Convergence insufficiency

[elise1mds]

Tell me what you know and what you have experienced, please! I had been wondering if my son was dyslexic, but after talking with a vision therapist via phone, she said it sounds (based on his reading and comprehension levels and specific problems) more like convergence insufficiency.

In some ways, this would be a HUGE relief because our insurance won't cover dyslexia testing because it is an "education" issue rather than a "health" issue but I can take him to his ophthalmologist to test for convergence insufficiency. On the other hand, I don't know anything about it! What I am reading about the problem makes sense, especially since DS had strabismus repair at the age of 2, but nowhere can I find anything about treatment other than pencil push-ups. I see lots of threads about vision therapy right now, but I'm not sure what would be involved if his ophthalmologist is able to see and/or diagnose convergence insufficiency. I have no clue about anything that vision therapists do. Any experience is appreciated :)

[Meg5]

Just make sure you go to an optometrist trained to diagnose convergence insufficiency. We did and my son had it as well as something else I can't remember right now. We did the therapy and I'm glad we did, but it did not make his learning challenges go away. It is a piece of the puzzle, but be prepared that it may not solve all of the problems. Good Luck! Megan

[bluedarling]

The best thing would be to see a developmental optometrist, but some regular optometrists have the training to check for the issue (maybe the younger ones?). Our regular optometrist found the issues with my 2nd child, and referred us to the developmental optometrist.
--Deidre

[MerryAtHope]

My son has convergence insufficiency, and both of my kids are also likely dyslexic. I've not had them tested, I've just read enough to think that's the case (and looking at our family history think it's likely). Using an Orton-Gillingham based program has really helped both of my kids in spelling and reading (we use All About Spelling (http://www.allaboutspelling.com/Merry), and before that used Reading Reflex). After one year of AAS, both kids reading scores went up two grade levels & I saw even bigger gains in LA skills.

When I took my son for an evaluation, I could see what happens when the therapist showed me what to look for. My son's eyes will dart out and then quickly back in when he's trying to focus on words. This means he can lose his place easily, read the wrong line, leave out parts of words or sometimes read the end of a word as if it's in the middle of a word. It's a pretty frustrating way to try to read! Last Fall I started him on Webster's Syllabary & 1824 Blue-Backed Speller word lists (which divide things into syllables for you), and realized just how much he was guessing from context. Although he tests on grade level for reading, he is really filling in from context! With individual words that didn't have any regular pattern from word to word, reading was difficult enough to cause a melt-down (he's in 7th grade, we don't have too many melt-downs except when he's very frustrated, usually related to these vision issues). That convinced me to get additional help for him even though he didn't have all of the symptoms listed. He doesn't get headaches often, but sometimes, and sometimes gets tired reading, though he enjoys reading since working on OG methods. He does tend to trip (or did, he is showing improvement with therapy).

Therapy can be involved and costly, our insurance only covered the exam. The office we go to is 2.5 hours away, so we only go every other month & we do therapy at home. That has saved us a lot of $$$. Definitely make sure you go to a developmental optometrist for therapy, check out www.covd.org (http://www.covd.org) for referrals.

HTH some! Merry :-)

[RamonaQ]

Just make sure you go to an optometrist trained to diagnose convergence insufficiency. We did and my son had it as well as something else I can't remember right now. We did the therapy and I'm glad we did, but it did not make his learning challenges go away. It is a piece of the puzzle, but be prepared that it may not solve all of the problems. Good Luck! Megan

My son was diagnosed with severe convergence insufficiency. After 6 weeks of vision therapy, he stopped skipping words and losing his place. It was like a miracle. I very much agree with, Megan. It is a piece of the puzzle.

[OhElizabeth]

We've been stepping down this road, trying to find our path. Like you say, I think a neuropsych diagnosis of dyslexia and the eyes are two separate things. I don't have a dyslexia diagnosis for my dd, but it's VERY clear we have the eye problem. We've had problems basically since we started schooling (needing constant breaks, fatiguing and getting cranky easily, etc.), but I thought it was just normal. This year the workload increased, because of course she's 5th grade. All the writing, the expectations brought everything to a head. By Christmas she was finally complaining of headaches (which she may have had all along, but now she was mature enough to put words to it). When I asked my local homeschooling optometrist friend at what age kids can comfortably read books with small print and got a really funny look, I started putting two and two together. Took her to the eye doctor immediately, got reading glasses, even with the 20/20 vision, because she said dd's such and such focusing was slow, indicating it was taking a lot of effort. (There are two types, stimulative and reflexive?) Anyways, the reading glasses helped that near-focusing, lessened those headaches, and then we started getting MORE headaches. And for the last month we've been at the point where she DREADS school. She gets headaches, very bad ones, with small amounts of work. Even doing stuff she likes like playing with Puzzibits or sewing will give her a headache.

So after talking with my optometrist friend some more, I started pursuing the vision therapy thing, reading all I could. You might find this article helpful. http://www.drsmilburn.com/candidate.html It has an interesting, balanced take that reconciles some of the apparent issues raised by the NYT article. (find it by searching the boards) I don't know that VT is good for everything and their brother, but it does appear helpful for strengthening the fine focusing and convergence. So anyways, the next link you might find helpful is at www.eyecanlearn.com where they have interesting exercises you can try. Turns out my dd KNEW she couldn't cross her eyes and never told me!! Go figure.

So the next step is to find a therapist. Please talk with a whole bunch before you take the plunge. I finally went to a parent workshop at one last night and think I have found the best one for at least an hour drive. There are lots of single doctors willing to do it, but the place I've found SPECIALIZES in it. It's all they do is treat kids for this, all day long. I was afraid it was going to be some factory, but instead I think what it means is they have more experience and have invested in more tools, more modalities, more than a doctor would who just sees this kids a few times a week. Also, you REALLY, REALLY want to get parent feedback. If you just start asking around, you'll probably find people doing it.

I'm with the others, that you probably want to look at COVD for a developmental optometrist. The opthamalogist around here who does it is recommended by someone (homeschooling big wig), but the feedback I heard was less than stellar. I think again that's someone doing other things who does it on the side. I even found Occupational Therapists doing it in an optometrist's office. I think their take might be a bit different, don't know. The person I'm pursuing using with my dd is actually a certified therapist through COVD.

I'm also quite interested in the sports vision therapy KarenAnne's dd got. The place I'm pursuing taking my dd does some integration of kinesthetic with the eyes and crossing the midline. (crawling, standing on something that moves while you do your tasks, etc.) Karen's though sounded amazing. I just couldn't find anything like that here. In the meantime, I thought I'd pursue the cross body exercises (cross creeping, cross crawling, marching while tapping, skipping, etc.) and do some of the things Karen described. I think any time you're working cross-body with these kids, it's going to be good. My dd didn't crawl properly as a child, so it makes good sense to me that we need to back up to this place. If you go to www.littlegiantsteps.com you can find their resources and articles section and read a ton of stuff on this, auditory and visual processing testing, digit spans, etc. I think they're all just pieces to the puzzle. For my dd, it's very clear her eyes are causing the headaches. In talking with them, they also said the convergence is probably why my dd's writing sprawls. I've been working since *1st grade* to bring it in, and I can't. This was the year I finally realized she wasn't being bad and that telling her to try harder wasn't helping. So who knows, maybe after a few months of therapy it will magically transform, hehe. They actually showed an interesting video where one precious child could form perfect letters while writing with only her left eye, perfect with only her right, and she couldn't even hit the lines when using both. That's when I figured out we were on the right track, lol. Now my dd's isn't THAT bad, but still. :)

She reads like the wind (learned with SWR) and has told me she skips words. I assumed she was only skipping words she didn't know (since she can't sound out). It never occurred to me she might be skipping more. It's funny the things you never think to ask. On the way to the workshop last night I asked her if there was anything else about her eyes she'd like to tell me. Starts off not really, then she launches into this whole long explanation that it probably wouldn't interest me but would I like to know how she fuzzes stuff in order to focus on objects? Go right ahead. So yes, doesn't everyone do this? No, lol. Apparently everything looks fuzzy all the time and when she wants to see something she picks it and focuses on it, intentionally fuzzing everything else. So then I asked how in the (insert strong word, emoticon, whatever) world she passed a 20/20 vision test, she said they were fuzzy and she made them clear. Ugh. So it's the stuff they DON'T tell you, the stuff they think is normal. She thought everyone had headaches. (I have them a lot, so why shouldn't she?) She thought everyone fuzzes and focuses images at will. She thought it was just per peculiarity not to be able to cross her eyes.

And she's a very verbal child who had the words to explain it, once it occurred to her to mention it!!! Can you imagine a kid who wasn't quite so talkative and forthcoming? You'd never even know what they're seeing or how to pull it out of them. The docs at the session told stories that were hair-raising.

Well anyways, keep researching. Take your time. Call tons of docs and learn how they do things. Every time I called another office I learned something. Many of them will email you and answer your questions too.

[elise1mds]

Thanks for all the tips and experience! We have an awesome ophthalmologist that deals ONLY with children and does diagnose convergence insufficiency. The vision therapist I was talking to actually asked if I'd ever heard of his office when we were talking and was pleased to hear that I had taken him there. So I know that they can diagnose it.

Treatment will be a whole different kettle of fish. I'll have to dig through my insurance to see what they have in the way of places to treat around here. They will happily cover psychologists up to a certain number of visits per year, but when I had looked into occupational therapy before for his sensory issues, the only place that they covered is a 45-minute drive each way from my house. That wouldn't be a huge problem in the summer because I could schedule things to do and/or errands to run in town on those days and we could just make a big trip of of it. During the school year, though, since DD goes to a private school and has to be picked up, it would be more of a pain. There is a fantastic vision therapy place in the same office as my son's psychologist, but they're not on my insurance. It's very frustrating, and I'm not sure what I'll do. We may wind up going to only the rare appointment at the non-covered office and doing what we can in between like someone else had mentioned doing.

The more I read about convergence insufficiency, though (and thank you for all the articles!), the more it fits. I found one site where it talks about the disorder affecting not only reading but also motor skills. My son can't catch a ball to save his life. I had always figured it was more of a motor skills issue, but now I wonder if it's because the ball gets fuzzy and just moves too fast for him to keep track of it. Same with other gross motor functions. He also is prone to motion sickness. For reading, the more I question him now, the more that comes out. He says that entire lines get fuzzy and "float" up into each other, which is why he skips lines. He has less of a problem with individual words but probably has a coping mechanism there. He also will misplace or reverse syllables though he still reads incredibly well - I tested him on a web site the other day and he's at roughly a seventh-grade level. I think he reads like my husband does and swallows words whole, so to speak, rather than working through them. That probably has to do with a focusing issue, too.

I'm good at harrassing doctors - I had called four different places in the last week about getting him tested after I found out our insurance wouldn't cover dyslexia testing and the only doctor in our psychologist's office who does that testing wanted nearly $2K to do it. Yeesh. I'll talk to the ophthalmologist and see what strings I can get pulled. There's no way I can let him continue to have these problems in good conscience if vision therapy can help. I know it won't solve every issue he's got, but if he can learn to catch a ball, I'll be thrilled beyond words! I'll keep doing his sensory therapy here at home, too. I recently yanked out The Out-of-Sync Child Has Fun again and have been working on a few items every week. He's loving it. :)

You guys are awesome :D

[OhElizabeth]

Sarah, just to clarify, the diagnosis of the convergence insufficiency isn't the helpful part. Apparently the tests each doc uses are different, and it's not some standard thing. So you have to pick out your therapist and use the doc associated with them. Otherwise you start all over with a new evaluation. Where I'm looking at going, the therapists are overseen by the doctors, making a fluid process.

You mentioned sensory issues. Interestingly, the place I've found integrates work on that into the vision therapy sessions. But Karen brought up a larger issue which is that, it seems to me, if the wiring is not firing cross-body (the ultimate in sensory issues, lol), the vision therapy is going to have a hard time connecting. Or maybe I'm just speaking as a fool here. All I'm really saying is to research the connection between the sensory issues and the eyes. Those articles at www.littlegiantsteps.com might be helpful to you.

The opthamologist here that does kids is really bizarre. She wants to dilate their eyes and view it as some medical anomoly. The developmental optometrists don't do that. Instead they do things like having the kids write with one eye patched, then the other, the both eyes working together. I'm just suggesting that if you dig into it you might find significant differences between the way an opthamologist and a developmental optometrist approach it.

Also, if your finances are tight, you might talk more seriously with the place you conclude is the best or your dream option. Around here they use sliding fee structures and deferred payments to bring it more in reach. As you say, this for us has become the issue we have to deal with before we can move on. And yes, my dd has issues with catching balls, lol. We blew off a lot of the things we saw over the years, thinking she was just "bambi" (tall for her age, not coordinated), and then when we learned about this all the dots just came together.

[wapiti]

All I'm really saying is to research the connection between the sensory issues and the eyes. Those articles at www.littlegiantsteps.com (http://www.littlegiantsteps.com) might be helpful to you.


:iagree: The place we went to for OT believes that ocular motor activity is a subset of sensory processing, which at its broadest includes the whole central nervous system. Indeed, we saw great benefits to dd's vision from OT (we could literally see the difference in how she was able to move her eyes; it was coincidental in that we were doing the OT for other reasons, SPD). Interestingly, one of our local developmental optometrists (www.covd.org (http://www.covd.org)) has an OT on staff.