All Roads Need a Foundation

Gosh it’s been 7 months since our initial meeting with Kathryn’s First Grade teacher in which she opened our eyes to the possibility of Kathryn having a learning disability. This wasn’t a complete surprise to us. We knew Kathryn had difficulty retaining information. She was slow to pick up on instruction. I was able to model a task for her, help her practice and succeed at that task but then if I asked her to replicate it again in the future she did not know where to start. There was no thinking through,  no problem solving, no pulling from previous experiences to help guide her in accomplishment. It was as if each attempt at something was her first.

I remember the parent/teacher conference. I explained to the teacher that I knew that she was behind what is to be expected of a first grader but I had hoped that through time she would become developmentally ready for the tasks at hand. Before being a mom I taught elementary school for 13 years and I’d seen it before, at some point the light bulb turns on for struggling children. They experience the “aha” moment and suddenly it all makes sense for them. No rhyme or reason to it – they just get it! I was praying for that “aha moment” for Kathryn.

Although I used the term developmentally ready I really did not understand the scope of what is involved in a child reaching that milestone. I’ve had training, I knew about Piaget, I knew about the National Association of Education for Young Children and their best practices and I tried to use them with my children in their preschool years. Most days we had a routine that involved physical activity, music and movement, interaction with books, play-doh or other manipulatives, rhyme, counting, matching, sorting, practice printing, lacing cards/beads, etc.  I believe I provided her with a well balance childhood, one that would prepare her for future success in school.

Now I know there is a rhyme and a reason in how to become developmentally ready to learn. I have a much deeper understanding of the process because for the past few months every opportunity I have had I have been researching and reading and learning about what possibly could have caused this disruption in Kathryn’s development. And boy have I learned a lot.

• All humans are born with the same brain and for the most part, with the exception of cultural differences which may inhibit some behaviors, most infants replicate the same sequence of motor development in approximately the same time frame. When a newborn needs to suckle for nutrition, if the parent strokes the baby’s cheek he/she will turn their head in the direction of the stroke. If you press your finger or another object into the palm of a baby’s hand their fingers will grasp around the object so tightly you may need to pry the object away from them. Babies gaze at their extremities, they reach for their toes, they pull up, they accidentally roll over, they position themselves on all fours ready to crawl. And the list goes on. It is these activities that help create an individual who is developmentally ready to learn 5 years later.

Kathryn did these activities. She was a very average baby with these exceptions:

• She did not take to a bottle only to breast feeding. I still don’t know if that should have been my first clue. All the parenting books say that nursing babies should be introduced to a bottle within the first month. She was an early December baby and Christmas hoopla kept me from that window. She ate well, was growing steadily and I was providing her nutrition as nature intended it.
• She was a difficult baby to get to sleep. She would require a little nursing to relax her and lots of rocking. When I did place her back in her crib she would cry and cry and cry. This went on beyond the first year and well into the second. Some babies are difficult.
• And the last tell-tale sign was her lack of speech. We did seek help. She had hearing tests by an audiologist, she had evaluations from the county early intervention specialists and she has been receiving speech therapy since she was 2.5 years old. Everyone said “She’ll speak when she is ready.” We believed them.

We had no idea that the reason she had difficulty drinking from a bottle, or the reason she experienced uneasiness at being placed in her crib, or the reason she had difficulty learning to talk would reappear and inhibit her ability to learn to read and write.

Dianne Craft, a trained special education teacher, has created one of many programs to help the struggling learner. She uses the term "processing problem" to describe inefficient patterns the brain has made routine. She has a unique way of describing levels of processing problems:

1. Glitch: Child has to work harder, but is not behind. This does not need intervention, but it would help.
2. Dysfunction: Child has to work harder, and is about a year behind. Intervention can get this child caught up easily.
3. Dyslexia or Dysgraphia: Child has to work harder and is about two years behind. Intervention is vital to help this child learn. (note this is her definition of Dyslexia/Dysgraphia which may differ from other definitions)

I believe all of her life, Kathryn has experienced “glitches.” She has been able to meet developmental milestones (with the exception of speech) along the way within the accepted time frame. It’s never been easy for her, in fact, as an attentive mom, I might have encouraged or even taught her these necessary skills that should have developed in their own course. Without my interventions, her “glitches” may have become "dysfunctions" and might have been recognized earlier. In essence I’ve been providing her, or she has developed, compensation strategies all along. But now, there are no compensations to get her past her difficulty in reading or spelling or with mathematical concepts.

I will end with a snippet of a video program that I stumbled upon several months ago. Robyn Cox is the Producer / Director of the ‘Get Ready for School’ DVD and qualified Primary School Teacher. She is currently using her program in a classroom in New Zealand. This introduction to her program explains through analogy why learning is so difficult for some.

In my next post I will provide an overview of the Foundational Skills introduced in this video and discuss how my interventions at the most basic skill level have started Kathryn on the Road to Vision and Learning.

Magical Powers

Kathryn begged to go for a bike ride, relentlessly, just her and me. So once I got the other two squared away with Steve and plans for dinner underway we went for a ride. Kathryn's New Year's Resolution is to ride her bike. Not learn to ride her bike, she's known for about a year. But to actually ride it. So this was a big deal!

I do like my alone time with Kathryn because I learn so much more about her. As a classic middle child there is always someone interfering. An older sibling righting her wrongs, a younger sibling unaware of the social graces of speaking in turn. It's a mixed up jumble trying to talk to her when others are around. So it's times like this that provide me the most insight.

Kathryn: I had a dream the other night, Mommy. Do you want to know what I dreamed?
Mommy: Yes, please tell me.
Kathryn: I dreamed that a wizard came to me at night and gave me magical powers. Everything I touched turned to 3-D. Trees, fences, animals, toys. Everything turned to 3-D but I could only use the power until morning and then it went away.
Mommy: I think your dream has come true, my love. Except your 3-D will NOT go away.

Thanks to binary lenses (OK...my mistake - in the past posts I referred to them as prism lenses). In case you missed it, Dr. Collier is our Developmental Optometrist who has diagnosed Kathryn with strabismus (misaligned eyes causing quadruple vision). The first course of treatment was glasses. As Dr. Collier so kindly corrected me, prism lenses only work the actual eye. Binary lenses effect the brain and that is where we are working.

This led so easily to my chicken or the egg question that I had prepared for him: Which came first, Kathryn's strabismus or something amiss in her brain development. Unequivocally, he responded her brain development (or lack of natural progression) caused the eyes to not work together. This is evidenced by the absence of double vision at close range. I believe him because he has experience helping people rework their brains. He has corrected this many times before.


So now on to the actual exam. First he asked her to notice the buttons on his shirt specifically how they were one on top of the other in a column. He asked her to remove her glasses and look into the phoropter and to tell him when the two letters were in that formation. At our initial exam her gaze from her right eye was 3 degrees above the gaze of the left eye which prevented the brain from being able to fuse the image into one. Instead of reporting to me what he read on the machine he asked me to see for myself. Zero. She indicated that the two letters were aligned at 0 degrees. Now that is how a pair of eyes are supposed to work together!


As you can imagine the same test was completed for her exotropia which at our initial exam proved her right eye to display an 8 degree deviation outward from the gaze of the left eye. Again causing her mind to recognize two of the same images. Put that together with her hypertropia and she saw 4 of everything beyond 3 feet. I got to read the phoropter again. ZERO - nada - nothing. No deviation. Single vision.


A result of double vision is amblyopia, or the brain's ability to suppress the input of one eye. By only using the vision from only her left eye her world was not in stereo. It was flat. She was not able to recognize distance or depth. Now along with her clear single vision her brain no longer has to make the accommodation of suppressing the image of her right eye. Binocular vision.


Three weeks  have passed since she started wearing her lenses. Those of you who have ever tried to take on a new habit know, it takes 21 days of continually repeating a task to make it habitual. Using the glasses created a new habit for her brain processing and as long as that pathway continues to be used the old inefficient paths will diminish.


Clear, singular, binocular vision. Goal obtained! So Mr. Wizard from Kathryn's dream, your granted super powers are not going to disappear at daylight. They are here to stay. Kathryn's 3-D vision will NOT go away!

Thank you Dr. Collier.

Confidence

It’s been a whirlwind of weeks lately. On top of the steep learning curve I have been on reading everything I can about brain development and vision problems, we’ve also celebrated my sister’s wedding to a wonderful man. The union took place in Maui, Hawaii with most of his very large extended family in attendance. Now, you might be wondering how being in Hawaii with a lot of unfamiliar people plays into Kathryn’s vision development. Oh but it does.

The first weekend after Kathryn started wearing her prism glasses I was lucky enough to be able to spend a lot of time with her. Mostly just regular weekend stuff running to and fro in the minivan, but it gave me a chance to really listen to what she was saying. And she was really into puns and jokes. Ones that actually had a hint of humor in them. You see, Kathryn like any other developing child at some point “gets” jokes are supposed to be funny. They set it up and deliver a fail of a punch line. And in order to avoid pointing out failure, a good parent goes along with the joke and chuckles, “That’s a good one!” Somewhere along the developmental timeline the relationship between the set up and the punch line becomes cognizant and humor is developed.

Additionally, a child begins to distinguish between real and imaginary. That was another topic of conversation during our excursions. You see, on our kid friendly radio station the disc jockey was interviewing a popular cartoon character. A disconnect occurred. I can only hope that this how it played out inside her brain. “This person who I have seen on the radio website is talking to a character from one of my favorite shows but those two people are different. Is Doofenshmirtz real?” Here’s my take on the sudden newfound humor and realizations – She doesn’t have to “think” so much about her environment because now she has clear sight. Her cortex can tend to higher level functioning like humor, real vs. imaginary, and hopefully all the other school related learning she has missed out on.

We attended the School Open house where we got to speak briefly to her teachers. They noticed that she has displayed more confidence since wearing her glasses. I can only imagine that school tasks are so much easier now that she can see clearly. In the past she was always a hesitant child, always unsure of her expectations. Now she is easily able to understand her expectations because she no longer has to concentrate on interpreting her blurry world. A confident child comes out.

And speaking of confidence…how many adults avoid public speaking? Well, we attended a Rehearsal Dinner during our visit to Hawaii. As expected the fathers of the intended gave a few remarks on the couple as did other friends and relations. When my brother-in-law’s niece, about the same age as Kathryn, gave a small speech, Kathryn looked at me and said, “I want to say something too!” This is in a room full of more than 50 strangers! My little Kathryn who clings to me like Velcro and she wanted to speak and she did! It was short and sweet and not quite loud enough, but it was her idea.

That was just the beginning. The following evening at the wedding Kathryn was off with her “cousins” and new friends, the harpist, servers, and disc jockey. I had very little interaction with her all evening. This is my shadow we are talking about. In the past at parties or other large events she stuck beside me for a good three-quarters of the evening, just about when the party was wrapping up and then she would feel comfortable enough to experience the event independently. Confidence.

Today we will attend a follow up appointment with our Developmental Optometrist, Dr. Collier. I am hoping to have many questions answered. Yeah right. Answers from Dr. Collier just lead to more research, leading to more questions. But it’s all good because I am learning what I can do to help my daughter. I’m hoping to acquire a Primitive Reflexes Program. Again I am still so confused by this area of brain development. Chances are her problems have resulted in an underdeveloped cerebellum. The cerebellum is responsible for receiving input from all the senses and then directing motor control.  Here is a well produced video from www.brainhighways.com about how children deal with cerebellum development delays.

Stopping at the School Open House

It’s Open House week. You know the time of year where teachers are scrambling to pull together a wide array of samples of their student's work to display to the school community. An opportunity to shine! The room is immaculate, tables and chairs neatly arranged, bookshelves dusted and tidied and bulletin boards popping with pictures and published works. Parents, grandparents, aunts, uncles, loved ones all descend on the school to "oooh and ahhh" over their special child’s work. Lots of shining children’s faces. Lots of proud parents too.

We will be there. Yes, but behind our beaming faces will be the shadow of sorrow, the inability to resist comparison. We will recognize the scratchy script resembling that of a four year-old in a sea of six and seven year old perfection. We can point out the drawing with eyes slightly askew, body not symmetrical. Yes that is what we will see because we are parents of a learning disabled child. Open House is actually a time of dread. A slap in the face to bring us back to the reality that our child truly does not perform consistently with her peers. And sadly she will see it too.

But yes, we’ll be in that group of proud parents. Not because our child's project is perfection, not because she excels above the rest, but nontheless - our child’s face will shine. We will compliment, congratulate, hug and show our love and pride for our dear child.

This year we are proud of our daughter for being able to achieve all that she has. She can form recognizable letters even though the letter shapes her mind sees look nothing like the formations we know. Her illustrations are carefully colored. It's understandable that sometimes she doesn't color all the way to the line or slightly beyond the line because she probably sees 4 lines. From her perspective, she stayed within one of them. Everyone will see the pride we have in our daughter because she has adapted so well.

This year we will face our fate with understanding. Something we did not have last year. Now we understand that Kathryn’s fine motor problems are a result of lingering primitive reflexes. These reflexes are quickly inhibited, within the first year of life, as higher centers of the brain develop and voluntary responses dominate. Kathryn's reflexes display a mild response. She won't let them go and in doing so they are preventing her development.

Confusing, I know. I’m just beginning to wrap my mind around this one. It’s one of those red flags that keep coming up in many of her evaluations – the occupational therapist mentioned IT, the physical therapist mentioned IT, the developmental optometrist mentioned IT. And I still don’t get IT. But I will. And IT is one part of the puzzle to get her beyond the road to vision and on to Easy Street.

So the next time you are visiting your neighborhood school and you notice someone’s work that doesn’t quite look as polished as the next one, please think twice about that student. Try not to judge. Remember that beside that child are a set of parents whose hearts are breaking. They watch from afar as their child does the best that he or she can do. They struggle with the why. And they most likely are trying everything they know to do.

For more information on Primitive Reflexes and problems in school see Functional Healthcare Solutions.

The Cow is Round

Yesterday was a whirlwind. Thus I've created a timeline of the events and how they occured. Leap Day 2012 has become our leap of faith day. I believe this day is going to positively impact Kathryn's future success!

2:30 PM - I just picked up Kathryn's glasses! Dr. Collier said that when she puts on the glasses she will immediately start seeing in 3-D. Everything will become so vivid for her for about one hour. After that time her brain will revert back to its old way of processing. She will report that everything will look like it is wrapped in plastic. She is to keep the glasses on as long as she is comfortable wearing them. She gets to wear them to school tomorrow and keep them on all day. He anticipates that we should start seeing changes in her thinking patterns, the way that she's able to express herself more clearly, an increase in her tracking ability and in her reading by possibly the weekend but certainly by Monday!

3:00 PM - I am holding what I hope to be the solution to so many of Kathryn's difficulties in my hand. It is such a surreal feeling! Hopefully - finally she will get the help that she needs so that she can see the world in the same ease that the rest of us take for granted. Driving home from the doctor's office I am overcome with emotion: anticipation, hoping, longing for success, loving this child and only wanting the best for her. Before I know it I'm weeping not because of sadness but of overwhelming love for my sweet daughter.

I'm hit with the same feeling I felt when I was in labor with dear Kathyrn. The same reason I cried that night before her birth (and the birth of all my children). I'm overcome with the powerful feeling of unconditional love and nurturing for this human being. So uncertain as to the future but yet so certain that I will do anything and everything to help this child.

I can't wait to hear it through her words and her actions. I love my Kathryn with all my heart - her quirkiness,  her way of communicating that only I can so easily understand. It has become my second nature to answer the quizzical look upon the faces of friends and family who are trying to talk with her. I know that is a connection to Kathryn that will go away once she is able to clear her mind of all the confusion. However, I will gladly exchange that for her independence and her feeling of acceptance from everyone.  It's well worth the trade. I am so anxious and ready to see the awesome girl that my baby will become.

6:00 PM - Steve and I present Kathryn with her glasses. She is so ready to put them on! But we have to prepare her for how her brain will respond. It's funny how after her diagnosis several revealing converstations emerged, one being that she "wished our house were in 3D." In fact she wished the world were in 3D. So today I got to ask her, "Kathryn if you could see anything you wanted to in 3D, what would that be?" Of all things, she wanted to play with the animals in her Little People farm. Happily she played pretend with her animals and then I finally asked her, "How are the animals different?" Her response, "The cow is round." THE COW IS ROUND! The first time my baby experienced depth...roundness of a pudgy Fisher Price cow. THE COW IS ROUND!
We went outside. She got to pet the neighbors Scottie dogs as they went by on their nightly walk. She looked at the daffodils. She jumped, she skipped, she ran, she swang. She was happy!


Another discovery: The TV is square. IT'S SQUARE! Until that moment it had always been a circle. Imagine looking through one of those small tubes with a plastic lens at the other end that are usually given out as birthday party favors. It causes you to see more than one of an object. Imagine 4 squares - two stacked on top of each other and one on either side - and the shape processed by her mind is a circle. THE TV IS SQUARE!

After dinner and after the small window of initial depth perception had passed we went back to the Fisher Price farm. The cow was not nearly as round and it may have been blue(????).  But she was certain we had two lamps on the foyer table (in actuality there is only one). TWO LAMPS! All her life she thought that cluster of stuff on the table was that...a cluster of lamps, a cluster of vases. But tonight there were noticably TWO LAMPS which is different than what it was just a few hours before during her small window of clarity. That clarity will return. Of that I am certain.

Stella's Road

While Googling around for what to expect when Kathryn receives her prism glasses I stumbled upon a wonderfully written blog. This mother writes of her toddler's experiences with vision therapy. Her account of the initial developmental optomologist appointment is so insanely similar to ours! This blog brought tears of relief, happiness, regret, and anticipation for me. Reading it might help you understand Kathryn's world a little better.

how-vision-therapy-is-saving-stellas-toes-and-then-some

Asking for directions

Once we decided to seek the help of a Developmental Optometrist the nagging feeling of doing anything and everything to help Kathryn catch up to her classmates disappeared. This had to be the way. Originally I thought I would make the appointment for President's Day so she wouldn't have to miss anymore school but once the decision was made I couldn't spare another moment. I called to make the appointment on Thursday and they were able to see us the next day.

Our peditrician consulted several specialists and referred us to Dr. Collier. I consulted the online community for our small city and found several positive reviews of Dr. Collier and his practice. There are a handful of Developmental Optomologists in our area, but based on his positive reviews and the his convenient location, he is the one we chose.

I had heard that he had a very dry sense of humor and used a lot of scientific language. He is said to be a brilliant man and if the layperson can adapt to his "bedside manner" he was an excellent resourse. To my surprise, Dr. Collier was very child friendly. He had playful toys for Kathryn to focus on and distracted her with imagination games.

The first procedure he performed with her involved her reciting a tongue twister "purple hippopotomus". No surprise that Kathryn stumbled over the words and wasn't able to pronounce hippopotamus. He pulled a set of lenses out of his drawer, placed them on her eyes and asked her to repeat "purple hippopotamus"... and she spoke with complete clarity like I've never heard her speak before! Could her vision been the crux of her past speech delays???
          
A Diagnosis

Strabismus is the misalignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the forms into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain.The result is "double vision" or more like "quadruple vision" as Kathryn continues to report that she sees objects in groups of 4. Two or four, it is certain that her perception differs from actuality.

Further discoveries include that her right eye has a 8 degree difference from the other. So when she is gazing forward her right eye is 8 degrees inward. Her fidgeting is due to helping to regulate the timing of her cerebellum. The tilt of her head assists her with a inbalance in her vestibular system. All of these behaviors are coping mechanisms that she has discovered help her process the world around her.

In order to relieve symptoms of double vision, she is learning to ignore the misaligned eye's image and see only the image from the best-seeing eye. This results is a loss of binocular vision, impairing depth perception.

It takes a lot of effort to control her gaze and because she is still developing these compensations sometimes her brain will alternate which eye’s input to attend to causing the image or text to appear to wiggle or move.

Treatment

Through the help of her Developmental Optometrist, Dr. Collier, she has a treatment plan. In a few weeks she will start wearing glasses with special lenses that have a prism ground into them. The prisms alter the light entering the eye and assist in reducing the eye turn. Sometimes the prisms are able to fully compensate for and eliminate the eye turning reducing the double vision/moving text.

The glassess are like braces for her eyes. It is a step to help the eyes work together. She will also complete a structured program of visual activities prescribed to improve eye coordination and eye focusing abilities.

Through therapy we hope she gains comfortable, single, clear, normal binocular vision at all distances and directions of gaze.