When L came home from China, she had a variety of delays, but didn’t qualify for Early Intervention. I have been keeping an eye on her milestones and while she is still in the range of normal for most things, I have always wondered if maybe– just maybe– she is still struggling to catch up a little. The problem was that I could never exactly pinpoint what exactly the problem was. In most things she is fine, but she had a few nagging issues that never seemed to have anything to do with each other at all.
When it came time to select a preschool, we enrolled L in the preschool is run by our local school district as a developmental preschool. Kids with all kinds of developmental delays go there, but about 50% of the kids are typical peer role models. We thought this would be great for L. Even though she was a peer role model, there is a lot of developmental work going on in the class for all the children.
About a month ago, I had L’s very first parent-teacher conference. L’s teacher clearly likes her a lot. (Maybe too much, actually. She tends to think everything L does is charming even when she is not doing what she is supposed to do.) I think if you asked the teacher, she would say L’s conference was a good one. She had lots of good things to say about L.
I, on the other hand, thought that L’s conference was a warning shot across the bow. In particular, there was on comment that set off all kinds of warning bells for me: “Well, L has a hard time staying on task…She is too young for a diagnosis, but she really doesn’t pay attention as well as the other kids her age. Especially when we are doing table work.”
Huh.
Too young for a diagnosis, but clearly the teacher was implying that she thought L was leaning toward ADD.
We also looked over some developmental tests that all the children were given. The teacher mentioned a few unusual results that came up with L. In particular, in one she was supposed to trace a cross. At her age, it is expected that she would trace it from top to bottom and left to right ( or the opposite). Instead, L traced each of the four sections of the X by starting about an inch from the center and drawing outward. She missed the middle entirely. The teacher also told me that she evaluated L has being slightly right-handed. I thought that was crazy because L has been favoring her left hand for eating and drawing ever since we met her. We also discussed L’s rather unimpressive fine motor skills.
I went home from that conference quite bothered.
Armed with those test results and Dr. Google, it didn’t take more than about 15 minutes to make an amateur diagnosis. I decided that L had a visual processing disorder which is one kind of Sensory Processing Disorder. The information I found could explained all the random issues that had been niggling in the back of my brain and the comments from her teacher. I was also not surprised to learn that visual processing problems can be related to a lack of tummy time and stimulation in infancy.
I got busy finding a pediatric/behavioral optometrist who could do the full spectrum of vision testing necessary to figure out what was going on. Regular eye exams just cover eyesight. This exam looks at how the brain processes the information the eyes are gathering.
Long story short, today L completed her eye screening and they confirmed that she definitely does have a visual processing problem. More specifically, she has a pretty significant problem with tracking. Her eyes skip and hiccup when she tries to follow moving things. She also showed at least a 9 month delay in Visual Motor Integration. Add those issues to L’s reluctance to cross her midline and not so great fine motor skills, well, it is clear we are going to be spending time in therapy.
The eye doctor is recommending Vision Therapy. Twice a week for a minimum of three months and maybe as long as as TWELVE months. I was shocked that the monthly cost is going to be about $575. I was not shocked to learn that neither our vision or medical insurance will cover that therapy. (Let’s just say I am glad we aren’t going to have a mortgage payment in the near future! Yipes.)
I am also contemplating an Occupational Therapy evaluation. I might wait until we do a couple months of vision therapy to see what kind of results we get, but I feel that sooner or later OT might be in the picture as well.
I am surprised that I don’t feel upset by the results of L’s testing (though I am decidedly unthrilled about the cost). I am actually quite relieve that we have finally put the pieces of the puzzle together. I am also really glad we figured this out now, rather than when she started having problems with her reading skills in kindergarten. Hopefully, we can whip her brain into shape and nip these problems in the bud.
Just be sure to do your research about this! (Though I’m sure you have.) My son has strabismus and our opthamologist told me that vision therapy was not as effective as they claim it is. He could offer vision therapy for much more $$ and less risk than surgery for strabismus, but he won’t do it because he thinks it’s crap.
I have a friend that is currently paying for V.T. for her son but she felt like it was something that they had to try after trying lots of other approaches.
A second opinion might be worth it.
Surgery is not always the answer. I posted this on my blog (http://www.MainosMemos.blogspot.com) a while back with some comments. DM
Surgical Management of Childhood Intermittent Exotropia
…Intermittent exotropia is a common form of strabismus presenting in childhood. While nonsurgical management is appropriate in many cases, surgical correction is a mainstay of therapy. Specific procedures may be based on classification of the exotropia or surgeon preference. While by most estimates more than half of patients are corrected with one procedure, the need for additional surgery is not uncommon. Careful patient selection, parental input and education, and appropriate preoperative management can result in both cosmetic and functional improvement and a high rate of satisfaction. …
Comments: So let me get this straight…almost 50% need a second surgery? Why would you want to have the first one with that kind of outcome? Don’t get me wrong….I will recommend surgical intervention from time to time….but only after optometric vision therapy. At least then the outcomes are better! DM
can i just second that a wee bit?
my friend was a teacher and then a reading specialist for quite a while. she has no problem with a little bit of woo, and even she was very skeptical bout vision therapy. You might want to investigate what other treatments are at your disposal?
Those nagging feelings usually have basis for being there. Moms (and sometimes Dads) know.
I so understand the relief as well, still not understanding the “two young to diagnose”–no, wait until she really has a hard time catching up. The earlier the better, so glad you found not only the problem but possible solutions or at least helps.
My L is developmentally delayed. She is “too young” for a diagnosis (through EI) but I am taking her to a specialist. I need to get to the bottom of IT no mater what IT is. EI won’t TREAT something that has not been proven there for her. I am glad you did what you did. Good job, Mama.
I hope we can help our daughter. BTW, your child has to be delayed in two thing (significantly delayed in one and moderate in aanother) to qualify for EI – up to age three. After age three it is through town or county. I sont remember how old you L is off the top of my head, sorry. but guessing over three. if so that means you can get her an IEP that will help her immensly. tyry wrightslaw.com or .org and good luck
Delurking to say that we saw great results from working with an OT for similar issues with my child who is on the autism spectrum – Originally, we went to an OT for help w/ sensory processing issues, and that led to the eventual autism spectrum diagnosis. My child also didn’t cross the midline, and had a delay of approx 18 mos in several areas (including visual motor). 6 months of weekly OT visits made a huge difference, so much so that her delays were too small for her to qualify for our local developmental pre-K program w/out the autism diagnosis. So, I guess that’s a long-winded way to say that I’m a big fan of good pediatric OTs. And also that those large bills that aren’t covered by insurance are, unfortunately, standard when it comes to a lot of developmental delays. Ugh.
well, you know what just happened with Belle. The intense one-on-one remedial reading tutoring 90 min per day and the shadow 50% of the time in the class. it’s been less than a month, she read a full sentence yesterday. it’s never too early to diagnose, not if you find the right person. And don’t settle for the first opinion, get more than one.
It’s wonderful that you caught this problem so early! I didn’t catch it until the end of Kinder with my Pipsqueak.
After about 10 months of vision therapy she was caught up and is now, in 3rd grade, doing just fine.
Vision therapy is a lot of work, as well as expensive, but it is so worth it.
You’ll be amazed at her progress.
It’s great that you caught it now – always good to go with your gut. The Moms and Dads usually know. Our daughter has sensory processing disorder (sensory-seeking), but she struggles more with auditory processing rather than visual and also her proprioceptive and vestibular senses.
One of my nephews also has sensory processing disorder. The other nephew (they are brothers) was not diagnosed with sensory processing disorder, but he WAS diagnosed with visual processing disorder. He received vision therapy for about nine months and it made a world of difference (he learned to read, for one thing). Pencil push-ups are a wonderful thing.
I’m going to a meeting with Hannah’s eye doctor tomorrow and I’m 90% sure that he’ll want her to do vision therapy. I just hope it’s not that expensive here, because we really can’t afford that.
Good luck. My daughter Cam has been in and out of OT with sensory issues and low tone and fine/gross delays her whole life. She is a lefty, had issues with crossing midline and is scared of many things typical kids aren’t. We typically take her for 6-8 months and then we are good for 6 months and then back for another 6 months, she cycles in and out of delays. But this last round of OT we threw in some traditional therapy and the Dr said ADHD (we don’t think it is). But now, in school and dance etc she is doing well. OT has really helped us and I really recommend it (if you can find a good adoption centric/sensory one). Good luck!
I have been an educator for many years and have seen success with vision therapy in many students. You definitely want to see a developmental optometrist for issues with vision tracking.
If it is linked to reading issues as well, the best program by far is called Vantage Reading based in British Columbia Canada. It couples vision therapy with saccades training, which is unique.
I’m so glad you were able to figure out what’s making life harder for L so that she can get the help she needs to do what she needs and wants to do. It sounds like you have lots of well-informed readers and I’m sure you’re doing good research, but from my whole one interaction with L I’d be somewhat surprised with a purely ADHD diagnosis and I’m glad you went with your gut and were able to figure out what’s going on at a deeper level. It’s great that L is going to be able to get interventions now rather than later, and I’m sure her preschool experience will help. (It’ll be even better if you can find a way to do it without spending ridiculous amounts of money, but don’t let me rant about healthcare here!)
As your first commenter indicated, there’s a lot of controversy surrounding vision therapy (frankly, one of the reasons that insurance doesn’t cover it).
The scientific literature suggests that vision therapy might be useful for developing fine stereoscopic vision and correcting amblyopia, but is unproven for other disorders.
http://www.ncbi.nlm.nih.gov/pubmed/15825744?dopt=AbstractPlus
There is a professional battle going on here that adds to the scientific confusion, because ophthalmologists (MDs/surgeons) and optometrists (DO’s) disagree. But, all the more reason to get second opinions, especially when the diagnosis is causing you to give money to the person who made it.
But, unlike some therapies (chelation for autism, which drives me crazy), vision therapy isn’t dangerous, so the only thing you have to loose is time and money, if it doesn’t gain you the results you’re looking for. The advice I’ve seen that I can pass on is the following:
“If you are considering a vision training program, request a written report detailing the problem, the proposed treatment plan, an estimate of the time and costs involved, and the prognosis. . . . If you are not sure what to do, invest in a second opinion, preferably from a university-affiliated practitioner.”
That’s a good plan for any non-dangerous intervention — that the plan & outcomes be detailed ahead of time. Then, if it doesn’t work, you can stop. You will not get caught up in a constantly changing plan (i.e. needing more and more therapy, at additional cost, or equipment). And, you can protect yourself against assertions that you haven’t followed the treatment plan (if it’s been given to you, and you document your compliance).
PS: I’d suggest another experiment — take M in for the same vision screening (expressing vague concerns, but no details), and see if they also suggest M needs vision therapy. If they do, that’d be a reason to run.
I have the same problem with orthodontists, incidentally. I had one tell me that I needed braces when he thought I had insurance, but not when he thought I didn’t. He didn’t remember me in between visits. Now, my L actually needs orthodontic work, and I’m having a hard time getting over the trust issues — we’ve delayed while trying to figure it out. Delay is a bigger deal for you and your L, so I understand.
I have this cite to add:
Learning Disabilities, Dyslexia, and Vision
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 837-844 (doi:10.1542/peds.2009-1445)
http://pediatrics.aappublications.org/cgi/content/full/124/2/837
I have a bee in my bonnet about this issue because years and year ago, when the field was just starting out (actually, my first job out of high school), I did reserach on eye movements & dyslexia. I’ve followed the literature since, and it has always bothered me to see people spending money (and time, and the treasure of their children’s early development) on unproven treatments.
I *will* stop bugging you, unless you want to ask me anything. And, I fully support a mother’s right to make her own decisions about her children (well, except about chelation). But, you’re not considering that.
About that *&*$& statement from the AAO. From http://newsfromaoa.org/2009/07/29/researchers-paper-on-vision-therapy-outdated-flawed/
A “Joint Policy Statement” published online in the Journal Pediatrics on July 27 appears to cobble together outdated research and vision science, such as the controversial Irlen lens, in an attempt to discredit optometric vision therapy, according to prominent optometrists.
The policy statement, developed by the American Academy of Pediatrics, Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; and American Association of Certified Orthoptists, sheds doubt on the claim that vision therapy treats dyslexia – a claim that vision researchers and clinicians have not made for decades.
It also ignores the evidence of the proven benefits of vision therapy, such as in well-designed studies, most notably the Convergence Insufficiency Treatment Trial (CITT), which was funded by the National Eye Institute. This study showed that vision therapy administered in an eye care provider’s office is the best course of treatment for that condition.
“This publication pretends to be a review of the literature, but instead is a straw man argument,” noted Leonard Press, O.D., chair of the AOA’s Pediatrics and Binocular Vision Committee and prominent member of the College of Optometrists in Vision Development (COVD). “The references at the end, for example, include outdated research literature, and are padded with 23 references to the Irlen lens concept. None of the positive studies on vision therapy from optometric literature is included.”
The timing of the “joint policy statement” seems curious as well, noted Dr. Press, with recent studies showing positive results from vision therapy and with prominent individuals from the academic and scientific communities supporting vision therapy.
* In May, Susan R. Barry, Ph.D., professor of neurobiology in the Department of Biological Sciences at Mount Holyoke College, published a book, Fixing My Gaze, about her long struggle with vision problems and the ultimate success of vision therapy treatment.
* More currently, there is the well-publicized success of former vision therapy patient Larry Fitzgerald as a wide receiver for the Super Bowl-contending Arizona Cardinals earlier this year. Fitzgerald credits his grandfather’s vision therapy treatments as a key to his success in catching the football. Just last month, Fitzgerald started working with COVD as a spokesperson.
* And now, as children and parents ready for the school year, and the AOA is engaged in a media campaign to raise awareness of the importance of having vision examinations before school, there appears to be a campaign to discredit vision therapy.
Dr. Press said there has been a regular pattern of such publications.
“What the policy statements have consistently done is link vision therapy treatment to unrelated conditions and then show the treatment is not successful,” he noted.
He prepared a detailed refutation of the “joint policy paper” (see here) and told AOA News that he was grateful, in a way, for its publication because the paper provides another opportunity to cite relevant research, recount the success stories and raise awareness of the role of optometric vision therapy in treating vision conditions that inhibit learning.
Other prominent optometrists and educators also took issue with the “joint policy paper.”
“It should also be noted that every school and college of optometry teach courses in and provides clinical experiences for students in the area of vision therapy and that the procedures used in vision therapy have been codified within text books published by major publishers throughout the United States and the international community,” said Dominick M. Maino, O.D., M.Ed., professor of Pediatrics/Binocular Vision at the Illinois College of Optometry and editor of Optometry & Vision Development.
“Optometric vision therapy is a scientifically sound series of therapeutic procedures used successfully for a number of vision disorders from amblyopia to learning-related vision problems,” Dr. Maino said.
“In this era of evidence-based medicine it is disheartening to read this panel of ‘experts’ purposefully misleading the reader by disregarding recently published randomized clinical trials and the only quality research about the effectiveness of treatments for convergence insufficiency,” said Mitchell Scheiman, O.D., chief of the Pediatric/Binocular Vision Service and a professor at Salus University. Dr. Scheiman was the study chair for the year-long CITT study, which had clinic sites in nine states and included 208 children.
The authors of the joint policy statement falsely note that “symptomatic convergence insufficiency can be treated with near-point exercises, prism convergence exercises, or computer-based convergence exercises. Most of these exercises can be performed at home, and extensive in-office vision therapy is usually not required. Alternatively, for other patients, reading glasses with base-in prism or minus lenses can be used as treatment,” Dr. Scheiman said.
“The references they use to support these statements are not research studies, but are editorial responses to the CITT studies published in Archives of Ophthalmology. The authors of these editorials base their opinions about the effectiveness of home-based therapy on their “clinical experience” and fail to present any quality data from randomized clinical trials. The authors also conveniently chose not to reference the only randomized clinical trial of base-in prism for the treatment of convergence insufficiency. That study, in fact, found that base-in prism was no more effective than placebo reading glasses.”
My grandson’s pre – K teacher talked about his being right handed but with poor motor skills. He has been using his left hand to eat with since he was born. Now in Kindergarten my daughter told the teacher he is left handed ( she had told the preK teacher the same thing but she didn’t listen). His teacher this year did listen and amazingly his motor skills are no longer a problem and he is completing his work “in a timely manner”. Good luck with L! Glad you found some answers.
Our older (adopted) son, now 3.5 yo, has been in speech therapy for the last year or so, and he just stopped OT because he’s made so much progress that he’s caught up and surpassed his age level. The speech thing is one that’s been keeping me up nights, but it’s not just the “not talking” thing, it’s the “not connecting” thing too. My younger (bio) son is a year younger and although he is also not talking, his non-verbal communication is vastly superior to my older son’s. We’ve done the whole EI thing too with the older and he made a lot of progress there. We had an IEP with the school district when he turned 3 and they said he is NOT autistic (phew) but just has “regular speech delay” whatever that means.
About the cost, is this not covered by your regional center, or if L is over 3, by the local school district? Not sure how different it is there than in CA.
Good luck with everything!
$575 a month?!!? Who can afford that? This is sending me into yet another panic about the expense of raising children. I’m so very glad you’ve identified some areas to work on– I’m super-impressed by your Google skills– but holy MOSES. That’s horrible.
Let’s put this in perspective….and I do optometric vision therapy so I am necessarily unbiased….but let’s say vision therapy is $600/month. That is $125/week. What do you think you pay for psychological counseling, psychiatric intervention, speech/lang therapy, occupational therapy or any other specialized labor intensive intervention. This is not inexpensive….but it is not unreasonable either.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
dmaino@ico.edu
http://www.mainosmemos.blogspot.com
But those types of therapy are often covered by insurance and/or provided by the district, are they not?
Optometric vision therapy has been used since the early 1920′s for a wide variety of eye and vision problems. It is taught in every school and college of optometry around the country. It has been codified in numerous textbooks. And it has been shown to be appropriate for may eye and vision problems including convergence insufficiency, amblyopia (lazy eye) (several clinical trials) and other disorders (the research here is not at the same level as a clinical trial…but the volume of positive outcomes is quite convincing…)
For more information…or if you ever need a second opinion, certified doctors can be found at http://www.covd.org
It should be noted that my ophthalmologic colleagues do not learn anything related to vision therapy during their residencies but often offer opinions when they lack any real knowledge about this area.
It is unfortunate that professional rivalry gets in the way of good patient care.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor, Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
dmaino@ico.edu
http://www.MainosMemos.blogspot.com
I am so happy you now know exactly what L is faced with – it is so much easier than guessing.
I took my daughter for a vision screening when we first came home (she was barely 1). The doctor told me I was perceiving her Asian eyes as crossed because of the skin folds. He did tell me that she was slightly nearsighted, so to bring her back when she was 3. I knew she was cross-eyed (my mom and my nephew both are so I am hyper sensitive); however I trusted this doc because he is really good and had has great progress with my nephew.
I took her back when she was 3 and her eyes were crossing a lot more. Turns out – I was right. At 4 she got a MUCH stronger RX and we started patching about 3 months ago. Her vision has improved 10 fold.
We did not have to do vision therapy – but it was talked about in case patching didn’t work. Thankfully she cooperates with the patch.
All I can say is that I’m glad I was persistant, but I’m also glad I trusted my gut and my family’s previous experience with the doc.
All you can do is what you’ve been doing, advocate, follow your gut and be persistant!
I think parents know their kids best. My son will be 7 on xmas day and when he was 5 I noticed speech impediments…he couldn’t pronounce certain sounds correctly. I was pooh-poohed by all. He started 1st grade last year and the speech problems came out in his dictations and spelling tests, he doesn’t hear certain sounds and confuses similar sounding letters (in Italian, c&g, p&b, d&t, f&v). He’s been in speech therapy since last year and has greatly improved. No one wants their child left behind and the earlier you get working with the child, the better it is in my book!
great job. bravo.
good for you for being able to catch this early.
My first thoughts upon reading this were that if L now has a diagnosis the treatment should/would be free through early intervention. Next, I wondered why, as a cognitive psychologist who does testing all day long, I hadn’t heard of “visual processing disorder”. All of the comments here have been enlightening… I’m not writing to wield another opinion but I look forward to hearing how you think the therapy is going.
I don’t know how it works in your state, but here EI turns into ChildFind at age 3, and any delay that impedes learning qualifies for services. S doesn’t qualify, because her issues are trauma, sensory (not spd) and low tone-not impacting education in the strictest sense. And not clearly identifiable as a dagnosis, but we are working with the psychiatrist at the hospital to get a full evaluation. We are doing OT, PT and probably equine therapy in the spring. And working with the counselor from CCAI whom you recommended last year.
hi, haven’t had computer access so just seeing this –
when my daughter finally received diagnoses from someone I trusted, and whose diagnosis I believed in, I remember the relief. It is so much easier to fight the enemy when you know what it is.
By any chance are there any home programs appropriate for someone L’s age? Not to replace proper therapy, but to reinforce and hopefully mean less overall therapy time needed. (I know adding a home program to the stuff you have to do was probably not on your Christmas list…)
You’re a great mom, I know this will work out. and in honor of the day – Merry Christmas!
Thanh has this kind of difficulty as part of her sensory processing disorder. She is making good progress in OT. I was kind of taken aback at first. Definately orphanage-related stuff at play for Thanh. Poor nutritiona can be part of it, which was hard to hear. Good luck.
Our oldest daughter also had visual processing issues – especially with tracking and convergence. We got the hard sell for vision therapy – when I left I felt I had just been to the used car lot but using my daughter to pull at my heartstrings! We Googled like crazy and consulted other professionals and got the OT evaluation. While I am sure there are many excellent developmental ophthalmologists, you need to be VERY careful before diving into vision therapy – many are businesses which are pre-packaged franchises designed to empty your pockets. Be careful!
Vision processing issues are often based in lack of core strength – as you said lack of belly time. VT does not address this but OT does. Our daughter was successful with the OT vs. VT. She will never be 100% but it really improved her reading, attention, fine motor, etc. We were given (paid by insurance!) many tools for her to use at school and at home – slant boards,clear magnified rulers and even simple prism coloring books. We were given exercises to do at home and only visited the OT every two weeks – much easier on our schedule that VT would have been. Gymnastics and dance were also helpful as when the OT was done, this continues to strengthen her core.
Just our experience and we don’t feel “quite” so poor!