Executive Functioning Explained

I found a great article in my inbox this morning that I just had to share! It is by Dr. Alison Block and titled Smart, but Scattered?: Understanding Executive Functioning in Children and Adolescents. I am copying and pasting it here, but you can also click the link to go directly to her blog.

SMART, BUT SCATTERED?: UNDERSTANDING EXECUTIVE FUNCTIONING IN CHILDREN & ADOLESCENTS

Is your child smart, but scattered? Children face many challenges in today’s dynamic world, and it can be difficult for them to easily navigate its course. You may be realizing that you personally struggled with the same signs of anxiety, disinterest or frustration that your child is experiencing.  At home, it may seem like harmless daydreaming, frustration over dressing for school, emotional outbursts over changes in plans, or even laziness over not wanting to complete a homework lesson.

Your child may be suffering from a lack of executive functioning (EF) skills, which may be impacting him academically, socially and emotionally. No more yelling or arguments! Instead, it’s time to learn about EF so you can help your child to function at home or school.

Executive functioning allows us to develop and apply problem-solving skills as circumstances arise. We need EF skills to tell us how and when to start or delay reactions to our environment. In the moment, people who lack good EF skills cannot anticipate the impact of their quick decisions.

WHAT IS EXECUTIVE FUNCTIONING (EF)?

Before we can learn how to compensate for executive functioning deficits, we need to understand the definition of EF and how it presents itself. Executive functioning (EF) is the umbrella term for the skills needed for goal-directed behaviors. These can include making a new friend, learning a new academic skill, or knowing how to behave in a social situation. Anticipation, judgment, self-awareness and decision-making all require EF skills.

Deficiencies in EF can affect the relationship between the brain and behavior. During childhood, these deficiencies are frequently undiagnosed. In Dr. Mel Levine’s book, The Myth of Laziness, he noted that children are often dismissed as unproductive or “lazy” when in fact they suffer from what he calls “output failure”. Once a child reaches middle or high school, organizational problems become very apparent, and often the adolescent’s EF deficits continue to be overlooked. If left unchecked, the child’s decreased belief in his ability to perform can cause difficulties moving forward.

Executive functioning problems are also associated with a number of psychiatric disorders, including ADHD and learning disabilities. Brain damage related to Alzheimer’s disease, strokes, or head injuries can also lead to problems with executive functioning. In this article, however, I focus on the average person’s difficulties with EF.

UNDERSTANDING THE BRAIN AND EXECUTIVE FUNCTIONING

A child enters the world with all the neurons he will ever have and EF skills start at about nine months of age. Over time the brain forms new connections among those neurons due to experience. Once the basic plan of the brain is laid down, neural network connectively can be enhanced by the complexity of experience and environment. For example, a child who is well regulated and attentive in a structured classroom may be silly and hyperactive at a sleepover.

EF is influenced by the maturation of the brain’s frontal lobe circuitry. This part of the brain directs attention and behavior so your child can use past experiences to guide future decisions and behaviors, to observe, to manage and control emotions, and to change strategies.

COMPONENTS OF EXECUTIVE FUNCTIONING: HILL, SKILL AND WILL

Think of executive functioning as a resource or plan, and not a set of specific functions. The how and when is meaningless without the reciprocal interaction with other cognitive and motor domains of the brain. The parts must work together and be implemented for the goal of a positive end result.

Like an orchestra conductor or chef, EF brings together the thoughts and actions required to reach a predetermined goal. A conductor unites instrumental sounds and actions with the end result of a harmonious performance; whereas, a chef gathers and prepares his ingredients, follows a recipe, and works to present a delicious meal. Parents and educators will also offer their own EF skills to help young children whose EF skills are not yet fully developed and need help hanging up a coat, doing homework, or dressing for school.

Executing functioning is often explained by using the words Hill, Skill and Will.  The Hill is a metaphor for any plan or goal, and Skill reflects the organization of behaviors over time, as well as the flexibility required to accomplish the goal. Will means that over the course of action, your child will direct and maintain his energy and attention so that he can focus on reaching that Hill.

8 AREAS THAT COMPRISE EXECUTIVE FUNCTIONING

Below are eight areas (domains) that comprise executive functioning. Some apply to social and emotional behaviors, and others pertain to more task-oriented actions that follow thought. Familiarizing yourself with the areas will help you to better understand where your child’s abilities are falling short, and where you need to assist with executive functioning.

1. Inhibit

Does your child often call out the answer in class and speak out of turn?

Inhibit involves curbing the knee-jerk responses of your child’s immediate reactions in situations and during tasks that require delayed response and the ability to resist and not act on impulse. In difficult or emotional interactions, it is important to inhibit inappropriate physical, verbal or emotional responses.

2. Shift

Does your child become agitated over the last minute cancellation of an extracurricular activity or the replacement of a favorite teacher with a substitute, resulting in angry or anxious outbursts due to poor emotional control?

Shift is the ability to adapt or be flexible when unexpected plans or events occur. It is also exhibited in difficulty changing focus from one topic to another. People who cannot shift are described as rigid, and are often inflexible in their thinking, generate fewer ideas for problem solving, can’t get beyond a specific disappointment or unmet need, and take the same approach, over and over, despite negative outcomes.

3. Emotional Control

Is your child easily brought to tears by a frustrating puzzle or does he throw a tantrum over a sold out video game?

This domain exhibits itself in your child’s ability to self-manage emotions.When emotional control is absent we refer to the individual as being explosive or emotional, creating drama over seemingly minor events, laughing or crying easily with little cause, and engaging in temper tantrums that are not age appropriate.

4. Monitor

Does your child have a problem sharing and thus fails to recognize the negative effect it has on his playmates’ emotions and his ability to make friends?

All executive functioning domains are dependent on the ability to self-monitor by tracking one’s own social behavior and being aware of its affect on others. If your child is not aware, he cannot tweak his environment and change his strategy. Adults who are not aware cannot tweak their environment or strategy cannot improve their productively, functioning or relationships.

5. Working Memory

Does your child leave his assignment book at school often or have trouble doing math problems verbally?

Working memory is the ability to hold information in mind for the purpose of completing a task or generating a response like remembering directions, keeping track of what your child is doing as he works, remembering what he is supposed to retrieve for a specific task, and being able to implement a sequence of activities. A child needs to sustain attention over time to have a good working memory and not be sidetracked by details or minutia.

6. Planning and Organization

Does your child’s simple writing assignment about his favorite sport turn into a fumble over words?

Planning and organization is the ability to hold a plan and begin strategizing, sequencing and ordering, managing time, initiating tasks, being persistent, and staying on track to meet a goal. If unable to plan and organize, your child will approach a task haphazardly, be easily overwhelmed by large amounts of information, and have trouble completing a project.

7. Organization of Materials

On a daily basis, do you find yourself asking your child to locate his backpack, team uniform, or assignment book because he never puts it in the same place twice?

Organization of materials is the ability to organize the everyday environment with respect to orderliness of work, play and storage spaces. Without it, your child cannot function efficiently because his environment is in disarray.

8. Task Completion

Does your child have problems completing assignments or projects?

Task completion is the ability to finish things in a timely manner thanks to an outcome of well self-regulated problem solving. Although different from Working Memory and Planning and Organization, problems in this area are related to other executive difficulties such as selective attention and self-monitoring of impulse control. If your child cannot hold the goal and task steps in mind, develop an organized plan to approach the task, and inhibit task-irrelevant actions, it will be hard for him to complete the task or goal at hand. A child may have a great idea and plan, but there is a lot going on cognitively behind the scene in order to reach a goal.

NEXT STEPS….

Once you understand and pinpoint your child’s executive functioning deficits, you can provide him with the skills required to become a confident, self-sufficient decision maker. It’s time to end the temper tantrums or lack of motivation. Step back, breathe and begin taking the necessary steps towards a better understanding of your child’s EF needs.

My next blog post will offer ways to succeed at executive functioning. In the meantime, please contact me with any questions or to schedule a private appointment.

Where we are

3.5 years later and here we are. It is so hard to believe. I started this blog back when Will was in 3rd grade?  We were at such a loss. We had no idea what was going on... only that SOMETHING was going on.

Now, Will is in 7th grade. Yes, he still has struggles. No, everything is not perfect. Yes, he will tell you he has ADD. "Not ADHD, because I am NOT hyperactive!". Yes, he can see when that gets in his way. Yes, he is still majorly struggling with headaches. (Though, knock on wood, we have gone several days in a row with not even a mention of a headache) No, it is no longer a battle to get through homework. But, yes, he still procrastinates as long as he can. Yes, he just failed a math test. No, he doesn't fail them all.

I feel like his obstacles are not so much obstacles anymore. We are at the point that they are just speed bumps. They slow him down at times. They make him work harder for some things. But, they aren't huge. They aren't dominating his life. He has adapted. We all have adapted. I am so proud of him. Sure, he will probably have these speed bumps to deal with all of his life. I just pray we are laying the foundation and giving him the tools he will need to deal with those bumps and not let them stop him. Not let them stop him from doing anything he wants to do.

Will surprised us all and decided to try out for show choir. He made it and they have been rehearsing since September! Talk about commitment! He has to arrive at school every single morning at 6:50. Yes, I have to drive him there. They rehearse every morning for 45 minutes. And they rehearse two afternoons a week for 2 hours. They compete in regional show choir competitions and apparently are quite good. This choir, last year, won Grand Champion of every competition they entered, except the one where they were first runner up! He is loving it. Back in October they had a weekend where they spent 17 hours with a choreographer that came to town to work with them. And, in the last two weeks, preparing for the competition season (that begins this weekend) they will have spend almost 30 hours rehearsing, before all is said and done. And the cherry on top is that they were invited to participate in Nationals in Nashville in April! Can't wait!

So, Will is doing well. We will continue to work our way through issues that come up due to his visual processing issues and his ADD. That will be ongoing and just a part of life! But it is so nice to report that we are in a good place right now!

Irlen Syndrome

It's been a little while!

I'll update on where we are in another post. In the meantime, I wanted to put out some links to info on something I have recently stumbled upon.

To back up real quick, Will has been dealing with chronic headaches. He has had headaches for a long time. They improved for a while back when we began the vision therapy, but they seem to have picked up in frequency again this school year.

I have a Google alert set up to send me emails when articles are published about Visual Processing issues and Executive Functioning. It's great. I get an email whenever something new is published to the internet.

So, a couple weeks ago I received an email, I think under the alert for Visual Processing and it addressed something called Irlen Syndrome. I had never heard of that before. But I was intrigued because it mentioned headaches. So, I started reading more about it. I am providing some of what I read below (taken from-http://www.irlenvisions.com/pg/What-is-Irlen-Syndrome.php :

What is Irlen Syndrome?

Irlen Syndrome, also known as Scotopic Sensitivity System (SSS) is a type of visual perceptual problem. It is not an optical problem. It is a problem with how the nervous system encodes and decodes visual information. Academic and work performance, behaviour, attention, ability to sit still and concentration can all be affected.

Individuals with Irlen syndrome see the printed page differently. Many do not realize their page is different. Irlen syndrome prevents many people from reading effectively and efficiently.

 Until recently it has baffled educators and medical scientists because it has been undetected by standard visual and educational tests. Irlen has a patented treatment method using specially formulated colored overlays, or spectral filters worn as glasses or contact lenses, to reduce or eliminate perception difficulties.

Now there is much research showing why.  Read more.

See a three dimensional scan of the brain (PDF, 1.34MB) having Irlen Syndrome, compared to a brain without Irlen Syndrome

Take the self test.

Some of the symptoms of Irlen syndrome include:

• headaches
• sleepiness when reading
• skipping lines or words
• losing place
• poor comprehension
• depth perception
• light sensitivity
• Words that shift, move, blur, become bright, or have haloes

Research now shows that Irlen syndrome can help:

• Research on Headaches and migraines. Read more.
• Research on Traumatic Brain injuries. Read more.
• Research on Autism and Asperger's syndrome. Read more.

Individuals with Irlen syndrome may:
• Lose their place on the page easily
• Skip words, lines or reread words or lines
• Squint, open their eyes wide, rub their eyes or have red and watery eyes
• Be able to see only a small portion of the page in focus. The rest may be blurry
• Move around or move the book to get it to focus
• Display a short attention span because of eye strain or fatigue while reading
• Experience nausea because of movement on the page
• Get a headache after reading for a while
• Shade the page or move it to avoid glare
• Be fidgety or restless while reading
• Prefer to read in a dim light
• Make errors when copying from the board
• Misalign numbers in math problems
• Have slow and choppy reading
• Be unable to stay on task
• Be an underachiever


Some have one symptom and some have many.
It is important to realize that this syndrome is a perceptual dysfunction rather than a vision problem. Irlen Syndrome, like any reading problem, can occur with someone who wears prescription glasses or even with someone who does not need them. Those who do not need corrective lenses will wear on-prescription filters with their specifically prescribed Irlen spectral color in them.
For those suffering from this syndrome, one or more of the colors that are part of the visual spectrum effect the speed and consistency of how the brain is able to interpret, not only the printed page, but everything around them.
Studies show that Irlen Syndrome affects to some degree approximately 12-15% of the general population, or over 17 million people in the U.S. In the population of those with learning problems, the incidence is about 45%.


So much of what I read here fit what we have experienced with Will over the years. Yet, I had never heard of Irlen Syndrome. I reserved a book at the library and went and checked it out. I read the majority of it. I am very intrigued and would like to investigate this as a possiblity with Will. 
His headaches are almost daily and it drives me nuts that he grabs for the Ibuprofen whenever he has one. I've been trying to keep him hydrated and all. So, this Irlen Syndrome is interesting to me and I will be discussing it more here in the coming days.

Attention disorder…or vision problem?

Attention disorder…or vision problem?

What a fantastic article that really helps drive home the idea that many attention disorders are actually Convergence Insufficiency in disguise. It links to several other articles, that I have not read yet, but sound like they might have lots of good information, as well.

Several of Dr. Martin's comments in this article hit home with our situation. For example, "...a child may not realize his vision isn't normal. All he knows is that reading and writing are difficult, and he will do just about anything to get out of it". Oh if I had a dime for every time we just thought Will was being lazy. That he just wanted to avoid doing the work because he didn't feel like putting the effort into it. Well, of course he didn't want to put the effort into it... because it was soooo much effort. And he didn't know that this wasn't normal. Actually, that is not true. He was starting to realize it and thought it was because he was "dumb". Which is even sadder, really. I think a lot of kids, who do not get the help they need, end up feeling this way. They can't help it. They know how difficult some tasks are for them, but they see many other friends who can accomplish these tasks easily. So, of course, they come to the conclusion that something is wrong with them (which it is), but it isn't that they are "dumb" or "stupid" or "they just don't get it". It is a tangible problem that can be corrected! That is the good news in all of this. Convergence Insufficiency can be fixed!

Getting the word out about CI

I think I have mentioned it before, maybe not, but I learned how to set up Google so that I get emails when anything is pulished to the web that mentions Convergence Insufficiency. It is this neat tool I stumbled on and I don't know if I could go back and figure out how to do it again (probably, I could) but I am so glad I did.

Sometimes I get really good info out of that! Like the other day. Through Slideshare, a slideshow was published, titled "Convergence Insufficiency. What Every Physician Should Know 3.0". You can see it by clicking the title. It is chock full of fabulous information. And although it is really geared towards doctors, it is easy to follow and really does some good explaining about what CI is. It also addresses the need for more physicians to recognize the symptoms for this.

So, I posted this link to my FB page on the morning I found it in my inbox. I got some interesting comments. People that didn't know my son was going through this. A family member who's own son was recently diagonsed (through a school vision test!!!). People asking how we figured it out. People just thanking me for the info.

I am continuously amazed that so few people know what CI is. Yet, if you read the information that is out there you find that it is actually a fairly common problem. There is a big percentage, according to this particular slide show, upwards of 13% of school children, that have this issue. It also quotes a study from 1996 that says 1 in 12 children have Convergence Insufficiency.

How do we get the word out? How many children are being treated (maybe even with medication) for other problems when, in fact, they have CI, and vision therapy could help them? It is a question I continue to ask myself. I post things to FB periodically, just to let my friends know about it. Hoping they will share with their friends, etc... I suppose that has turned into one of the missions of this blog, too. To help get the word out there. Provide information and a story behind the condition. Maybe we will help somebody with their own child or even themselves.

Gathering More Info

I just found another great article with information on convergence insufficiency and how it can effect a student in school. In fact it is called Convergence Insufficiency and Problems in School (clever title!).

Reading the symptoms described in this article just remind me of how bad Will was before he was diagnosed. However, they also remind me that he is still struggling with this to an extent. For example:
A person with convergence insufficiency may experience continual eyestrain during and after focusing on text. This continual strain can result in headaches, and blurred or double vision. Vision problems then often lead to an inability to concentrate and a short attention span as the reader constantly loses her place and grows increasingly frustrated. At graduated levels, someone with convergence insufficiency may experience motion sickness or vertigo as words appear to float, jump or swim. 

Read more: Convergence Insufficiency & Problems in School | eHow.com http://www.ehow.com/info_7900044_convergence-insufficiency-problems-school.html#ixzz1iYBasflG

Will still experiences headaches. Many days he arrives home from school complaining about one. Still. He does indeed still have the short attention span and loses his place when reading. Like I said in a recent post, homework is still a struggle at times. I believe it is just hard for him to sit and do it. It is a strain.

The therapy has certainly helped. Especially when we were doing it every week. We have reduced our visits to every other week. While he enjoys going and we can see a difference, they are expensive!

Anyway, back to this article. There are several other links on the page with good info on how to accommodate convergence insufficiency in the classroom and other good advice and information. I wish there were a way to get the info out there to parents like me. Who know there is a problem, but have no idea what or how to go about figuring it out. I feel like we went through 2+ years of wondering what was going on and had we known to look for potential problems such as this, we could have helped him earlier.

Convergence Insufficiency Makes the News

An article was published yesterday that claims "After Effective Treatment for Convergence Insufficiency, Academic Behavior Problems Decrease".


I'm telling you! I really think CI is a bigger problem than people think. I think it accounts for what many people diagnose as ADHD. There are so many similar symptoms. And, so few people know about these vision issues.


I am just glad to see it being talked about. The more info that gets out there, the more kids can be helped!


You can read the article through this link, or here:

For Kids with Near-Vision Disorder, Treatment Reduces Problems at School

Released: 1/3/2012 10:00 AM EST
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

After Effective Treatment for Convergence Insufficiency, Academic Behavior Problems Decrease

Newswise — Philadelphia, Pa. (January 3, 2012) – For children with convergence insufficiency (CI)—who have difficulty focusing on objects close up—effective treatments can help to reduce problems at school, reports a study in the January issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"A successful or improved outcome after CI treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work," concludes the new research, led by Eric Borsting, OD, of Southern California College of Optometry, Fullerton.

After Positive Effects of CI Treatment, Parents See Fewer School-Related Problems
The researchers analyzed 218 children and adolescents from a previous study of treatment for CI. Convergence insufficiency is a condition in which the eyes have trouble working together to focus on close-up objects. In addition to symptoms like eyestrain, headache, and double vision, CI has been linked to problems in doing school work, reading, and studying.

In the study, children were assigned to different treatments for CI—office treatment by an eye care professional, two different types of home-based treatment, or an inactive "placebo" treatment. In 42 children, treatment was rated "successful" (near-normal binocular vision), while another 60 children were rated "improved." The remaining 116 children did not respond to treatment.

The researchers compared scores on a simple scale of academic behavior problems. Rated by parents, the scale included problems like difficulty completing assignments, avoiding reading or other close work, and careless mistakes in doing school work. Before treatment, the children's average score on the academic behavior problem scale was about 13 out of 24 (with higher scores indicating more problems).

For children who had improvement in CI after treatment, academic behavior problems were significantly reduced. The average improvement was four points in children whose treatment was rated "successful" and three points in those rated "improved." By comparison, children who did not improve with treatment had just a one-point improvement on the problem scale.

In particular, parents reported fewer worries about the child's school performance and fewer problems with attention to detail after effective CI treatment. Children in the "successful" and "improved" groups had similar improvement in academic behavior problems.

Convergence insufficiency is a relatively common problem, affecting about five percent of school-aged children. In addition to eyestrain and visual symptoms, children with CI are more likely to have problems such as difficulty completing school work, avoiding reading and studying, and inattentiveness while reading and studying. The new study sought to determine whether treatment for CI can alleviate such problems.

The results suggest that children who respond to treatment for CI have significant improvement in academic-related behavior problems, as rated by parents. When treatment is effective, attention to detail improves and parents are less worried about how their child is doing in school.

Although the study has some limitations, it is among the first to show how effective treatment for CI can affect school-related behavioral problems.

About Optometry and Vision Science
Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry
Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.5 billion ($4.7 billion).

Reflection

I just spent the last 45 minutes rereading most of the posts I have written on this blog. Amazing to look back at the beginning and see where we were. 3rd grade, so may questions about what was going on with Will. Nobody knew where to direct us. Nobody REALLY thought there was a big problem. And maybe there isn't. Not a REALLY big problem, but big enough for us.

Looking back on what we have found out, what we have done, what we haven't done, etc... is fascinating. I read over these posts and I remember things I had forgotten. I see things I didn't see then. I am thinking of things we ought to be doing and aren't! It is so easy to get caught up in one aspect and lose sight on the others.

An example I am thinking of is how we really jumped on the vision processing disorder diagnosis. It answered so many questions and came with therapy! A way to treat the problem! Exactly what we were looking for! However, diving into that made us put the ADHD diagnosis aside. Was that smart? I am not sure. I have gone back to it from time to time in my mind. I have had a few conversations with Chris about it since then. But, we have not really addressed it.

That is the problem, I suppose, with getting by! If things are going ok, grades are being maintained, teachers aren't calling us about problems. We tend to forget there are issues potentially there. The fact that he can't maintain his binders without serious parental involvement, is probably a factor of his ADHD. The fact that his locker probably looks like a bomb exploded inside of it is also a factor. The fact that I do have to sit with him to get him to complete his homework. The fact that he has trouble remembering what he has for homework. All of this is probably connected to his ADHD. But, he gets by. With help. And we go on and don't address the real problem.

And, maybe that is okay. We still do not want to turn to medication, unless necessary. But, reading one of my posts from last fall, about my friend's daughter who was also diagnosed ADHD, inattentive-type. They were very anti-medication, until they decided to try it. It changed their daughter's world. They are homeschooling this year, though. I wonder if she still takes the medication or if they are able to manage it better with her being at home... a question to email her.

So, things have improved, I can see that after reading all my posts. But, I can also see things have evolved. Problems have changed. Nothing we can't handle. Middle School comes next and I wonder what that will bring. For now, we will continue on as we have been. Try to address some other issues that are there, like the ADHD. Try to instill more self-responsibility. I'd like to look back at 2012, next year, and be able to post how many positive changes we have made and how they have helped Will blossom into self-reliant, responsible, organized young man!

Does It Get Easier?

So, here we are, in 2012. It's been a long time since I posted anything. I was going to shut this blog down, actually, until I noticed how many page views it has had. It's not a lot by any means, but to me, it is. So, maybe it is worth it to keep it going. To keep updating how things are going with Will.

I worry a bit though, as he gets older, that I am putting this information out there. God forbid a friend or someone stumbles upon this blog. Will would be horrified. He is pushing 12 years old and it is only a matter of time before he might find something like this. So, not sure what to do with that in mind. Maybe I remove all of his pictures? Change his name... I'll have to figure out what to do.

In the mean time, we are now, ALMOST, half way through his 6th grade year. What a big difference 6th grade is. He has 4 teachers, instead of 2. That is a huge change. After talking to Dr. T, before school began, we decided NOT to talk to his teachers about his vision issues. Dr. T, who is a retired teacher, told me that she hated hearing about student's problems beforehand. She preferred to figure them out on her own. She felt like some students were pigeon-holed by their "diagnoses". I agreed with her, mostly, though I do believe in some situations it might be beneficial for a teacher to know about a student's limitations.

But, I must say it was a good decision. He has struggled here and there, but no really big issues. But, here is where the "Does it get easier" title comes in to play. I still have to remind Will to check his planner, I have to remind him to start his homework, to finish his homework. I pretty much have to be sitting at the table while he does his homework. I have to remind him when he has a test coming up, when a project is due, etc, etc, etc...

It gets old, it really does. And part of me wants to just back off completely and see what happens. Actually, I need to do that. I am sure he has become totally dependent on me when it comes to schoolwork. I worry, though, that if I back off, his grades will plummet... Quite the conundrum. So, 2nd quarter comes to an end in the next couple of weeks. I think we will make a goal for the 2nd half of the year, of me not helping him so much. It is time for him to take responsibility for himself. I am sure it is well past time for him to take responsibility for himself, but this is how we have rolled. It has gotten him by. Time to change, though.

I'll have to do some thinking on exactly how to make those changes, but I am going to do it.

Early on this year, Will was tested in math, to see if he qualified for intervention. Students were chosen based on their OAA scores at the end of the 5th grade year. If they were in a low enough range, they were pulled out for further testing. Frustratingly, I only knew about this because Will told me. Of course, he didn't know why they were testing him, just that they were. I emailed the school psychologist and he told me why they were doing it. You would think that would be something parents would be notified about. So, weeks went by and I never heard anything about the outcome of the testing. I emailed the school psychologist again. Oops, they forgot to tell me, he didn't qualify for the intervention. He scored in the 44th percentile. :( That is considered average by the school, so he didn't qualify. Hmpf!

So, we have been working hard on math at home. He seems to be getting a pretty good grasp on what he has been learning. His biggest problem is, and always has been, transferring what he has learned to a test situation. He has never done really great on tests. Sitting at home, working on homework with someone, he gets it. Almost always. Give him a problem, with nobody to talk it through with, or worded a little differently, and he struggles.

Okay, this post has kind of been all over the place. I am going to try to keep this blog more up to date and address some specific things we have continued to deal with. I am toying with the idea of adding Ben into the mix. While he doesn't struggle with school, he has his own host of idiosyncrasies that go along with his "giftedness" we are trying to figure out.

3 months later

Long-haired Will ready for his Spring Concert

Hard to believe it has been 3 months. What kind of blogger am I? Not a very good one, apparently. It seems to me that once the new year hits, I lose my free time. Too many commitments, not enough time!

We have continued seeing Dr. T for Will's vision therapy. We have also used her for some tutoring here and there as well. She is a former teacher after all and she just loves to help Will, particularly with math, which is great cause that is where he struggles most! Chris finally got to take Will to VT and he got to try out some of the exercises Will does while he is there. He was impressed with what they do together and can see how it is so helpful to Will.

School has continued to go well. He has struggled here and there, mostly with motivation. He had a few projects during the 3rd quarter that he pretty much waited until the last minute to complete. I think 3rd quarter is the most difficult quarter anyway. It sort of drags on, it is winter and we are all stuck inside. The days are longer and there is lots of work to be done at school. But, we got through it. Report cards will come home later this week. I do think this will be the first quarter this year that he doesn't have straight A's. I think he has a B+ in Language Arts. But I see that as a good thing, really. We can get on Edline and he can see where he could have done better, particularly with some homework assignments and he could have ended up with straight A's again. I struggle with that, though. There is nothing wrong with a B+. Absolutely nothing. He should be proud, so I hate pointing out what he could have done better. But, at the same time, he really could have and should have had an A in that class based on what I see on Edline.

Will had quite a few sick days during this last quarter. A couple episodes of vomiting kept him out of school on two different days. Then he caught some virus with a fever and bad cold symptoms and that kept him out for 4 days. That resulted in lots of make up work for him. It has also resulted in some anxiety for Will. The vomiting through him for a loop. It happened at night, after he laid down to go to bed.  So, ever since then, he has had several times where he gets very nervous and anxious that he is going to get sick again. He comes in my room and says he has to throw up and he does NOT want to throw up. He gets so upset about it he causes his stomach to get upset and he ends up with diarrhea. This has happened a couple of times. He has decided he needs to talk to Dr. Nannie about it! So we are going to go see her tomorrow. Hoping that allays his fears!!!

Still going well...

This coming week is the last week of the 2nd quarter. Hard to believe that the school year is already just about half over. That is crazy to me. Before we know it, it is going to be summer again. But, let's not get ahead of ourselves.

I don't know if they are trying to prepare the kids for final exams or what, but Will has 4 tests/quizzes next week. That seems absurd to me, but it is true. Monday, Tuesday and Wednesday. Ugh! So, now it is just convincing Will that it is worth his time to study! He knows it is, he knows he needs to, it is just a problem for him "choosing" to study over whatever else it is he would rather be doing.

Amazingly, he currently has straight A's. A few A-'s, but all A's. So, really he needs to rock these tests this week and the kid will have made the high honor roll again! Who woulda thunk? Man, oh man. He is just doing so well. I am so proud of him. He has such a different attitude about school so far this year and even homework. For the most part... Sometimes he reverts back to his, "Oh, I have a headache" or "Ugh, I am too tired to do homework", but for the most part he is agreeable and really puts his best effort into it.

He also seems to have, maybe, discovered girls. Well, at least one girl. Mia. Apparently she chases him everyday on the playground and takes his hat and tells him that she hates him. That is true love! He pretends like it bothers him, but then he keeps telling me about her and the things she does. Like, she found his tickle spot! It's cute and I figured bound to happen! Just so she doesn't go breakin' his heart. .Because if she does, well then she is going to have to deal with me!

Happy New Year!

I wanted to give a quick recap to our last month of 2010. The biggest, most exciting news was finding out that Will was chosen to be Student of the Month for the month of December. Woo hoo!

Student of the Month Dec. 2010

We got to go to an early morning (7:15am) breakfast in honor of the students that had been chosen. Each teacher gets to choose one child each month to receive the award. It was a big deal and Will was so very proud of himself. We found out about it in a letter he brought home from his principal. He had no idea what it said. I had just found it in his folder. I read it and then showed it to him. He, literally, screamed! He was just so darn excited. It was really very sweet!

Will up on stage after having his name announced.

It's not a great picture, but here he is after being called up on stage. Unfortunately, because of a snow day, the breakfast was pushed back a day and Will's teacher, Miss P, was not there that day. She was preparing for her wedding to take place two days later. So, he was given his award by his sub, Mrs. K, who is a retired teacher and well known and liked. He was okay with it. His other teacher, Mrs. K, came up to us afterwards and told us that both her and Miss P. knew Will deserved the award that month. He had worked so hard all quarter and they had both been impressed when he presented his Star Student report to BOTH classes, at the spur of the moment, when the other student was absent. He just rolled with it and presented to 50+ students and did great!

We are so proud. We also found out that Will's all A report card landed him on on the High Honor Roll. His name was even in the local newspaper because of it! Awesome!!!!! Again, he was so proud of himself and what he accomplished.

We've continued with Dr. T and he is doing real well there. She always comments that he is such a hard, self-directed worker. Makes a momma proud!

Race to Nowhere

I would love to see this film. As far as I can tell it is not being viewed anywhere near here, though I suppose I could push for it to be shown somewhere, myself.

Anyway, the link below is to another's comments on the film. Very interesting. I would love to sit in on a discussion of the film and the topics generated by it.

Race to Nowhere

Homeschooling has always been something I have had in the back of my mind. Heck, back when Will was getting ready for Kindergarten and we lived in our old neighborhood it was more like in the forefront of my mind! I wasn't going to send him to the neighborhood school and we seriously contemplated it. Chris would do it in a heartbeat right now. Reading what this guy had to say about the movie made me really think. Really think about the pressure we are putting on our kids.

I laughed when Ben asked me if his grades were good enough to get him into the University of North Carolina. He is in 3rd grade. That should not have even come out of his mouth. It should not even be in his head... but it is. Who put it there? I am sure it must have been us. I am sure over the years as he has talked about being a Tarheel, we have said, "Oh Ben. You have to get really good grades to go to that school. That is a really tough school to get into." I know we have said those things.

Then I think about how we celebrated the heck out of their straight A report cards. Of course, we should celebrate, but how much pressure did we just add to next quarter's report cards. B's are fine. Even C's are fine. I got a lot of B's and C's growing up. Sure I wished I could do better, but I didn't and my parents were always very accepting of my grades.

There was something in the article that really hit home with me. It talked about a boy who was at the screening the author went to who spoke after the viewing. He made a comment about how he would come home from school or sports and his mom would immediately ask him, "Do you have any homework? How did your test go today? What do you need to study?". That is ME! I do that every single day. To me, I am just checking in, planning out the evening in my mind as far as who needs to get what done. But, this kid said it just added to the pressure he was already feeling from school. Is that what I am doing to my boys when I ask that. I sure don't mean to be, but I can see how it would be seen that way.

So, as of today, I vow not to make that the first thing out of my mouth when they get home anymore. Instead I'll offer them a snack or something fun to do. Or just a hug. I am going to consciously watch what I do and say and try to catch myself from adding to the pressure. I am sure I do it in ways I don't even know.

A Fly on the Classroom Wall: Memory Strategies to Use in the Classroom

Wow, what great ideas!!!! I am definitely going to try some of these out for Will at home!

A Fly on the Classroom Wall: Memory Strategies to Use in the Classroom

Great Information on Vision and Reading

Borrowed from www.childrensvision.com

I feel this does a great job explaining how these vision issues can effect a child and his or her learning.

Throughout grade school, the demands placed on children in the classroom are great. However, no task is more challenging in those early years of school than learning to read.

Reading requires children to accurately use all of their language, decoding, phonetic, and visual skills to successfully recognize words and gather meaning from the written text. Unfortunately, about 20% of school-aged children struggle to read. Some of these children suffer from learning disabilities or dyslexia, the inability of the brain's verbal language or auditory processing centers to accurately decode print or phonetically make the connection between the word's written symbols and their appropriate sounds. However, a large portion of children struggling to read are not dyslexic at all; their phonetic awareness and language processing skills are fine. It's their vision that is interfering with their ability to read.

Vision plays a vital role in the reading process. First of all, children must have crisp, sharp eyesight in order to see the print clearly. School vision screenings routinely check children's sharpness of vision at distance--measured by the 20/20 line on the eye chart--and refer children for glasses if they have blurry far-away vision and can't see the board from the back of the room. Unfortunately, this is all school vision screenings are designed to check, and children's vision involves so much more.

For success in school, children must have other equally important visual skills besides their sharpness of sight, or visual acuity. They must also be able to coordinate their eye movements as a team. They must be able to follow a line of print without losing their place.  They must be able to maintain clear focus as they read or make quick focusing changes when looking up to the board and back to their desks. And they must be able to interpret and accurately process what they are seeing.  If children have inadequate visual skills in any of these areas, they can experience great difficulty in school, especially in reading.

Children who lack good basic visual skills often struggle in school unnecessarily. Their "hidden" vision problem is keeping them from performing at grade level, yet teachers and parents often fail to make the connection between poor reading and the child's vision.

The following information summarizes each of the major areas which can interfere with a child's school performance.   

Learning-Related Vision Problems

Eye Teaming         Tracking         Focusing        Visual Perception        Visual Motor Integration

Eye Teaming Problems

Our eyes are designed to work as a team, but each eye functions independently.  When we look at something, the right eye records the image and the left eye records the image.  Then the two separate images are transmitted up the optic nerves to the brain, which combines them into a single picture.  For the visual system to work correctly, each eye must aim at the exact same point in space so that the images being recorded are identical.  This allows the brain to combine, or "fuse", the two incoming images for clear, comfortable single vision. However, if the eyes aren't aiming together, then the images being recorded are slightly different.  If the disparity is great enough, the brain can't combine the two pictures.  The result is double vision.

Unfortunately, about ten percent of school-aged children have eye teaming problems-- technically, called convergence insufficiency or convergence excess.  At the close up distances required for reading, children with eye teaming problems are only able to aim their eyes together correctly for short periods of time.  As their ability to accurately aim their eyes breaks down, their eyes end up pointing at slightly different places on the page. The result is a great deal of visual strain and eventually blurred, scrambled, or double print. 

Example:  

Of course, reading and comprehension become increasingly difficult as the child strains to aim both eyes at the same place to keep the print from blurring, jumping, or splitting apart like this:

In addition, children with eye teaming problems can be highly distractible, finding it difficult to concentrate and remain on task when the strain on their eyes is so great. (In fact, many of these children are often  misdiagnosed with attention deficit disorder.) Other symptoms of eye teaming problems include loss of place as the print "swims" and moves, eyestrain, fatigue, headaches, and frustration. 

To keep from seeing double, many children with eye teaming problems end up suppressing an eye.  In other words, their brain "turns off" one eye by neurologically blocking its visual input.  This allows allows them to maintain single vision because they're just using one eye.  While suppression helps the child cope, but it's extremely tiring and robs the child of concentration.

Because these children have always seen this way, their vision seems normal to them. They don't recognize that they're fighting their eyes harder than anyone else just to maintain a clear, single picture. Very rarely do children realize something is wrong and report transient double vision or the eye strain and fatigue which usually accompanies suppression.

Left undiagnosed and untreated, eye teaming problems can appear to be a learning disability or dyslexia.  They are not. Eye teaming disorders are visual problems, not language-based reading dysfunctions. The symptoms, however, are similar and only a complete eye exam by an developmental optometrist trained to diagnose and treat eye teaming problems can determine for certain if vision is the basis of the child's struggle to read.

The good news, however, is that eye teaming problems can be treated very successfully. One type of teaming problem called convergence excess is often corrected with reading glasses. Another teaming problem called convergence insufficiency is usually corrected through vision therapy. Vision therapy is  a series of special eye exercises and treatment procedures prescribed by doctors of optometry that correct problems that glasses alone can't help.  During therapy, the child learns to gain control of his or her eye muscle coordination and builds the eye teaming skills necessary for success in school.

 

Tracking

Tracking skills, or the ability to control the fine eye movements required to follow a line of print, are especially important in reading. Children with tracking problems will often lose their place, skip or transpose words, and have difficulty comprehending because of their difficulty moving their eyes accurately.  Many are forced to use their fingers to follow the line because their eyes can't.

When we read, our eyes don’t move smoothly across the line.  Instead, our eyes make a series of jumps and pauses as we read.  The small jumps between words or groups of words are called saccades.  The brief pause we make while looking at the words is called a fixation. After a fixation, we move our eyes to the next word or group of words—another saccade.

This very precise coordination of jumps and pauses is controlled by our central and peripheral visual systems.  Our central vision processes what we’re seeing in clear detail and defines what we’re looking at. Our peripheral, or side vision, simultaneously locates surrounding objects and let’s us know where to look. (These two systems are sometimes referred to as the "Where is it?" and "What is it?" systems.) In reading, our central vision processes the word, while our side vision locates the following word and tells us where to aim our eyes next.  The integration of these two systems is what allows us to efficiently move our eyes along a line of print without overshooting or undershooting, or mistakenly aiming our eyes at lines above or below. If there is not continuous, fluid, simultaneous integration between these two systems, reading will be jerky, loss of place will be common, and comprehension will be poor.

Children with tracking problems can't control their eye movements at close ranges. The following is an example of how their eyes move during reading, especially as they fatigue:

Focusing

Our focusing system, technically called accommodation, allows us to see clearly, especially up close.  Our eyes are designed for distance vision, so when we look at something up close, the natural lens in our eye has to change shape to redirect light rays on the retina for near objects.  At the close ranges required for reading, this is the visual skill needed to maintain clear sharp images for extended periods of time. It also includes the ability to quickly shift focus when looking from near to far, such as when looking from our desk to the board.  For children with accommodation problems, print will become progressively blurry as they read for longer periods of time, and their eyes will fatigue from the strain of trying to keep the print clear. Sometimes children with focusing problems will hold their books very closely or lay their heads down. Headaches are very common.  Reading glasses are often prescribed to help shore up inadequate focusing systems, but sometimes therapy is need to improve a child's focusing stamina.  

If a child is struggling with his focusing system, print on the page will often look like this:

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Vision Perception--the ability to interpret, analyze, and give meaning to what is seen. Visual perception skills can be broken down into the following areas:

Visual Discrimination--the ability to determine exact characteristics and distinctive features among similar objects or forms. In reading, this skill helps children distinguish between similarly spelled words, such as was/saw, then/when, on/one, or run/ran.  

Visual Memory--the ability to remember for immediate recall the characteristics of a given object or form. This skill helps children remember what they read and see by adequately processing information through their short-term memory, from where it is filtered out into the long-term memory. Children with poor visual memory may struggle with comprehension. They often subvocalize, or softly whisper to themselves, as they read in order to help compensate auditorily. They may have difficulty remembering what a word looks like or fail to recognize the same word on another page. They may also take longer copying assignments because they must frequently review the text.

Visual Sequential Memory--the ability to remember forms or characters in correct order. This skill is particularly important in spelling. Letter omissions, additions, or transpositions within words are common for children who struggle with this skill. They often subvocalize (whisper or talk aloud) as they write. Recognizing and remembering patterns may also be a problem.

Visual Spatial Relations--the ability to distinguish differences among similar objects or forms. This skill helps children in understanding relationships and recognizing underlying concepts. This area is closely related to the problem solving and conceptual skills required for higher level science and math.  

Visual Spatial Orientation helps us with letter reversals. Many parents and educators considered letter reversals after age seven to be a symptom of dyslexia. While this can be true, the most common cause of reversals in older children is a lack of visual spatial development--consistently knowing left from right, either in relationship to their own bodies or in the world around them. Children with poor visual processing have not developed adequate skills in visual perception and spatial orientation, such as laterality and directionality.  Also, children who experience frequent double vision deal with such visual confusion that their brains often misinterpret their visual input.

Visual Form Constancy--the ability to mentally manipulate forms and visualize the resulting outcomes. This skill helps children distinguish differences in size, shape, and orientation. Children with poor form-constancy may frequently reverse letters and numbers.

Visual Closure--the ability to visualize a complete whole when given incomplete information or a partial picture. This skill helps children read and comprehend quickly; their eyes don't have to individually process every letter in every word for them to quickly recognize the word by sight. This skill can also help children recognize inferences and predict outcomes. Children with poor visual closure may have difficulty completing a thought. They may also confuse similar objects or words, especially words with close beginning or endings.

Visual Figure Ground--the ability to perceive and locate a form or object within a busy field without getting confused by the background or surrounding images. This skill keeps children from getting lost in details. Children with poor figure-ground become easily confused with too much print on the page, affecting their concentration and attention. They may also have difficulty scanning text to locate specific information.  

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Visual Motor Integration

Twenty percent of the raw visual data coming off the retina does not go back to the visual cortex for imaging but breaks away and travels up to the brain's motor centers to help with balance, coordination, and movement. Visual motor integration, commonly called eye-body or eye-hand coordination, is a critical component of vision.  Think of it as a visual "follow the leader": the eyes go first and tell the muscles where to follow. 

Gross Motor Eye-Body Coordination--the efficient visual input to the body's relationship with its surrounding space, commonly referred to as eye-body coordination. Good visual motor and bilateral integration skills allow children to use their visual systems to monitor and adjust placement of their body weight against the gravitational forces on both sides of their body's midline, allowing for good balance and coordination. Children with poor eye-body skills may have difficulty in such areas as sports, learning to ride a bicycle, or general "clumsiness." 

Fine Motor Eye-Hand Coordination--the efficient visual input into the body's fine motor system. Children with poor eye-hand coordination may have poor handwriting and take longer to complete written assignments. They usually become frustrated over time and lose concentration, resulting in less time on task.  

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            Help for Children who Struggle 

There is help for children who struggle to read and learn because of poor vision skills. A developmental optometrist who specializes in children's vision can run a complete diagnostic workup to determine to what extent a child's visual skills are hindering school performance and prescribe vision therapy to correct the problems.  Vision therapy is the science of remediating inadequate visual systems by improving function and performance.  Vision therapy is highly successful, supported by decades of research and the testimony of countless parents and children whose lives have been changed when dysfunctional vision systems are restored to normal. Remove a child's stumbling block to learning, and you allow him the opportunity to succeed.  

 If you suspect your child may be struggling because of an undiagnosed vision problem, you may want to review the checklist of common symptoms.  The first step in helping your child is getting good information. To locate a qualified behavioral optometrist who provides vision therapy contact the national certifying board of the College of Optometrists in Vision Development at 1-888-268-3770 or visit their web site at http://www.covd.org.   Also, your family optometrist can be a good resource.  Ask if he or she provides vision therapy or if they can make a referral to a colleague who does.

You may be interested in reading the resolution passed by the national PTA. Because so many school-aged children are struggling with vision-based learning problems, the Parents and Teachers Association is calling for better school screening methods to identify at-risk students. 

 

The Children's Vision Information Network was created to raise public awareness about potential vision problems in children.  This site is not intended as a substitute for a complete eye exam and professional advice from your family optometrist.   Parents, teachers, occupational therapists, psychologists, and related professionals have permission to make paper copies of information contained in the site for educational, non-profit purposes only, with the condition that credit is given to this site and the URL is included.  We invite other websites with related missions to link to our site; however, please extend us the professional courtesy of not copying our content directly to your site without written permission.  Direct specific inquiries to Mary Barton, Director of Vision Therapy, at VTdirector@childrensvision.com.