silent reading

Hi Peg,

You’re description of your son’s reading fits a pattern I’ve seen in some of my clients. He’s smart, so he could memorize the words in first grade, but the load in second grade gets too heavy, so the reading problem shows up.

I assume the “impulsive reading” description is just another way of describing what I have taken to calling simply “careless reading.” I’m guessing that he makes a lot of careless errors such as mixing up “when” and “then,” “where” and “there,” and doesn’t really care whether he says “the”, “a,” “of” or “from” when he encounters one of them. I’m also guessing that he’s taken to jumping to the first logical guess when he sees a multisyllable word, a strategy that might work in first grade, but fails miserably in second.

My suggestion would be to look for a good behavioral optometrist who has an associated vision therapy department (one with plenty of satisfied parents,) and get him tested. The first grade test in school would not have picked up most of the visual problems out there.

Hope this helps….Rod

I want to second Rod’s advice to find a good developmental optometrist. A developmental vision evaluation includes about 20 tests of visual function not included in a regular eye exam. You can find certified developmental optometrists in your geographic area at http://www.covd.org.

My daughter’s developmental vision problems weren’t obvious until she had learned sufficient decoding skills to be able to actually read. At that point, her excruciating problems with fluency pointed to some problem in addition to phonological processing. We found out that at age 9 she had the focusing speed of a 3-year-old. She also had tremendous problems with gross and fine saccades (1st percentile) — the ability to keep your place as you move and stop your eyes to track across a line of text. These were all problems her opthalmologist did not test for. Vision therapy was instrumental in bringing her skills to age-appropriate levels.

It’s also possible that your son’s decoding skills are not as good as they seem. Bright children, especially, are often able to compensate amazingly for poor decoding abilities. My daughter was tested by a speech and language pathologist. On the CTOPP (Comprehensive Test of Phonological Processing), she scored just fine on the sub-tests that used real words. On the same sub-tests that used nonsense words, her scores were terrible. This was because she was able to utilize impressive receptive language skills, memory, and intelligence to pick up subtle clues in the real words. Her ability to compensate camouflaged the extent of her difficulty with pure decoding.

Have you read the book “Reading Reflex”? If not, I highly recommend it. Cost is about $16 at most bookstores.

Mary

Thanks to Mary and Rod for your ideas— I’m still fairly new at all of this. My son seems to be a “visual learner” and a relatively poor decoder—he has memorized an extensive sight vocabulary and has no trouble at all on spelling tests (he can actually spell the words forwards and backwards!) He does make careless errors in oral reading such as mixing up “he” and “she”, “for” and “from”, almost exactly as you described, Rod. He skips whole words and phrases or guesses from context. He sometimes freezes up when he sees multisyllable words and lately will either stop reading entirely and say he is “tired” or will try to get me to start reading to him.

The speech pathologist thinks he has improved, but I am questioning whether I am actually seeing a regression. His oral disfluency seems to have worsened and he actually cannot sustain silent reading on some books he had no problem with last year. The problems I have noticed with losing his place on the page are relatively recent ones—he tells me there are “too many words on the page.”

Is what you call “careless reading” usually related to a visual problem? I was under the impression that most reading problems are not due to problems with vision. Any other suggestions on finding a behavioral optometrist? The nearest one listed on the covd website is over two hours from here.With so many reading programs out there, how can anyone possibly figure out the best one(s) for each child?

Thanks again. It is great to have access to advice with such a complex problem.

Peg

I work with kids who are ADD and have reading issues and I am an SLP grad student…What you have described is quite common for kids who have ADD and this is what I have observed. Their mind wanders when they are reading When they are focused their focus radar is up but the minute their radar goes down and that is when they have the hardest time reading because of lack of focus..

Watch him when you are working with him, see if he is easily distracted by sounds, visual stimuli, a window or cluttered desk etc…if you notice he is frustrated ask him what he is thinking about, where his mind is at, you may be very surprised at what you hear….It is the most amazing thing to observe as I work with kids who know the orthographic code aka the sound to symbol relationship… can decode words in isolation, but the minute you introduce text they start to glaze over. What I have found interesting is that they read so slow and labored because of the battle with attention and having to misread because of their inattentive errors in reading… this is when you see them scramble their eyes are trying to pick up clues from the pictures, or they are literally trying to figure out where they are in the text…If he is bored and not able to focus you will hit a plateau until his ADD and focusing issues are addressed.

It may not be his eyes…….

Thanks for your ideas,…yes, he does at times have focusing problems, but I don’t think this is all that is going on. Even when he is very interested and caught up in the story we are reading, he has trouble with his mind and eyes racing ahead of his actual oral reading/decoding. It is not any kind of external distraction at any rate. Right now confronting a whole page of printed words is really more intimidating to him than it was last year, even when the books are at the same reading level as last year. We have tried him on stimulant medication for the ADHD with no luck so far, it just doesn’t seem to help.

Peg

Peg — I am 100% with Rod on this one.

Your son’s *major* problem doesn’t seem to be visual, at least from this short description. Certainly a serious visual checkup and help with any weaknesses found are good ideas, but the vision problem you describe is *habit*, not organic.

The “visual learner” and “learning styles” stories are also nice slippery slopes that lead to major disasters in Grade 6. I am presently working with a girl in this situation — good visual skills and incredible memory carried her to middle school without anyone noticing that she is actually reading like a kindergartner — now it’s a heck of a lot of un-learning and catch-up. She may be reading disabled for life.

If your son is like most I deal with, he is actually not *reading* in the sense that you and I read. Probably, what he actually does is to scan his eyes in random circles around the page and the pictures, and then he takes familiar-looking words from the text and ideas from the pictures and puts together a sentence that he hopes will come close enough that you’ll accept it. Doing silent “reading” is so much easier because he doesn’t have anyone arguing with his interpretations; he just needs to pick up enough key words from the page and enough pictures that he can circle or check the right thing on the workbook. Also if he’s like many I deal with, he is doing EXACTLY what he was taught to do, and as far as he is concerned, this *is* reading, what his beloved Miss Smith told him to do when he was five (and if Miss Smith was really good at it, she told him to ignore the silly things his parents tried to teach him because she knows the “right” way), and of course he is tremendously frustrated when you insist on this linear examination of those meaningless markings.

A few steps backwards are absolutely necessary before you can make any real forward progress; the student has to drop the circular scanning habit and the picture-analysis habit and has to learn that all those markings are not meaningless. This is a hard pill to swallow.

However, it seems that your tutoring this summer has missed the core of the problem, that he isn’t scanning text linearly, isn’t taking meaning from the text sequentially, and is dropping from visual memory overload so he can’t get either meaning or enjoyment out of books.

The suggestion of Reading Reflex (or any other well-designed *oral* phonics program) is a good place to start. He’ll need re-training of his visual habits; a good reading tutor will work on those too, but a developmental optometrist may be able to do more. Work on RR or something similar, and expect him to re-start at Grade 1 level. Donm’t force the grade-level books too soon, before he really has the skills; as you have seen, this just leads to shut-down. With good tutoring, most primary school kids can catch up to grade level in a year.

My 9 yr. old son only testing at 1.5 reading is a smart kid he is ld is sped. He plays the guessing game alot when reading the books he brings home from school I think sometimes he memorizes alot of the book.

This summer I have a remedial reading teacher tutoring him and she won’t let him do the guessing thing. She is good at being able to see it coming and tells him to skip that word, finish the sentence, then go back and start from the beginning of the sentence again. She also brings her own Level 2 books that are interesting and all new to him. He hasn’t had a chance to look at the pictures and guess.

About the sight thing I took my son to the eye Dr. for an exam and he did need mild reading glasses. Not a major big deal but I wish I had done it sooner

Iam with Mary on this one. My son had trouble with starting to read a word and then “creating” a new ending to the word-often I would realize it was the end to the word next to or below it. I heard the “careless reading” label so often it was starting to stick. I was lucky enough to describe him one day at cheerleading practice as “reading like a child with ADHD” (which he does have) referring to problems with focusing. I had a very well informed Mom eavesdropping who walked over and told me about Vision Therapy.

I am SO glad I met her. We are still dealing with visual processing issues but he is at least reading the right words now. He is not blinking constantly and he ACTUALLY likes to read. I just read a book on Reading Disabilities and they basically called the field of Vision Therapy damaging. I’d like them to see the difference in his CAT scores for reading comprehension (from at 47 national to a 81 national) after only 5 therapy sessions. I wish we could have done his CATS after his 20th (and last) appointment.

Your insurance will pay for the evaluation even if they turn down the therapy (and email me later for advice on how to deal with that if you get to that point) so you have nothing to lose and everything to gain.

Hi Peg,

Just an observation that you should consider.

The vision therapist that I have a good relationship with tells me that it is almost impossible to work with a child during vision therapy if the child is on Ritalin. I don’t know about other medications, but the therapist says that Ritalin frustrates the process of retraining the visual system.

Keep this in mind if you locate a behavioral optometrist. In that regard, you said elsewhere in this thread that the nearest behavioral optometrist is over 2 hours away. Many of the clients I work with did have to travel nearly that far to reach the optometrist and get the vision therapy, and they are glad that they did so.

However, I would suggest calling the closest two or three and ask them if they know of someone closer who offers vision therapy. I suspect they will tell you if there is, but then be sure and check some parent references. As in every field, there are some unsuccessful vision therapists out there.

Rod

Hi victoria,

I agree with virtually everything you’ve written in this post, but want to add something.

I’m fortunate enough to be located very close to a reputable vision therapy department, so I have the luxury of referring when in doubt.

I have “retrained” a number of kids exhibiting exactly the behavior you describe so well in your post, but many of them proceeded to “fall apart” when the print got smaller. I now routinely refer these kids to the optometrist.

Granted, I see many kids who are just using the wrong reading strategy (as you described so well,) but these kids move right on along as the print gets smaller.

I’m coming to the conclusion that an intelligent 9-year-old who is reading at the first grade level very likely has a significant visual deficit which is preventing him from picking up the phonetics of the language. I would place that probability at close to 50%, but this is entirely subjective on my part.

Also, as you indicated, the visual learner designation is a slippery slope. Ironically, if I turn out to be correct, many of the kids considered visual learners (because they’re looking at the pictures, guessing from context and not getting into the “meaningless markings”) probably have a visual deficit, not a visual strength.

Nice to see this thread going, as it describes a lot of the kids I am currently working with, and parents need to know that there’s a lot of similar situations out there, and that they can be addressed…….Rod

Mis-reading the “little” words is often a characteristic of careless reading. Careless reading most often refers to inattention to detail while reading, which is an attention issue — often tied to decoding problems — rather than a vision issue.

However, skipping entire words and phrases is definitely a characteristic of a vision problem, as is the complaint of fatigue soon after starting to read. The complaint of “too many words on the page” is characteristic of a visual-spatial problem, which again relates back to vision rather than carelessness. None of these complaints is typical of careless reading alone.

Even if the closest developmental optometrist is 2-1/2 hours away, it can be worthwhile to get the evaluation. If the optometrist is willing to design a primarily home-based program of vision therapy — assuming VT is indicated by the evaluation — then you could probably get away with an office visit just once every two weeks or once a month. I know one mother who did vision therapy this way. Once a month she and her son would go in for a progress check and the mother would get trained in any new exercises to be done at home daily before the next visit.

Medical insurance typically covers at least the regular eye exam portion of a developmental vision eval. Some insurance will cover the whole eval. Where we are, it’s possible to get a developmental vision evaluation done for about $100 without a written report. However, I recommend getting a written report of the test results as it really helps with understanding what is going on. Here a written report (and a meeting with the doctor to go over the written report line by line) costs an additional $100 or so.

Keep in mind too that it’s possible to have combinations of problems, so you could be looking at (1) a developmental vision delay *and* (2) a decoding problem *and* (3) a lack of attention to detail.

One thing I want to mention is the longer these problems continue, the more the child becomes entrenched in a “guessing” strategy with reading. Guessing can become a very bad habit that is actually more difficult to overcome than just teaching decoding skills. We had this problem with my daughter.

There is a lot of bad information floating around about vision and reading. It’s true that vision is not a problem in all children who have difficulty reading, but it is definitely a significant problem for some children. It is up to the parent to determine whether an individual child does or does not have a developmental vision problem. I’m really glad I finally decided to ignore our opthalmologist’s advice and took my daughter to a developmental optometrist. It was a huge turning point for her with reading.

Mary

If he’s been reading one way — memorizing the words — and has had to learn a different way to do it, then it makes sense that he’d seem to regress. If I’ve learned to swim with my head out of the water because I don’t know how to breathe properly, I can still get pretty fast… and I’ll probably go slower if I make myself put my head in at first. Once I’ve learned the more efficient way of doing things, I’ll take off and leave the inefficient ways behind.

And, it’s even harder to learn something if you’ve also got to unlearn a different way of doing it first/at the same time.

Another fairly common problem (though not universal) is simply not having practiced one skill enough before moving on and expecting the kid to be able to apply it. Some kids benefit hugely from “overlearning” — makes all the difference between constant frustration and mastery.

Is that just with Ritalin?? My son was on Adderall during his VT this past year and his DO knew it. He did not have any problems. He had severe Convergence Excess with tracking problems and was treated successfully in 20 sessions.

Hi Beverly,

Yes, it was just Ritalin that the therapist mentioned, and this was only the opinion of one therapist who doesn’t like Ritalin anyway, so it may have been an exaggeration. I probably shouldn’t have stated it so strongly but I don’t like Ritalin either, as it happens.

Rod

Thanks to everyone for all the valuable ideas. It is obvious that my son has a lot going on that is going to be a bit difficult to sort out. He is a very creative, verbal, outgoing child who was described by his second grade teacher as a “divergent thinker.” He is also clearly hyperactive in the motoric sense of having lots of trouble sitting still in many situations, yet we have always read to him and he has always been captivated by stories and books. He has some clear strengths in visual memory (he quickly memorizes words that he can picture in his mind) and has never until fairly recently seemed to me to have trouble keeping his place on the page. But he has always tended to read too fast, to skip many little words like “the”, “a”, and to misread -both linguistic and phonological miscues. On the CTOPP test last spring, his scores were in the average ranges for phonological memory and rapid naming, but significantly below average for phonological awareness. Last year in second grade, he read a total of 89 books during school time and achieved about 83% accuracy on his accelerated reader (comprehension) tests for books in the grade 2-4 level range.

Rod, he is not presently on Ritalin or any stimulant medication because we had not seen any improvement in his ability to focus while on these medications. After our tutoring attempts over the summer, he did seem to be overloaded as one of you mentioned and to be unable to sustain silent reading and to be less fluent in oral reading (more hesitant and skipping and losing his place on the page). I don’t think he would currently be able to read a complete book at the second grade level on his own right now. However, my husband is reading the “Little House on the Prairie” series to him for pleasure and in the past few days, he has been able to read quite fluently the first page of each chapter for his dad. I am not sure if he is now using a different reading strategy than he was last year, because it seems to me that he still has almost as much trouble as ever sounding out words (especially those multisyllabic ones).

I’d like to read more about vision therapy before we decide about pursuing this route. Does anyone have suggestions on what to read first?

Peg

Peg,

You said that your son misreads small words like “the” and “a” and that his reading appears to have regressed with phonetic instruction.

Davis Dyslexia Correction specifically addresses this small word problem. The program does not involve phonetic instruction, but emphasized comprehension and cognition, and visual word recognition skills. Students with dyslexia and ADD can do very well with this approach, precisely because they get frustrated and confused with trying to break words down phonetically. Of course, phonics cannot be abandoned entirely, but generally if children are able to read at a second grade level, they are ready for an approach that emphasizes whole word recognition and comprehension.

The Davis program involves several techniques. I wrote an article describing this in some detail, that is posted on the “Dyslexia Parents Magazine” web site here:
http://members.aol.com/dddyslexia/mag16.html

Part of the program includes modeling the small words like “a”, “the”, “it”, “he”,”she”, “for”, “from” etc. in clay, along with developing an understanding of what those words mean and their function in language. If these appear to be the main stumbling block for your son, then his reading problem is not one of decoding or phonics, as clearly these are not difficult words to decode.

Davis methods also include some tools to help with attention focus and developing self-awareness and control over energy levels, so it is good for ADHD kids, too.

You wrote: “he states that something has happened so that he can’t read as well as he could last year.” This is probably true - it is likely that overemphasis on phonetic approaches has actually made reading more frustrating and comprehension more difficult for him. The combination of bright + ADHD means that he really doesn’t have the patience to get meaning from print if the pace is too slow for him; Jeffrey Fried, author of “Right Brained Children in a Left Brain World” has reported success in some instances with ADHD kids with speed reading techniques.

More information about Davis methods is at the web site at http://www.dyslexia.com/ and forum at http://dyslexiatalk.com/

It sounds to me like your son is actually capable of doing very well — reading 89 books in second grade with 83% accuracy is very impressive.

Best wishes,

Abigail

“20/20 Is Not Enough” was an excellent book recommended by our Developmental Optometrist. It addresses tracking/teaming/binocular dysfunction issues as well as visual processing issues. I have no clue who wrote it because he had it in his office and I read it there udring appointments. The doctor also had several other books in his office, maybe the doctor you would go to could recommend some. If he /she is not willing to give you titles and authors, he/she is not someone you would want to take your child to. He/she should understand thst this would represent a large time and money commitment and that you want to be fully educated.

Hi Peg,

You might try reading “When Your Child Struggles — The Myths of 20/20 Vision” by David L. Cook, O.D. It covers the types of visual deficits that are addressed by vision therapy and includes a few brief tests that may give you some clue as to whether there’s a problem. They are by no means comprehensive tests, however.

I got my copy online at either bn.com or amazon.com. It was around $10-$12, I think…not sure.

Your comment that he reads the first page with decent fluency, then (I assume) loses that fluency or just wants to stop, is consistent with a visual problem. Think of a person who is effortlessly moving materials from one side of a table to another for hours. As long as the material being lifted is not at all heavy, all they need are short breaks to relieve boredom or to refocus on the task. This is analogous to a good reader.

Now make the material individual one-pound blocks. These too will be effortlessly moved from one end to the other for some time, but then the weight starts to impede progress. Eventually, the worker becomes highly stressed, able to hardly lift the next block. Yet, after a long break, (like the time it takes Dad to finish the chapter,) they can again perform well at the lifting task. This is analogous to the reader with a visual problem. Something (poor accomodation, intermittent suppression, tracking problems, etc.) is causing additional, undetected, reading stress. In other words, he can read, but he can’t sustain the effort (because it IS an effort, above and beyond anything you or I have ever experienced.) And, ironically, he doesn’t know he’s undergoing an unusual stress….he thinks this is what’s involved in reading, because this is the way it’s always been.

It’s like color-blindness. People will go years without knowing how easy most people determine when to stop and when to go at a stop light, until someone tests them and they learn that the top light is visibly different to everyone else from the bottom light.

Finally, the reason I consider misreading little words (which I call careless reading) a byproduct of a visual problem in some cases is because I have often seen the carelessness resurface when the print size diminishes. I know they can decode such simple words, but at least two things could be happening. First, they may not see the little words as well in smaller print. Second, and more likely, they are suddenly having a much more difficult time with the multisyllable words again, and they lapse back into a careless habit as regards the “little words.”

While you are doing your reading on vision therapy, make it a point to talk to a few patients of your nearest optometrist. They will open your eyes a lot on this, because some of them are going to have kids whose reading problems are going to sound very, very familiar to you, and if the vision therapy was good, you are going to be talking to some satisfied parents.

And finally, I haven’t said much about Reading Reflex in all this, but you should also take a look at it. I have seen kids who really didn’t need it after successful vision therapy, but I have also seen a lot who were way behind in their reading even after the vision therapy and who would benefit from the curriculum in Reading Reflex. And also, if the vision exam finds no problem with his visual system, then Reading Reflex may be the way to go to bring his reading up to speed.

In fact, a lot of Phono-Graphix therapists (the curriculum in Reading Reflex) would say to go that route first, and you might try that. I just think that you’re describing a child with an underlying vision problem and would at least have the testing done first.

This is awfully long already, but let me tell you briefly about the testing. The optometrist will probably do an exam looking for deficits that he can detect. If he finds nothing obvious he may still recommend a full developmental vision exam be done by the vision therapist. This will pick up problems undetected in the initial exam. I’m out of my depth here, as I don’t know what each one tests for, but I know that that’s the routine in the office I’m familiar with.

Rod

There’s quite a bit of information on these websites:
vision3d.com
visionhelp.com
visiontherapy.org
visiontherapydirectory.com (another place to get referrals—might find someone closer to you geographically)

Along with Rod, I would caution that not all optometrists are created equal. I have found that medical doctors vary a lot in ability, and developmental optometrists have that same range. You need to like and trust the doctor that you see. Get a second opinion, if necessary. The developmental optometrist we used was affiliated with a non-profit foundation that provided services to a school for challenged children. There are other good optometrists out there, but I did meet one I didn’t like.

Incidentally, I have found http://www.metacrawler.com to be very useful for finding websites like this. I use it whenever I want to research a subject — great tool!

Mary

http://www.vision3d.com
http://www.visionhelp.com
http://www.visiontherapy.org
http://www.visiontherapydirectory.com

Thanks to Beverly, Rod, and Mary—I really do appreciate your help. I have found a behavioral optometrist less than one hour from here and will call him soon and also will check out “Reading Reflex.” I still don’t know if he fits the picture of a child with a visual problem, since he was reading better last year and rather suddenly has lost fluency just as we were focusing so much on phonological awareness. He could probably read more than one page per chapter of the book his dad is reading to him, it is just that he has refused to read aloud or silently much since this problem started over the summer — he cries and protests so much that we don’t know whether to push it. So it is not something he can’t do so much as something he won’t do right now, but fatigue definitely becomes a factor as he reads more pages. It really just seems that he has completely lost his joy in reading that he had last year. That is why his dad has started trying lots of reading to him again. We are talking about physical factors, but I wonder if there isn’t some kind of psychological factor here, too(focusing too much on weaknesses?). He is going to have to do some silent reading in school this year, so we will have to see how that goes.

I have a couple of other questions—can vision therapy be done at home and how does this work? He is so resistant right now that I am not sure another
“required” task is going to go over very well whether it be vision therapy or the Reading Reflex approach, unless somehow it seems fun to him.

Also, do any of you use any kind of line marker or device to help the child keep track of his place while reading? I know the ADD warehouse sells one, but our speech and language pathologist told us not to use it.

Thanks again.

Peg

The doc recommended using one (it was a white card with a cut-out window and laminated) during therapy but not when it was over. The therapy was done in-office with daily homework. We are doing visual processing via a computer program at home ourselves but it apparently was not an option for the eye teaming/tracking issues due to the interactive computer programs that were used.

I guess I am going to come in more aligned with the point-of -view expressed by Victoria, Sue and Pattim. I don’t see indications from your post that suggest a vision problem to me, though I am admittedly not an expert in that area. I do however see a child with a condition that impacts his stamina and attention to detail (ADHD) who has been successfully zooming along silently- you think. At his age, oral reading is a far more accurate assessment of how they are really doing with the words than silent reading- and that was less strong? It is quite likely that he was skipping over stuff that he couldn’t decode, or using the picture cues and his good vocabulary skills to help him out. (That is a pure speculation from your statement that he is bright BTW) He thought he was reading, his teacher likely thought so too, and so did you. Now you have begun to insist on a finer level of control and attention to detail and he doesn’t like it and isn’t doing as well. I think that this is fine and normal behavior on his part. I don’t blame him a bit. I would feel the same way if it were me. It would be like telling him that he needed to learn a whole new way to ride his bike. I also think that as he becomes more skilled at decoding, it will become more automatic for him and he will resent it less- because he will be able to be more fluid.

Fluent reading may take him a bit longer because of the ADD, but there is no reason that it shouldn’t develop. Medication is helpful to lots of kids in terms of allowing them to maintain focus and control impulsivity but not all. If you and the Dr. find the right one it can make a huge difference however.

Robin

Many developmental optometrists will design a primarily home-based program of vision therapy, which substantially reduces the cost of VT. If cost is an important consideration, ask about this before you make the appointment for evaluation. Some problems need to be addressed in-office, but many of the exercises can be done at home. (VT is usually not covered by medical insurance.)

Our developmental optometrist offered to design and supervise a primarily home-based program for us, but we opted to do the therapy in-office even though it was considerably more expensive. This relieved me of a lot of responsibility and anxiety. My daughter actually enjoyed the office visits (the therapists were wonderful with children and made it much more fun than I ever could have!). We would have had daily fights at that time if I had tried to do it at home. However, I do know mothers who have successfully done home-based vision therapy.

Switching to reading out loud is an excellent approach. This develops language skills, which are very valuable for comprehension later.

There is no harm in using a plain index card under the line of print as he reads. This can help a child with tracking problems at least stay on the correct line of print.

Personally, I found that all of my daughter’s complaints about reading were actually grounded in fact. It sounded like whining, but in fact reading really *was* a physically more difficult and less rewarding task for her than for other children. In her case, Reading Reflex corrected the phonological processing delays, while vision therapy and PACE addressed the visual processing problems. Not all children have both problems, but those who do have both problems need help in both areas. I just wish we had started the whole process sooner, so that my daughter would have spent less time experiencing frustration. Even though she reads above grade level now, she still does not read on her own for pleasure — probably because of the early conditioning.

Mary

You say you’ve found a place to get vision therapy; good, probably will be a lot of help. As long as the therapy goes well, I would go with it; if he gets overtired and frustrated there too, try another therapist.

Remember you started with a problem with reading, and he will need some reading instruction as well as vision training. Phonographix/Reading Reflex is strongly supported by a lot of responsible people on this board, and would be a good way to go. Again, forget pushing the grade-level books for a few months; use PG to rebuild the foundations that were weak on the first go-round, and get back to books after he has the skills to enjoy them.

I personally have a very strong feeling against the ruler under the lines to hold place. I have NEVER seen it help, and I have often seen it hurt. Kids who have been trained to do this start out with a handicap — they can’t just pick up a book and read, they have to go through a ritual finding their ruler and setting things up. And they have been labelled as having a “reading problem” and the ruler is a visual sign of the “problem” and a crutch and all too frequently an excuse. Then they can’t read ahead to the next line, so their reading becomes unfluent and choppy and wrongly stressed, and comprehension goes out the window. Then they lose lines anyway as they try to move the ruler down. When I see this habit, I take the ruler a way from the kid and tell him to use a pen as a pointer if necessary, and in every case I have seen, the reading fluency *instantly* improved.

I have, once, used a card with a window to break the ingrained habits of a very intelligent Grade 4 non-reader who used the circular scan and picture-guess system. He was bright enough to catch on to L-R linear scanning in three sessions, and once he knew I really meant it and wouldn’t get him get away with his coping tricks, we dropped the window. It still took six months more of hard-headed insistence to make the new habits automatic, however.

This has been a great dialogue for me and I realize there are no easy answers. I agree with Robin that the ADHD probably plays a role in his difficulty with reading fluency, yet I feel there are processing delays also (phonological and perhaps visual also). Like many kids with ADHD, he is bright and easily bored and resistant to activities that involve a lot of practice and it is a challenge to present the phonological awareness activities in a way that interest him. I think that his “careless” reading habits are due to a combination of factors and I am beginning to learn a lot from this board about how to deal with this problem as we read together. I really had no idea how to work with him on this, even after several joint sessions with the speech pathologist.

Robin, we have tried both Ritalin and Concerta for several months and he experienced some pretty bad side effects, including trouble sleeping, extreme irritability, and weight loss. There was no real change in his hyperactivity or ability to focus, as observed at home or school, so we stopped the medication. I know there are other medications we could probably try, but I’m not ready to get back into that quite yet. We have found that he requires more sleep than many kids and that sleep deprivation is clearly a factor in his learning and behavior. This school year we are trying to create a calmer and more structured home environment and to increase his sleep hours. That is one reason why I hope that vision therapy is not required because the time and energy and travel required will definitely be hard on him. Home therapy would also be stressful at this point, I’m afraid.

By the way, can someone tell me what PACE is?

Peg

Have you checked Dr. Daniel Amen’s site about different forms of ADD and the treatment options? I think if you search his name you will find it pretty easily. It might have some descriptive information that would help you. Medication isn’t the answer for all kids- it is nice when it works, but it isn’t a cure either. You sound like you are very sensitive and common sense about your son.

Speech pathologists are wonderful and knowledgeable people and with little guys are the first place I would go for help identifying potential learning issues. Most of them however, are not reading teachers. We- or at least I- am delighted to have helped a little. And this has been an interesting thread!

Robin

I find your comments about scanning around the page in circles to very interesting and, certianly, plausible. Can you suggest any reading I might do to access research on eye movement patterns that differentiate dyslexics from non?

PACE stands for Processing and Cognitive Enhancement. We did PACE as a follow-up to vision therapy because it contains many exercises to develop visual processing skills (as well as other cognitive skills in the areas of auditory processing, reasoning and logic, short-term memory, etc.). It tends to be very helpful for ADD. Certain aspects of attention are trainable (impulsivity probably is not), and PACE does a great job in this area. Biggest problem is that it is expensive because of the extensive one-on-one tutoring required. Where we are, a 12-week program runs about $2400. It is an intensive program and, if done during the school year, parents usually arrange for no homework or even time-off from school in order to fit in the tutoring and homework practice. However, most children find it rather fun and interesting to do — not boring. Website is http://www.learninginfo.com

Because PACE is such a huge investment, I always advise checking out sensory level development first. PACE trains cognitive skills, which build on a foundation of sensory level development. If, for example, there is a sensory-level problem with vision (“visual efficiency” skills such as binocularity, tracking, gross saccades, focusing, etc. — the level of vision development that underlies “visual processing” skills such as short-term visual memory, directionality, speed, etc.), I recommend getting enough VT to correct the sensory deficits first.

Audiblox is a home-based cognitive training program that tends to be very helpful for dyslexics, and also helps to train attention. This program is inexpensive (about $80 for book, video, and starter kit of manipulatives) but it does require 1/2-hour per day of one-on-one work with the child. This is a very good program, not as comprehensive or intensive as PACE, but I know that some parents had difficulty keeping at it with their children, in part because the exercises can become boring after awhile. Website is http://www.audiblox2000.com

Interactive Metronome is another therapy that has had very good results with training attention. Cost is about $1,000 for 10 hours of training. Website is http://www.interactivemetronome.com

For a phonological processing problem, I always recommend Reading Reflex first — it is really great for teaching decoding skills.

Hope all this is clearer than mud! It’s a lot to take in all at once. I learned all this over a period of two-and-a-half years, and I’m still learning.

Mary

Sorry, I don’t have specific research on this particular topic at my fingertips. I read any info I can get on reading and dyslexia and pick up a bit here and a bit there — everything from Scientific American to the ERIC website. The particular description I gave is based on experience and personal observation, although all the research that I’ve read is consistent with this.

I have Dr. Amen’s book, along with dozens of others on ADHD. I agree that there have to be many types of ADD/ADHD and I admire his attempt to sort out various treatments for different types, but unfortunately, the research just isn’t there yet to support what he is doing clinically. My son really doesn’t fit into any of his categories very well and I am wary of using medications other than the more widely used stimulants. He has so far functioned fairly well with the ADHD and has excellent social skills, so unless he falls further behind academically, we will hold off on further medication attempts. We have also tried some dietary changes and have him on a well-researched fatty acid supplement for children with ADHD and are hoping this may eventually help him.

Now that school has started here, my main concern is with his new teacher who seems to be piling on homework already, leaving very little time for us to focus on what I view as the most important area, his reading. I’m glad I’ve found this board for some support—it looks like it’s going to be a rough year!

Thanks, Mary, for all the information.

Peg

I found a copy of “20/20 Is Not Enough - The New World of Vision” by Drs. Arthur Seiderman and Steven Marcus. It was published in 1989 in hardcover….I don’t know about paperback availability.

I’ve read the first half of the book and it does a good job of describing the need for vision therapy, as well as some of the testing that is done. Not much is said about the specific tasks done in vision therapy, however, so don’t expect to be able to start a home course in vision therapy from it.

From personal experience with several children, I would say that I agree with the general thrust of the book, which strongly advocates more visual testing in a number of situations. As I’ve said a number of times in here, I have seen children who achieved significant gains in reading ability primarily as the result of vision therapy, and I have worked with children who required vision therapy before they could make effective use of the Phono-Graphix therapy that I use. And, of course, I’ve worked with children who only required Phono-Graphix, as they had no visual problem………Rod

My son is currently doing PACE, which has a number of visual processing exercises in it. I am the trainer which means I have to almost do the exercises with him, in order to to ascertain whether he is correct. I quickly discovered that they wore me out as much as him. The particular exercises I have found difficult work on fixation.

Anyway, I learned to read by myself at age 4 and haven’t had any trouble since. I wonder if, except in extreme cases, vision issues aren’t problematic by themselves but only in combination with other problems. I say this also because my son, after vision therapy, tests normal in the OD’s office, but still has problems tracking. He has auditory processing problems as well and my theory is that his visual processing isn’t automatic enough for him. Another child with his visual skills, but without the additional auditory processing problems, would appear for all practical purposes to not have any visual issues.

If my theory is correct, this could explain how vision therapy seems to have an inconsistent effect on kid’s ability to read. Frankly we saw no improvement in reading with vision therapy. This isn’t to say I regret doing it. My son now is able to do worksheets which he had been previously unable to track. We also saw improvements in his visual-motor skills, such that he tested in low end of normal rather than as having an LD. And I think it laid the foundation for the success we are having with PACE. I have seen major improvements since starting PACE in his ability to track (without a finger, pencil, ect), although if the print is small or he is tired we are back to where we were in June.

Somedays I can’t believe how anyone ever learns to read!!

Hi Beth,

Just a couple of points….

If your son has obvious trouble tracking, then he shouldn’t “test normal in the OD’s office,” unless the OD isn’t testing for the kinds of visual problems that vision therapy addresses. A developmental exam should show a problem with tracking, or at least, that’s what I thought. I’m a little confused about how you can know there’s a tracking problem, but the OD can’t find it?

As for why vision therapy doesn’t always correct a reading problem, I think there’s two alternative explanations. First, there are ineffective vision therapists out there, or at least that’s what I was told by two different parents who finally found an effective one and saw significant improvement in their children’s reading behavior.

And second, vision therapy doesn’t teach reading. If the child has had poor, or ineffective reading instruction, and is years behind in his reading, then there is no reason that fixing his visual system should suddenly make him a reader. In my opinion, the reason a lot of kids do make significant gains with vision therapy is that the sort of parent who finally discovers the existence of vision therapy is oftentimes the same parent who would have left no stone unturned in seeking help for the original reading problem. One of the first avenues they would have likely pursued would have been systematic, explicit phonics instruction, in whatever form they found it. That is, some of these kids will have had some form of Orton-Gillingham, Phono-Graphix, Lindamood-Bell, etc., and once their visual system was corrected, they would be ready to take off, using their previously-acquired knowledge of how the English code really works.

One child I am working with now is, I believe (and hope) exactly such a case. He now understands HOW to read, and can decode four-syllable words of reasonable difficulty which he will be encountering in math, science and social studies in junior high, but when faced with a page of fine print, he becomes overwhelmed. In my opinion, (and I certainly hope I’m right) there’s an excellent chance that he has a visual issue that needs addressing before he can read successfully. Given what he has learned about reading in the last two months, his reading will take off during vision therapy, IF he turns out to have needed it and IF it is effective vision therapy.

I should add that many of the kids I now work with have already had vision therapy. Many of the children who successfully completed the vision therapy regimen are turning out to be easy clients, but the fact that I am working with them at all is an indication that not all kids instantly become proficient readers just because they’ve successfully completed vision therapy.

Good luck with PACE….Rod

Rod,

I defined his problem as tracking because he was skipping lines when reading. He didn’t do this in the OD office. His weakest score was fixation but even here he now is in the normal range. It may be that this is what was causing his trouble with tracking.

I thought the guy we went to was decent but he didn’t take my breathe away. He wasn’t overly cooperative, for example, in helping me figure out what I could do at home to help him. I actually didn’t expect him to turn into a fluent reader but just stop skipping lines. Even that did not happen. Perhaps a different OD would have managed that but we seem to be getting there with PACE.

I have a different question for you about PG and my son.

My now eight year old son went to a PG intensive a year ago August. He had ended first grade as essentially a nonreader. He came back reading but clearly not on grade level. My husband, who took him and sat in on the sessions, went through all the advanced code with him over the next months. We then focused on fluency because he was such a slow reader by keeping him at the same level of readers. We did segmenting ect. when necessary.

AFter some other interventions, his reading fluency is fairly normal. He seems to have forgotton much of the advanced code, however. That is, he reads what he now knows automatically (which is close to grade level now) but isn’t very good at decoding a lot of other things.

I want my husband to start over in the advanced code with him. Because of other things we have done, my son is now doing much better with memory, retreival, and visual and auditory processing. He had a very hard time retaining anything last year . I have no doubt he would have messed up Read America’s statistics for how long it takes to remediate a child to grade level using PG, had we lived in Orlando and been able to keep him going to the clinic!

What do you think? My husband is somewhat resistant because he feels like all his work was for nothing. He wants to just keep reading with him. He says that most people don’t know the code in isolation. I’m concerned that, even after all our work, he doesn’t seem to have the basic skills necessary to keep moving. I can’t see it coming just from increased reading, even with PG corrections, but maybe I am wrong. That is what I would like to know, from someone who is very familiar with PG. What would you do with a kid like my son?

BTW, his blending and segmenting are fine. His auditory processing (PG definition) did not move with PG work. (He has CAPD). I haven’t retested him lately but hopefully PACE’s auditory processing work (which is drill, drill, drill) is solving this problem. He is moving along on it, although at a snail’s pace.

Thanks for any insight you might have.

Beth

Hi Beth,

I’ll comment on the vision therapy you got first and tackle the PG question in another post.

In my opinion, one of the hallmarks of a good vision therapy dept. is their willingness to show you what to do at home. They know that exercises may have to be done over a relatively prolonged period of time and that most people are capable of directing a significant part of the exercise regimen themselves, once instructed how.

Also, for reasons including both time and money, it is simply not possible to schedule all of the vision therapy at the office. Some therapy can take up to a year, and maintenance may go on for some time after that.

I don’t know what is going on in the other offices, but I suspect it’s got as much to do with making money as it does with correcting visual problems. Ask yourself if you would give another parent a good reference to your vision therapist. I suspect not, which is why I continually advise people to check parent references. The good vision therapists have created some pleased parents though, of course, not every client will be a success story…….Rod

Hi Beth,

You ask what I would do.

Well, if you brought him to my office, I would probably start at the beginning, testing him to verify his segmenting and blending capabilities and to see where he was at in phoneme manipulation. I’d also check his Word ID level and Word Attack level, and then listen to him read.

Here’s what it sounds like I would find…..a boy who, as you say, now has good skills, and a reading vocabulary, but with poor word attack skills (relative to his reading level.) I would also expect to find that he was reading relatively fluently in material higher than his word attack level would indicate, but not at grade level. I say all of this, incidentally, because of your description.

I worked with exactly such a boy last year…..good skills, lousy word attack (virtually none at the time of intake) and yet very good fluency in real text, though below grade level. I was dealing with a child who could memorize easily, and had adopted it as his main reading strategy.

You want to avoid this happening. Practicing easy material over and over again is a good way to ensure that it does happen, unless you are also moving ahead on the advanced code work and multisyllable work.

It’s possible that he knows enough of the advanced code to be able to simply do a lot of word analysis during reading sessions, while working on his chunking skill when encountering multisyllable words. The main thing is that he understands the nature of the code (especially alternate spellings and overlap) and is comfortable trying the overlap options. If this is Greek to him, you should probably repeat at least part of the advanced code work.

However, if he can encounter a word like “probably” and chunk it as, say, “proe—bab—lee,” and then knows what you’re talking about when you point to the “o” and ask what else it can be (easily substituting the “ah” sound for the “o,”) then he should be able to make progress assuming you’re doing good error corrections.

Having said all this, let me add another detail about the boy I worked with. After 12 or so sessions, I finally referred him because he just wasn’t “getting it.” It was like information was going in one eye and out the other….it didn’t stick. Yet I was dealing with an obviously intelligent child with good verbal skills. The only clue I had to a visual problem was a tendency to wear down rapidly when reading unfamiliar text. He could blaze through a pre-memorized text and seemed to enjoy reading then. But put a new book in front of him and have him read it, and he was yawning and showing avoidance behaviors within five minutes.

I finally referred him, with great reluctance because I just wasn’t sure, and he ended up in vision therapy. Not a lot happened at first, and then gradually, he became able to read on a more sustained basis, and also became more receptive to new information on the code. It started “sticking.” Because of his intelligence, we went through a lot of material early on that he seemed to understand, but that simply didn’t sink in. We also experienced a lot of frustration trying to practice what he had “learned.”

Now, lessons are wrapping up, and he is about on grade level, and the frustration is gone. All that remains is to increase his comfort level with multisyllable words a bit more, and I feel he will be able to go on his own. I don’t think we would be to this point without the vision therapy. Also, I am way above 12 hours with this boy….more like 40, with a good deal of it wasted due to the frustration he was experiencing. (It was volunteer work, so I felt free to keep on going….I learned as much as he did, I think, even though I’ve been at this for almost three years now.)

Just recently, upon hearing that letters “move around on the page” for some kids with visual problems, he said that’s what had been happening to him before. This surprises me, and may be an invention of his, because I asked such a question early on when I was wondering about a vision problem. And yet, there are adults who post in here (scriabin being one such, I believe) who relate exactly that experience. They just assumed all their lives (until undergoing successful vision therapy) that this was normal.

You asked what I would do. If you brought him to my office, I’d start at the beginning, move as rapidly as possible until I hit his learning level, and if I saw too much frustration while trying to apply what he was learning to real text, I’d refer him to an optometrist with a reputable vision therapy department. I define reputable as “having created a lot of pleased parents.”

Good luck….hope this helps….Rod

I may have made it sound worse than it was. We got homework but I had some other ideas from LDonline and he wasn’t very cooperative with those. For example, I had vision aerobics (a computer program) and I wanted to know how to work it into what he was doing.

I did feel like there was some interest in making money there. We had insurance that paid a good portion of our costs.

I thought about switching providers but honestly convenience played a role. There was noone else in our county and his office was on the other side of town.

Rod,

Thanks for your reply. You describe my son pretty well, except for the memory part. He has not learned by sight at all. He has acquired a pretty good vocabulary simply by repetition and by resolving some of the problems with retreival that were hindering him. Keeping him at the same level of text helped with retreival, but as you know, caused some other problems. He, however, was never at the point of automaticity with the code, despite much repetition. He is just a really tough case, with multiple underlying problems that have hindered his acquiring decoding skills.

My son does, however, understand the nature of the code in terms of overlaps. I don’t know if he could decode “probably” correctly. I will try later and see what happens.

My son is also due back at the same optometrist next week for a check up. I think I will try taking him somewhere else just to get a second opinion.

I think at this point his reading is being hindered by 1. still some visual issues. 2. auditory processing problems that are really a devil (more than visual issues). 3. incomplete knowledge of the code. His memory has improved but everything seems to take so much repetition with him.

I think we will “start” over and see what happens. Thanks so much for your insights.

Beth

You and Rod seem to have gotten together on a system that is likely to do a lot of good.

Some thoughts:

Most learners, most of the time, do a certain amount of backtracking and circling and plateaus before leaps forward. This is normal, to be expected, and to be worked through patiently. Just because your son isn’t “getting” everything at once from the first go-through is no reason either to panic or to give up. Only if he stalls completely for several months do you need to change the program.

I would, in your situation, have dad continue “just reading”, reading real books of limited but progressively increasing vocabulary.(Old reading texts from the local second-hand store have oodles of fun stories for “just reading”) Dad seems to enjoy it from your description, and it’s a valuable activity by itself. I feel even more strongly than Rod that reading the same thing over and over is actually counter-productive, leading to bad habits of memorization.

I would also review even the basic code (a quick couple of weeks, making it clear to the kid that this is just review, getting ourselves ready to dig in to the hard stuff later) and *then* re-teach the advanced code. So he didn’t get it all the first time — well, neither do most of us. Just keep at it and based on your previous success, it should stick better with age, practice, and feedback from reading other real books.

I have been out of town so I didn’t get back to you before now….I had years of eye therapy as a kid because of strabismus and tracking issues, I don’t feel that your child needs vision therapy, I am still sticking to my gut feeling about ADD being the root of the problem…did you know that Concerta is just 12 hour timed released Ritalin? Perhaps your son would respond to something like Paxil, Zoloft, you wouldn’t have the sleep or eating problems with Zoloft…and there are different stimulants that can be tried such as Adderall or Dexadrine.

I tutored a teenager that didn’t do well on a stimulant when she was in first grade. As a result the parents didn’t pursue anything to resolve the ADD but the problem remained…The next 6 years this “bright” child kept drowning more and more in school, getting further and further depressed and by 7th grade the untreated ADD became a nightmare that resulted in a teen who was seeing a psychiatrist. The psychiatrist decided to put the teen on Zoloft, and what a difference… the teen was able to focus, mastered reading and spelling through tutoring has learned new behavior modification strategies and now gets decent grades instead of F’s… and the mom said…”I wish I had done this sooner, we wasted 6 years..and now have so much to catch up on.”

If meds are an absolute no-no then I would suggest an assistive listening device to help him learn how to pay attention and focus.

If he doesn’t get a handle on his attention now….it is going to impact his self esteem. I see this happen with many middle and high schoolers that I have worked with and it takes a lot of patience to help them realize and be aware of what they are doing to try and compensate for their ADD. It is so much easier to teach these skills when an ADD child is young than to the weary and depressed ADD teen who is giving up on learning and reading after years of failure and frustration.

PACE can help, but many ADD kids I have worked with find the metronome irritating, they get bored of the Auditory drill part of PACE quickly and I had some kids just balk after the brand-new program novelty of PACE wore off within a week or two.

Hi Victoria,

He wasn’t reading the same text over and over but rather at the same level, which I think you suggested. It helped his fluency some but I guess in the process we didn’t keep at decoding a wide enough variety of words.

He knows the basic code fine, partly from PG and partly because of the Auditory processing drill of PACE.

I have been thinking of using Master The Code from PACE. It has a drill like approach, which is distasteful on one hand but I can see that he has finally got some automaticity on single sounds anyway doing it with PACE. It is a more intense method than PG. Frankly, I think they have combined some of LIPS and PG and added a drill like format with a metronome.

Beth

P.S.

I got a recommendation for an OD from the audiologist we have been seeing for therapy. I will see whether the story is the same.

I also had him decode “probably”. He actually got the sounds correct but had trouble blending it. It took him several times of decoding it and blending it before he got it. It partly was the multiple syllables I think. I thought it was interesting because I think he is generally better at blending than segmenting. Maybe he just got lucky.

Hi Robin,

I’ve been re-reading this thread to see whether I overreacted when I suggested the problem might be visual. I owe that to your comment that you don’t see any reason from the original post for a vision problem to be suspected.

I guess I still come down on the same side of the argument, with the proviso that he may come around with a good tutoring program. The reasons I still think that a vision check is warranted are:

1. According to his mother, he improved in his decoding skills, but his oral reading deteriorated. This is typical of a vision problem. Since the print gets smaller as grade level advances. his increased decoding ability is frustrated by an inability to attend to the parts of each word.

2. His tendency to let his eyes wander all over the page, and to resist tracking with his finger, are both possibly bad habits, as Victoria says, but they are exactly the habits that will be picked up on his own by a child who is having trouble visually tracking print. It’s just too uncomfortable to maintain the effort, so they find a “better” method.

3. He specifically says that “something has happened so that he can’t read as well as he could last year.” Kids are notoriously poor at determining that they have a vision problem. To them it’s always been that way, so it’s “normal.” What might have happened this year is that the print got smaller. When this happens to a kid with a vision deficit, they don’t look up and say, “Hmmm, I can’t see this as easily as I could see the big stuff.” Instead, (and this is based on a lot of personal observation) they sound like poor readers, and especially, poor, careless readers. I have one text with three sizes of print (large/bold, medium/bold, and small/unbolded.) One boy I worked with last year could read the large/bold question that led into the topic very well. He could also read the medium-sized/bold type summary answer quite well….no problems. Then he hit the small-type/unbolded print and you would have thought he had just dropped back two grade levels. But he didn’t say anything about the size of the type, or about anything being unreadable, even when prompted. When referred for a vision check, he was found to be a candidate for vision therapy.

4. If it were my child, I would definitely prefer to rule out the possibility of a vision problem, no matter how slight, before attempting medication. These are mind-altering drugs people are talking about, with obvious benefits in some cases, but also with obvious side effects, and we know nothing about the long-term affects of many of them.

Anyway, that sums up why I leaned so hard to the vision checkup. I should add that I had just gotten home from listening to a boy who I knew had dropped out of vision therapy without completing it. He was reading extremely well for me, had eliminated his careless habit, and was decoding significant multisyllable words. I dropped the text size and he immediately reverted to a poor, and careless, reader. The text wasn’t any harder….just smaller. I suggested they not pay me any more money until they completed his scheduled eye exam. I’m almost certain their money will be better spent on vision therapy.

I appreciate your point of view, Robin….Thanks….Rod

That’s okay:) I always appreciate the time you put into your responses - and many times I agree with you. I am so on the fence about vision therapy that I cannot recommend it though. I appreciate Mary’s point about the research and how the lack thereof does not mean that the therapy isn’t effective. But for me to recommend it to anyone, even in this semi-anonymous setting, I need more than a limited group giving positive anecdotal evidence. At the very least I need to hear the other side. That isn’t likely to happen here- but if VT works the way people say it does then there will be a study sooner rather than later.

All of those behaviors are also characteristic of ADHD- which the mom already knows this child has. I didn’t get the impression that the family was anti-meds, just that Ritalin and it’s variant didn’t work. And while I am not generally well disposed toward long term meds for kids,and I know that many of ADHD symptoms can be worked with through therapy, the reality is that the child frequently can’t access the benefits of the therapy and self management strategies until you can slow their poor little overdriving brains down enough for them to participate and know what it feels like to be in charge. Meds are part of the treatment plan- not the whole plan:)

Robin

Hi Robin,

Just a couple of comments, one on vision therapy, and one on meds/ADHD.

I understand completely why you wouldn’t want to recommend something you haven’t satisfied yourself regarding efficacy. I would just encourage you to continue to maintain an open mind. I work closely with a vision therapy department and I have seen, and talked with, a fair number of very satisfied parents. I have absolutely no doubt of the efficacy of the therapy for some of the children whom I’ve then run through Phono-Graphix. If they successfully finished the VT, they are very easy clients generally, whereas if they quit the VT midstream, we tend to encounter problems as the print gets smaller.

As for ADHD and the med situation, the book by Peter R. Breggin, MD, entitled “Talking Back to Ritalin” absolutely scared the H out of me. He attempts to debunk virtually all the claims of both drug efficacy and drug safety, and pretty much tears apart the diagnostic criteria for ADHD as well. If anything deserves a healthy dose of skepticism, in my opinion, it’s ADHD and its attendent medications.

Interestingly enough, about every third or fourth kid I work with has been labeled ADHD and after five or six sessions of working with them, I can’t remember who’s ADHD and who’s not. I can, however, tell which one can’t sustain a full page of reading in spite of having absorbed the lesson content. And he’s not ADHD…he’s the one with a vision deficit. I know this is controversial (and anecdotal to boot) but this is what I’m finding….a lot.

Respectfully……Rod

You must have this thread and the other one with lots of VT discussion -and that great post by Victoria coming out your ears:) I do have an open mind about VT- you can’t ignore all the anecdotals. And I actually do have some personal history with exercises to correct tracking problems. I will keep listening and waiting for the “hard” evidence.

I am somewhat less ambivalent about ADD. I think that we know certain things as a function of several different types of research. We know for example, that it is a neurological issue related to chemical balance. We know that it has a fairly complex profile and isn’t particularly easy to diagnose. (or shouldn’t be) We also know that there is a lot more to learn:) The fact remains that in many cases, some form of medication is indicated and when the medication works- it is a wonderful thing. It is no different than the pharmacological interventions for other neurological conditions- many mental illnesses for example. I may not like the idea of long term meds but I like the alternative less. It is also a reality that behavioral interventions are less effective than most of us would like to think, partly because it is so hard to get kids on board. Dietary stuff- well you know that has always made me think that the behavior attributed to ADD might be related more to food allergies and, like many other things, may be mimicing the symptoms.

The process for careful diagnosis is fairly explicit and multi-leveled. First you collect the data- clinical observations, interviews with adults who work with the child in different settings, and checklists from student, teachers and parents. There should be LD testing(cogn/ achiev) a physical,and a hearing assessment also because diagnosis is as much a matter of ruling out other factors in the discovery process as anything else. Then, after you have ruled out LD, CAPD, diet problems and emotional stuff- you suspect ADD-and send all this to the physician who will ultimately decide. This is a complex process and should be. Given that I have gone through this exact process a teacher, RR teacher and diagnostician enough times that I am fairly comfortable that this is what happens where I live. I don’t know about elsewhere, but things happen elsewhare that continually amaze (and frequently disgust) me anyway.

Take care- I apologize for the length- this turned into a bit of a ramble…

Robin

Here is a link to a great article by Scientific American that you can read about the brain and how it affects ADD.

http://www.sciam.com/1998/0998issue/0998barkley.html

I have lived with ADD my whole life. I can trace ADD on both sides of my family back several generations and my kids are ADD. Our brains definitely work differently on meds than off meds,we are bright and intelligent people but it is hard to focus. A person with ADD, has a brain that races 24/7, full of energy that can be a gift and a curse at the same time.

Imagine being creative and intuitive but sometimes overwhelming people with abundant ideas accompanied by a difficult time to channel the ideas and finish things. Imagine being overwhelmed because you can’t focus and don’t know where to start. Imagine being able to understand the code of language but still being plagued with disfluent reading. Your mind is decoding words but wandering off someplace else, due to misreading and getting a totally different gestalt…..finding that you can’t control your wandering brain except through constant awareness of trying to keep your radar up but finding it is so exhausting. Even being aware of what you are doing isn’t enough and you find yourself frustrated and depressed because the harder you try the worse it gets and you don’t know how to stop it.

Imagine being plagued by slow processing and reading skills even though you know the orthographic code to reading and spelling, not being able to read past 35 words a minute on a cold read and it doesn’t matter whether it is 2nd grade level material or 6th grade level material, you just can’t get past the misreading and wandering mind. Your vision and tracking have been checked and are fine.

Imagine as a last resort trying meds after years of feeling stupid and overwhelmed and when you go for reading therapy you are able to double your reading speed on the 6th grade level material. You don’t have to re-read any passages because you aren’t losing your place, your decoding is exceptional and you are just cruising along. Imagine after reading along with an audio tape you are able to break what seemed to be like an insurmountable barrier of 100 words a minute during a hot read because you are finally able to focus and concentrate. I have seen this happen, both professionally and in my own family. The proper medication works wonders for children and adults with ADD.

Imagine not having meds because your parent forgot to call in for a refill and that your reading speed goes back down to 35 words a minute, you know that your brain just isn’t firing on all cylinders because you aren’t on your meds. Then you get frustrated because you know what you can do but you just can’t do it efficiently and find you are working too hard, the meds allow a person with ADD to do what many people find effortless…focus and processing information more efficiently..

The brain is absolutely an amazing instrument, it is basically a huge computer controlled by a network of electrical impulses, some work efficiently, while others don’t work efficiently and that is where the executive functioning problems and processing speed come into play. When someone is ADD meds are a blessing that allow the person with ADD to reach their potential.

Take care….keep up the good work with your students…

Pattim,

I want to tell you that you have really changed my attitude about ADD. I used to think it was just a faddish diagnosis brought on by parents who couldn’t discipline.

A question. My son has CAPD and his attention has improved with treatement. He still processes slowly though. For example, he is slow with his math facts. We’re doing PACE and it has helped. I think it may be a retreival issue but am not sure. He has documented word retrieval issues. (he is very fast with certain types of math facts—mainly money or using 5’s or 10’s). He also has a devil of a time with anything requiring divided attention with PACE. Are these characteristics typical of ADD? The ADD issue was brought up in first grade and I didn’t pay much attention, especially when he was subsequently diagnosed with CAPD.

Beth

Beth,

I think you should have him do a Continuous performance test, I know with the TOVA they can do it not only auditorially but also visually. Knowing that I have a hearing impairment the psyche decided to do the TOVA visually, I aced it but I had to keep myself entertained.. it is so B O R I N G….:-0..I kept counting, doing ABC’s anything to keep myself focused…as you can see I have learned to compensate but it took everything I had to last the 20 minutes. I lost it in a couple of spots and I can tell you exactly where I lost it but according to the test I wasn’t ADD but the Nelson-Denny Reading test was where I blew it…I can read 700+ words a minute but when it came to marking the right spots on a scantron, my ADD-Inattentive came out in spades…I missed a line and the rest of the test was wrong…LOL…the Psyche was baffled because of the discrepancy between my attentiveness on the TOVA and my lack of attentiveness on the Nelson Denny reading test….but when he noticed what I had done and checked. sure enough all the answers were correct if you took into consideration that I had lost my place…He laughed….

You should have seen me when I tried to do the Divided Attention exercises during my PACE training…LOL it was so hard…I still struggle with it…I can give the exercises without a problem but trying to do them myself is tough…I have learned to do the STROOP test but if you asked me to do the one exercise where you have to turn and and do the PACE tricks I would be up a creek..The same thing for my ADD kiddo’s…As I tried to express in my last post, people with ADD aren’t stupid, our minds go 24/7 and it is so frustrating to know that you are really smart but you can’t focus as well as other people. I always wondered why I could never memorize piano pieces for recitals, I was a 25 year old adult and I was so frustrated that I could only memorize certain parts but to get the whole thing memorized was like asking me to do the impossible, I tried, oh how I tried but I could never get it together… does this help???