad eye" went from 20/125 to 20/65. Hmm. Snake oil? We don't think so.

[laundrycrisis]

Part of our son's VT was specific for helping improve his visual memory. If a child has no trouble with phonics but is unable to build any fluency - that is automatic recognition of words on sight - when reading - I would ask for a test for the visual perceptual skills (totally different than the visual motor skills) and if necessary, the VT that is specific for visual memory. It made an absolutely huge difference for our son. He also needed help with form constancy and closure. Treating all three of those problems unlocked reading for him.

[chadzwife]

Dianne Craft has not been mentioned at all in the posts. Her therapy is done at home by the parents. Used with auditory & visual processing issues and dysgraphia--hates to compose or even copy from a board or book. I am currently using it. the CVPD eye dr we went to did the eval, said yep shes got issues and then wont get back to me now. Becuz I have no way to pay for therapy lol. An audiologist told me to get a CAPD also. Either way tho, after im done with the visual therapy, ill do the auditory exercises. Getting a CAPD eval is quite difficult around here.

Understanding exactly wat is going on with processing disorders, I know why my dd can sound out cat in the same sentence, slowly and painfully. She never puts anything in her memory. Shes 8 and has a reading word memory of about ten words. The only thing that will work is Dianne Crafts method, or something like it. We only use Orton-Gillingham phonics (Writing road to reading style) here. It's not a reading methodology issue. Her brain is incapable of learning to read by conventional methods. we are fixing that, ideally. I have high hopes this will actually retrain her brain to WORK.