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So I have been following this thread with interest because my DS doesnt fit neatly into any of the LD or VT categories but there's something going on.  He definitely has fine motor issues, and perhaps fine motor integration issues which make his handwriting a mess. We had one set of vision tests which identified a tracking issue but not a huge one. He has zero difficulty reading but clearly has something which makes the spacing of letters in words and between words so difficult for him. And someone - Polarbear? - mentioned the eating every meal standing up - wow is that famillar.  

We are waiting to set up the next level of vision testing for perceptual stuff and there some fight going on between eye doctors about the skills tests being necessary before the perceptual test and the doctor who did the first set of tests saying its not necessary. So I don't have the report yet which is driving me crazy because it is preventing me from having something to give to his 1st grade teacher about his vision and writing as an amendment to the IEP.

But, the reason why I chimed now  is the discussion sent me to my insurance carrier's policies to see what they said - wow - there's quite a fight going on being the AAP the AAO and other alphabets orgs dealing with vision, children etc. so my policy says, we pay for VT for these things, but not those things and expressly highlighted these studies regarding VTs ineffectiveness for dyslexia and other LDs. Most interesting for our situation was- they cite this - 
And then it goes on to say there is no discernible effect and blah blah blah not covered! I get that the n's are small.  But what is really interesting here was the fact that the evaluation can clearly identify deficits, so worth doing, but they can't determine outcomes of therapy as conclusively. But it seems to suggest that if reading is an issue the testing is valuable - the mixed response is about what can be done to remediate.  Doesn't help us as much since reading is not his issue and it's not just a core/strength issue but I found it interesting and thought I would share!

DeHe

Dehe - interesting!

As for your DS, my DS also has benign congenital hypotonia (apparently inherited frm my husband), which causes problems with core/strength and fine motor. Eating meals (or doing anything really) standing is a big tendency for my guy b/c it is somethign about sitting an holding posture that is really difficult b/c of the hypotonia. You may want to look into that. An OT can help but I don;t think they can diagnosis per se... A neurologist diagnosed by DS but all the OTs could tell me he had it easily and quickly. One thing that goes along with hypotonia is hypermobility (double jointedness) - my son can "click" his joints for example (creeps me out)... as he gets older, stronger does therapy his ability/tendency to "click" seems to be declining thank goodness but hypermobility, I believ goes hand in hand with hypotonia.

I had a conference with new vision doctor yesterday. I checked into a new one b/c the one we are with now is farther from me, much more traffic en route and has limited hours.

The new place is so much nicer.... it's bigger, better hours more therapists, therapist are really good with DS - young, etc.

Also, they gave DS more tests and sat me down for an hour conference (free of charge)to explain the results... the other place did not do the "conference" really. The other place was super nice and good too but this place is more .... I don't know... efficient? professional?

I am feeling so much better about it all. Alhough it so breaks my heart to see from the tests how much my poor DS was struggling to "see" (despite his 20/20 vision). They gave him visual spatial skills tests, visual analysis skills tests (visual memory he scored hgh and in visual discrimination he scored really really high!), they gave him visual motor integration tests including the BEERY. They wrote up all about each tests, DS' performance and what it means in a report for me and the school with some clear recommendations for the school about what DS needs. The doctor was very, very optomistic about the VT truly fixing my DS' problem - DS is like the type of case that is ideal for VT. This guy said DS would not be a a good canidate for surgery in his opinion.

I have to say DS' reading alone has imporved so much already. After two years of it being so laborious filled with angst, eye discomfort, and misery, yesterday he read an 18 page book - "The Tortious and The Hare" so fluently, easily and he actually enjoyed it... I can't believe it. Finally. Even he was like "is this real?!? I can finally read now?!?"

I made an appointment with a surgeon anyway - just to get yet another opinon. The surgeon is recommended by a neighbor whose child (same age as my DS) had surgery last year for intermittent exotropia. They felt they had no choice but surgery. I definitely plan to stick with the vision therapy for now as it seems to be helping tremendously and the prognosis is so good. However, I like to research things thoroughly and so I do want at least have the surgeon's thoughts and opinons... Current doc said that he is pretty sure the surgeon will not recommend my DS for surgery, though.

I am feeling so relieved and optomistic. The doctor and therapist that evaluated my DS were so impressed with his intelligence... they really had may many good things to say about him and said he was a real pleasure to work with (his other VTs say this too). They all got a big kick out of him. Which is so nice to hear since all school year I hear a lot of negative comments about him. Maybe that will change now with this problem being identified and addessed.

I'm leaning toward setting up an apt with someone different than the more "aggressive" developmental OD I was originally planning to have dd see b/c I'm hearing from more than one person that he is inclined to push VT for everyone no matter how small the problem or whether it is LD based or mechanically based.

However, I have one question to see what you all think. One place we could go and have the "routine exam" covered by insurance is a more traditional eye center (sees people for regular glasses, more opthamologists on staff than the one OD, etc.). What they tell me is that their one OD can test for convergence insufficiency as part of the regular exam, but if that's what it is, it would no longer be considered a routine exam and would, therefore, no longer be covered by our vision plan: it would go to our medical plan where we'd likely wind up playing most of the $285 cost.

I guess that was a sidetrack, not my question, lol! Anyway, so here it is:

Do you think that ANY OD could dx convergence insufficiency as well as any other. In other words, is it an objective diagnosis? I suspect that this guy would be a lot less likely to see something that isn't there or push for treatment of a very minor problem that isn't likely causing all of the issues we're seeing, but don't know if that also means that he'd be less likely to catch a problem.

From what the office says, he doesn't do VT himself, but can refer you to someone else for it or get you set up with a computer program for VT.

I think so ... I think the diagnosis is objective but the OD needs to give the tests, which is why a basic vision test doesn't catch problems. However, perhaps the problem comes with the OD knowing (and willing) to give the battery of tests, ykim? Anyway, that's just my gut reaction not expert or substantiated in any way really (obviously). Except that, during my son's initial developmental tests I could "see" his disability quite clearly - like, all he needed was to be given the test. Having said that, the new place I went gave several more tests (obviously) - like the Berry, etc... where more valuable information was revealed about what exactly DS eyes are doing, when and his visual processing. However, my understanding is that those tests aren't really given automatically - I think they are only given when the diagnosis/problem is found. This new place touts sort-of a more complete (for lack of a better word) approach - they refer out to neuropsychs, do dyslexia screenings, etc. The feeling there is "we can give you visual info and diagnosis and we can point you in the right direction if that is not your child's problem or if there are additional challneges we think are present." In my case, they believe that additional LDs are not present, that DS' problems are completely physical/visual (eyes over-crossing intermittently causing tracking, sequencing problems, etc.) One of the neuropsychs I know they refer to is listed on the Hoagies website and has a great rep for LDs.


Anyway, not sure how much that helps you. I wish you live din my area. I feel like this second/new place I went would be a really good place for you ...

I have a friend/acquaintance who is an OD, I could try to ask her if you like?

What, exactly, did they do during this test? The other office I mentioned had the OD's assistant ask the OD himself as to whether a routine exam could pick up convergence insufficiency and what they told me he said was the there was "another test" he could do during the routine exam that would pick it up. I guess that I'm wanting to know what this other test ought to be.

Sure, that would be great if you have the time. Thanks .

Hi! Okay I talked to the woamn that I know who is an OD about Your questions Cricket2. Here is what she said:

"The question as to who can diagnose CI is a little tricky. Yes, we are all legally able to diagnose it and we are taught it in school. It is a relatively objective set of tests. However, the average eye doctor probably diagnoses CI or other VT issues maybe once or twice a year when it's a patient with crossed eyes or obvious headaches and double vision when reading. The rest of the time, they just don't do the tests that would uncover the problem. They really don't.

Now if she specifically went in there and said "I think my child has convergence insufficiency and I would like you to test for it", they could manage to do a test or two. The one that's most relevant is called the "Near Point of Convergence" or NPC. That's when we bring a shiny ball (or sometimes a pen or toy) slowly up toward the patient's nose and have them follow it in closer with both eyes together, watching for one eye to lose grasp and listening whether the patient gets double vision. There are also other tests of their eye positioning and ability to handle a convergence demand. The NPC is the most basic and easiest to do, so that's probably the other test the doctor was going to add on.

But honestly, why not go to a doctor that actually treats the problem to make the diagnosis? It's the same co-payment."

I hope that helps you Cricket! I may private message to make sure you get the info...

I think that my main reason on "why not" is that I am hearing from others that the drs who actually treat this type of problem regularly also tend to over-diagnose and b/c, from what the one guy's office tells me, if they see a likely problem in the regular exam, they'll suggest a second $385 exam, that isn't covered by insurance, to confirm and in order to recommend treatment.

Oh great you saw this info!


Oh yes, sorry, I understand that! I just cut and copied her email to me (and I hadn't included any info on you being concerned about over-diagnosis in my original email) ... I wonder what she would say if I explained that to her... She feels strongly about diagnosing these conditions, though, she feels they are missed so much and cause so many unnecessary problems so I wouldn't want to come off like I think it's a scam or whatever. But anyway, yes I get and understand your concerns!