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Joined: May 2013
Posts: 2,157
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I think you are probably right about her being overly cautious, hence the score. It probably makes a big difference on a test like that. Kids with true slow processing speed are slow in everyday life, so if you are not seeing that I don't think you need to worry about the score.
I'm curious about the number calling test you mentioned. How do you do it informally at home?
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Joined: Sep 2011
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{quote=blackcat+So when I hear people say that their child has reading difficulty because of their visual convergence issues, I am very skeptical.[/quote] Our dd who has visual challenges had a diagnosis of convergence insufficiency, as well as double vision and limited peripheral vision. Her situation is different than blackcat's ds and her issues were due to low muscle tone, not injury. Vision therapy helped her tremendously, in ways I wouldn't have recognized until we were in the thick of it. I was able to sit in on her appointments and saw the exercises she did with her therapist and at home, as well as testing over time that showed her improvement. Sorry I don't have time to write more at the moment, but fwiw, quite a bit of what was impacting our dd were things that we couldn't see until they'd been addressed by her VT. I'll be back later to try to explain more fully ![smile smile](/bb/images/graemlins/default/smile.gif) Best wishes, polarbear
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Joined: Mar 2014
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I have a question. If she was only tested a year ago is there a reason that they did not use a WISC V and a WJ IV? The pattern should remain the same but Please keep in mind that the scores on both the tests she was given are going to be somewhat inflated because there are updated versions (and updated norms on both of these tests), I am seeing as much as twenty point differences between the old and the new. My experience is that the verbal items have a much higher ceiling and the PRI and FR do as well.
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Our dd who has visual challenges had a diagnosis of convergence insufficiency, as well as double vision and limited peripheral vision. Her situation is different than blackcat's ds and her issues were due to low muscle tone, not injury. Vision therapy helped her tremendously, in ways I wouldn't have recognized until we were in the thick of it. I was able to sit in on her appointments and saw the exercises she did with her therapist and at home, as well as testing over time that showed her improvement. Sorry I don't have time to write more at the moment, but fwiw, quite a bit of what was impacting our dd were things that we couldn't see until they'd been addressed by her VT. I'll be back later to try to explain more fully ![smile smile](/bb/images/graemlins/default/smile.gif) Best wishes, polarbear My point is that DS had very severe convergence issues and didn't have any reading issues. It ranged from very severe to very mild as his eye gradually moved back and the paralyzed nerve healed (each day after the first couple months there was a tiny bit of movement until he could fully track to the outside). So I am not sure why a convergence problem would cause reading problems in some kids but not others. That's why I'm skeptical. I'm also skeptical of VT. How do you know that your DD wouldn't have improved anyway or that the VT is what helped? Maybe there was something else going on at that time, like a good teacher, or working with her at home, or simply maturation that caused the improvement. I'm not saying that I'm positive the VT didn't do some good for your DD but when there are no decent controlled trials on a large number of kids, I am skeptical. A lot of people spend thousands of dollars on VT and don't see an improvement, or the improvement is temporary.
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Joined: Nov 2013
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blackcat - I've pm'd you about the test.
sallymom - the psychologist was still using the WISC-IV because there were no extended norms for WISC-V yet (at that time anyway). her Woodcock-Johnson III reading scores were pretty low relative to the VCI and GAI, and that fact presumably wouldn't have necessarily changed even with a different IQ test (but who knows for sure). also, aeh looked for me and said that they weren't WAY out of line relative to the VCI ... but given that VCI itself may have been something of an underestimate for the reasons described before, the fact that that the difference between reading achievement and VCI didn't quite reach statistical significance isn't completely reassuring.
all: to be clear.... most people seem to lump VT all into the same category. however, there's a joint statement by American Academy of Pediatrics and the big ophthalmology organization that accepts VT as proven for convergence insufficiency. how they define that, I don't know - I believe a lot of medical folks think that the optometrists overdiagnose that as well. but anyway, if someone has a CI diagnosis, I don't think you can automatically say that using VT is unproven. with other diagnoses, though, it's different, and the medical people do in fact say that VT for these other diagnoses is unproven. Of course, everything that is now proven was at some point unproven. Apparently many sincere DOs, and intelligent parents, do feel that they see a difference that is attributable to the VT. But of course, there may be many more who don't see a difference (and the truth is, people who didn't get results are less likely to speak up - no one likes ruining someone else's hopes; I have a feeling that the "yays" are going to be way overrepresented on boards like these). And yes, even for those who do, most are going to be hard pressed to attribute it to the VT. In most cases where someone felt that there was a dramatic change, it took a pretty long time AND the child was undergoing other therapy or other changes at the same time. Still, I've heard enough stories, as have people like Linda Silverman and our psychologist, to think it was worth checking into, if not necessarily actually deciding to do the very difficult (not to mention expensive) therapy.
The biggest problem I see now is that the diagnosis that isn't now in question - convergence EXCESS - is not the one that the medical people agree could call for VT, and not the one that most children of parents who swear by VT had. (Some of those kids had both tracking problem diagnosis and convergence insufficiency, but it's less clear which one mattered in terms of the VT making a difference in the child's life. And, as I said, it appears to me that the DO either misinterpreted the tracking test, or recorded a typo that made a huge difference in the way it should be interpreted. So while possible tracking issue was one I was in fact thinking of when I sought out a DO for an evaluation - esp since her score on the cancellation structured was lower than her score on cancellation unstructured - I don't think we now even have a legitimate tracking problem diagnosis.
blackcat- not sure why a severe convergence insufficiency problem wouldn't cause some reading problems, at least if I understand what that is. Is it possible your child had learned to ignore input from one of his eyes? Also, I have read that many profoundly gifted kids with big convergence insufficiency problem still read many years above grade level, but they had other symptoms, read less than they did after treatment, etc. But I don't really know enough to have informed opinions here, just speculating.
I do appreciate everyone's sharing opinions and experiences with me.
To clarify for anyone who hasn't read more of my posts: my DD2 does have some issues - it's not like everything is perfect and I'm getting concerned ONLY over some test results. They're not terrible, esp last year (5th grade). But she is slow in real life at times, she does get stressed at times, she has occasional headaches and gets tired at times. Her reading level as measured by WJ-III is a little low, she makes occasional "careless" errors (reads questions wrong, skips a question). Her handwriting is messy (poor spacing between words esp). She used to resist writing, she used to resist reading aloud. She seems to read weird (really fast, saying that she reads at least a line at a time, maybe more). She possibly hasn't made as rapid progress in terms of choosing to read difficult material as I might have expected (but who knows really - I don't have many to compare with here).
Could these be caused by other things, including being EG / asynchrony (not related to vision) and/or just be typical 11-year-old behavior? Or something completely different, like dyslexia. Or just normal behavior (how many careless errors too many careless errors, how many headaches does the average 11-year-old get, etc.). Yeah, sure could.
This is what makes the decision hard. This and the concern that we might be missing a "window" (with vision, dyslexia, something else, who knows). If I didn't believe that there were windows, I would probably just wait and see if we have a "good" year again next year. I am leaning toward doing that again anyway - we have a lot of very difficult things coming up next year in some other ways, and not necessarily time to add another very difficult thing onto our plates.
My thought was that if we could expect to see an unmistakeable change more rapidly - say 4 to 6 weeks - we would maybe try to power through. But that doesn't seem to be the case. The long, expensive, very very troublesome therapy (both in-office and daily at home), when I can't find even one person who believes her kid was successfully treated for convergence excess, seems like too much, just in terms of costs and probable benefits.
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polarbear - welcome back. when you are caught up with everything, maybe you can check in on my private messages... thank you!
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Joined: May 2013
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blackcat- not sure why a severe convergence insufficiency problem wouldn't cause some reading problems, at least if I understand what that is. Is it possible your child had learned to ignore input from one of his eyes? Also, I have read that many profoundly gifted kids with big convergence insufficiency problem still read many years above grade level, but they had other symptoms, read less than they did after treatment, etc. But I don't really know enough to have informed opinions here, just speculating. All I can tell you is that he was able to compensate very well. He claimed he had double vision when his eye was not patched, and when it was patched, we were patching the normal one. The impaired one barely tracked at all, and for a while it was severely crossed inward and you could barely even see his pupil. So how was he able to read with an eye that didn't track, I have no idea but I listened to him read aloud, and he was fluent. Without the patch, I think he just looked at one of the images or closed one eye. . He claimed to have headaches, but I think that was because he fractured his skull. But who knows. It's hard to figure out what is really going on with a 5 year old, But you don't want to try something based on anecdotal evidence from just a few parents. I don't want to be a debbie downer about VT. Maybe it does work for some kids. We all want to try anything with our kids that might work. But VT is very controversial and sometimes it seems that anyone who gets evaluated by a dev. optometrist walks away with some sort of diagnosis and a prescription for vision therapy. Does anyone have normal vision? I hardly ever hear anyone say "we went to a dev. optometrist, and didn't find any problems." I am guessing many kids are referred to therapy even if they are not one of the few that it would help. Another thing that I want to mention is that DS's OT was not particularly surprised at the fact that he is reading fluently, even with eyes that appear to track independently from each other, because the eyes do not really track with reading even w/ people with normal vision. They jump from place to place.
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Joined: Sep 2011
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polarbear - welcome back. when you are caught up with everything, maybe you can check in on my private messages... thank you! Hi LaurieBeth - thanks for the welcome back ![smile smile](/bb/images/graemlins/default/smile.gif) I'm in the midst of trying to catch up on everything, but promise to catch up on your pm too asap! Definitely within the next day or too... sorry I'm a bit behind! polarbear
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So I am not sure why a convergence problem would cause reading problems in some kids but not others. That's why I'm skeptical. I'm also skeptical of VT. blackcat, I *totally* understand your skepticism - I was very *very* skeptical myself. The reasons I considered following through with vision therapy for my dd were these: 1) It was recommended by a neuropsychologist whom I respect - she's the same dr who diagnosed my dyspraxic ds and had been highly recommended by our ped. She's a professional I knew and trusted, and who also wasn't going to benefit financially any which way in recommending vision therapy. We landed at the neurospych to begin with because my dd was struggling with what seemed like cognitive issues - she couldn't follow a multi-step direction if her life depended on it. She was also struggling in school, yet we knew from a pre-K eval that she *shouldn't* be struggling based on IQ. The neuropsych eval found her to be extremely "constant" (same close percentile range) on all but two WISC subtests - both of which relied heavily on vision. 2) at the same time that we were pursuing the neuropsych eval, our dd had been complaining that she couldn't read the board at school (it was the start of a new school year, different teacher, different handwriting, moving into a grade where more was communicated than previously via instructions written on the board. Naturally we took dd to our optometrist when she complained about not being able to read the board, and her eyesight was measured at 20/20... so we thought her vision was a-ok. Again I was skeptical of the whole VT concept in spite of np's recommendation 3) I have a friend with a dd who's ahead of my dd by a few grades in school, who I knew had gone through VT, so I called her up to ask her and she raved about what a tremendous difference it had made for her dd re reading and being able to study for school. Again, I didn't buy it - so I asked our regular optometrist, who I anticipated would say it's hogwash - and she didn't, she actually recommended it, saying that while it's definitely not proven for dyslexia/etc and is sometimes claimed to cure ADHD etc, which it absolutely isn't a cure for.... vision therapy does in fact work well for people who have vision issues related to low muscle tone (which is my dd's issue). I was very confused about why our eye dr wouldn't have already caught an issue during her exam, but she explained that her exam only included looking at the sight in each individual eye - not how the eyes work together. Soo... we decided to take a chance on VT based on our eye dr's recommendation (fwiw, she also knew the developmental optometrist and had other patients who had worked with him successfully.) And there was one last person who clinched it for me - I found out in a round-about manner that our school's librarian had been through VT too, and had benefited from it. She'd thought her near sight was going due to age changes when she hit 40, but her eye dr determined it was instead convergence issues, she went through a course of VT and the VT worked for her. The thing that *really* convinced us, though, was the initial VT eval. I was there for the eval and was watching when they held a stick out about 4-5 feet in front of dd and asked her how many she saw, and she said 2 with complete confidence like it was the most ordinary thing int he world to see two of everything. Up until that point I'd had *no* idea that she had constant, severe, double-vision. When asked about it, she confirmed it. So that made me realize she needed *something* so we followed through with her vision therapy. FWIW, I also saw tests that illustrated the convergence issues and tests that determined the very limited extent of her peripheral vision. How do you know that your DD wouldn't have improved anyway or that the VT is what helped? Maybe there was something else going on at that time, like a good teacher, or working with her at home, or simply maturation that caused the improvement. The things that we saw that helped - 1) almost immediate improvement in things that we didn't realize were tied to vision. For instance, we learned pretty quickly that the reason she couldn't follow multi-step directions was that she spent so much mental effort trying to follow through on the first due to visual challenges that she'd forget about the second/third etc directions. DD confirmed this - if we asked her to pick up a book in the living room, take it to her room, then go to the kitchen, for instance, she would have a tough time picking up the book and would never get to her room. This all changed within the first few weeks of vision therapy, and she told us it was because she would get confused when she was seeing two of everything. The other thing we noticed almost right away was she was no longer the place-at-the-table with crumbs everywhere, and she was no longer our "family clown" who bumped into everything continually. Second thing, although she was a capable-enough reader, she wasn't reading at the level her IQ would predict, and she also didn't enjoy reading. At approximately 3 months into VT, she morphed from a kid who really didn't care about books to a kid who literally lives with her nose covered by books 24/7. Her reading speed is phenomenal, and she loves loves loves to read. She didn't undergo a personality change, she simply was finally able to see well enough to discover her love for books. DD also never sat still before VT - there were many times we thought, and many people who also thought she must certainly have ADHD. Yet once she'd been through a few weeks of vision therapy, she could sit down and read and do school work continuously for more than a nano-second. She also no longer bent her head around in odd ways to look at her schoolwork, and she started maintaining eye contact with us (prior to VT she looked off to the side... after VT she explained the reason she always looked off to the side was to avoid seeing double heads...) The bending around in odd ways while studying was due to her brain shutting down the eyesight in one eye to compensate for double vision. We never see that any more. Most important change perhaps - she doesn't get tired when she reads and studies anymore. We didn't really realize she was tiring before VT, but it was very obvious in hindsight. I also know quite frankly that VT wasn't a cure-all - dd still has to work to keep her eyes tracking together, but she can make them track now and it's much less work and much tiring than prior to VT. Could it have been the result of something else - a good teacher? work at home? developmental growth. No way. She didn't have a teacher focusing on helping her learn how to read more efficiently, we were for sure not working on eyesight/reading etc at home *outside* of the exercises she did that were specifically assigned from her vision therapists. I sat in on each of her VT sessions, the therapists explained the goal of each exercise, I saw the measurements they took to evaluate progress. I didn't see any quack science (and I'm a scientist), I just saw caring professionals explain the services they delivered in a way that made sense, and I saw the exercises work over time. I'm not saying that I'm positive the VT didn't do some good for your DD but when there are no decent controlled trials on a large number of kids, I am skeptical. I totally get this, and it's also interesting that you bring this up w/re to this one dd of mine - because this same dd has a medical issue that consumed us when she was a young toddler and in early elementary. She's not the only kid on earth with the issue, and during early elementary when she wasn't following the developmental curve with respect to outgrowing the issue that her dr predicted she should, new ideas were coming out re how to approach this issue. I will never forget being lectured by her dr when I asked could we consider one new idea with the "there have been no clinical trials to prove..."... well... by the time clinical trials had been conducted and proved/disproved the theory, my dd would be grown up and her childhood would be over. I hope I don't sound like a soapbox here, but I suppose I approach life a bit more from looking into something and determining if it makes sense.. and then if there are no clinical trials yet, so be it. I wouldn't let that stop me from something that may help and won't hurt (as long as it's affordable). We were lucky there - our insurance covered the VT. Which might be another indication, perhaps, that it has some perception of being a recognized form of treatment for vision issues caused by low muscle tone. Sorry if I sounded like I was screaming from the top of my soapbox, I'm not. Just wanted to try to explain what we found, for our *one* dd, my only true experience with it. I definitely don't have any professional credentials to back me up ![smile smile](/bb/images/graemlins/default/smile.gif) ... and I do think that the cause of my dd's convergence issues was very different than your ds' issue. Best wishes, polarbear
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Yes, polarbear, and thank you for your detailed descriptions; they show how very different your situation is from ours.
On repeated questioning, DD says she never sees double and never has blurry vision.
She seems to read well ("13th grade" overall on WJ-III at age 10.5, 10th grade Broad Reading, which even takes into account the timed portion of the reading tests), although her score was on the low end of the range of not statistically significant. She loves reading.
She doesn't think her own reading or vision is problematic in any way.
She has occasional headaches (and nausea), but it's not clear that they are correlated with near vision tasks (though I'm trying to start keeping better track of that).
All of the other problems are vague, possibly quite normal, possibly related to other issues for an EG kid, or could mean something else. And they weren't nearly as bad in 5th grade as in 4th and 3rd (although many things changed in 5th grade, and it's hard to know if this will continue).
Based on policy statements online, it appears that neither United nor Aetna will pay for vision therapy for our diagnoses (I think it may be otherwise for convergence insufficiency, in line with the American Academy of Pediatrics and opthalmology association statement of position).
When I asked how long it would take to see unmistakable improvement, DO first said 8 weeks, then said at least 8 weeks (and you know that if we miss one 20-30 minute session at home or one in-office therapy appointment, due to headaches or illness or homework or someone's birthday party or holiday or need to take DD#1 on a college search trip, they will say, "well, that's set you back...").
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