Gifted Issues Discussion homepage Forums Twice Exceptional SPD and Vision Therapy

Hi everyone-

My DS6 has Sensory Processing Disorder and recently started vision therapy. He’s been in OT for SPD for a while and we have a pretty good sensory home gym and work hard to keep him regulated. When he initially began vision therapy, I noticed his sensory system went completely out of whack, and he really struggled (our whole family struggles when his sensory system isn’t somewhat regulated). He had about 4 sessions of vision therapy, but then we took a break (vacation and other reasons). He was so much better (sensory – wise). Now that we are back into vision therapy, he’s been a mess again. It is so difficult. It seems to be directly related to his vision therapy. Has anyone else noticed this with their kids who have done VT that also have SPD? I’ve asked the behavioral optometrist about it and he said, “well, maybe.” The OT said she hadn’t heard of that kind of extreme response, but she has noticed he needs much more intense work at his sessions. I’ve heard that completing vision therapy can improve some sensory issues, so I’m confused by his reaction.

He doesn’t fit the typical description of a child needed vision therapy. He’s been evaluated by two people. The first specializes in gifted kids (but is not local) and found he suppresses his right eye at a distance and alternates at near, and he has adequate depth perception, but not optimal. When we went to the local Dr., he initially didn’t find anything at all. I asked that the first evaluator call the local Dr. He had us come back in for further testing. He explained that he made several calls regarding DS and wanted to evaluate further. During the second evaluation it became clear how he missed the issues during the first test and that he did indeed have some things that vision therapy could help.

I just looked back at the notes from the different Dr.’s and found that the local Dr. found DS6 suppresses his left eye. That’s different from the first Dr. Now I’m wondering if the therapy isn’t focusing on the right thing if it will cause more of the upset with his system?

I’ve actually looked into switching Dr.’s, because I’m not a fan of the techs that do the therapy, but he is the only Dr. within an hour of us that takes our insurance.

The reason we had him evaluated is because it was recommended by the tester that tested him on the WISC-IV. His scores for Perceptual Reasoning are:
Block Design 14
Picture Concepts 21+ (did not reach discontinue point)
Matrix Reasoning 25+ (did not reach discontinue point)
Standard Score 161

The tester attributed the lower Block Design score to apparent visual confusion and slow processing speed (42nd percentile). Are these scores similar to other kids that have needed vision therapy?

I’m putting so much info here because I still don’t quite understand how it all fits together yet. It seems to me like he does need vision therapy, but that his problems aren’t too bad. Yet, vision therapy seems to have a huge impact on his sensory system, behavior, etc. Just wondering if anyone else has experience this, and if it is a normal response.

Thanks in advance for any help!

Hi!
I don't have any real advice, but maybe some things to consider (if you haven't already).

Can/ do you sit in on the vision therapy sessions? I've been offered to watch but my ds6 has a younger sibling. Also, I know ds will respond better if I'm not there. I ask this, because I wonder if there is something in particular (maybe if you saw) that you could tell was agitating the spd? Where my ds goes they do different activities each time. Would that bother yours?

Have you tried asking the tester thoughts about the change since vision therapy? Maybe that person has insight esp if he/ she know the optometrist and the OT.

I am sorry for this added stress for you and your family. Hope you find a resolution. There are people on this forum with a wealth of knowledge and experience. I'm sure they will offer advice.

Take care.

Oh- and tanking block design was the big indicator that my ds needed vt.

What were the individual psi scores?

Melessa- Thanks for your thoughts. I have been going in the sessions with him, but haven't noticed anything there that would bother him. He has a appointment tomorrow, so I'll talk to them then.

MumOfThree - Is psi processing speed? If so, he got 9 on the coding section and 10 on symbol search. I know gifted kids often have a large discprepancy between Processing speed/working memory and Perceptual Reasoning/Verbal. His overall verbal was 162 and working memory was 16 digit span and 14 arithmetic (not a super mathy kid). I've wondered if his scores indicate a LD, but not sure how to find out or where else to research it.

Sometimes whether its coding or symbol search that is poor can tell you something, but those are both similar and I am not any sort of expert in visual issues.

It makes a certain kind of sense to me that in a very sensitive person it would cause major disruption to reprogram the visual integration system. But I can't really opine knowledgably about whether I think there IS a problem to therapize. The gap between VCI and processing PSI and the fact that it was only block design that was low seems to indicate something but I have to say I would have guessed motor over visual for him to do so well on the other two PRI subtests - which are purely visual with no motor component.

My DD has minor visual issues (poor coordination and tracking but nothing earth shattering), her block design was stronger than the purely visual tests.

Heather, does he seem tired and/or agitated right after the sessions? Are you doing VT exercises at home, and does he seem more disregulated after those sessions? VT can definitely be hard work - my dd does not react in an increased sensory need but it's fairly obvious when she's had a session of VT that is tough - I imagine if she'd been through VT when she was younger it might have resulted in increased need for sensory input or stimulation.

I also wonder - did the psych who tested your ds do any other follow-up tests? Typically a neuropsych, when there is a similar split in scores between PSI and VCI/PRI, will administer a test of visual-motor processing that will help determine if the lower PSI (and potentially block design) scores are due to fine motor challenges or to visual challenges. My ds who has fine motor challenges had a similar dip in coding to your ds', but not symbol search - his symbol search was not as high as his other subtest scores but also not anywhere near as low as his coding. My dd who had severe double vision and has been through VT (successfully), hit the *floor* on symbol search - literally. One of her PRI subtests was also extremely low compared to the other two - I can't remember which for sure, but I think it was block design. For both of them, the follow-up Beery Visual Motor Integration test clarified the root of the problem (visual v motor).

Have you asked your ds how he feels about VT? Has it helped his vision at all yet? Does he like the exercises or do they bother him?

Also curious - are they doing any type of computer-screen or light therapy?

And one last thought - you mentioned your ds was better when he went on vacation from VT - were there other things left out of his schedule during that time? Are you sure it's VT, or could it be something else?

Best wishes,

polarbear

MumOfThree- Thanks for your insight. It's helpful!

Polarbear- He is tired after his sessions. He hates to do vision therapy at home - says he hates it because he has to stand still (we are talking only a couple of minutes at a time). We've tried to think about what else was different for those few weeks, but VT seems to be the common thread. He has had what I call a 'sensory meltdown' either the night or the day after a VT session. He has done some exercises on the computer, but no light therapy. During his session he gets really floppy and has a hard time even sitting up. (Normally he doesn't stop moving and seems to have endless energy) He always asks how much longer each exercise is. I'm going to try to do a lot of heavy work before and after his appt. today to see if it helps.

The tester was out of state, so they didn't do any follow up testing. We've researched a few neuropsychs that are local, but none of them really understand giftedness. One even didn't believe SPD was a real thing. He also suggested grade skipping DS would be harmful in the future.

Thanks for your ideas.

Block design involves timed handling of components. Wouldn't SPD inherently impact the physical aspect of that?

Just a thought as one possible lens... given brain plasticity, if there is a deficit in one area of the brain, therapy or training can lead to an alternate area being involved in managing some sub-system. So, if his brain is being trained through OT to use his vision system to help manage his physical coordination, then the sort of impacts you are describing would make sense to me.

I thought timed block design was until they got older -8? In my ds case, the tester knew vision was involved because of how he acted during it (turning the paper with the design, turning his head to the side, squinting.)