Struggling 6 Year Old Girl **Discussion - Visual Problems**

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Kelly
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Post by Kelly » Sun Jan 06, 2008 6:25 pm

Thanks for all the advice.

Well, the school year has finished over here, but we have got together some new bits and pieces to try.

We have purchased a few of the ARI books to see how she goes with a brand new, slightly different approach. She knows all of the sounds in the first set of books so it should (fingers crossed) help with getting some fluency.

To trial we have also purchased a set of coloured overlays. We are all starting to wonder if the fatigue is due to visual processing difficulties e.g. text moving. Her fatigue does seem to be genuine. Even when she is really enjoying a particular activity she is yawning and like I said this is across the board not just at phonics/literacy time.

It will be interesting to see how it goes.

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maizie
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Post by maizie » Sun Jan 06, 2008 6:53 pm

You said in your original post that she had had eye tests. Did this reveal anything? Were they really thorough? Does she actually report that text is 'moving' or are you just considering this may be a possibility?

I only ask because I am working with a (much older) child who had 'had eye tests', but when, after 6 month's nagging, he was finally taken to a good optometrist, who tested him very thoroughly, it turned out he has astigmatism.

He used to be physically exhausted after decoding one line of simple text...

I know you say that exhaustion seems to be her normal 'state', but visual difficulty is worth considering and checking for.

Judy
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Post by Judy » Sun Jan 06, 2008 7:09 pm

We are all starting to wonder if the fatigue is due to visual processing difficulties e.g. text moving.

Kelly, I think this is worth looking into! The pupils who yawn a lot in my lessons do seem to be the ones who have to deal with the text moving around, coming and going etc!

Have you seen this -
http://www.convergenceinsufficiency.org/

I work with a nine year old who has quite a lot, but not all, of the symptoms listed. In particular, he loses his place easily and if he looks away from what he is reading or writing for an instant, he invariably goes back to a place much further down the page and he frequently covers one eye. He starts off reading enthusiastically but quickly slows down and it is obvious that his eyes are givng him some sort of trouble. I managed to persuade his parents to get his eyes tested last year and he did get some glasses but they don't seem to make any difference at all.

He always seems very quiet and tired but that is not uncommon as the lessons are in the late afternoon or early evening. So I was surprised when his mother told me he is normally very lively and usually has lots of energy. Embarrassingly, he actually fell asleep towards the end of one of his lessons last year! At the time I put it down to the fact that it was late in the day and the room was very warm, but since reading about convergence insufficiency, I'm not so sure! On the other hand, he doesn't seem to benefit from coloured overlays at all. Initially, he was very slow to recognise words that he had just sounded out when he met them again a few moments later, but all of a sudden, he seemed to be able to do that.

I'm wondering whether anyone can advise me how to go about getting him tested for convergence insufficiency. Would this be done through his school or would the parents have to find someone to check him out independently?

I'm sorry to hijack your thread, Kelly, but since you mentioned visual processing problems, I thought it might be worth looking into this in more detail.

Judy
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Post by Judy » Sun Jan 06, 2008 7:14 pm

BTW, I've recently discovered that this little lad was a very prem baby, only weighing just over 2lbs at birth and that his parents were told that he might develop problems with his eyes and ears but he was monitored by a paediatrician until he started school and all seemed to be well.
Last edited by Judy on Sun Jan 06, 2008 8:43 pm, edited 1 time in total.

Kelly
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Post by Kelly » Sun Jan 06, 2008 7:37 pm

maizie wrote:You said in your original post that she had had eye tests. Did this reveal anything? Were they really thorough? Does she actually report that text is 'moving' or are you just considering this may be a possibility?
The eye tests didn't reveal anything, but I'm not too sure how thorough the test was. I will ask at the start of the next school year.

She doesn't actually report that the text is moving, but we are just considering the possibility. She is the type of child that you don't always get a straight answer. :grin: :roll:

It is my gut feeling that something is happening though. Something isn't quite right. She is an average child and there has to be a reason why tasks that require a lot of visual concentration leave her so exhausted.

Thanks for that link Judy. That was very interesting. Your student sounds a lot like an older version of mine!

PS Thread jack all you wish! :grin: I might change the initial subject heading (if I can) to include 'visual problems' so it can be found later.
Last edited by Kelly on Sun Jan 06, 2008 8:52 pm, edited 1 time in total.

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maizie
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Post by maizie » Sun Jan 06, 2008 8:29 pm

Well, Judy's child sounds very much like 'mine'! So it looks as if thorough investigation is definitely called for!

A good site to look at is Rod Everson's 'On Track Reading' site:

http://ontrackreading.com/the-ontrack-reading-story/

He has a lot of interesting stuff about vision problems.

jenny
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Post by jenny » Mon Jan 07, 2008 9:13 pm

An expert on these matters in this country is a man called Ian Jordan who has written on the subject and trains teachers. Infornation on www.visualdyslexia.com

Judy
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Post by Judy » Tue Jan 08, 2008 12:27 am

Thanks, Jenny - I think it's a pity that Ian Jordan doesn't make it very clear what the symptoms are in terms that the lay person can understand (unless I missed something!)

I've discovered today from the boy's mother that he has great difficulty catching or kicking a ball, but now that he's old enough to play rugby, he's finding the larger ball easier than a small one.

So this may be something for Kelly to enquire about as it's listed on the 'convergence insufficiency' website. Apparently he is almost hyperactive at home - quite unlike his behaviour in his lessons, when he always seems tired and listless.

Have also found out (though another parent) that the way forward is through the GP, who will refer him to the local paediatrician, who will then refer him to a specialist all the way up in Shrewsbury, if necessary. I'm thinking I'll probably have to find some information for the parents to take to their GP in case s/he doesn't know much about this field. Unless, of course, anyone knows whether the school could refer him?

FEtutor
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Post by FEtutor » Tue Jan 08, 2008 1:42 am

If no local screening can be found, there is always the Institute of Optometry at Newington Causeway in London ( www.ioo.org.uk ) where there is a special clinic for people with dyslexia, migraine, visual disturbance etc. In addition to a normal eye test, a range of tests (including unusual eye muscle movement and colour-background sensitivity) are carried out. I imagine it includes convergence insufficiency too. There is a charge for full screening, if I remember right.

The IOO is a research institution run as a charity. My local optician did some further study there at one point, and he now offers colour- sensitivity screening since he saw how much it helped his own son. (OK, I know that there is dispute about it, but some people have certainly found changing the background colour is helpful in fixing the print for them.)

I've recommended the IOO to several students and also a very fussy friend of mine- she was very pleased when they altered her lense prescription and her migraines disappeared.

Anna
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Post by Anna » Tue Jan 08, 2008 11:30 am

Hi Judy and all,

I have done quite a bit of investigation on the topic of convergence insufficiency on behalf of a new pupil who I (and her school) believe has is dyspraxic to a degree. These visual problems do often apear to form part of the dyspraxic pattern of difficulties (although the individual combination of dyspraxic difficulties varies with each child). The first thing the mum of this pupil said to me, was that she complains of the text moving around. She has an RA the same as her CA but of course the usual problems we encounter when you look further. There is a strong presence of dyslexia and dyspraxia in the close family.

Dyspraxic children have a combination of motor and peceptual difficulties and the problems with eye movements seem connected to the visual perceptual difficulties. A good starting point for info on these difficulties is Lois Addy, an experienced occupational therapist. I have her book How to Understand and Support Children with Dyspraxia pub by LDA. It is very good at outlining the underlying perceptual difficulties and has practical advice for schools.

I would suggest that if a parent suspects any difficulties with these skills they should go to the GP and ask for a referral to the local Child Development Centre. The parents of a former pupil of mine did this and he saw the paediatrician and was then assessed by an occupational therapist and given a programme of exercises to address his difficulties.

An excellent source of advice is the Dyspraxia Foundation - www.dyspraxiafoundation. There is also the Discovery Centre in Cardiff - www.dyscovery.co.uk the only national centre for assessment (you have to pay though).

Re the visual problems - this is a controversial area, certainly as regards the best treatment. You need to find an optometrist who has specialised in this area. It is not investigated in ordinary sight tests, so these coming up as fine doesn't mean a child doesn't have these problems. Many who have specialised in behavioural optometry are interested in this area. Look up the British Society of Behavioural Optometry for a list of members.

The main forms of treatment seem to be coloured lenses, overlays, eye exercises or lenses which are changed as the problem improves - these work instead of the exercises. The advantage of this is that it can be hard to get pupils to keep up a programme of exercises! It can also be hard to get a self-conscious child to wear coloured lenses.

I am planning to refer my pupil to a local optometrist who has done a lot of research in this area and has come highly recommended by Patoss colleagues and my local SpLD Base. This particular chap is not keen on coloured lenses, as they alter many things in the visual field but says to use overlays if they help. One thing which he said when I heard him speak, which sticks with me, if that anything is better than the glare of black print on white paper (esp glossy paper), so I always print my worksheets on cream paper.

I'm not sure this is necessary for many pupils. However, my new pupil found it more comfortable straight way. She said the print wasn't 'raised' and was more 'settled'. When we have work a worksheet laid out in columns she prefers to cover up any columns which we aren't working on, as they really distract her. This is because dyspraxics have difficulty in visual figure-ground discrimination - focussing on one thing and excluding background stimuli. This often leads to attention difficulties - the child who is distracted by everything around them and has to touch and pick things up!! All 3 of my dyspraxic (or suspected dyspraxic children) are like this. They also get very tired by the end of the day, as do the children with the worst dyslexic difficulties - with working memory problems.

As an aside, I am using Write from the Start, (recommended by Frances)written by Addy to address these motor/perceptual difficulties, with another pupil aged 6. It really seems to be helping her. After working on 2 booklets her handwriting suddenly became much smaller and neater, although it deterirates if she isn't interested in the task! We need to work more on letter formation though, as she starts all the letters at the bottom.

Back to vision therapy. The problem with this treatment is cost. Only the ordinary eye test part of assessment is covered by the NHS. So this could be a big issue for your pupil, Judy.

I have lots of handouts on dyspraxia and visual problems which I can send you Judy, if they would help.

Judy
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Post by Judy » Tue Jan 08, 2008 1:06 pm

I have lots of handouts on dyspraxia and visual problems which I can send you Judy, if they would help.
That would be really helpful, Anna. :smile:

Anna
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Post by Anna » Thu Jan 10, 2008 12:50 pm

I spoke to a colleague a few days ago re. my own pupils with visual difficulties and she also highly recommended the Institute of Optometry in London. I looked at the website and was very impressed. They have a clinic specialising in Specific Learning Difficulties and visual stress and the assessment appears to cover all the key tests.

They seem to take a very measured approach - ie only testing for coloured lenses after a child has used an overlay for some time and is still finding it useful. Also, as it is a research centre they are regularly examining the effectiveness of treatments.

I do wonder how much of these problems are exacerbated by the current teaching methods, when it comes to the visual problems with reading (just as with the phonological and working memory difficulties). Children are being encouraged to look at words as whole or look at rimes first then at onsets, looking ahead to try and work out words from context (which assumes they can read the other words)! As Debbie has pointed out many times, this is constantly working against the proper eye movements needed for reading.

As the IOO is a charity, the prices are much more reasonable than many of the private practitioners working in this area. This was one of my concerns - recommending a treatment which was so expensive to parents.

Judy
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Post by Judy » Wed Mar 05, 2008 7:29 pm

Maizie, Kelly and others may be interested to hear that the boy I mentioned above has had an appointment with his GP at last and been told that he has a slight problem. I assume it is 'convergence insufficiency' because he has been given some exercises to do daily with a lolly stick, which sounds just like 'pencil pushups' that I've read about it.

I don't know when this appointment was - the parents often forget to tell me things - but he has seemed to make more progress with both reading and spelling recently and is actually doing some homework at last! :grin:

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