My 9-year-old son (just finished third grade) was diagnosed last year with ADHD and is currently taking Concerta. In the course of the psychological evaluation, he was also identified as “gifted,” and has just been accepted into a “G & T” program that begins in 4th grade. He reads and processes verbal information on a high school level, but has had real problems with writing—it takes him MUCH longer than other kids to produce any kind of writing. The psychological evaluation (which was prompted in large part because of his teacher’s concern over the discrepancy between his oral verbal skills and his writing) showed a 44 point gap between verbal IQ and performance IQ (144 vs. 100), with particularly bad scores in Coding (age equivalent 6 years 2 months). The psychologist noted problems with figure-ground discrimination, processing of visual detail, etc.
An evaluation of visual-motor integration done last summer by an OT found figure-ground scores of 50th percentile, visual-motor speed of 25th percentile, and visual closure of 37th percentile (these were the lowest scores—the others ranged from 50th percentile to 91st—spatial relations). The visual-motor score was the basis for three months of occupational therapy. Can’t say whether it was the OT or the Concerta, but handwriting is now much more legible, though still relatively slow and labored.
Nothing was said, though, about the visual closure issue. I wonder about this now because on the testing that was done for the “G & T” program, my son did badly on the tests that involved visual (i.e. non-verbal) presentation of material (67th percentile on “Analogies,” for instance), badly enough that he would never have been accepted into the G&T program had it not been for the existence of the earlier report. The school doesn’t consider these visual issues to be a problem since they’re not affecting my son’s grades, except for handwriting and art. The principal has given verbal assurances that she’ll back me on insisting on accomodations for writing assignments (use of the computer as much as possible), but that’s about it. The ADHD is also considered a non-issue (again, because my son is getting good grades). My question is this—should I be concerned about some of these apparent visual processing issues? Or does a score of 37th percentile (visual closure) just fall into the category of “not everyone is good at everything”? What relation does “visual closure” have to academic work at higher levels (I’m thinking of geometry in particular)? Should I pursue a more detailed evaluation with, say, an optometrist? I’d like to prevent potential problems rather than wait for them to present themselves.
I’d be grateful for any input anyone can offer on these issues. Thanks, and sorry for the long e-mail.
Southern Indiana Mom
Re: visual processing problems?
To be safe, I think you need to get a developmental vision evaluation. This assesses visual efficiency skills (convergence, focusing speed, etc.). You can find board-certified developmental optometrists at http://www.covd.org
If visual efficiency skills are all in the normal range, or after vision therapy has remediated severe deficiencies, it is a good idea to follow-up with a cognitive skills training program (such as Audiblox or PACE). PACE, especially, works a lot on developing visual processing skills — visual attention, visual sequencing, visual short-term memory, visual processing speed, tracking, etc.
Occupational therapy will help integrate vision with the other senses. Unfortunately, it will not remediate a visual efficiency deficit. A visual efficiency deficit can be the underlying cause for the poor integration!
Nancy
Re: visual processing problems?
Hi, Victoria and Nancy (coincidentally, my name is also Victoria),
Many thanks for your informative e-mails and good suggestions! I was happy to see that we had, generally unknowingly, implemented some of your recommendations already; others I will definitely follow up on.
In my original e-mail, I forgot to mention that we did have our son’s eyes checked last summer—a thorough evaluation, not the “read the top two lines” screening they do through the school system. As Victoria suggested might be the case, the optometrist found that D. is farsighted and has a slight astigmatism; D. now wears glasses. We had a consultation with an education specialist (it’s a university facility with good resources) who suggested further testing (including the Developmental Test of Visual Integration—do I have the name right), but since we were already scheduled for the OT evaluation, we didn’t follow up. I can now see that this was a mistake. It seems to me that each specialty has its own emphasis—the OT honed in on the motor problems but wasn’t interested in the purely visual issues. I guess this is natural, but I wish there was more guidance for novice parents like myself! I’m learning everything as I go along, and making plenty of wrong turns along the way.
D. had an excellent teacher for third-grade; she was a stickler for good handwriting and worked the kids very systematically. I agree with you, Victoria, that handwriting can’t be dismissed as trivial; I do want D. to learn to type well so that he can do essays and school projects on the computer, but you’re right—there are just some situations where the computer can’t do the job. So we’ll add handwriting to our list of summer projects. Incidentally, I have a number of friends from Eastern Europe who insist that handwriting is just not the problem there as it is here; they attribute this to the very systematic approach, going back to pre-school, taken to teaching handwriting.
D. has never been much for team sports—when he played soccer a few years back in the kiddie league he was always the last to figure out where the ball was, and by the time he got there the ball had moved on down the field!—but he’s been enjoying martial arts, which seems to be good for both coordination and attention issues. He enjoys swimming, too, so this may be the time to get serious about swim lessons (he’s had swim lessons, but two weeks in the summer in a large class, combined with his attention problems, hasn’t yielded good results). I hadn’t thought about encouraging arts & crafts—he’s always hated anything of the sort, wouldn’t even color in coloring books as a little kid—but I can see how this might be useful. Anyway, I guess the first stop is the developmental optometrist.
Again, many thanks for your input and excellent suggestions!
Victoria
Re: visual processing problems?
I’ve benefited immensely from my brothers’ little league inabilities, which prompted my parents to switch them (and their younger siblings) to competitive swimming. Even being the slowest person on the team, you’re a better swimmer than anybody who’s not on a team; the discipline, and I do suspect the “crossing the midline” stuff that you have to do for crawlstroke, and the rather direct connection between learning to do the strokes right and practicing with getting faster times, provided me with a foundation I never got in classrooms. (Lifeguarding also is preferable to most other entry level teen jobs - and it’s where I learned to teach & figure out kids… you can make all kinds of observations from the lifeguard chair.) It sounds like he may be getting those kinds of benefits from the martial arts — sounds like you’re doing an awful lot right :-)
http://www.gtworld.org has a link to “twice special” email list — it’s a very knowledgeable and supportive group. They’ll tell you to make sure the school doesn’t ignore the gifts and think everything will be fine if a kiddo can get passing grades in the regular classroom, when a gifted/dysgraphic child will be either wallowing in toxic boredom buildup as teachers “teach” the stuff he knows… but expect expertise without instruction for things like handwriitng.
Re: visual processing problems?
Yes, I work with a lot of Europeans, and the reading, handwriting, and math anxiety levels are very much lower there. Still exist, but at a much lower rate.
Yes, absolutely, systematic teaching is the first and most important thing.
Martial arts are probably very good. Keep working on all those other things too. If he’s gifted, he’ll want to be kept busy.
Re: visual processing problems?
Thanks again, everyone! And thanks, Sue, for providing the link to the “G & T” site.
D. was initially rejected from the “G & T” program—he got in off the waiting list. I was pretty upset, mainly because we had had two great years with unofficially “pre-G & T” teachers and I dreaded a repetition of first grade where D. was bored and unchallenged and heading down the road to class clown and nuisance. This wasn’t entirely the teacher’s fault, of course—I suspect that unrecognized and undiagnosed ADHD played a role—but he really needs to be in a classroom that provides challenge, stimulation, and peers who share some of his interests (or for whom a preference for protozoans over sports is at least not completely bizarre). The school psychologist herself noted that D. performed better when the task was challenging and complex.
Time to call the optometrist and then sign up for swim lessons!
Victoria
(Southern Indiana Mom)
Re: visual processing problems?
>In my original e-mail, I forgot to mention that we did have our son’s >eyes checked last summer—a thorough evaluation, not the “read the top >two lines” screening they do through the school system. As Victoria >suggested might be the case, the optometrist found that D. is farsighted >and has a slight astigmatism; D. now wears glasses. We had a >consultation with an education specialist (it’s a university facility with >good resources) who suggested further testing (including the >Developmental Test of Visual Integration—do I have the name right),
Just to be clear, a developmental vision evaluation consists of about twenty tests not performed in a regular eye exam (the kind that detects acuity problems and astigmatism). Although a developmental test of integration may be one of them, there are many other tests. Offhand, I can think of convergence, accommodation, gross pursuits, gross saccades, fine pursuits, fine saccades, field-of-vision (peripheral vision), visual closure, and reversals. There are more, but I would have to look them up…..
For more information about developmental vision problems, see http://www.childrensvision.com .
Usually the only way to get a complete developmental vision evaluation is to use a board-certified developmental optometrist. You can find the ones in your area at http://www.covd.org . Fellows have to achieve a higher level of certification than associates, although that doesn’t necessarily mean they are better.
You may also want to check out home vision therapy software. This does not address all problems, but helps some of the most common ones. The software (including pre- and post-testing) usually costs less than $300. A list of optometrists who provide this software is as the website: http://www.homevisiontherapy.com
Nancy
Re: visual processing problems?
Thanks for the info.! The site on children’s vision, which I just scanned quickly, is really interesting and informative.
Victoria
(Southern Indiana Mom)
This profile sounds a lot like my own and my daughter’s. I was gifted in school but couldn’t write, drew an absolute blank on figure-ground tests until my twenties when after art training and glasses and sports suddently a light flashed in my head (weird feeling I can tell you!) In fact I am very good in geometry — classic Euclidean, and it was my favourite school subject. Can’t tell you about my daughter because she had a terrible curriculum (PG County MD) and some weak teachers so she never really had a high school geometry class)
Advice from someone on that same road:
(1) work and work and work on the handwriting. It’s a necessary skill no matter what anyone says, memos and snap tests and higher math that’s a pain to type and all sorts of other things. Don’t kill yourslef trying to do everything at once which never works, but do a little bit every day — ten minutes a day or twenty minutes three times a week. Many people here speak well of Handwriting Without Tears, and you can email me for my own notes
[email protected]
(2) Figure-ground and visual closure CAN be learned and I am walking proof. First, get a really good ophthalmologist and get the best glasses possible. He may have subtle problems like I did, in my case astigmatism at different levels in each eye and farsightedness which is uncommon in young children so that (even though my brother was known to be farsighted) incompetent people discounted it and claimed my vision was good, ending in severe amblyopia; so get second and third opinions from real ophthalmologists here. Second, it is still experimental and there are varying opinions, but many people here say they have had very good results from vision therapy so look into it and see what you think. Third, he needs to work on getting the senses and the body working together. Sports which put a high demand on timing and space, in my case swimming, downhill skiing, rock and roll dancing, and trampoline, are about the best thing you can do. Note these are individual sports that you can learn and enjoy at your own pace; team sports may be good for other things but they won’t give the chance to build skills as he needs to. Many people here also have very good things to say about Interactive Metronome. I’ve heard that Dance Dance Revolution is good although I don’t know it personally. Fourth, try to get him into some arts and crafts to help develop the fine coordination and detail vision — calligraphy, woodwork, better-quality model building, clay sculpture, a drawing class with a positive approach if you can find one, etc. Fifth, when he gets to the stage where this is useful (usually adolescence when the brain is developing abstraction), try to get him a good tutor who teaches real geometry, not memorization of geometry trivia. Real geometry is a question of logic and reasoning, while geometry trivia consists of memorizing long lists of poorly-understood formulas and shoving numbers into them. The logic should attract a gifted student, and the intense study of geometrical forms can then *help* the visual processing.