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.)

Heather, do your ds' VT sessions include any kind of Brain Gym (up and moving type) exercises, Bal-a-Vis-X, or anything like that? This is just me totally guessing from thin air, but fwiw - here are a few more thoughts -

Our sensory dd had really low tone in her trunk when she was younger (still does but she's not quite as squirmy as she used to be, now she mostly slouches....). Her VT therapists always start off her sessions with a "cross-walk" where you step up high like marching and touch the opposite hand on the knee and follow a type of figure-8 path. There are a few other exercises mixed in between that have her standing up and doing Brain Gym-like activities, and I think that helped her not get overly stressed from eye strain etc.

They also have exercises they do on a mini-tramp - where she jumps and holds out her arms after a pattern that the therapist shows her. Another thing they do which she like is the Bal-a-Vis-X - it's basically just rhythmic and patterned bouncing of small balls. I think having exercises like that tossed in between the other types of exercise (where she is looking at paper up close, trying hard to match letters etc, or staring at the computer screen) helped reduce her overall sensory strain during the therapy.

They also have her sit on a bouncy ball while she does her VT.

Another thought might be to try just one type of VT exercise at home for awhile - just a few minutes each day - if you can find something that just by itself doesn't bother your ds too much. Also maybe consider just giving the VT a rest for now and trying again in 6 months or a year when your ds is a little older and might be more able to communicate what he's feeling and seeing, and also after he's been in OT longer and maybe made more progress with it.

The test I mentioned that discriminates between visual and fine motor issues is called the "Beery VMI" (VMI stands for Visual Motor Integration) and I think that there are OTs who can also administer it as well as psychologists. I wouldn't honestly worry too much about whether or not the person administering the test works with a lot of gifted children - I think in your situation I would start by first thinking through the things you see impacting your ds - does he seem to have difficulty with fine motor tasks? Vision-related tasks? Some of it might not be obvious of course, but think through what you see in everyday life and try to relate that back to the dips in scores on the WISC. If you think there is a possibility of fine motor challenges in the mix, ask his OT if they can do an assessment such as the Beery VMI to tease out what's up.

I'll also add that VT doesn't necessarily cause overnight changes, particularly if it's not a huge issue that is being worked on to begin with. And it's hard work. I think Zen Scanner is right on re the possibility that what you are seeing makes sense as his brain is being retrained to use vision to manage physical coordination.

Best wishes,

polarbear

Our son is scheduled for VT for the first time next week.

He's not been diagnosed with SPD, and I don't know how he's going to react, but he has had a long history of sound sensitivity, and recently he's been complaining about light sensitivity.

According to the doc, the outlook for his VT is excellent. (Pun intended.)

I hope the sensory melt-downing is a temporary hurdle for your DS, Heather123.

Just curious what kind of eye doctor you are taking him to? How do they know he is suppressing vision in one eye?

My DS had a traumatic brain injury from an accident on New Years Eve (at age 5 1/2) which resulted in a sixth nerve palsy and almost total loss of tracking ability of his right eye for months. His right eye was stuck in the corner by his nose. He had to wear an eye patch on his good eye for 6 hours per day, and when he didn't have the patch, he had double vision at all times--so for instance he would see two TV's side by side or two books or two of every person. Strangely, we saw almost no change in his behavior or abilities. There may have been a small decrease in fine motor. He has developmental coordination disorder, so probably had some issues with sensory integration and visual tracking all along, but the results of the accident were extremely severe in terms of his vision, and his eyes were very obviously misaligned for months. He said that he liked having double vision and it didn't bother him. When he read, he said there were two books side by side and he just looked at one of them. I took him to a neuropsych who did the WISC IV. At the time this was done, his eye had started gaining some motion and was tracking past the mid-line but i don't think it was completely normal. His overall non-verbal IQ was 99.7 percentile, but he only got a 13 on block design, which is timed. The neuropsych attributed this to his poor fine motor skills. He scored below the 1st percentile on a timed pegboard test. One could argue he was scoring that low on the pegboard and block test because of his vision, which I guess is possible, but he scored really low for fine motor coordination before he was in the accident. I think he may have had issues with visual tracking before the accident though, too, but not nearly as severe. His processing speed I think was an 11 or 12, so slightly above average.

I took him for an OT and PT assessment and even though his eyes "look" normal now, rather than completely crossed, they say he can barely track moving objects at all. I don't know if this is from lingering effects of the sixth nerve palsy, or if he was always like that due to developmental coordination disorder or hypotonia. I have an appt. to take him to a neuro-opthamologist since the regular pediatric opthamologist thinks his eyes are completely normal now (despite what the OT and PT say). I'm hoping that a neuro-opthamologist will be able to tell me what's going on with the poor eye tracking and help him somehow. His depth perception is impaired and I'm hoping if he learns to track, it will help some of his fine motor skills and reading. I'm curious what vision therapy entails. I just thought I'd share that my son's eye was massively messed up, it happened very suddenly due to being in an accident, and it must have been hard for him sometimes wearing a patch and sometimes not, and looking at the world where everything was double, but it seemed to have little effect on him or his mood or behavior. Every once in a while he complained about getting a headache above one eye and he still does when he reads.

blackcat, my dd11 had severe double vision until she went through vision therapy the first time at age 8. We don't know when or how it started, but she never once told us she saw two of everything - she just accepted that as normal, and until she was tested by the developmental optometrist and we found out, I don't think it occurred to her that everyone else wasn't also seeing double. She had amazing improvement from her first round of vision therapy, most likely because her double vision was due to weak eye muscles and the VT strengthened them. Over time, after she'd completed her first round of VT, she slowly began seeing double again - and again, she didn't bother telling us, just accepted it. For me, that would be beyond frustrating but for whatever reason, for our dd, she just accepts it as part of life and doesn't get upset or worked up over it. Note - now that she's had successful VT and seen the world without her double vision, she does know she'd rather only see one of everything but she'll still not tell us if she's seeing double, or if we ask and she is she'll just say "yep, I see two" very nonchalantly as if it's not a big deal.

Our developmental optometrist told us that for some kids (including our dd) who have double vision, the brain will actually shut off vision in one eye as a way of coping with making everything not-double. We were able to tell when our dd's brain would do this because she would tilt her head in a funny direction when she was reading or writing or trying to watch tv or look at something up close.

I don't know if VT would help your ds - our eye dr feels it's really helpful for issues related to muscle weakness but not successful for other issues - but I think the exam that DO's give when a child is first assessed for vision therapy screening might be helpful even if VT wouldn't - the assessment will tell you how your ds' eyes are working together - which is very different than a typical eye dr exam where you find out how each eye is functioning individually. You'll find out whether or not eyes are tracking, how much peripheral vision your child has, etc.

Best wishes,

polarbear

Polar bear I have this clear memory when talking to the therapist about DDs BO assessment and they mentioned the turning the head thing to turn off one eye. DH piped up "Oh yeah I've always turned off one eye to read numbers, especially in colums"... And it did not once occur to him to mention this to me, even when we were setting up aptts for assessment...Our kids really won the genetic lottery with he and I as parents.

Thanks for the input. The regular opthamologist insisted he wear a patch on his good eye (with at least 3 every day with no patch) because she was worried about amblyopia and that he'd lose his vision in his bad eye. I think he did lose a small amount of vision in between the time of the accident and when we started patching, but then regained it. Small kids (probably toddlers-preschoolers) are especially prone to losing their vision.
The OT told me to take him to a neuro-opthamologist and I'm hoping she is helpful. If not, I will try a developmental optometrist. Since there is a brain injury, I'm worried there will be information that an optometrist wouldn't be entirely familiar with. The OT said that he should get vision therapy but most insurance plans won't cover it, so they will try to work on vision in regular OT first. I remember last summer, before he was even in the accident, his old OT mentioned that he has eye tracking issues and I wish I knew whether they are worse now. She didn't seem to think it was a big deal and didn't work on vision in therapy so I'm guessing it's worse now. The new OT said that since he had double vision and was patched for months, he probably learned to use one eye at a time and therefore doesn't know how to use them together anymore. So, he becomes disoriented when looking at a Where's Waldo book and he also tends to skip words/lines when he reads.

My pg ds7.5 was born with a tbi (severe plagiocephaly), torticollis (neck/head tilting), low tone, severe SPD, and other stuff. He wore two helmets as a baby and had tons of therapies, including 2.5 yrs of vt between 4-6 yrs old. This past year, he was in neurofeedback, which helped address some SPD issues.

There was a period with VT when my son was quite dysregulated and out of sorts. He then swung around and settled down.

It took a long time to address his visual perceptual issues due to the torticollis - and since then I've learned the tbi too. NO one had mentioned that the tbi would have affected his vision, though this is quite dumb since my ds's head was severely 'misshappened' when he was born. Years of pt and ot helped, but vt made a dramatic difference.

Blackcat - I don't know how many behavioral optometrists are familiar with tbi. I do know that there's few who know about torticollis and the ramifications of head tilting or having visual deficits as a result. I used to talk about this things with my son's former behavioral optometrist in NY.

Yes, most plans do not cover vt. We paid for vt out-of-pocket and it cost us a bundle. Ditto for neurofeedback and water therapy - which I would also recommend for tbi. However, I had no idea my son was pg (bright yes, pg no) before my son had vt. The results were dramatic and I would do it again in a heartbeat. He absolutely needed the vt.

I know my son's former behavioral optometrist in NY does treat patients long-distance. We continued to do his program and consult via e-mail after we moved back to MA.

My son's seen two neurofeedback providers this year due to the insurance issue. One didn't take our insurance and cost us a fortune. We then switched and found a neurofeedback provider who did. So I completely understand with the expense for these treatments.

Zen Scanner- If block design is timed, that would expalin a lot. He hates anything timed and it freaks him out. The tester said that he would find the right design, but not realize it was right, and keep moving things.

polarbear- Sounds like you had a great VT! Our OT does a few of those things, but they don't do anything at all like that in vision therapy. The do some things with different shaped blocks, he does something on a large computer screen, and then something with little blocks with letters and numbers. They said he does okay, until he has to think while he using his eyes, so they will quiz him on math while he does the exercises. He hates it, but it's good for him! I have to ask them to let him get up and move around in between things beause he just can't sit still that long. I've been looking into Brain Gym and I'm thinking I should incorporate some of the exercises at home. You had some great ideas- thanks!

Ametrine- Good luck with your DS and vision therapy. Let us know how it goes!

blackcat- wow, you have been through a lot. I really hope you can find someone who will be really helpful for you.

Mumof three- My DS does the same thing. That's why they missed it during the first eval. The second eval he asked if he always saw the cross, and he said, "no, but I can make myself see it if I tilt my head, squint a bit, and change the way I look at it. I thought that's what you wanted me to see."

cdfox- thanks for your input. It's helpful to hear so many experiences.