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Strabismus and dyslexia

Submitted by an LD OnLine user on

Hello, I’m new here. What great resource this board is!

My 7yo daughter had severely crossed eyes as a baby and had eye muscle surgery at 6mos to correct that. Since then she has had 3 additional surgeries to correct intermittant upward and outward eye turns. I began to lose confidence in her pediatric ophthalmologist when I questioned him about trouble she was having learning to read and why she could see a 3-D movie if she didn’t have binocular vision. He seemed to have a lot more interest in her cosmetic appearance (which is quite good, considering) than he did in her functional vision.

I took her to a developmental optometrist that I located through covd.org hoping to get a better idea of how her strabismus may be affecting her ability to learn to read. After the first hour of testing and a very long questionaire, he told me that she did have partial binocular vision, especially when the target is large, as in a 3-D movie and that he felt with training she could obtain some improvement, but probably not eliminate her intermittant eye turn. However, he didn’t think that was the biggest issue with her reading difficulties. He said he needed to do some additional testing, but he thought it very likely she was dyslexic.

She does have some of the characteristic problems. At the end of 1st grade she was about 3mos behind on the sight word lists that the teacher provided. She still confuses b and d at first glance and adds or overlooks letters when sounding out words. If a word is more than 4 letters long and she doesn’t recognize it immediately, she is completely overwhelmed by the prospect of breaking it down into syllables and figuring it out bit by bit. And she hates reading aloud. Her first grade teacher was very concerned about her progress and suggested we consider retention, especially because my daughter was the youngest child in the class.

My husband and I absolutely refused to consider retention for several reasons. She is very verbal with good vocabulary skills. She has no trouble with any of the other subject matter, including math. While she has a bit of a tendancy toward melodrama, she’s socially mature and outgoing. She was tested by her school’s speech therapist and her speech and phonics skills were determined to be slightly above normal for her age, though that put her slightly below average for her grade. Her Iowa Test of Basic Skills scores ranged from 24 to 92% except for reading comprehension which she didn’t/couldn’t complete. I really don’t see any difference between her skill development and her older brother’s. However, her older brother was always the oldest in his class.

We have had her working with a reading tutor over the summer and the tutor says her phonics mastery is age appropriate and her sight word mastery continues to improve at a normal pace. The biggest weakness the tutor sees is in fluency. I’m wondering if we should pursue a psychoeducational assessment. The school did provide very small group tutoring through the ReadingAssist program, but I’m not sure if that was helpful or not. I’m not even really sure that she has a problem that goes beyond being young for her grade. But I don’t think anyone who has looked at her so far is really qualified to determine that.

Any advice would be appreciated.

Laura

Submitted by bgb on Fri, 08/26/2005 - 2:35 PM

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Welcome, Laura.

I’m just a parent and my children have others issues so I can not post advice or suggestions. I just wanted you to know that others who probably can help will be along sooner or later. Give the board a few days…its somewhat slow.

Again, welcome.

Barb

Submitted by pattim on Fri, 08/26/2005 - 3:40 PM

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Privately that is through the pediatric vision therapist? I had strabismus and several eye surgeries as a young child. The first was at 2 years and another when I was about 6 or 7. However, after the last surgery, I had vision therapy for a couple of years which strengthened my eyes. I was also hearing impaired on top of the strabismus so between vision therapy and learning phonetics as a 1st and 2nd grader my reading and vocabulary just took off.

Submitted by LauraB on Fri, 08/26/2005 - 7:36 PM

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Thank you for the welcome, Barb. I am already picking up a lot of good information reading old messages and will have many more questions, I’m sure.

pattim, if you were asking about the reading tutor, she is not affiliated with the optometrist. She was recommended by a teacher at my daughter’s school. She primarily uses Lindamood Bell with other strategies incorporated as she deems necessary. The vision training would be totally separate. I’m glad to hear your vision training was helpful.

Laura

Submitted by victoria on Fri, 08/26/2005 - 9:13 PM

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Hi.

“Age-appropriate” phonics skills — that means pretty weak, a lot weaker than she needs to be a good reader. Since the majority of schools still teach Grade 1and even 2 by guess-and-pray, the majority of Grade 1 and often 2 students have minimal phonics skills. That doesn’t mean it’s best to be that low on phonics, just that everyone else is bad too.

I *never* teach words by pure rote memory as “sight” words. This leads to guessing, panicking over long words, inaccuracies ofver similar words, and all the problems you already have — so why continue a failed experiment?
I teach kids to track *every* word from left to right, period.
A thought, a question which nobody has ever answered and which I don’t think there can be a reasonable answer to: OK, so you have “sight” words which you are supposed to have memorized by some magical undefined process, and you have other words which you are supposed to decode phonetically; so, when you meet a word you don’t recognize, how can you know whether you are supposed to sound it or to guess it?? Learning to read with two incompatible sets of rules just has to be confusing and slow.

You can help a lot here by getting a good, *complete* phonics program and teaching it systematically from start to finish. This takes time and works in small steps, but after a while you look back at the change and it looks like a miracle.

For the reversals, I teach handwriting with a very strong stress on directionality. If you form b and d systematically they are formed very differently and so the student learns kinesthetically as well as visually — and slowly the visual reversals fade out. This is a long-term project, just a little time at any one practice, say ten minutes a day or twenty minutes three times a week — and LOTS of reminders every time the child writes in your presence — but you carry it on over several months and keep up the reminders and occasional practices for a year or two. If you are willing to put in a little time regularly and a certain amount of hard work, it *does* succeed.

You can do a lot of this yourself, or you can see if your tutor is willing to cahnge approaches or you can get another tutor who is used to systematic programs.

It is better to take positive action to change things now, while your child is still young and learning habits. Arguments over labels and waiting for things to happen just get nowhere.

You can get information at Sue’s website, you can ask Des and Janis, and you can email me for my tutoring outlines at [email protected]

Submitted by pattim on Sat, 08/27/2005 - 1:07 AM

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The reason is…if she has a history of difficulty tracking and she is getting the sound symbol relationship but is having trouble with visually tracking her letters which is impacting her fluency then I would suggest strengthening her eyes. If you think it is just a reading fluency thing…with the sound/symbol relationship only then do Read Naturally. It sounds like the tutor you have for reading is good, but many times the tutors don’t spend enough time in building reading fluency. They spend more time in the foundational skills establishing the sound/symbol relationship but the children bog down in multisyllabic words without fluency work.

Submitted by LauraB on Sun, 08/28/2005 - 3:13 AM

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[quote:5d82885a7c=”pattim”]The reason is…if she has a history of difficulty tracking and she is getting the sound symbol relationship but is having trouble with visually tracking her letters which is impacting her fluency then I would suggest strengthening her eyes. If you think it is just a reading fluency thing…with the sound/symbol relationship only then do Read Naturally.[/quote]
She seems to get the sound/symbol relationship when asked about a single letter or blend, but when she has to string more than three sounds together using a printed word as a guide, she loses track of them and starts throwing sounds in to come up with a word she knows. If you give her even a short nonsense word, she will sound it out and then morph it into a real word. The VT did a test where she wore goggles that tracked her eye movements while she read a short 1st grade level story. Her eyes moved together across the lines of text in a systematic way, but she spent “too much” time on many individual words. Then she missed about 7/10 comprehension questions asked orally. It was that test that led him to suspect dyslexia.

She’s pretty good at mazes, paint-by-number, I Spy pictures, visual fine detail in general. If you ask her to pick out a specific sight word off of a page of 30 sight words, even when some words are at odd angles, she’s very fast. However, if you point out that same word and ask her to read it, she’s much more likely to struggle. The tutor had asked us to focus on fluency at home so we have been having her read “easy” books to us, but the last couple of days, I have had her read books that required her to really decode a few words. She is *so* much better at starting with decoding rather than guessing, and doing it in a systematic way. The improvement after only about 12 sessions with this tutor makes me wonder if she just hasn’t gotten the phonics intruction she needed until now.

Laura

Submitted by pattim on Sun, 08/28/2005 - 4:46 AM

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Because she has the visual skills to pick out things from large fields…and it sounds like she has been using her good visual skills to make up for what she doesn’t understand with the sound/symbol relationship nad phonics.

I would also suggest having her doing lots of manipulation of letter tiles like lindamood-bell does. Give her a work orally and have her select the tiles that make up that word. Have her read it back to you. Also she can do the same thing with dictation of words by having her write out the words. Ask the tutor about Read Naturally, see if she does it to help wtih the fluency. At a learning center I worked at we did LMB and to build reading fluency we did Read Naturally. It amazed me at how much Read Naturally helped these kids develop their reading fluency.

Submitted by LauraB on Sun, 08/28/2005 - 1:21 PM

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She likes to play with Scrabble tiles, using as many tiles as she can to make as long a sentence as she can. Getting her to spell words selected by me should be pretty easy if she can then incorporate them into a sentence. Do you think stopping after every few words to make a sentence would be too distracting?

I looked ReadNaturally online and it looks very simple. I couldn’t really tell what the upper limit was. Could you use Level 5 for an 8th grade average reader or for an adult? My husband is sure he has fluency problems. If we could make measuring improvement into a family game, my daughter would be *very* motivated.

Thanks for all your suggestions.

Laura

Submitted by pattim on Sun, 08/28/2005 - 7:30 PM

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Having her stop and read the sentences back isn’t going to be a problem. Read Naturally has a 7th grade level which would probably be more appropriate for an adult.

Correct me if I am wrong…(I can’t see your first post as I write this), but I thought your daughter was younger, like 1st or 2nd grade so a Read Naturally level more closer to her age and grade level would be more appropriate. You want to start where she is comfortable and she is not making lots of miscues in reading. You want to build her confidence and the stories gradually get more complex. Doing it in this manner builds her reading repetoire without getting frustrated and reinforcing more bad reading habits.

Also after reading a selection you can have her write about what she has learned. This will also work on the sound symbol relationship and help her with written expression.

Submitted by LauraB on Mon, 08/29/2005 - 12:30 AM

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Yes, she is just starting second grade. The Level 1 looks just right for her now. I was asking about the highest level for her brother (8th grade) or her father. They are both competent readers, but probably have fluency issues. If one or both of them were doing it along with her and we could figure out a way make it into a competition where she had a good chance of winning, she would be much more motivated.

For example, I took some advice from this forum and we just started keeping score when we read together (a point for me if she guesses at a word, a point for her if she gets through a sentence without guessing). She wasn’t ready to quit after 3 of her early readers. When I told her that was it for the evening, she started a 4th on her own so she could be sure to “win even more” tomorrow. This is a child who hated reading aloud just a few days ago.

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