Vision therapy - not done yet

I'm feeling a little disillusioned about vision therapy lately. Since the Great Leap Forward that happened around September, I haven't really seen much more advance with Dash's reading.

We are approaching the end of his originally scheduled sessions, but when he had an assessment last week the doctor said that his eye teaming was still not great, and added a few more to work on that specifically. I told her that his reading still seemed slower than I would have expected, and she admitted that when he did the Readalyzer test, his eyes were still hopping around the line rather than following the letters sequentially as you would expect.

When we started this, early last summer, I felt that the worst outcome would be if they "passed" him at the end of his allotted sessions, said that everything looked fine on paper, and yet we couldn't see any noticeable difference in his reading. I don't think that's going to happen - some of his numbers have definitely improved, and his reading level has definitely gone up a few notches; maybe I'm just asking for too much. Maybe I should be happy with where we are.

But then. A friend of his was in the house last week - a boy who I know is reading way above his grade level, so I shouldn't compare them at all. But he read the warning on the side of Dash's Beyblade arena (if you don't know, don't worry about it) just the way you or I would, fluently and conversationally, while Dash was still trying to get it together to focus on the first couple of words. It hit me, a little bit.

Reading isn't rocket science. Everyone can read. It's not hard. It shouldn't be this hard. For Dash, I can tell that it's a big effort. He's not lacking desire, or curiosity, or interest, or practice, and he's smart to boot. And yet, I heard him struggling over the word "house" last night as if he'd never seen it before. It's as if he has to start over remembering the rules and concentrating hard every time he cracks open a book.

I just want to know if it will always be that way.

Reading to his sister, which is definitely a first, so I shouldn't complain. 

Vision therapy: further update

Dash has a vision therapy assessment this afternoon. I haven't been talking about vision therapy much because I want to do a big reveal when it finishes up, but I'm tired of waiting, and frankly I'm excited about the way things are going.

At the start of the summer, Dash was seven and a bit and fresh out of first grade. He was reading a little above grade level, but it was a struggle and far more halting and laborious than it should have been. He was comfortably reading books like this:

More tellingly, he never spontaneously read a road sign or a store name. He resisted reading anything we asked him to, though he faithfully did his 20 minutes of homework reading every night, eventually, when all other options had been exhausted. He would blink and say the words had gone blurry after a sentence or so, but he'd persevere. It was painful to listen to.

He began vision therapy in June - two half-hour sessions a week, with a few minutes of "homework" to do every morning and evening in between. It's hard to explain what the therapy consists of - reading and pointing and following arrows and picking out highlighted text and finding letters in order and learning how to focus and unfocus his eyes as if he were doing one of those magic-eye pictures that I can never do. Games and puzzles and things on a computer.

We had a preliminary assessment after six weeks or so, and to be honest at that point I was still ambivalent about how things were going. I couldn't see any change, really, in his homework reading. I felt at that point that the worst outcome would be if his reading improved a little, but nothing really changed much, and if we'd never know whether he'd just caught up late as he was going to do all along or if the therapy helped.

Less than a week later, something changed. He started reading the next level up and stormed through a level-three Ninjago book in a few nights. Words didn't go blurry any more. He was reading paragraphs.

Now he's reading text that looks like this:

He's on his third Magic Treehouse book. He's still reading aloud, and only for his 20-minute mandated time, but if you'd told me when we started this that we'd have reached this point as soon as October, I'd have said all my hopes had come to fruition.

Today he was off school. We were talking about his reading and he said "...and when I'm finished all the Magic Treehouse books, I can read higher-level books and when I'm finished all of those I can start reading about real things."

"You don't have to wait till you've finished all the fiction in the library to read about facts, you know. We have a history book at home."

So he did this:

He read two pages about World War II, asking me what things like N-a-z-i and C-z-e-c-h-o-s-l-...  and D-u-n-k-i-r-k spelled, and taking in every word even though his supporting background knowledge and geography are pretty hazy because it's quite an advanced level book of world history.

His handwriting has improved to the point where he's writing essays entitled "Why my writing is so neat." He brought home a report card full of straight A's last week. (This is his first letter-grade report card, so I can't really compare it to previous ones, and I really don't care and don't want to put any pressure on him to stay a straight-A student, but that's a different blogpost.) Last week at a birthday party he willingly read out the list of scavenger hunt items, even though they were in an unfamiliar cursive font.

At Wednesday's session I got talking to another mother. Most of the kids I see at vision therapy are Dash's age or a little older, but this woman's son is in tenth grade, which makes him 15 or so. His deep voice sounds out of place beside my son's piercing trill as they both do their separate exercises with their therapists, around the corner from where I sit and wait.

This mother said they'd spent thousands and tried everything trying to figure out what was going on with her son's reading. He'd bring home A's and B's but his homework was taking seven hours a night. He'd had an IEP (individualized education plan; for children who need extra help while in mainstream schooling due to something like high-functioning autism or ADHD, maybe). Nothing had helped until they discovered vision therapy. She looked at me with hopeful weary eyes and told me we were blessed for finding this now, when Dash is seven, for saving ourselves all those years of struggle. I don't doubt it.

Vision therapy isn't over yet, and today's assessment is to get a better idea of how he's doing and how much more he needs. But I am happy to report that things are looking good. No pun intended.

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To read more about Dash's journey with vision therapy, see here or type "vision therapy" into my Search field. If you wonder whether vision therapy would benefit your child, read this very informative page and take a look at the checklist linked at the bottom. We found a qualified developmental optometrist in our area using this search. Feel free to e-mail me if you've any specific questions, though obviously I'm far from an expert.

Vision therapy update

Dash has been doing his vision therapy for a while now - a half-hour session twice a week, with "homework" every day. We have had letter charts and arrow charts and number stars taped to the walls, and he has been pointing or reading or dancing or whatever he's meant to do, morning and evening. Sometimes getting him to do it is just like school homework all over again, but he does it, and we hope it's helping.

He'll have another assessment midway through, and I'll be interested to see if the numbers have changed. One thing about this process that I like is that the results are measurable; we're not just wondering if his reading has improved, and if so if it was going to do that anyway. Of the barrage of tests he did at the beginning, we were provided with a list showing the range an average 7-year-old's results would fall into, and then where his results were. Those aspects where his were below that range are the things his therapy focuses on, and when he's re-tested we should see the difference.

We have at least continued with his daily twenty minutes of reading through the summer, even if other plans to beat summer slide, like daily copying out of a morning message, never got off the ground despite my best intentions and his avowed cooperation. This morning he actually continued past the timer's beeping so that he could finish all of Green Eggs and Ham. Admittedly, the plot twist was not unexpected, and he's well able to read all the words; but because he knows it so well he was happy to keep going and - for the first time ever - I heard him read with expression instead of just stumbling over one word at a time. I don't know if the vision therapy has anything to do with it, but I was pleased.

The optometrists had given us, with Dash's report, a list of accommodations we could ask for at school, such as sitting closer to the front, not being asked to copy from the board (changing focus from far to near is a problem point), getting some extra time for reading or writing assignments, that sort of thing. I was called in for a meeting this week to discuss these, and I was very pleased with the way things went.

I met with his teacher for next year, the principal, the guidance counsellor, the head of special ed, the school psychologist (didn't even know we had one) and one other person, and it was mostly just a great opportunity to tell these people - most of whom had not dealt with Dash before, though I bet they'd recognize his big grin - who my son is, what a great kid he is, how much he loves school, and what's going on with his vison right now. They were all open to learning more about how they could help, and we had a great discussion. I left feeling really positive about the school and its staff, which is a lovely way to start the year off.

In a most amazing coincidence, Dash's best friend, daughter of my best friend (known in these parts as Helen's Mom), has some of the same vision problems. There are just two days in age between her and Dash, and though we don't see her so often any more, we spent much of the toddler years together at playgroups and playdates and library storytimes and the like. Helen (not her real name) is also a bright kid struggling more than you might expect with reading, though she's reading at or slightly above grade level. Our story was ringing so many bells with her mom that she got Helen tested too, and vision therapy is probably in their future.

Which makes us wonder whether there was something in the water at all those playdates. Or maybe it was the extended nursing. Dun dun dunnnnn. (THAT WAS A JOKE. I WAS JOKING. I SWEAR I WAS JOKING.)

Diagnosis

We had the meeting to discuss the results of Dash's vision assessment, and this - in bald terms - is what we learned:

• He has an oculomotor dysfunction. That means his eyes don't track smoothly or move easily from one line of text to the next.
• He has a binocular vision dysfunction. This means his eyes don't work together quite the way they should. This is what makes the words blurry and makes it hard for him to read from the blackboard.
• He has difficulties with visual memory.

He's going to start therapy in a few weeks, two sessions a week if possible, for 36 weeks. They say his "prognosis for improvement with timely intervention is very good. "

The tests also showed things he was good at. He can tell left from right like a champ, which impresses me no end as I still have to stop and think every time. He's very good at reading made-up words, which proves that he knows all the rules and applies them. I know he can read pretty much any word he wants to; it just seems that his eyes get in the way sometimes. His fine-motor skills and shape-copying skills are dandy, so his bad handwriting is within the bounds of normality and let's just say he gets that from his father.

The doctor was particularly impressed, if that's the word, with the way Dash tackled one of the tests. He was asked to read out loud along a line of unevenly spaced numbers, and then to the next line, and so on. She and I both observed that when he got to the end of the first line, he looked down to the end of the line directly below, followed it back to the start, and began reading aloud again from there. It worked - he didn't lose his place - but it was tedious and slow and not the way the rest of us read lines of text. She said she'd never seen that tactic before, though.

I still have a lot of thoughts about all this. It seems like a very first-world problem. It seems like a very privileged solution. (Our insurance will probably pay for half of the therapy - the oculomotor part - but not the rest.) It seems like the sort of thing one could easily be duped about - what parent, when told they can give their child extra help, would say "Nah, we'll just let him keep doing it the hard way, thanks." Our bullshitometers were, if not exactly on high alert, at least engaged. Let's just say that our healthy Irish cynicism had us vaguely wondering if they're just trying to part us from our dollars.

Naturally, I also wondered what we'd be doing at this juncture if we were still in Ireland. I have no idea whether an assessment would be possibly or any therapy available if we were there. Would we be told he's a slow reader and left at that? (I'm inclined to believe that many "slow readers" have these problems, but have been left to fend for themselves and catch up if they could. How long would it take? How much would they fall behind? Or does the pace of schooling now mean we have to catch up more quickly whereas back then (whenever "then" was) it wouldn't have mattered so much?
 
But on the whole, though vision therapy is a fairly new field, it seems to get good results, and, obviously, deciding not to pursue it was not something we seriously considered. Dash's teacher, to name one trustworthy source, has done this for two of her children. The office has excellent credentials and they have a waiting list for therapy and are extending their premises right now. (So if we are being duped, we're not alone.) I asked the doctor, "Does it work?" and she told me it does. I'm willing to give it a whirl, because I can't imagine a life where reading is not a source of joy and excitement and the best pastime I could ask for.

Lots of kids have speech therapy; this is vision therapy. We'll see what happens.

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If you want to find out more, I found this Reading and Vision site very useful and used the checklist linked there to decide we should investigate further. I found the office we used from the directory at the College of Optometrists in Vision Development site, which lists those qualified in behavioral, or developmental, optometry.

Further uninformed thoughts on Dash's vision

 Continuing the story from here, if you missed it before.

I always thought so long as you were reading you'd be okay. (You being anyone, in elementary school, to make any sort of decent progress.) It never ocurred to me that reading itself might be a hurdle. We had books in the house, we read stories every night, we visited the library; I was pretty confident that some time between four and seven, the reading would just happen.

I have no memory of learning to read, I just remember shouting out all the road signs from the back seat and reading the cereal box from an early age. So all this faltering and halting progress was new to me; but he's a boy, I thought, and he's not me, I thought, and he's his own person and clearly more interested in running and jumping and taking things apart and thinking about how things work and what stuff they're made of than I ever was. I still think that.

Dyslexia is a recognised thing. (I don't think he has dyslexia.) But how many other similar, lesser, learning/vision difficulties are there, and when does it become just searching for new ways to say "Well, he's a slow learner;" or is there really no such thing as a slow learner, just children with undiagnosed vision problems? Conversely, are we just trying to put names and explanations (and excuses, maybe) on things that don't really call for it?

Will it all turn out fine in the end? Probably. But this is one of those in-between points where you can't tell whether it's a vital decision that you're about to make or if it really won't make any difference. Short-term, long-term: I know he'll be fine in the end, but I'd really like something that makes second-grade homework less of a pain for all of us than kindergarten and first-grade homework was, especially as I know the stakes are higher and the expectations greater next year.

And then I think "For heaven's sake, it's second grade. I don't remember learning anything in second class." On the other hand, I could read pretty well by then. On the other other hand, that was in another country, and besides, those days are dead and gone (and with O'Leary in the grave). And then sometimes I think that maybe everyone here and now is far too focused on getting your kids into "a good school" (that means university) and the notion that you can't get a decent job without at least a graduate degree; then again, people are also agreeing that degrees are devalued when everyone has one, and there's a glut of PhDs out there with no jobs to go into, and that if he becomes an electrician he'll never be stuck for work...

It's all hypothetical until I know what we're talking about, which we will find out on Friday at our meeting. Assuming that we trust the professionals, that we feel like they speak the truth and that their methods are good, then we will listen to what they have to say and make decisions about what, if anything, we should do to help Dash with his reading. I am eager to find out.

Extra-vision

 
You may remember that Dash got glasses late last year. I hoped that that would do the trick, and his reading would take off like a rocket, the way his teacher assured me that with his large vocabulary and interest in learning, it was bound to.

But it didn't. We sort of ignored it, and his reading did improve. He ended first grade reading at a mid-second grade level, which should be perfectly good enough for anyone. And yet. It didn't help that I kept hearing tales of his peers who were suddenly leaps and bounds ahead of their supposed reading level - I mean, a certain number of people have to be average (because we don't live in Lake Wobegone), and I'm not demanding that everyone has to admit that my baby is brilliant... but.

I still had the feeling there was more to it. The tipping point came last week when a comic arrived in the mail - a late birthday present that's a bit more advanced in reading requirement than the sender realised, I think, but Dash was eager to get stuck in. Listening to him laboriously sound out the contents of each speech bubble was painful. Thinking harder about it, the all-caps style of comic writing probably makes it harder to recognise words than the ups and downs of regular mixed case; but surely he should be further ahead than that by now, I thought. Something just hasn't clicked for him the way it should have.

I asked some helpful people online, and some helpful people online gave me just what I needed: the vocabulary to Google the right resources. What I needed to look for was not just a regular optometrist, or ophthalmologist, but a behavioral or pediatric or developmental optometrist/ophthalmologist. These are doctors trained not just to assess how well people's eyes work, but also how well the eyes are working together and sending messages to the brain, and how the brain is interpreting those messages.

In short order, I had found this website and this directory, and was feeling a lot more proactive about the whole thing.

A lot of what that Vision and Reading page said had me nodding and aha-ing. I got Dash to look at the examples of blurred text and he spotted the one that looks the way his blurry words look. (They're only blurry sometimes, but I don't think that's the full extent of his issue.) The clincher was the checklist: I came up with a score of 29. They say anything over 20 warrants further investigation.

The next morning I called our pediatrician's office and our local optometrist to see if they had any recommendations, but in the end I used the COVD directory and found an office not too far away that sounded from their website as if they were just what we needed. They had an appointment for an initial eye test on Tuesday, so along we went.

Tuesday's was mostly a regular eye test with a few different elements and a chat with the doctor about why we were there. But what we said, and my answers on their slightly different checklist, were enough for them to bring us back in today for a two-hour long evaluation that covered how Dash reads, how he sees and interprets and remembers shapes, how he writes and spells, how his eyes track lines of text, and probably many other factors I didn't even know were being assessed.

The paperwork included a question sheet to be filled in by the child's teacher, but with only two days' lead time (we'd filled the spot of a cancellation) I didn't manage to get hold of Dash's teacher before the appointment. However, she called me back later and said that her own children had benefitted from vision therapy, that she'd been surprised when Dash did not test into TAG (the more advanced stream) based on her observations of him, and that she had wondered why his reading hadn't improved even more than it did this year. (You know, I do feel she should have said something about that to me without this prompting.) So we'll add her input to the pile too.

We wait two weeks for all the information to be put together, and then we go in for a conference to see what's up. It's likely not to be something that's a quick fix with new glasses; it might be something that calls for vision therapy. I don't know if there's a middle path between those two. Worst/best-case scenario, I suppose, we just paid out of pocket to be told that our son is a perfectly average slowish reader. I would be okay with that. Honest. I don't want him to be a supergenius hampered by dyslexia. (It's probably not dyslexia. But the problems we're talking about are in that sort of family.)

I will keep you posted.