Optometric visual training, sometimes called vision therapy or VT,
is that part of optometric care devoted to developing, improving and enhancing people's visual performance.

Over several decades, behavioral optometrists have developed and used visual training in combination with appropriate, judiciously selected lenses to:

• Prevent vision and eye problems from developing
• Develop the visual skills needed to achieve more effectively at school, work or play
• Enhance functioning on tasks demanding sustained visual effort
• Re-mediate or compensate for vision and eye problems which have already developed

Through visual training, people are able to develop more efficient visual performance.

Vision: A Set of Abilities

Nearly all humans are born with the potential for good eyesight, but vision‐‐the ability to identify, interpret and understand what is seen ‐‐is learned and developed, starting from birth.

In learning to walk, a child begins by creeping, crawling, standing, walking with assistance, and finally, walking unaided. A similar process from gross to fine motor control takes place in the development of vision.

One visual skill builds on another, step‐by‐step as we grow. But many people miss a step, or do not complete a step, or must begin to perform school or other visually demanding tasks before an acceptable foundation of basic visual skills is in place.

Science indicates that we do not “see” with our eyes or our brain; rather, vision is the reception and processing of visual information by the total person. Since two‐thirds of all information we receive is visual, it becomes clear that efficient visual  skills are a critical part of learning, working and even recreation. Athletes, for example performance in their sport.

Developing visual skills includes learning to use both eyes together effectively. Having both eyes move, align, fixate and focus as a team enhances your ability to interpret and understand the potential visual information that is available to you.

Intelligent persons who are very highly motivated can be good achievers, even with very poor visual skills and abilities, but at untold cost iii wasted energy and unnecessary effort and stress. For those who are less motivated, even one or two deficient visual skills can produce enough stress and frustration to create a non‐achiever.

What Are the Visual Skills?

The visual skills, which can be developed and enhanced through visual training, include:

Tracking. The ability to follow a moving objects smoothly and accurately with both eyes, such as a ball in flight or moving vehicles in traffic.

Fixation. The ability to quickly and accurately locate and inspect with both eyes a series of stationary objects, one after another, such as moving from word to word while reading.

Focus Change. The ability to look quickly from hr to near and vice versa without momentary blur, such as looking from the chalkboard to a book or from the dashboard to cars on the street.

Depth Perception. The ability to judge relative distances of objects and to see and move accurately in three‐dimensional space, such as when hitting a ball or parking a car.

Peripheral Vision. The ability to monitor and interpret what is happening around you while you are attending to a specific central visual task; the ability to use visual information perceived from over a large area.

Binocularity. The ability to use both eyes together, smoothly equally, simultaneously and accurately.

Maintaining Attention. The ability to keep doing any particular skill or activity with ease and without interfering with the performance of other skills.

Near Vision Acuity. The ability to clearly see, inspect, identify and understand objects at near distances, within arm’ length.

Distance Acuity. The ability to clearly see inspects, identify and understand objects at a distance. People with 20/20 distance sight still may have visual problems.

Visualization. The ability to form mental images in your “mind's eye," retain or store them for future recall, or for synthesis into new mental images beyond your current or past direct experiences.

Visual Skills/Visual Stress

If a person's visual skills are not adequately developed, or a person fails to coordinate vision with other senses, vision problems may occur. With poor binocularity, for example, one eye may locate an object in one place while the other eye locates it in another. The confusing signals may result in:

Headaches. Especially near the eyes or forehead, or occasionally at the back of the head.

Double Vision. Two objects are seen when only one exists.

Reduced Performance. Losing your place while reading, rereading words or lines, difficulty with Understanding or recalling what you've read, reading slowly.

Discomfort, Fatigue. Body tension, stress or pain; weariness at the end of a school or workday.

Suppression. Information from one eye may be blocked or ignored to avoid seeing double. If the visual problem is not corrected, it may get worse.

Near point visual stress, the result of sustained visual activities done at less than arm's length, may produce most of the problems listed above.

There are many other common eye and visual problems, which can limit the way you live and enjoy life. These include:

Nearsightedness. Myopia‐seeing more easily at near than at distances.

Farsightedness. Hyperopia a‐seeing more easily at distances than at near.

Strabismus. Crossed eyes.

 Amblyopia. Lowered visual acuity (clarity), not correctable to normal acuity with lenses.

Astigmatism. Distorted vision‐interferes with seeing clearly at any distance without effort.

Poor Vision‐Body Movement Coordination. Clumsiness, awkwardness, inefficient eye‐hand or eye‐ body coordination, poor handwriting.

Visual training, usually combined with appropriate lenses, may remedy, improve or prevent any of these conditions in both children and adults. Visual training and lenses are intended to alleviate the symptoms and eliminate the underlying cause inadequate visual skills and visual stress.

Studies show that success in visual training depends on an appropriate program prescribed by your optometrist, and on an individual patient's cooperation, participation and motivation.

Beyond Visual Performance

Visual training also has proven to be a remarkably effective tool in helping' people with learning‐related visual problems. Many problems in learning to read and write are made worse by poorly developed visual skills.

Dozens of experimental programs involving thousands of children and adults demonstrate that when visual skills are enhanced through visual training, learning is easier, reading levels rise, and in some cases, IQ scores have increased.

Building visual skills also increases the ability to visualize, conceptualize and to create. Dr. Johan Pestalozzi, a Swiss educated reformer, notes that “conceptual thinking is built on visual understanding “ visual understandings the basis of all knowledge.”

What is a Behavioral Optometrist?

Behavioral optometrists spend years in post‐graduate, continuing education to master the complex visual programs prescribed to prevent or eliminate visual problems and enhance visual performance.

Not all optometrists practice behavioral optometry, which includes developmental and functional optometry. If you do not now have an optometrist who practices behavioral optometry, call or write the OEP Foundation. Or, make sure you receive a yes answer to each of the following questions before you make an appointment:

• Do you make a full series of near point vision tests?
• Do you make work‐ or school‐related visual perception tests?
• Do you provide full vision care and visual training in your office, or will you refer me to a colleague if needed?
• Will you see me again during the year, and periodically to determine my progress?

Optometric Extension Program Foundation, Inc.

1921 E. Carnegie Ave., Ste. 3‐L

Santa Ana, CA 92705‐5510

(949) 250‐8070

Pamphlet Copyright © 1995, OEP Foundation, Inc. ‐ A nonprofit foundation for education and research in Vision

Permission to reprint the contents of this brochure granted to VISUAL EDGE, INC. ® ‐ 05/01/09 by: the Optometric Extension Program Foundation, Inc.

WHAT IS OPTOMETRIC VISION THERAPY?

Optometric vision therapy is an individualized treatment program designed to improve visual function and performance. It is an approved treatment modality for disorders including, but not limited to:

• Ocular motility dysfunction/eye movement disorders
• Vergence dysfunction/inefficiency in using both eyes together
• Strabismus/misalignment of the eyes
• Amblyopia/lazy eye
• Accommodative disorders/focusing problems
• Visual information processing disorders
• Visual sensory and motor integration

Visual rehabilitation after traumatic brain injury or stroke all of which result in inefficient visual information processing.

Most people who visit an optometrist know that any eye health problems will be detected and managed and that glasses or contact lenses will be prescribed if indicated. That picture is incomplete because there are visual conditions that are best managed by optometric vision therapy. This therapy enables an individual to learn more efficient ways to perform visually. It is an art and science of vision care that complements the prescription of eyeglasses, contact lenses and the treatment of eye disease.

Optometric vision therapy, also referred to as visual training or orthoptics (CPT 92065), is an established, medically necessary therapy when prescribed by an optometrist. Optometric vision therapy can improve visual function much like physical therapy can improve general motor function. An optometrist to determine the presence of visual deficiencies administers clinical tests with associated normative values. If optometric vision therapy is indicated, the optometrist recommends a specific treatment plan.

Optometric vision therapy typically invokes a programmed combination of office treatment and home therapy. Lenses, prisms, optical devices, and specially adapted computers are some of the devices through which one learns to use vision more effectively. The specific materials are less important than the feedback provided to the patient to enable change. Visual skills need to be developed until they become automatic and are subconsciously integrated with the other skills. The extent of success is also linked to patient compliance.

The benefits of optometric vision therapy, which include improved visual information processing and the ability to sustain visual function over time, are as applicable to the child in the classroom as they are to the adult using a computer or reading a book. Without efficient visual skills the act of reading can be frustrating. Some of the common symptoms relieved through vision therapy include eyestrain, visually induced headaches, inability to concentrate when doing visual tasks, and errors such as loss of place or reversals. More often, individuals have no recognized symptoms due to their avoidance of visually demanding tasks or an adaptation that decreases their performance. Optometric vision therapy also facilitates appropriate visual development, and serves as a component of the multi‐disciplinary effort following stroke or head injury.

Members of the College of Optometrists in Vision Development (COVD) have post‐graduate education in the diagnosis and management of conditions for which optometric vision therapy is an appropriate treatment. Fellows of the College are certified in providing this vision care. For further information, contact COVD or consult with your COVD optometrist.

Dedicated to the Enhancement of Vision

Permission to reprint the contents of this C.O.V.D. White Paper granted to VISUAL EDGE, INC. ® ‐ 05/01/09 by:

College of Optometrists in Vision Development

243 N. Lindbergh Blvd. Ste 310

St. Louis, MO 63141‐7851

(314) 991‐4007 1‐888‐COVD770

FAX (314) 991‐1167

How does your visual performance shape up against the demands placed on your visual system:

• At work
• At home
• At school
• At play?

You may not be aware of it, but your visual system brings you much information about your world. When you look at something, you don't just "see" with your eyes; you inspect, discriminate, identify and interpret ‐ all as a part of your visual system.

Behavioral optometry is an expanded area of optometric practice. When you visit your behavioral optometrist, you may notice a difference in your examination. You will find that you are tested for specific visual skills. You may find that many of your questions about vision are answered. And you will receive the clinical guidance you need to develop the skills that provide for an efficient visual system.

Why Behavioral Optometry?

Our ancestors had hunter's eyes for survival in the wilderness; their vision was designed for spotting game and enemies at a distance.

In the last 100 years we have been forced to deal with sustained, near visual tasks and the resulting stress on the visual system has produced many symptoms and problems.

If you experience headaches, blurred vision, tired, itchy or watery eyes or other vision linked problems, you may already know how uncomfortable sustained visual stress can feel. Your discomfort may be related to the heavy vision load of working at near distances.

If you are a student, you may read almost three times the number of textbooks your grandparents did. If you are employed in an office, you probably use your visual system for hours of close‐up work. If you work with computers, you may

spend much of your day looking at a computer screen. These tasks can all contribute to visual stress.

Even if you have "20/20 eyesight," you may have difficulty working at close tasks. The term "20/20" means you can see well at distances of 20 feet or more, it does not usually refer to how well you see at 12‐16 inches, the distance at which you do most of your close work.

There is a solution.

Your behavioral optometrist has studied the effects of stress on vision. Through the use of carefully selected stress‐relieving and preventive lenses and visual training, you can enjoy relief from even the most stressful close‐up visual conditions.

More About Behavioral Optometrists

Your behavioral optometrist takes a holistic approach to vision care. You are treated as a whole person and your visual problem as a part of the whole system. Your behavioral optometrist works with you and your children, rather than doing something to you.

You and your children will receive help in developing the important visual skills you may need to reach academic and professional goals.

Even the visual achievement of successful learners and earners can be enhanced through behavioral optometric care.

Who Needs a Behavioral Optometrist?

Behavioral vision care is useful to virtually all patients. However, the following individuals will especially benefit:

• Children of all ages, but especially children just starting school.
• Children who are having trouble with reading or learning.
• Children who seem to be uncoordinated in visually demanding sports.
• Children who are considered "behavior problems"
• Children who are reading "below their potential."
• Anyone who participates in athletics and wants improved performance.
• Anyone who works at a computer.
• Anyone who has a visually demanding job.
• Anyone who suffers from burning, itchy eyes, eyestrain or visual fatigue (with no medical eye problem).

See your family optometrist annually.

More Good News... If your behavioral optometrist prescribes visual training (also called vision therapy) for you, and even if your medical insurance does not cover eyeglass prescriptions, your major medical may cover visual training.

Visual training often falls under the category of physical therapy. It usually involves a series of visits during which you perform specific activities to remediate your vision problem under the close supervision of a professional.

The office staff can help you determine if your policy covers visual training and with their help, you can submit the proper claim and receive entitled benefits.

What Is a Behavioral Optometrist?

Behavioral optometrists spend years in post‐ doctoral education to master the complex visual programs prescribed to prevent or to normalize ‐visual problems and enhance visual performance. Behavioral optometry is an umbrella term that also includes developmental and functional optometric practices. Not all optometrists practice behavioral optometry. To find one who does, call or write Optometric Extension Program Foundation Vision Extension. If you do not now visit a behavioral optometrist, call or write the OEP Foundation for a referral list in your area.

Optometric Extension Program Foundation, Inc.

1921 E. Carnegie Ave., Ste. 3‐L

Santa Ana, CA 92705‐5510

(949) 250‐8070

Pamphlet Copyright © 1984, OEP Foundation, Inc. ‐ A nonprofit foundation for education and research in Vision

Permission to reprint the contents of this brochure granted to VISUAL EDGE, INC ® ‐ 05/01/09 by: the Optometric Extension Program Foundation, Inc.

PHYSICAL CLUES

¨      Red, sore, or itching eyes

¨      Jerky eye movements, one eye turns in or out

¨      Squinting, eye rubbing, or excessive blinking

¨      Blurred or double vision

¨      Headaches, dizziness, or nausea after reading

¨      Head tilting, closing or blocking one eye when reading

¨      History of recurrent ear infections

PERFORMANCE CLUES

¨      Avoidance of near work

¨      Frequent loss of place

¨      Omits, inserts, or rereads letters/words

¨      Confuses similar looking words

¨      Failure to recognize the same word in the next sentence

¨      Difficulty identifying sounds in words and recognizing rhyming      words (phonological awareness skills)

SECONDARY SYMPTOMS

¨      Smart in everything but school

¨      Low self-esteem, poor self image

¨      Temper flare-ups, aggressiveness

¨      Frequent crying

¨      Short attention span

¨      Irritability

¨      Day dreaming

¨      A history of speech or language delay

¨      Family history of literacy learning problems

¨      Muddling sounds in words eg ‘hostipal’ for ‘hospital’

¨      Enjoys being read to but no interest in looking at the words

LABELED

¨      Lazy

¨      Dyslexic

¨      Attention deficit disorder

¨      Slow learner

¨      Behavioral problem

¨      Juvenile delinquent

¨      Working below potential

¨      Has no interest in being read to (may be described as an ‘outdoor kid’)

EVEN THOUGH THIS IS AN EXTENSIVE LIST OF SYMPTOMS, IT DOES NOT COVER ALL THE POSSIBLE COMPLICATIONS ASSOCIATED WITH NEUROLOGICAL PROCESS DIFFICULTIES.   FOR MORE INFORMATION AND RESOURCES PLEASE CONTACT THE COLLEGE OF OPTOMETRISTS IN VISION DEVELOPMENT (COVD), OPTOMETRIC EXTENSION PROGRAM FOUNDATION (OEP FOUNDATION) AND NEURO-OPTOMETRIC REHABILITATION ASSOCIATION (NORA).

TO ACHIEVE THESE BENEFITS THE FOLLOWING MUST BE ARRANGED

Working Surface: A sloping working surface must be used that is tilted between 20 and 23 degrees from the horizontal.  The Visual Edge Slant Board is at 22 degrees, which has been found to be the optimum angle.

Posture: Seated comfortably, relatively erect, feet flat on floor or box.

Working Distance: The "Harmon Distance" is the optimal distance from the eyes to the working surface. It is the distance from the elbow to the first knuckle. This can only be assured with a proper chair height to desk relationship.

Near point Lenses: ONLY IF PRESCRIBED BY A DEVELOPMENTAL OPTOMETRIST. A specific, low power prescription not used to correct a defect in the eyes but to put the eyes into better balance for near tasks. This enhances and integrates the posture, working distance, and surface relationship.

INSTRUCTIONS FOR VISUAL HYGIENE

1. Ensure your reading material is at an angle of between 20 and 23 degrees.  The Visual Edge Slant Board is at an angle of 22 degree which research has shown to be the optimum angle at which to read.

2. Do all near point activity at HARMON distance or slightly further. This is the distance from the center of the middle knuckle to the center of the elbow measured on the outside of the arm. Working at the Harmon distance reduces near point visual stress.

3. Be AWARE of space between self and the page when reading. Also, be aware of things around and beyond the book.

4. When reading, occasionally look off at a specific distant object and LET its details come into focus. Maintain awareness of other objects and details surrounding it. Do this at least at the end of each page.

5. When studying, place a bookmark 3 or 4 pages ahead. Get up and move around for at least one minute each time you reach the bookmark.

6. Sit UPRIGHT. Practice holding your back arched while you read and write. Avoid reading while lying on your stomach on the floor. Avoid reading in bed while lying on your stomach on the floor. Avoid reading in bed, unless sitting reasonably upright.

7. Provide for adequate general illumination, as well as good central illumination, at the near task. The illumination on the task should be about three times that of the surrounding background.  Avoid the use of florescent lighting.

8. Do not sit any closer to TV than 6 to 8 feet, and be sure to sit upright. Maintain good posture.

9. When riding in a vehicle, avoid reading and other near activity. Encourage looking at sights in the distance for interest and identification.

10. Encourage outdoor play or sports activities that require seeing beyond arm's length.

11. When outdoors, sight a distant object at about eye level. At the same time, be aware of where things are on all sides.

12. Walk with head up, eyes wide open and look TOWARD, not at, objects.

13. Become very conscious of the background of the objects you look TOWARD, be it a person, print on a page, an electric sign, the TV, or any other object.

TELL A FRIEND TODAY!

Board games are a useful way of developing many different mathematical ideas and skills with young children. They are particularly useful to give the necessary added practice needed by children with specific learning difficulties. However, it is important that the game is adapted to suit the specific needs of your child.

Well known commercial board games such as Snakes and Ladders, Ludo, Trouble and Headache can easily be adapted in a variety of ways to develop different basic number skills.

When playing the game according to the rules, using a normal die (that is, one with spots) young children are learning that for every 'spot' on the die, the player must move one place along the track. Mathematically this is known as one-to-one correspondence and is the foundation of all mathematics.

Being able to count the number in a group by matching a number name to each object, then realizing that the last number said is the number in the group is also an important early number idea. As children count the number of spots on the die, they are getting experience of this concept

Substituting (the instant recognition of the number of spots from the pattern, without counting) is another important mathematical skill. Again, playing games using different dice, gives children the opportunity to develop stronger subitising skills.

Placing stickers over the spots and then writing the required numerals on the stickers can alter existing dice. If preferred, buy blank dice, or make a deck of twenty cards from scrap cardboard with just numerals written on them (from 1 to 10), two of each card. These can be used instead of a die as this allows for all numerals 1 to 10 and all basic addition and subtraction facts to be practiced.

CAUTION:   Do not use a pack of ordinary playing cards. This is because the pattern on the card does not match the number. For example, the seven of diamonds actually has nine diamonds on the card – seven large diamonds and two smaller ones, (one under each numeral). This can cause confusion for children still learning to “match” the total number of objects to the numeral.

SOME USEFUL VARIATIONS

1. Using a die with spots develops basic one-to-one correspondence and subitising skills.

2. Using a die marked with the numerals 1 to 6 (or cards) develops basic numeral recognition.

3. Using a die marked with the numerals 6 to 10 and 0 (or cards) develops higher numeral recognition.

4. Using a die marked with the numerals 1 to 6 (or cards 1 to 10), have players mentally “double” the number thrown/shown and move that number of places, to practice basic addition doubles.

5. Using two dice, one marked 1 to 6 and one marked with spots, encourages the “counting on “ strategy as children need to start with the numeral and then add on” the spots.

6. Using a die marked with the numerals 1 to 6 (or cards), have players mentally add one to the number thrown.

7. Using a die marked with the numerals 1 to 6 (or cards), have players mentally add two, then three to the number thrown.

8. Using a die marked with the numerals 3 to 8 (or cards 3 to 10); players mentally subtract one, two, then three from the number.

9. Using a die marked with the numerals 1 to 6 (or cards 1 to 10), players subtract the number shown from 10 and then move the "answer" number of places.

10. Using two dice, one marked 0 to 5 and one marked 5 to 10, have players throw both dice, calculate the difference between them and move that number of places.

Contributions by:  Val Badham and Paul Magaudda

ATTENTION DEFICITS

A Developmental Approach

Attention Deficit Hyperactivity Disorder or ADHD is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that over one million people presently have this disorder.

The fourth edition of the Diagnostic and Statistical (Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary for diagnosis.

In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.

Even though it is generally assumed that people diagnosed as having ADHD evidence a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:

• Making careless mistakes in schoolwork
• Difficulty sustaining attention to tasks
• Not listening to what is being said
• Difficulty organizing tasks and activities
• Losing and misplacing belongings
• Fidgeting and squirming in seat
• Talking excessively
• Interrupting or intruding on others
• Difficulty playing quietly

These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.

Physicians often recommend that ADHD be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.

In addition, many common drugs for ADD, which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self-esteem.

A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.

TREATMENT OF ALLERGIES to pollen, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.

VISION THERAPY improves skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. This allows them to pay more attention to the higher level senses of hearing and vision.

The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and the treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.

When making a choice about treatment for attention deficits:

• Consult a behavioral optometrist for a developmental vision evaluation
• Have a child evaluated by an occupational therapist with expertise in sensory processing problems
• Consult an allergist regarding possible reactions to foods or airborne particles

References:

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-lV), 1994.

Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979.

Crook, William G., Solving the Puzzle of Your Hard-to-Raise Child, Professional Books, 1987.

Gesell, Arnold, and Ilg., Frances L., Infant and Child of the Culture of Today, Harper) 1943.

Goodman, Gay, Poillion, M. J., The Journal of Special Education, "ADD: Acronym for Any Dysfunction or Difficulty," Vol 26, No. 1, l992, pp. 37-56.

Kavner, Richard S., Your Child `s Vision, Simon and Schuster, 1985.

Rapp, Doris J., Is This Your Child?, Morrow, 1991.

Schmidt, M.A., Smith, L.H., Sehnert, K.W., Beyond Antibiotics: Healthier Options for Families, North Atlantic Rooks, 1994.

Smith, Lendon, Foods for Healthy Kids, Berkeley Books, 1981.

FOR RESOURCES IN YOUR AREA

Vision Therapy

Optometric Extension Program Foundation, Inc. (OEP Foundation)

1921 E. Carnegie Ave., Ste. 3-L

Santa Ana, CA 92705-5510

(949) 250-8070

College of Optometrists in Vision Development (COVD)

215 West Garfield Road Suite 200

Aurora, OH 44202

(330) 995-0718, (888) 995-0719, FAX (330) 995-0719

Occupational Therapy

Sensory Integration International

1602 Cabrillo Avenue

Torrance, CA 90501

(310) 320-9986

American Occupational Therapy Association, Inc.

4720 Montgomery Lane

P.O. Box 31220

Bethesda, MD 20824-1220

(301) 652-2682

"WE WERE TOLD OUR CHILD HAD 20/20 EYESIGHT.

THE TEACHER THOUGHT THEY JUST WEREN’T TRYING HARD ENOUGH."

An eight year old child passed the 20/20 eye chart test with flying colors, yet she saw letters move around on the page, words and letters disappear, and print go in and out of focus. When asked if she had ever told her parents or teacher that this was happening, her replied was, "No, I thought books did that to everyone."

Children with learning related vision problems rarely report symptoms. They think everyone sees the same as they do.  The fact is 1 in 4 people, adults and children, have a vision processing problem.

Up to four children in every classroom see print this way!  They can’t control their eye movements at close distances, making reading and attention almost impossible.  As the print moves and blurs, they stumble over words, lose their place and can’t comprehend.  Out of desperation, they give up and quit. Is it any wonder they struggle in school.

It is estimated 10 million children 10 and younger have a vision problem.  80% of what a child learns during the first 12 years is obtained through vision.  Children with a vision problem are typically associated with developmental delays and the need for special educational, vocational and social services.

Vision is more than 20/20 eyesight. It is a complex process involving over 20 visual abilities and more than 65% of all of the pathways to the brain. Nearly 80% of what a child perceives, comprehends and remembers depends on the efficiency of the visual system.

A child can't learn to read when the words get jumbled up on the page and he/she can't remember or make sense of what was just read.

Every person adult and children should receive a comprehensive eye exam that are struggling or have struggled with reading.  Please refer to College of Optometrists in Vision Development (COVD) or Optometric Extension Program Foundation, Inc. (OEP Foundation) for a referral to a trained Developmental Vision specialist.

College of Optometrists in Vision Development (COVD)

215 West Garfield Road, Suite 200

Aurora, OH 44202

(330) 995-0718, (888) 995-0719, FAX (330) 995-0719

Optometric Extension Program Foundation, Inc. (OEP)

1921 E. Carnegie Ave., Ste. 3-L

Santa Ana, CA 92705-5510

(949) 250-8070

In the first few years of school, most children bring books home to read with their parents as part of the school reading program. Parents are often given a briefing on how to listen to these readers through a parent/teacher information session or through advice given via a note sent home.

Despite this, many parents remain unsure how to best listen and assist their children, particularly when they make mistakes or they can’t figure out a word/text.

This is unfortunate as reading at home can be such an enjoyable and extremely valuable addition to a child’s learning, not to mention a wonderful positive time for nurturing both the relationship and a love of reading.

Giving and seeking advice on listening to home readers can be difficult because there are differing opinions on how to best teach literacy. I don’t know of anyone who has all the answers, though there are some who claim to have the only ‘right’ way and everything else is the ‘wrong’.

Every child is unique and there is no one generic model/technique that will suit every child in every instance. There is no “one size fits all” prescription.

To help give parents more specific and practical advice on how to listen to their children at home, the following is to provide general guidelines and specific techniques that have been found effective over the years, and to outline some of the basic principles that underlie reading. However please keep in mind that we are constantly learning and improving our knowledge and skills. This is just some of what can be done. Try all of it or part of it, modify it, use it as a framework, and add to it from other sources… I hope that it will give you a foundation with which to begin listening with confidence to your children and help make the process more enjoyable and worthwhile for you and your children.

1. Reading at home should be enjoyable for you and your child

If the experience is fun, satisfying and positive then your child will be far more likely to want to read next time. And, the more children practice then the faster their skills & confidence improve. Keep in mind that it usually takes two to three years for children to learn to read at an independent level. Of course, some children will take a little longer and some a little less. Either way, children only learn to read once.  Be patient, realistic, and enjoy the process, as well as the time you have together.

1. Choose a desirable time and place

Set your child up for success. Find a spot that is comfy and free from distractions (turn the TV off, send the other kids outside). If you or your child is busy, tired, cranky (or all of the above!) tolerance and concentration levels will be decreased.  Remember reading should be enjoyable! Sit at a table with the book on a sloped work surface is the best environment to read.  However you can sit on a couch, or even lay on the carpeted with cushions.  Do what will make your child enjoy reading time.  You can even read when going to bed, but be warned!  If your child is tired, they are more likely to make mistakes and become frustrated, leading to more mistakes etc. It is best to have your child sit on your left so their right ear is closest. The right ear has the fastest route to the left hemisphere of the brain, which almost always processes language. Plus, sitting this way introduces a routine and a sense of predictability.  Speaking of routines, many children thrive with consistency, and it may be worthwhile reserving a consistent time each day to read.

1. Keep the reading time short

When reading to you child at home keep it short and sweet. Children are far more likely to make mistakes and become frustrated if they become tired or lose concentration.  Adults take reading for granted and often forget that learning and practicing to read can be exhausting. So, keep your reading time brief - 5 to 10 minutes in one sitting is plenty for most young children.

1. Be positive and encouraging

This is especially true when they are learning and practicing new skills.  Notice things that they have mastered, or improved upon since prior reading times. Notice things they are doing well.  Say things like:  “I like the way you figured that out”; “wow, that was great reading”; “gee, I really enjoyed listening to you”; “gosh, you are reading so well, you could read that to Grandma when she comes over” (or, they could read to grandparents over the phone); “I noticed that you remembered that new word…” “very good, you had trouble with that word last time, and this time you got it first go..”; “you are making it look so easy”.  Sometimes show a previous book to demonstrate how far their reading has come.

1. Encourage independence

This can be a little difficult for many parents when there is so much at stake. We love our children so much and we want them to become good readers – there is a lot riding on it. In our eagerness for our children to learn to read, it can be very tempting frankly to ‘butt in’ all the time instead of allowing our children to figure as much of the reading out for themselves. Sometimes we can become so overzealous or overprotective (if they are struggling) that we even take over the reading! In so doing we actually disempower our children and deprive them of opportunities to learn. What we really need to be doing is encouraging our children to do as much of the thinking for themselves as possible.  You can do this by:

• Allow your child enough time to figure things out before jumping in.  Children process their thoughts more slowly than adults.

• Allowing time to realize they have made a mistake, and time to fix it as well.

This takes patience, self-control and practice!

1. Help your child when they need it

I realize this may sound like it contradicts the last point. The thing is, if your child can do the reading or figuring out – then let them! However, if there is no way on this earth that your child is going to be able to figure a particular part of text out for whatever reason (perhaps they simply do not have the required skills yet or perhaps they have never heard of that particular word) - then don’t let them struggle and flounder unnecessarily.  The bad news is that it can be tricky to know when to help. The good news is that the more in tune you are with where your child is at with their reading development, and the more you know about the learning to read process, then the easier it becomes.

• If your child is struggling with a word or section of text and you know that your child CAN or may well be able to figure it out – then let them do so, or at least let them give it a try and praise their attempts.

• If you know that your child has come across a similar problem before but is having trouble recalling the solution, you might supply ‘reminders’ rather than directly providing the answer.

• If you know that your child does not have the skills or knowledge to figure a piece of text out with or without hints/reminders, provide the solution quickly without drama and move on. In this case, I might say something like “that’s a tricky word, it says”.   Another occasion when you might quickly “jump in” is when the child is starting to lose track of the meaning/story-line.

Lastly, but most importantly, ensure the child is reading at the right level for their current ability.   Your child should be able to read the book they have brought home with a high rate of success.                    They should be able to read much of the book on their own (say, approximately 90% or more) with perhaps a little help from you. Continual struggle leads to negative thoughts/beliefs, low self esteem, a disliking of reading, reading avoidance and lost learning opportunities. Alternatively, continual success leads to high self-esteem, reading enjoyment, willingness to practice and more learning. Therefore, don’t be in a hurry to rush your child through reader levels. Your child will make the most efficient progress if they have books that match their current reading ability. Another thing to keep in mind is that children often hit learning plateaus, where they don’t seem to be making much progress. However these times are valuable days, weeks, months where children consolidate and master skills before taking off on another learning curve.

As far as ‘easy’ books go, while they don’t tend to offer many ‘new’ learning opportunities, they can be useful practice tools where children work on fluency (reading pace), expression and master/consolidate skills such as sight words.

If your child struggles continually with the books they bring home, then I strongly recommend that you speak to their teacher and discuss what is going on at home.

In summary, many parents find listening to their children problematic because they are unsure of what to do when they listen. Do they help? If so, how do they help? When do they help? This article has outlined some general pointers for parents to consider when reading with their children at home.

Contributions by Kirstie Wilson

Kirstie Wilson M. Ed has written a series of three articles in answer to one of the most common dilemmas that parents face when it comes to their children learning to read

Much has been said in government and in the media about the need to improve literacy skills but a workable solution remains elusive. In order to improve global reading results, we need to focus on teaching reading skills explicitly. This includes the teaching of pre-literacy skills, such as rhyme, vocabulary, visual matching, and language comprehension. As these skills are developing and we begin to introduce reading skills, we need to maintain an emphasis on vocabulary, and explicitly teach word decoding skills and reading comprehension skills through example and practice.

Research tells us that for most people with reading difficulties the underlying problem is a phonological deficit, a difficulty working with the sounds in words. The brain is malleable and particularly so in young children. We need to engage junior primary students in a powerful program, such as Jolly Phonics, that teaches them about the sounds in words and their relationship to letters. These are the foundation skills for reading. An introductory literacy program will be most effective if complemented by a phonics-based reading program.

It also important to remember research has also shown that one in four children in every classroom have a vision processing problem.  They cannot control their eye movement at close distances, making reading and attention almost impossible.    As the print moves and blurs, they stumble over words, lose their place and cannot comprehend.  Out of desperation, they give up and quit.  Is it any wonder they struggle in school.  For these children a comprehensive vision screening would be required.  It is highly recommended that all children receive a comprehensive vision screening to eliminate any possibility of vision difficulties associated with reading.  Please see COVD or OEP for a referral in your area.

One of the major barriers to the teaching of phonics is the adoption of reading levels by schools. Leveled books are classified in different ways depending on the system. Criteria include degree of difficulty based on semantic difficulty and the complexity of the sentences. What this means is that a book with a leveled vocabulary can have mixed text in it with all kinds of spellings as long as they are within the level. As a result, students may find some books easy at a particular level and others too hard. These systems include a testing regime to determine when children are ready to proceed to the next level.

My concern is that schools have adopted reading levels because they offer a convenient structure for a whole school reading program. Books classified according to a particular system can be grouped into ‘the red box, the blue box etc’ and the testing regime used to guide students through the levels. In many schools, there are expectations in terms of level for each grade. For example, students should be at Level 23 by the end of Grade 2. Because reading skills are not taught explicitly and systematically through these systems, students can find themselves at the same level for a whole year. This can have detrimental effects on their motivation and self esteem. The systems that level books now have a strong commercial base and schools prefer to buy books that fit into the leveling system they are using

A few years ago, I visited an elementary school and asked if they would show me how the reading levels work. The reading levels coordinator showed me the manual with the tests the students are given. As I looked at level 1 with words like “painting’ and “climbing”, I commented that the words seemed hard for a beginning reader. “They don’t have to read the words,” I was told, “they look at the pictures. It’s a form of reading.” This approach to ‘reading’, I believe, is responsible for the strategy used by many elementary students who are not automatic readers, what I call, the ‘look and guess’ approach. They look at the picture and guess the word based on key letters. Using this strategy in one of the tests I use, “book” has been read variously as “ball” and “bird”. You see all the pictures start with the same letter! And then there’s the little boy who said to me as we progressed from test items with pictures to items without, “I can’t read that, there aren’t any pictures.”

Choosing the right books

To ensure that beginning readers enjoy success, it is important to explicitly teach them phonic skills. These are the foundation skills of independent reading as they provide students with the ability to decode words they have not seen before. Teaching starts with the sounds of the letters of the alphabet.

Phonically controlled books

Phonically controlled books have titles like The Pet Hen and The Owl and the Clown and follow two guidelines:

1) They are written with a phonic rule in mind, i.e., short e and use mostly words that follow that rule i.e., The pet hen got the vet wet.

You won’t find words like ‘cough’ and ‘Guy’ thrown in with ‘cat’ and ‘fat’. When reading phonically controlled books, you show the child the new words, teach them the new phonic rule and the student can read the book independently.

2) Other words used are either words the student learnt in earlier books or new words that the author lists in the front or back pages of the book. Only a few are introduced in each book.

Phonically controlled books are classified by difficulty, too, but the classification is based on the difficulty of the phonic rule introduced in the book. One of the best known series of phonically controlled books is the Fitzroy Readers, now available in hard copy and on CD.

Regrettably, phonically controlled books are being relegated to the scrap heap because they don’t fit the system. As a result, children who need to be taught using the building blocks of reading (phonics) are failing. How many children might this be? Let’s look at the statistics.

Assuming a normal bell curve, the IQs of 25% of students are below average. The majority of these children need explicit skills teaching to learn to read. When you add to this the 3-10% of children with an average IQ and dyslexia, we are now talking about 30% of children and this still doesn’t include children in neither of the above categories who might have a Language Disorder, Vision Processing Disorder, Attention Deficit/Hyperactivity Disorder or Auditory Processing Disorder.

If we are serious about improving reading skills, we need to spend time providing explicit skills teaching. The value of running records is ignored if they are used to decide on promotion to the next reading level rather than for their primary purpose which is to find out where the student is having difficulty and what they need to be taught to progress.

That a minimum of 40 minutes/day be spent in junior primary classes on the explicit teaching of phonics, spelling rules and handwriting skills. At the beginning, this should be supported by the use of phonically controlled books. Once students’ reading skills take off, then they can move to leveled books with confidence and achieve success.

Reference: Overcoming Dyslexia for Dummies by Tracey Wood, Med

College of Optometrists in Vision Development (COVD)

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Optometric Extension Program Foundation, Inc. (OEP)

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Santa Ana, CA 92705-5510

(949) 250-8070

This Self-Assessment Checklist Can Reveal Vision Difficulties

Your visual system can undergo tremendous stress these days. Students now read three times the number of textbooks their grandparents did. Adults constantly use their near vision at their work. And the growing use of computers has engaged a growing number of workers in prolonged, near-vision tasks.

Eye discomfort, headaches, blurred vision, lowered visual performance a wide variety of vision-linked problems are related to this heavy vision load in the neat, arm's-length distance.

Human beings weren't designed to do this stressful seeing less than arm's length away. We have hunter eyes for survival, spotting game and enemies at a distance. Only in the last half century have so many people been forced to deal with sustained, near visual tasks. The result has been a constant stress on the visual system, producing many of the symptoms and problems described in this self test.

Many people who report these symptoms also have 20/20 eyesight at distance, yet just can't handle the visual stress associated with near vision tasks. Visual stress is linked to the development of permanent vision conditions such as nearsightedness, astigmatism and other problems that affect how one lives and even behaves.

EFFECTS OF VISUAL STRESS

When visual stress is present, people react in these ways:

• avoid the task by doing as little as they can get by with;
• experience pain or other symptoms (aches, visual and/or overall body fatigue, falling

asleep when reading, etc.);

• suppress the sight of one eye (at the cost of reduced efficiency and understanding);

develop myopia or astigmatism, or

• any combination of the above.

For most people, the response to stress is reduced achievement and understanding.

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                  WHAT IS A BEHAVIORAL OPTOMETRIST?

                  Behavioral Optometrists spend years in post- doctoral education to master the complex visual programs prescribed to prevent or to normalize -visual problems and enhance visual performance. Behavioral optometry is an umbrella term, which also includes developmental and functional optometric practices. Not all optometrists practice behavioral optometry. To find one who does, call or write COVD or OEP Foundation for a referral list in your area.