Gifted Issues Discussion homepage Forums Twice Exceptional reading difficulties, dyslexia?

My DS6 was recently given a test of visual perceptual skills (TVPS) to see if it is the cause of his difficulties with learning to read. Does anyone have any input on the results below? The OT who administered the test said that since he was in the average to low average range, he shouldn�t require any special accommodations in this area to be able to learn to read. She told me that average is anywhere between the 16th and 84th percentile. I find this confusing, as below the 50th percentile, more than half the children his age would do better than this � why is the 16th percentile considered average? Do any of these results point to a vision or tracking problem?

A. Visual discrimination (ability to recognize similar forms): average 25th percentile

B. Visual memory (ability to immediately remember characteristics of a form and be able to identify it when it is grouped with other similar forms: high average 63rd percentile

C. Sequential memory (ability to immediately remember a series of forms and be able to identify it when it is grouped with other similar series: low average (16th percentile)

D. Spatial relationships (ability to understand and use the concepts of spatial position such as above, below, beside, in front, etc): average (37th percentile)

E. Figure �ground discrimination (ability to distinguish the figure from the background and focus on an object): low average (16th percentile)

F. Consistency of form (ability to recognize similar forms despite changes in size and position): low average (16th percentile)

G. Visual closure (ability to mentally complete an incomplete form): average (25th percentile)

He also recently had a partial evaluation with a speech therapist to look at areas that might affect reading. He was above average on working memory, and average to above average on putting sounds together to form words verbally. The area where he was weak was on rapid naming (not sure of the official name as he took the test in French). This was a test where he had to �read� lists of colored shapes (e.g. red triangle, blue square, etc). He tested about 1.5 to 2 years below his chronological age on this test.

Background on DS: seems to be a bright child, likes math and has a good memory, vocabulary and understanding. He has motor dyspraxia (problems with fine and gross motor skills) and hypotonia. He reached all his motor milestones late. He is having a lot of trouble learning how to read. I have noted issues with word recall from an early age. It took him forever to remember the color �yellow� � he called it �the color of the sun� for a very long time. It�s like he has the concept in his head but can�t get the word out.

Any advice from those with knowledge of dyslexia and/or vision issues?

The lowest of those scores are certainly in the range where I would think further evaluation for vision and visual processing are in order. Have his hypotonia and dyspraxia been investigated further? There are neurological problems that can affect all of these functions simultaneously.

We have seen two different neurologists who both felt that he has "developmental coordination disorder" (dyspraxia, hypotonic type) and no other neurological issues -- but I would be very interested to hear of other possible neurological problems.

For vision issues, should I be looking for a developmental optomemtrist? Would my general optometrist be able to help?

He had an MRI that showed a slightly smaller than normal cerebellum which the neurologist thought DS was born with and could explain the dsypraxia. We've seen a geneticist who didn't suspect any type of syndrome. He has also had blood tests and muscle/nerve response tests that all came back normal.

He is a happy, bright, sociable boy, but I worry about whether he will be able to do well in school given his difficulty writing, and maybe reading too . . . He is currently in grade 1.

I think 16 to 84th percentiles are 'average' in that they are within one standard deviation of the mean. If you think of a bell curve, most of the population bunches up in the middle. That's why schools work in general.

You can try teaching him 'how to read' without reference to visual images. Just by talking about letters and what sounds they make and 'what word to you get when you put a 'c' with an 'a' with an 'r.' What if you put a 'b' in front of the 'ar?'

I guess you'd have to check that he knows the letters first, by asking 'how many letters can you name with no straight lines?' How many have no curves or circles?'

I would only try it if you can keep it 'fun' - perhaps while waiting in line at the grocery store, during car rides, as a way to pass the time.

Good luck!
Grinity

Thanks, that helps. I guess I wouldn't think of being one standard deviation below the mean as "average" but I suppose that is what they meant. 16th percentile seems problematic to me, especially when I am pretty sure his understanding and reasoning are above the mean.

He does know pretty much all his letters, and quite a few phonems (he is learning to read in French, so there are a lot of these), but seems to panic when they are all in a row in a long word.

For possible vision and visual processing issues in a child with that medical history, I'd suggest an evaluation by a pediatric neuro-opthamologist.

I think you are wise to stay on top of this. My ds now 13 and severely dyslexic had many of the same characteristics as yours at age 6. Things like poor sequencing skills that show up in his testing (16 th percentile is below average) and his slow development of motor skills come in to play with reading (think, keeping the letters in order, understanding that you need to go from left to right, letter confusion b/d, g/b etc). You also say that his rapid naming scores are low. This test may have been the CTOPP � comprehensive test of phonological processing or RAN RAS? (Although there are many different instruments). Low rapid naming is the single most consistent predictor of reading trouble. http://www.childrenofthecode.org/interviews/wolf.htm

The OT test is a good start, but since dyslexia is a language processing issue, I recommend that you get further testing including a full neuropsychological evaluation that looks at overall cognition (IQ, memory, organization) as well as receptive/expressive language, and academic achievement.) Let the evaluator know that you are concerned with reading so that they thoroughly evaluation reading, writing and spelling skills. Additionally, I would consider a speech and language evaluation that looks at how he processes and organizes language. There is often a link between oral language and written language.

In the meantime, I would begin to research reading disorders. The best book Is �Overcoming Dyslexia� by Sally Shaywitz. I also like Straight Talk about Reading by Susan Hall &Louisa Moats � my favorite when I started down the road. Here are some articles to get you started:

Is it a reading disorder or a developmental lag? http://www.readingrockets.org/article/32540

Resource for many good articles on reading http://www.readingrockets.org/article/c74/


Good resource for articles about LD testing http://www.ldonline.org/indepth/evaluation

The special ed process http://www.ldonline.org/article/Understanding_the_Special_Education_Process/20494

Great website about special ed law www.wrightslaw.com

Finally � if your child is in a public school it is important to understand the special ed process and laws governing special ed. If your child does have an LD of some sort, you will want to work with the school to insure he gets the right supports and instruction. Sometimes this goes smoothly, sometimes not. But outcomes are better for children with knowledgeable advocates. This forum is a good one to discuss the ins and outs of special ed as well as to get answers about how to recognize and treat an LD http://millermom.proboards.com/index.cgi? (Learning Disabilities, ADHD and Education Support).

Hope this helps � pat on the back to you for actively searching for answers.

Just wanted to add this resource that talks about tests for reading: http://concordspedpac.org/Whichtest.htm

And here is some basic information about dyslexia from the International Dyslexia Association:
http://www.interdys.org/FAQ.htm

Thank you Mich -- very helpful links, I've already looked at a couple of them. They made me think that I'm doing the right thing by not adopting a "wait and see" attitude to reading. The ones about special ed. process and laws might not be relevant for me though as we live in Canada.

I'm not sure about doing more testing right now (except maybe the opthomologist). The speech therapist only did a portion of the testing she usually does for language LDs and did not provide a written report -- she said that he does show signs of dyslexia (which I knew) and that we would be better to spend our money on therapy than on a complete work up with report, unless we need it for school (we don't this year as he is in Montessori and there are no IEPs or anything like that).

I'm open to hearing the other side of the argument though -- what is the advantage of more testing right now rather than just working on OT and speech therapy? To me he seems to have good organization, attention and social skills. His issues seem to be really dsypraxia/dyslexia.

Verona, fwiw, my son did the TVPS in July last year and had similar scores. We were told to remediate. Perhaps its because we're not in the Americas, so the standards are different. He has no problems with reading or math, but his physical skills are way behind, and I worry for his physical safety.

In November of last year, I brought him out of country to have his vision evaluated by a behavioral optometrist. Surprise- significant improvement across the board on a second TVPS. Seeing that he has been having vision therapy at various therapists on and off (mostly on) for 2 years prior, it must have been what went on in between july and nov that helped. This is what happened- I took charge.

I bought a balance board and did daily exercises with him. We each have one and we play ball this way.
http://www.balametrics.com/products/homekits.htm
I bought dr frank belgau's book as well- it's a good read and really helpful to understanding what's going on. The wider message to me is to focus on whole body improvement, in addition to visual improvement.

We also did a bunch of worksheet type exercises daily:
http://edhelper.com/visual_skills.htm
http://www.visuallearningforlife.com/visual-perception-worksheets.php

These 2 are subscription based. http://www.eyecanlearn.com/ is free but I didn't rely on this as much. I work closely with his vision therapist and speech therapist (he has CAPD) to implement the daily exercises they recommend.

I'm not spending more money on testing- my thinking is that experienced therapists can discover more along the way than any snapshot test. For eg, even though the recent TVPS looked great, I know that the improved skills haven't translated into significantly better physical skills. We've started working with a kinesiologist to help improve this area.

Good luck!

The other thing to add is that all his visual, auditory tests indicate that he should have difficulty with reading and language. Yet he has none. So in this regard, the tests have not been useful in terms of steps to take.

Hi Verona,

You are right � the Special Ed regulations and process in Canada are much different! The forum I suggested has a group of Canadian members, so when the time comes you might want to check in there for some guidance in terms of resources and laws.

You ask why test now. Given that you are already providing speech and language and OT support, you most likely have initial benchmarks in those areas and could put off testing. But, what you don�t have is an understanding of your child�s learning profile and a data for reading acquisition and other academic skills. You only have red flags that my gut (and I think yours) tells me might indicate an issue. But, without testing you don't know. The therapies you are using most likely will not address the reading difficulties, if there are some. If he has a language based learning disability such as dyslexia, he will need an explicit, systematic, multi-sensory, rule based reading program to learn how to crack the code. By waiting, you could loose precious time and perhaps allow your child to fall further behind. Given that remediation is much more effective when a child is young because their brain is more malleable, I would hate for you to lose this window of opportunity by waiting. If the testing comes back and indicates he is right where he should be, and there is no reading disability, you will have confirmation that you are addressing the priority areas with the OT and S&L, and you can relax and put your �wondering� about reading remediation to bed.

Note � if you do pursue more testing, be sure to get the names and versions of the tests that have already been used. Most tests are not valid if administered more than every 12 months. Your new evaluator will want to know the what tests to avoid and would most likely find the test scores helpful for background knowledge and developmental history. These domains are usually interrelated.

On another note, you write that you are considering vision therapy. When my son was 7 he participated in a year of behavioral VT. Initially the results seem to be positive, but they were not sustained over time. The therapy takes a large commitment and ongoing practice of the exercises. Over time, my very compliant son resisted. My experience is that the results were minimal and not sustainable. Additionally, the therapy does not address dyslexia � it only improves skills in the visual domain so that the child is more able to access the reading instruction. Here is a recent report on VT: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;102/5/1217 Again, you want to make sure that your resources (time and money) are targeted to the areas of priority. While VT could be part of the solution, I don't think you know whether it is the most important aspect of your child's remediation plan without data about cognition and academic achievement. You would get this important data via a neuropsychological evaluation.

Since you are in Canada, you may be interested in exploring the Arrowsmith School approach. I recently heard the founder, John Eaton speak. While I am not completely sold on the approach, it did seem interesting. And since I am fairly conventional, I tend to feel more comfortable with traditional approaches to remediation � you might be more open to alternative therapies. Here is the website: http://www.arrowsmithschool.org/. I'm not sure if there is a location nearby - I realize that Canada is vast!

Hope this helps � follow your gut � information is king.

Thank you Mich. I'm so glad to have your input on this.

I thought that the testing that the S&L therapist did was enough to diagnose dyslexia. She did tests for

working memory (OK)
verbal phonem awareness (ok)
rapid naming (not OK)
basic reading test (read this page of a book) (not OK)

She said informally that she feels he has some degree of dyslexia. And I agree.

I thought that the therapy she is planning to provide would be targetted at helping him learn to read and compensate for his difficulties. She mostly works with children who have language based LDs, so I thought this therapy would be what he needs. Are there other therapies/professionals I should be looking at for the reading program you suggest:

"If he has a language based learning disability such as dyslexia, he will need an explicit, systematic, multi-sensory, rule based reading program to learn how to crack the code."

I'd like to know more about this. He's not starting with the S&L therapist until February (waiting list!) so I have time to do some background research. Also, if I tell the school that I want something specific for DS during school hours, they might be able to accommodate (it wouldn't be a trained therapist, but they have a teacher who goes from class to class helping children who have difficulties).

I'm working at home with a book (in French)that the S&L therapist recommended that teaches phonems with pictures (like the sound "ch" is a little girl saying shhhh with the c as her mouth and the h as a finger). DS loves this approach and learned about 5 phonems in a week that we had been struggling with for a long time.

Yes, I've seen that vision therapy is sort of contreversial, and am not sure I'd do it with him. I'm pretty conventional too (and DH is even more so). I did try Padovan therapy (kind of a mixture of patterning and speech therapy, and song with some vision work as well) and didn't see a long term benefit.

A friend mentioned Arrowsmith also. I'll check out the site. DSs first language is French and this limits options as well.

I have seen posts over the years about multisensory/phonemic reading instruction in languages other than English, but I am not able to find resources right now - I'll do a bit more digging and if I find something I'll be sure to post.

As far as whether or not the speech and language pathologist can help - I'd say maybe. There are S&L in the US that are very well trained in both oral language and written language. In fact, a widely used reading for program for dyslexics was developed by a S& L Pathologist: LiPS. And there is a widely used writing program called EMPOWER that was developed by a Speech and Language Pathologist. The key is finding someone that is trained and experienced in using a proven reading program. The programs most often used to teach reading in English are: Orton-Gillingham, Wilson, LiPS and Project Read (at least in my area!). Again, I recall reading about a program for French, but can't remember/find it. (I actually was searching for my son to find out if there were a program for him to learn a second language!)

You may want to contact the International Dyslexia Association in Canada (specifically in Quebec, if this is where you live). They would have good resources on programs and practitioners.

It sounds like the testing that was given was more of a screen rather than a full evaluation. I would highly recommend that sometime soon you would get a full evaluation that looks at all areas of cognition and academics and uses standardized, normed testing. The evaluation should also look at the underlying skills for reading such as phonological memory and processing, overall processing speed, verbal and non verbal reasoning and organization. These are all important in understanding strengths, weaknesses and for diagnosing (or not) disabilities. In my area (Boston) the top evaluators schedule 4-6 months out. If it is the same in your area, you are talking about the end of the school year at best. Your Speech and Language Pathologist may be able to help you with referrals. The cost in my area ranges from $2500-$3500.

www.readingrockets.com is yet another resource that may help you understand the kinds of reading support he may need. It is encouraging that you are able to teach him the sounds using pictures. This is an example of multi-sensory. The programs I listed would use images, but also use fine and gross motor skills to help teach the rules. The idea is that if you use all pathways to the brain, the child will learn more quickly and will be able to recall the new concepts more fluently and accurately.

As far as help from the school - Straight Talk About Reading offers a number of approaches at the end of the book. This might be helpful to the school. My only concern is that if he truly has a problem, and eclectic approach may not be enough. His time would be more productive using a well -researched and proven systematic program that was developed by experts. But, as you wait, the ideas in "Straight Talk" are at least a start.

I checked a few Canadian/Quebec sites on dyslexia and the only approach I see mentioned is called EMS :�enseignement multisensoriel simultan� (EMS), bas� sur l�approche Orton-Gillingham" (a multi-sensory approach based on Orton-Gillingham). It also seems from these Canadian sites that most of the professionals providing interventions for dyslexic children are speech therapists.

I will call the S&L therapist and ask her for more details about what she is planning to do during her sessions with DS. If you don't mind, I might post again if I have questions about her approach.

Regarding a more thorough evaluation (WISC, achievement tests, etc), I am hesitant to do this. I found the process very stressful when I did it for DS10 -- I get focussed on the numbers and anxious. For DS10, I felt like the testing was needed because I was really confused about what was going on with him (still am). At this point, I think I have a good estimate of my younger son's abilities in my mind, and I'd rather assume that he is dyslexic and get him some help. I guess this might sound irrational, but there it is!

Verona - I totally understand about not wanted to test. In some ways I find it very invasive. I certainly wouldn't want anyone to look into my cognitive functioning in such a way and measure my competencies with hard numbers. And when I have had my children tested, it is hard to focus beyond the numbers and report and not get too caught up in it.

I'd say that if you are assuming he has dyslexia and are willing to address it, holding off on the testing for awhile would be ok. I did the same with my son as far as testing him for CAPD (central auditory processing disorder). I'm pretty sure he has it, I have an understanding of what type, and we are providing him the supports and interventions we would give him if he were formally diagnosed - so why put him through the testing?

I did a search on EMS and based on what I read with my very poor understanding of French - it is exactly the kind of program I was talking about. Using three senses (visual, auditory, tactile) it teaches the sound symbol relationship in a systematic way. It appears it was developed in conjunction with The Scottish Rite centers that are big providers of reading instruction in the US.

It looks like you are on the right track!

Dyslexia is complex and individualistic. The low scores in rapid naming and delayed word recall are indicative of the language processing problems of dyslexia and at his age it can be difficult to determine whether visual problems are memory/ processing problems or seeing problems. It is fairly common to have both to different degrees.

The low score of foreground / background maybe an indication of visual dyslexia. Not all visual dyslexics have poor depth perception but the rate is higher than the general population.

You may want to visit http://dyslexiaglasses.com for information about visual dyslexia.