OT for Visual Processing Speed?

You need to take her to a developmental optometrist for a developmental vision evaluation. This eval consists of a number of tests not included in regular eye exams. For more information, see http://www.childrensvision.com and to find developmental optometrists in your area see http://www.covd.org .

An occupational therapist can work on sensory integration issues, of which vision can be one (visual-motor integration, visual-auditory integration). However, if there is an underlying developmental vision delay that is causing the lack of integration, occupational therapy will be only marginally helpful. The underlying problem needs to be addressed first, or concurrently with OT.

If there is no developmental vision delay, or after therapy if there is one, your daughter may benefit from cognitive skills training. Audiblox is a good home program (http://www.audiblox2000.com ).

Nancy

Thanks Nancy for the advice. The school didn’t suggest a more thorough vision screening other than a visit to the pediatric opthamologist. I will look into it further.

A very, very few pediatric opthalmologists offer vision therapy (called “orthoptics” by opthalmologists). You may want to get a second opinion from a developmental optometrist.

Optometrists developed vision therapy, which opthalmologists scorned until independent research confirmed its effectiveness for problems such as convergence. Unfortunately, few opthalmologists incorporate either vision therapy or orthoptics into their practice.

Nancy

I have recently run into a large number of kids with reversal problems, and every time it has been in conjunction with very poor writing and very poor teaching of writing.
I have had success — slow but sure, no miracles but a good learning curve over six months to a year — with re-training directionality and writing together.
I have posted my notes on how to do this on Teaching Reading; try the search for both victoria and victoriah.
If that doesn’t come up with anything, email me for the writing notes at [email protected]

Just be aware that the American Academy of Pediatrics advises that there is currently NO evidence that vision therapy is an effective treatment for LD or ADHD.

As a PG reading tutor, I have sent a large handful of my students for developmental vision exams. No matter what the pediatricians say, I have seen first hand, that there is some percentage of children who have NO phonological processing problems, very good decoding skills, etc. who struggle with reading.

These are the children who can read any word in isolation or in 18 point type but can’t fluently read a page in a book. They skip words, lose their place, misread easy words, can’t attack multisyllable words in a big paragraph (but can do it perfectly in isolation), get fatigued very quickly, and sometimes assume odd postures while reading. When correctly diagnosed, most of these problems can be fixed. A qualified developmental optomestrist can usually prescribe simple exercises to be done at home for 5-10 minutes a day. This can make a world of difference for a struggling reader.

[quote=”LindaW”]As a PG reading tutor, I have sent a large handful of my students for developmental vision exams. No matter what the pediatricians say, I have seen first hand, that there is some percentage of children who have NO phonological processing problems, very good decoding skills, etc. who struggle with reading.

These are the children who can read any word in isolation or in 18 point type but can’t fluently read a page in a book. They skip words, lose their place, misread easy words, can’t attack multisyllable words in a big paragraph (but can do it perfectly in isolation), get fatigued very quickly, and sometimes assume odd postures while reading. When correctly diagnosed, most of these problems can be fixed. A qualified developmental optomestrist can usually prescribe simple exercises to be done at home for 5-10 minutes a day. This can make a world of difference for a struggling reader.[/quote]

Obviously, the children you describe have a VISION problem rather than a learning disability. A child who has good phonological awareness and can read words in isolation or in large type but not from a dense page of text has a seeing problem rather than a reading problem. That says nothing about whether vision therapy is effective for LD or ADHD.

Guest,

Children are placed LD in schools because there is a discrepancy between their achievement and ability. Rarely is in depth testing done to measure visual and auditory processing. I have also tested poor readers who had good phonological skills but had the problems Linda mentioned. These children ALL pass the vision screening and eye exam. It takes testing by a devlopmental optometrist to determine if there is a visual efficiency or functional vision problem. All I can tell you is that parents report significant improvement after doing the exercises. Just because someone hasn’t put up millions for a large scale study to “prove” it doesn’t mean there isn’t merit.

Children are placed as learning disabled every day without regard to the root of their problems. I see no reason to question the logic that if some kids have auditory processing issues, that they can’t have visual processing issues as well.

Janis

It wouldn’t surprise me if some of the exercises used in VT also stimulate areas in the brain (such as the cerebellum), which may help with language and reading — similar to Dore, Handle and other balance and vestibular exercises. For example, while researching exercises to stimulate the cerebellum, I read that having the eyes follow a pencil from the side of the head to midline stimulates part of the cerebellum. I don’t know how accurate this information is (it’s something I read on a website), but if something this simple (and doesn’t require much time!) could be helpful, I think it would be worth incorporating along with a good OG program.

Laura in CA

[quote=”Janis”]Guest,

Children are placed LD in schools because there is a discrepancy between their achievement and ability. Rarely is in depth testing done to measure visual and auditory processing. I have also tested poor readers who had good phonological skills but had the problems Linda mentioned. These children ALL pass the vision screening and eye exam. It takes testing by a devlopmental optometrist to determine if there is a visual efficiency or functional vision problem. All I can tell you is that parents report significant improvement after doing the exercises. Just because someone hasn’t put up millions for a large scale study to “prove” it doesn’t mean there isn’t merit.

Children are placed as learning disabled every day without regard to the root of their problems. I see no reason to question the logic that if some kids have auditory processing issues, that they can’t have visual processing issues as well.

Janis[/quote]

What you say is very true, but really, this just points to the need for better evaluations by schools rather than for a knee jerk response that a child with reading problems should see a DO for a vision therapy evaluation, especially when you consider how expensive vision therapy is and how little objective information on its effectiveness ( beyond for treating conditions such as strabismus) is available. I think that when people recommend controversial therapies, it is only fair to identify them as such and explain the nature of the controversy. It may be that a parent decides to give it a try anyway, but knowing that a particular treatment has its doubters is important for those who need to decide where and for how long to spend what may be scarce resources.

Guest,

We absolutely agree on that. I would NEVER propose that VT is a cure or that it even has the evidence to prove just who it will help. But I do see kids who have had the CTOPP and I am not seeing any phonological processing issues. They may have poor handwriting or the teacher says the child can’t copy from the board. They may have a low performance IQ score and subtests. That tells me that there is likely an unidentified visual or visual-motor problem. I am not qualified to really assess further than that. So I have told a handful of these parents that the problem is probably not auditory or language based, so they may want to have the developmental vision eval…with no guarantees. I also have told some that they may want to explore the possibility of attention issues. Even though I share your desire for more thorough testing, I do draw the line personally at medical evaluations. I really feel it becomes the parents’ responsibility to go to the audiologist, optometrist, or neurologist rather than expecting the school to pay for all that. However, the school should be willing to implement strategies suggested by the outside experts when appropriate. And the parent has the right to control that information and NOT release it to the school if they feel that is best as well.

Janis

Since the original post identified visual processing speed and reversals as being problem areas, it is only prudent to get a developmental vision evaluation to either identify or rule out visual efficiency problems.

As for vision therapy being controversial, independent research has confirmed its effectiveness for convergence and accommodation problems to such an extent that the American Association of Opthalmologists has established a sub-specialty to provide it, called orthoptics. Orthoptics calls the exercises “muscle retraining”, but these are the same exercises offered by developmental optometrists for years.

Nancy

[quote=”Nancy”]

As for vision therapy being controversial, independent research has confirmed its effectiveness for convergence and accommodation problems to such an extent that the American Association of Opthalmologists has established a sub-specialty to provide it, called orthoptics. Orthoptics calls the exercises “muscle retraining”, but these are the same exercises offered by developmental optometrists for years.

Nancy[/quote]

Yes, but this is not the whole story. The truth is that there is absolutely NO evidence that VT is useful in treating ADHD or any kind of learning disability. Possibly it may be helpful to those conditions, but so far the research doesn’t show that it is. We know from recent research that there may be a visual aspect to some forms of dyslexia. We also know that some children with ADHD also have convergence issues. What the research does not support, however, is that VT is a good alternative for traditional methods of remediating dyslexia or that it “cures” dyslexia. The research also does not support that VT reduces any symptoms of ADHD or makes the condition better in any way, either temporarily or permanently. An evaluation by a DO certainly has its place, but that place is at the bottom of the list after other evaluations and treatments have been had.

The original post did not mention ADHD, a learning disability, or dyslexia. It described a 6yo having difficulty learning to read and write, whose tests at school were all normal except for visual processing speed. The school had recommended occupational therapy to work on visual processing speed. It only makes sense, in this situation, to get a developmental vision evaluation to either rule out or diagnose visual efficiency problems, since they could be the source of the problem with visual processing speed and schools do not have the resources to conduct such testing.

I never said that vision therapy is a cure for dyslexia, ADHD, or learning disabilities, and I don’t think anyone else in this thread did either. It is simply reasonable to check out vision when test results indicate a possible vision problem.

Had the school testing revealed delays in development of phonological processing, then it would be reasonable to suggest working with a reading program rather than an occupational therapist.

Nancy

I did take my daughter to a pediatric optometrist as suggested. I was able to find one off of that link that Nancy posted. I’m not so sure about him though. They did the normal tests an eye Dr would do as well as 2 other tests not covered by insurance. My daughter does have 20/20 vision. The Dr then did some other tests while I was in the room. He asked her questions about what she saw. Did things move, how many lines she saw, etc. He said he didn’t get a good feel for her abilities/weaknesses so a second appointment was needed. The first and follow up appointment would be covered by insurance but that was it. The vision testing he wanted done by his office costs $250.00. Each visit after I would have to pay for as well. I would pay anything to help my daughter succeed but it almost feels like a scam. I asked her teacher about VT and she said she would ask around since she wasn’t familiar with it. The special ed/resource room teacher suggested that I wait on the VT until after the OT evaluation which is this Monday 6/21.

My daughter has much of what Janis describes. She can read words in isolation but struggles with reading words in sentences. They have called her “quirky”. Her classroom teacher had never mentioned and attention problems other than my daughter wanting to go to the nurse during any tasks she finds difficult. Her reading teacher says she needs to be reminded to stay on task.

I worry about her because she will more than likely not get the help she needs because she has a higher IQ and good test scores. She does not qualify for resoure room and may be over looked. Her current teacher is very concerned for her and has already spoke with her teacher for next year about it. Her teacher has made sure she was placed with a second grade teacher that had a Masters degree in teaching and a quite corner room. With the budget cuts this year, the outlook for Acedemic Intervention looks grim. Her new teacher and I will have to work hand in hand to be sure she doesn’t fall even further behind.

I will look further into the VT but maybe with a new doctor. I also don’t know about having to pay for these independant tests. I don’t know why he can’t suggest a way to help her without having to have her take all these tests again.

Thank you all for your suggestions and advice. It’s nice to know there are people out there who I can talk to and ask questions to because there really is no one at the schools who makes themselves available to you for this. Thanks again!

I would try and find out the names of the tests already completed and the ones he proposes to do next. Then maybe you can get some advice as to whether those are standard tests or not.

Janis

The school OT called me today, on a Sunday I was so surprised, to say she will meet with my daughter tomorrow. She said that VT may help but to wait to see what she finds in her evaluation. She said her son has a visual problem and he benefits from VT. She was very nice and she said she should be able to better tell me what the next step should be after the evaluation.

She said if she does need to see an optometrist, she can recommend one to me who is great with kids. I think I would be more open to the VT and the cost of it if it was a doctor that I trusted more. My daughter wasn’t comfortable around this optometrist and to tell you the truth, neither was I.

I do have a listing of the tests and her scores. It was provided to me by the school. I am curious to know which tests his office would have performed.

A developmental vision evaluation consists of two parts — the usual eye exam part that covers acuity, and the specialized visual perceptual testing.

The former is normally covered by insurance and is the type of testing we are all most familiar with — dilation of the eyes, reading letters off a chart across the room, perhaps testing for color blindness.

The latter normally is not covered by insurance. These are the approximately 20 additional tests that assess visual efficiency skills — things such as how fast the eyes change focus, how accurately they track, whether the brain is receiving a single image at reading distance or two slightly offset images, etc. etc. etc. Where we are, this visual perceptual testing costs about $150 without a written report — $75 additional for a written report of the test results, which I recommend if any of the scores are below the normal range. $250 sounds a little high to me, but then costs vary considerably across the country and can also vary from one provider to another, and perhaps this price includes a written report of test results.

If you got this specialist from the http://www.covd.org website, then he is a developmental optometrist, not a pediatric opthalmologist. Most pediatric opthalmologists specialize in surgery and do not have offices that provide orthoptic services (“orthoptics” being the opthalmologist’s version of vision therapy). Developmental optometrists usually provide more thorough evaluations and more comprehensive therapy. However, just as with GPs, some doctors graduated with A-averages from school and some graduated with C-averages, some care primarily about their patients and others care primarily about how much money they make, some keep up in their field and stay cutting edge, while others stick with what they learned in school 20 years ago. Board-certification gives you a starting point, but it doesn’t guarantee that any specific specialist is going to be a good fit for you or your family.

It’s important to be confident of your specialist, so by all means find someone else if you do not like this person. It’s a good idea, after consulting the covd website, to email or call all of the board-certified developmental optometrists in your area to find one you like. Ask for references from satisfied families. Before you make an appointment, ask if they are willing to design a primarily home-based program of vision therapy if VT is indicated by the test results. Be upfront about costs, and indicate that you need to keep costs down as much as possible. In-office vision therapy is the most expensive VT you can get, and with only a few exceptions you can do just as well working daily at home. I always think that those who are willing to design home-based programs really care about children, and are not interested solely in making money.

Another option is to visit an optometrist who provides software for home work — http://www.homevisiontherapy.com . Costs for this software, including pre- and post-testing, is usually under $300. The software does not address all visual efficiency problems, but is helpful for the most common ones.

Usually medical insurance will not cover the cost of vision therapy. One parent has posted that vision therapy *is* covered in most insurance policies unless specifically excluded, but that most people wrongly look under the eye section when they should be looking in the general medical section. A few parents have gotten vision therapy covered by medical insurance when the insurance company realized the alternative was surgery. However, most families who do vision therapy pay for it out of their own pockets. Some day this may change, but I wouldn’t hold up a child’s therapy waiting for that change.

I am going to some length to post all this because a thorough evaluation of vision is worthwhile — especially when other test results indicate problems in visual processing or visual-motor integration. Most vision therapy is *not* a scam. There is substantial independent research showing that it often fully remediates accommodation and convergence problems (which are not evaluated in a regular eye exam). http://www.childrensvision.com has a link to a page of abstracts of these studies — well worth some time to read.

Nancy

Please think twice about using “good with children” as your major selection criterion for a medical professional. I lost a molar and had permanent damage done to my general health by being sent to a dentist who specialized in being “good with children” — unfortunately he was lousy at dentistry. Yes, if you get a really bad feeling from a doctor you should think twice, but better someone who knows the business and gives tyou the message straight up than someone who smooth-talks you into a false sense of security.