5th Grader with Convergence Insufficiency

[EvieR]

I have a 10 (almost 11) year old daughter finishing up "5th grade."  She was recently diagnosed with convergence insufficiency.  She has started vision therapy, we're looking at an estimated 12-18 months of therapy.  I'm looking for recommendations for a reading/language arts curriculum, that isn't super intensive.  She is probably low-average as far as reading level goes, however she can't read for long periods of time without developing headaches and eye strain.  I want her to continue with some kind reading and language arts program, without overwhelming her.  She is the oldest of 5 kids, so my time to read and with her is also limited.  

[PeterPan]

My dd started her VT at the end of 5th, so I feel for you, sigh. On the plus side, you still have a lot of time left to see the academic jumps that come from getting her eyes working correctly. Like your dd, my dd was having headaches that were holding back her reading. By the time she finished high school she had top ACT scores and top scholarships. So you never know, lol. Also the visual memory will improve, so the spelling will improve.

Have you thought about getting her audiobooks? For right now, you really should. There's a lot of language development that occurs with reading, so you want her to have that language exposure. Doesn't matter if it's ear reading or eye reading, so long as she's reading. Your library will have them and you can download them onto an old phone, kindle fire, whatever. My ds eye reads minimally (dyslexia, ASD) and he listens to an audiobook a day. My dd (that strong reader!) used them into middle school, definitely till her VT was done. Highly recommend.

Have you ever wondered if there's dyslexia as well? Dyslexia is NOT a vision problem, but giving the challenged reading you're describing, I think you want to consider testing her phonological processing as well. The CTOPP (test of phonological processing) is completely oral, so the results on that should be clear even if done now. You might be able to find a tutor or SLP who specializes in literacy to run it for you. A full psych eval takes a while to get into and is a bit $$, so trying a tutor or SLP is a way to get in quicker and for a much lower cost. And an SLP who specializes in literacy would also have narrative language testing and other testing to make sure there are no other language issues affecting her reading. I would NOT assume everything you're seeing is vision and going to resolve with VT. It might, or she might need some other things as well.

Now, on that time frame, that seems too long to me. Did she have a lot of retained reflexes? How often are they doing therapy and homework? Are they trying to do all the work in office with no homework? Did she have some kind of extenuating circumstances? You should be looking at 3 months to get convergence under control and another 3 months to deal with visual processing, so like 6 months total. To me, if they're saying 12-18 months, something is up. The only person I've seen on the boards who took that long as driving a long way to appointments and could only go once a month. If that's your situation, where you have a long drive, frankly I'd consider spending 3 months with Grandma or someone who lives in another location and seeing if you can find a place that can work more expeditiously.

So no, this should not take 12-18 months so I'd love to hear what their explanation is on why. You really might want a 2nd opinion on that. Most people are happiest when they do 1-2 office visits a week with extensively daily homework. It's going to go as fast as you work it. 

Have you tested her for retained reflexes? Did the optometrist test for them? If there are retained reflexes and you don't integrate them, progress will be slow and frustrating. Maybe that's why this doc takes so long, because he doesn't integrate reflexes, hahaha. 

I'm not meaning to offend your choice of docs. I'm just saying this costs a ton of money and to be very careful. You've gotten the diagnosis, but now you want to slow down and be very sure all the ducks are in a row before you start plunking out. We've had some people be very happy with their VT and some people be VERY UNHAPPY. And those types of issues (no clear plan for homework, not integrating retained reflexes, etc.) were big parts. Being asked to pay a sum of money upfront is a big red flag. You might get a really different take from the next eye doc, and given the extremely unusual length of time they're suggesting, I'd be wanting that 2nd/3rd opinion. Like literally just call them up and say hey my dd has convergence insufficiency, what would this look like if I came to you...

Keep us posted! Come hang on LC. Sounds like you have a lot to talk about. 

Edited April 23, 2021 by PeterPan

[EvieR]

I chatted with the actual vision therapist, not the office staff.  The original letter that was sent out combined treatment times, not accounting for working on multiple skills at one time.  We are looking at more like 6-12 months, since we are only doing therapy every other week.  She will have homework we are doing daily.  We have limited resources were we live, also everything is via teletherapy here.  The 6-12 months estimate was on the outside, so that was helpful to know.  We reevaluate treatment every 10 sessions, so I'm pretty sure we're on a good path with where we are.

I'm a former reading teacher and have looked into other phonological issues, although we have not done any formal testing.  She does not have the typical dyslexia or dysgraphia issues and passes all the at home screening tests I've given her over the years.  She has never liked reading, but vision issues would explain a large part of that.  She does well with math, and is above grade level. Her auditory memory is good, and she has a high comprehension level when listening to information. She did well on all the reversal and single line tracking testing that eye therapy did.  She has issues with multiple line tracking and some spatial issues, which goes with the convergence insufficiency.  The plan is to work on the convergence and spatial awareness first, then add in tracking after a couple sessions.

I looked at the CTOPP, I'm thinking it may be easiest and cheapest to buy the kit and do the test myself! Do you think this would be reasonable to do?  I've administered a lot of standardized tests so am familiar with them.  

She hasn't been a fan of audiobooks in the past, but it has been awhile since we tried them.  I'll look at getting some more and giving them a try again.

[PeterPan]

4 hours ago, EvieR said:

We have limited resources were we live, also everything is via teletherapy here. 

Are you somewhere other than the US? Just asking. I'm trying to figure out how they're going to do flippers and use various cards, etc. to work on depth perception, etc. if they're only working via tele. Are they mailing her a packet and having her buy things? 

I'm not meaning to be nosey, just saying it's a lot of money and you don't realize things till hindsight. Those are things I would be checking. Good VT gets done in person literally 10X what I would get done at home in a session. And they should be using tools and doing hands on activities that you would struggle to do via tele. So if it's possible to do it in person, it's preferable. 

I LOVE that your person is working within your budget and giving you tons of homework. That part is awesome.

4 hours ago, EvieR said:

She hasn't been a fan of audiobooks in the past

Can she explain why?

4 hours ago, EvieR said:

I'm a former reading teacher and have looked into other phonological issues, although we have not done any formal testing.  She does not have the typical dyslexia or dysgraphia issues and passes all the at home screening tests I've given her over the years. 

Interesting. How is her spelling?

4 hours ago, EvieR said:

I looked at the CTOPP, I'm thinking it may be easiest and cheapest to buy the kit and do the test myself! Do you think this would be reasonable to do?  I've administered a lot of standardized tests so am familiar with them.  

Are you sure? That's $347. Around here I can get a reading tutor (SLP who does literacy) to do an intake assessment where they give the CTOPP and DAR and it will be $75. I think most Barton tutors give the CTOPP as well. It's just pretty common and I would think you could get it done by someone, even online, for much less than buying. And by working with someone who has more tools you might get more information.

I'm not trying to step on your turf, lol. I've had to explore most of the roads (dyslexia, APD, hyperlexia, and more) to help my ds, so I'm pretty open ended. If something is going on beyond the vision, you want to know. But what are you seeing that made you run so many other phonological processing tools? I doubt you're going to find that one is so much radically better/different than another. What are you seeing that is a red flag to you? 

I was very surprised to realize how close APD (disability with the auditory processing of language) is to dyslexia (processing of language when reading). We finally did evals (after all our other ones, a whole litany) and began working through some APD workbooks (ProEdInc, bought through Therapro), and it's stuff that you would THINK we had already worked with all the tons and tons of work we did with LIPS, Barton, etc. But nope, it's a new angle, new way, go figure. 

So personally, if you're asking me, no I would not buy a $350 test till you're more sure what you're needing to identify. And I try to do the testing with someone who owns more tests so you get more done for that amount of money. The CTOPP alone will NOT be worth it and you will be disappointed.  You could do one hour with an SLP specializing in literacy, have it bill around $80, and get many more things done in that one hour and actually have some information.

https://www.smartspeechtherapy.com/review-of-the-test-of-integrated-language-and-literacy-tills/  Here's a blog I always cross reference with when I'm looking up anything language. You name it, she has used it, eval'ed it, has an opinion on it, lol. Now she's pretty opinionated and even (shh) wrong on a few things (just a few). But still it's a helpful place to read. She really likes the TILLS. So me, I wouldn't be buying because your money is better spent other ways. 

Edited April 24, 2021 by PeterPan

[prairiewindmomma]

I have a kid who had convergence insufficiency. Therapy resolved issues for us—but we did find that we needed to do some motor work in order to progress on the vision front.

I would not do a formal handwriting program. I would work on typing. I would look at IEW’s SWI-A for writing instruction. I would have her listen to audio books and would match up topics from the common core/state directives. Most standard curricula is not going to be an easy match to her current abilities. The therapy exercises themselves caused headaches. If she needs reading comprehension help, look at Spectrum reading for her grade level. The passages are only a few paragraphs long but the questions require careful reading. It’s particularly helpful if she struggles with inference. Amazon carries sample pages. 🙂 

[73349]

DS is nearly finished with VT, but he does have dysgraphia as well. Audiobooks are great; sometimes he likes to check out both the print and audio versions of a library book and use them together.

We've used this spelling/typing program.

If your DD doesn't have a strong vocabulary, I'd look for a workbook for her to do on her own, maybe something like Evan-Moor's Word a Day or Vocabulary from Classical Roots. You could also do something like Daily Grammar, in which the exercises are short and meant to be done independently.

[ElizabethB]

I would do a lot of oral spelling. Logic of English essentials lite is free online right now:

https://elearning.logicofenglish.com

You can also work though my syllables lessons, 10 hours to work though, phonics to the 12th grade level. 

http://thephonicspage.org/On Reading/syllablesspellsu.html

After that, you could work thorough all of Webster's Speller's 2+ syllable words. 

[shinyhappypeople]

On 4/22/2021 at 10:06 PM, EvieR said:

I have a 10 (almost 11) year old daughter finishing up "5th grade."  She was recently diagnosed with convergence insufficiency.  She has started vision therapy, we're looking at an estimated 12-18 months of therapy.  I'm looking for recommendations for a reading/language arts curriculum, that isn't super intensive.  She is probably low-average as far as reading level goes, however she can't read for long periods of time without developing headaches and eye strain.  I want her to continue with some kind reading and language arts program, without overwhelming her.  She is the oldest of 5 kids, so my time to read and with her is also limited.  

For reading, you can use large-print books and audiobooks.  Good luck!  FWIW, my 17 yo has convergence insufficiency and was helped by a combination of VT and prism glasses (basically rx readers).  She's reading at/near grade level now.  She still doesn't like it, but she can do it.