Gifted Issues Discussion homepage Forums Twice Exceptional Test Results-Vision Therapy?

We met this week with the ed psych that tested DS7. Along with being LD in written expression, she said we should take him to a developmental optometrist for visual processing issues. I'm not sure I've even got that right. She said he commented several times about the pictures on one test making him dizzy. She also pointed out several areas when his writing/drawing were asymmetrical and very odd.

Can you all share your experience with vision therapy/visual issues? Do the vision issues relate to the LD or is it something else entirely?

Also, she didn't say dysgraphia but LD in written expression. Are these essentially the same thing?

Finally, his GAI is painfully close to the DYS cutoff. Do these issues affect that score?

We're likely to take a similar path this summer with DS8. We had hoped that having his vision addressed with patching two years ago would've helped the handwriting and fine motor will catch up on its own. But not so much.

Meanwhile, I've read a ton on this, particularly in trying to mark out how much is visual related and how much just the way his brain ticks. Dysgraphia literally would be a problem with writing, but specifically most of the references point to a core language processing issue that includes a spectrum of other flags like spelling problems and challenges in generated complex writing and such.

I think there is an interaction in there between the visual system and the neurological coding that can get thrown off if the eyes aren't working together during some critical growth phases. There may also be interactions with the brain's general organization; such that a kid wired more towards patterns rather than details has a harder time bouncing back or may be more likely to have a wider range of dysgraphia symptoms.

So, other than patching to rein his amblyopia in, we haven't gone towards vision therapy.

As to IQ, my DS8 didn't have the WISC, but on the SB5 which is designed to be half verbal and half non-verbal section he had at least a fifteen point increase in verbal compared to non-verbal components. But you'd likely need to look at the subsections on the WISC to determine if your son is similarly impacted. I'd expect things like block design to be significantly lower if it is the case.

Here's a recent thread on VT
http://giftedissues.davidsongifted.org/BB/ubbthreads.php/topics/184209/1.html
There probably are more if you search back further.

For my DD, VT helped with a convergence issue. Her eyes did not work together at all. She got reading glasses which helped by making the print bigger but didn't really solve her problem. We sent her to about 8 months of VT (weekly visits with lots of home exercises that my kid hated but did do). After VT, DD no longer had headaches when reading. Though she could not identify it (she never knew anything different), before VT she had two images that she could not converge into one so it looked like the words were animated or "running off the page." After VT, her convergence improved significantly and she no longer used the reading glasses.

One caveat, some VT providers will claim that VT can "cure" dyslexia/dysgraphia. I think this is total bunk. I can assure you that while DD benefitted from VT, she still exhibits the characteristics of a stealth dyslexic. Her brain is wired differently.

Dysgraphia, LD in written expression, and Disorder of Written Expression are all names for the same thing.

And the research on vision therapy is that it can be helpful for some of the things others mentioned, like tracking and convergence, but will not remediate underlying learning disabilities, such as those in reading or writing, as those involve different parts of the brain, having to do with language processing, phonological processing, orthographic mapping, etc., not vision per se.

One of my dds was referred to a developmental optometrist after an neuropsych eval - she had uneven scores on the symbol search and another subtest under PRI (sorry I can't remember which one at the moment). The neuropsych also gave her a follow-up test (Beery VMI), and the results were very similar to what you've posted - her drawings were asymmetrical and very "odd" - I saw the drawings, which were supposed to be copies... and the only way I can describe them is "very odd" - they didn't look at all like what they should have looked like

We were skeptical of the whole vision therapy concept, but talked to a friend who's dd had been through vision therapy and it was a huge success for her, plus found an adult at school who was currently going through vt and having amazing successes. We also asked our regular eye dr, and even she recommended we look into it - even though our dd had recently been in for a regular eye exam with her and had 20/20 eyesight. Our eye dr explained it to us this way: a regular eye dr is looking at eyesight and eye health - what she checked for (at that point in time) was how each eye functioned *individually*, not how they function together (which is what the DO assesses and what VT corrects). Our eye dr also told us that (from what she's seen) VT can have good results if the reason for the eyes not working together is related to a *muscular* weakness or something physical, but it does not work to remediate dyslexia or other neurological challenges (which it is sometimes advertised as helping with). Our dd was assessed by the DO and I was stunned - one of the tests checked for double vision, which I'd *never* suspected but which dd clearly had a really bad case of - the thing was, dd didn't know at 8 years old that everyone else wasn't seeing two of everything - she thought it was just the way we all saw everything - so she never complained or said anything about it - until the DO's staff actually tested and asked. DD also had issues with tracking and convergence and severely limited peripheral vision - but we'd honestly *never* had a clue at home that anything was off with her vision. DD went through a full year's course of VT (weekly office visits along with daily exercises at home - some of which she didn't enjoy but some of which she thought were fun). It made a *tremendous* difference in her vision and in her ability to complete her school work.

FWIW, our oldest child is dysgraphic, and when I went in for dd's neuropsych parent interview prior to her veal, when I showed the neuropsych examples of dd's schoolwork, the neuropsych took one look at the papers and dd's handwriting and said "Not another one!" - meaning she thought dd had dysgraphia from looking at dd's handwriting - and it did look similar (as in extremely messy, all over the place etc) as my ds' - but after the testing the neuropsych felt dd wasn't dysgraphic but instead had vision issues. This is the tricky part to understand if you just look at the WISC scores - dd's dips in scores were in similar places as ds'. Dysgraphia can have two sources - fine motor or visual processing. DS' dysgraphia is clearly fine-motor related - he didn't have the issues dd did with the Beery VMI in copying, but had results from the VMI and from other neuropsych testing showing that his fine motor skills were impacted. DD's fine motor skills tested a-ok, but she couldn't copy drawings accurately on the VMI - due to her vision issues. Soooo... just looking at those tests, you might think that DD also has dysgraphia, because of the test #s - but dd didn't have wrist pain while writing, she didn't have issues with reversals of letters etc.



This really depends on what the basis for diagnosing the LD in written expression (was it a diagnosis of "Disorder of Written Expression" - that's a diagnosis in the DSM-IV manual). "LD in written expression" is a term that is more often used by schools. "LD in written expression", "Disorder of Written Expression" and "Dysgraphia" sometimes mean the same thing, sometimes don't. For instance, Dysgraphia almost always refers to a neurological disconnect that prevents a child from developing automaticity of handwriting, but once a dysgraphic child is given an accommodation (oral scribing or keyboarding etc) in place of handwriting, they are usually able to create significantly better written expression. A child who has Disorder of Written Expression might have dysgraphia only, but also might have challenges with other pieces of written expression - for instance, my ds had a challenge with getting thoughts out and with organizing them - this went beyond dysgraphia, because it still impacted him when he was given keyboarding and scribing as accommodations. In purely technical terms, the "Disorder of Written Expression" referred to scores received on the achievement part of his WJ-III testing that was done at the same time as the WISC - ds had another neuropsych eval 3 years later, after having worked with a speech therapist for an extended period of time on expressive language, and he lost the "Disorder of Written Expression" diagnosis (even though he was still working on expressive language issues with his speech therapist) and even though the neuropsych found that the physical act of handwriting was still (and would always be) an issue for him (the neuropsych said verbally he is dysgraphic, but used other words to describe the dysgraphia in her report both times - she said the reason for the difference in terminology relates to what schools expect to see).


I'm sorry that I don't remember which subtest it is, but I know that my dd tanked one of the PRI subtests when she had her initial WISC, and the neuropsych felt it was related to vision. DD hasn't had a follow-up WISC (post-VT), but she has had a WJ-III Test of Cognitive Abilities and we didn't see any of the pattern of low subtests due to vision issues - so I am guessing if she was given a WISC again that one subtest score under PRI would rise back up to the level of her other subtest scores (with the exception of the subtests that relied heavily on vision, dd is one of those kids who has across-the-board almost-identical in range subtest scores). So yes, I would suspect that your ds' GAI might go up if his vision improves.

OTOH, my ds' has had his PRI/VCI scores flip-flop between his early and later-on WISC testing - overall GAI/FSIQ were very similar, but the PRI/VCI were different each time - which means some subtest scores went up, others went down.

Best wishes,

polarbear

NikiHarp, I'd suggest calling up the ed psych who administered the test and ask this specific question. We did that after our post-testing neuropsych parent interview, because we hadn't heard the term "dysgraphia" until after we'd been through the interview. Asking that question may get you some more info on the specific challenges your ds has, or shed a little bit of clarity - it did for us.

Thanks everyone. I appreciate all of your responses.

DS's lowest subtest scores were in working memory and processing speed. However, he got 95% in symbol search and 84% in block design. She said he was really slow with block design.

She did Beery too. I know nothing about this test, so let me know if more information would be helpful. He got Average in VMI and Motor Coordination and High in Visual Perception. I need to research this some more-we spent very little time discussing this.

I'm certainly not going to rule out vision issues, but I'm having a hard time making sense of this in light of his scores.

VMI stands for Visual Motor Integration - it's the subtest that requires copying designs. Since your ds scored high on symbol search and on Visual Perception on the Beery, it sounds like it's not an actual vision issue, but rather the ability for his brain to integrate visual information with fine motor. A lot of the exercises my dd did in vision therapy addressed that type of issue, but I can't tell you for certain whether or not VT would help your ds - since the psych suggested it, I'd consider going for an initial eval with a developmental optometrist that the ed psych trusts to be honest re assessments.

I think I might also ask the psych why average scores on the VMI and speed on block design would be a concern? FWIW, my 2e children's scores on their low subtests on the WISC and Beery were considerably below the scores you've listed.

polarbear

Thanks, polarbear.

I don't think those scores did concern her. I think it was his comments about being dizzy, his asymmetrical drawing in several areas and skipping a line while reading (?) that caused her to mention it.

From my limited understanding, the scores don't seem to back up her observations and I thought they would. Like you said, maybe the issue is with integration. I think the eval is worth it. If nothing else, we can rule it out.

polarbear rocks

Agreed. So grateful for the time you take to respond polarbear!