Thursday, January 6, 2011

Eye Eye See See You You

We recently took H for a consultation with a Behavioral Optometrist due to tracking difficulties that were observed by the school psychologist during an evaluation ( for a possible learning disability). Although H is exceptionally bright and is attending a very competitive academic program, he has been battling with the tasks of reading and writing for years. It has become more burdensome as he advances through the grades and the workload increases. In third grade, he was receiving Occupational Therapy services and classroom accommodations (time and a half for testing and in class written assignments) via his 504 plan for a Visual Fine Motor Integration problem. But, the "diagnosis" of Visual Fine Motor Integration disorder didn't sit well with me. In the initial report, there was very little to support that identification other than that recognition that his handwriting was below grade level. There seemed to be something more going on. We had always remarked at how brilliant his fine motor skills were. But, when it came to written expression, there was a complete disconnect between his thoughts /what he was able to verbally convey and what ended up on the paper.

He, by his own admission, is a boy of little words, meaning he does not like to talk. But, man, those very few words are so rich with vocabulary- to hear him speak, you would think that you had just gotten hit with a dictionary/ thesaurus combo. I used to scribe for him. Thinking that if I allowed him to recite to me what he intended to write, it would make it easier for him to then just copy in his own handwriting. But, it didn't help. His sentences broke through margins and were sometimes floating above the line. He would omit words or phrases that were right there in front of him. His spelling, again with the typed material right before him, was atrocious. We have been lucky up until this year that his teachers have been so accommodating and compassionate. They knew how much these hindrances hurt his confidence. They were patient and forgiving of his written work. This year he is in 6th grade and his team of teachers is more disjointed; and, due to district wide budget cuts and the removal of aides positions throughout the city schools, there is not any time in the schedules for extra help and attention. To make matters even more difficult, his teachers during an Open House presentation during the 3rd week of school, stressed that they are looking for absolute neatness and perfect spelling in all written assignments. I knew that H was doomed.

So, I set the ball rolling for reevaluation. I typed up a brief history and a reminder about H's Individualized Education Plan (IEP) for all of his teachers. And I arranged to have him reevaluated by the school and, tentatively, by an outside psychologist for a possible diagnosis of dysgraphia (a learning disability which affects writing abilities). When discussing my concerns with his consultant teacher from last year (she has since taken on a position in the district's 504 office), she suggested I perform a little research on Vision Therapy and Behavioral Optometry -referencing that one of H's former teachers had a successful experience with the program. I brushed it off because H's eyes had been tested on numerous occasions and his vision was always normal- or very near 20/20. I did not understand that vision involved more than simply acuity or being able to read the Snellen Eye Charts. It was not until H came home with the news that he had "jerky eyes," that I began to give the suggestion more thought. During one of the specialized tests performed with the school psychologist, H omitted entire lines of text and symbols. The psychologist had him follow her pen and she noticed that when tracking, his eyes had an uneven, jerky movement. To make a long story just a little bit longer, the behavioral optometrist, Dr. Gordon, after performing a battery of standardized tests, came to the conclusion that H had been struggling with a visual processing disorder, Ocular Motor Dysfunction. Basically, the poor kid, has been seeing double. The words move around and sometimes jump off the page. A little bit like this:
Dr. Gordon explained that, for H, every time he reads, it is like learning the words again because they appear differently each time he sees them. He likened it to learning the Chinese characters when all that you have ever seen is English letters. Ironically, H is taking Mandarin Chinese and has complained on numerous occasions about how lost he feels in class. Vision therapy was recommended to help correct the problem. It is an expensive treatment which is not covered by insurance; but, it will be worth every penny if it helps to diminish this hindrance to learning and boosts his self-confidence. I met with the 504 committee today at H's school to re-write his IEP. Both the psychologist and the SST/ CSE chairperson were exceptionally compassionate and enthusiastic about helping H. H had made such a wonderful impression on them both. The CSE chairwoman said that these cases break her heart the most because these children are often swept under the rug. They perform well in school, so little thought is given to their struggles. The school psychologist went so far as to call H a "hero" because he had not once given up on his school work despite the impairment he had been trying to adapt to. When we were finished with our meeting, H's IEP was covered in red ink with the new modifications. The chairwoman indicated that this is a unique case and that we needed to provide as much coverage as possible to protect him- to help him.

I share this story because we have struggled for years to get to the bottom of H's writing and reading difficulties. I truly would not have known about this disorder if it were not for his teacher's insight. And, I've researched the various conditions and disabilities linked to written expression/ handwriting/ reading; and, I've consulted with different doctors, teachers, specialists to find something that would explain the disconnect between his thoughts and his inability to express them on paper. Vision disorders never came up in my queries- and were never suggested. There is so much more involved to this all than I can explain here. But, by sharing this, I hope to provide a starting point for those who might happen upon this page, searching for answers about their own children's learning differences.


  1. I'm glad the issue was identified...H is truly a hero...

  2. Thanks, Cat. I am very impressed by how much he has accomplished knowing now what he has been going through. I can't imagine trying to learn that way.

  3. Thank you so much for posting this. We are just now starting on a vision therapy journey with our little guy (who starts Kindergarten this fall with ocular motor dysfunction and Convergence insufficiency challenges) and your description-- especially the visual example-- was so helpful.