Convergence Insufficiency and Reading Problems

Convergence Insufficiency

In the professional work I do, I see a number of families who have spent a great deal of money on educational testing, in an attempt to understand why their very bright child is not reading at a higher grade level. So very often, the test reports I read make the same recommendation: Follow up with a pediatric optometrist for Convergence Insufficiency. The families are looking for a second opinion because they’re not convinced expensive vision therapy is the best answer.

Convergence Insufficiency is a medical condition where a person’s eyes do not work together to focus on something close up, such as a book or a computer screen. To understand how CI works, think of what it feels like to look through a pair of binoculars. The binoculars force both of your eyes to center in on the same magnified spot at the end of your nose so you can look at an object in detail. For someone with CI, their binocular vision does not work correctly. One eye will wander off in a different direction when they try to read something up close. This inability to stay focused may cause double vision, headaches, or squinting.

The medical and vision fields know that CI exists and that it can effect a person’s ability to learn. Unfortunately, the expensive vision therapy that is so often recommended to treat CI does not always deliver the results that parents hope for.

Basic Facts About Convergence Insufficiency:

So, how do you know if vision therapy is going to help your underachieving kiddo? Well, the first step is to figure out if your child has a reading disability (they can’t seem to remember how to sound out words) – or if they have a problem with reading (they get distracted when they try to read)?

Reading disabilities are neurological in nature. For some reason, the person’s brain just does not remember the phonics skills they have been taught. Sometimes the breakdown is in remembering the individual sounds that letter combinations make up. Other times, the dyslexic child has learned those phonics skills but they just can’t seem to pick up the speed in piecing it all together.

Having a problem staying focused on a reading task, on the other hand, can actually have multiple causes. For some children, ADHD may cause their inattention or distractibility and a pediatrician could prescribe medication to help. For other children, they may have an undiagnosed learning disability so what looks like distraction may actually be avoidance so they don’t feel bad when they fail at their lesson. In this case, specialized instruction would be the best treatment option.

For children who actually have Convergence Insufficiency, the distractible behavior is linked to the visual system. Trying to read the words that they know is literally a tiring and painful task for these kids. CI can result in headaches when a person tries to read for a long time – which may cause some people to avoid reading altogether.

An easy way to screen your own child for CI is to go to prepare an informal reading test on your computer. Cut and paste some age-appropriate text into a word processor. Set the font size to 14 or 16 point. Print the sheet and tape it to a blank wall or an uncluttered refrigerator door. Ideally, the text should be at least 50 words long. Have your child sit or stand eye-level with the text at least 5 feet away and have them read it out loud. Do they stumble over words? Do they have to sound out most of the words? Do they take a long time to read everything? If so, there’s a good possibility that CI is not the cause of the underachievement and vision therapy will not help.

If, on the other hand, they have no problems reading the text from a distance, then try reading normally from a book. Ask your child how it feels to read something up close. If they complain about blurriness or or even that words are jumping around, it may be time to make an appointment with a developmental optometrist to discuss convergence insufficiency treatment.

Just as a person may go to the gym for strength training in their legs to help build up stamina for a long hike, treatment for CI involves training the eye muscles to work together to stay focused. Vision therapy cannot cure CI, but it help make reading an easier task. Generally speaking, if your child is not experiencing improvements after 4 weeks of vision therapy, then there’s a good possibility it is not the correct treatment for your child’s reading problem.

HoagiesGifted May 2015 Blog Hop About Gifted Friendships

This blog post is part of the HoagiesGifted May 2015 Blog Hop. Visit Hoagies’ Blog Hop home page to read more about twice exceptional children, written by other professionals and parents of gifted kids.

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Has your child been diagnosed with Convergence Insufficiency?
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The Trauma of ADHD Diagnoses

The Center for Disease Control (CDC) reports “approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011.” That staggering number has risen at a rate of about 5% each year for almost a decade.

Where a family lives seems to effect the likelihood that ADHD is diagnosed and/or medicated. Nevada leads the country with the lowest prevalence of ADHD diagnoses for children between the ages of 4 to 17. On the other hand, Louisiana leads the country by medicating more than one in ten children for ADHD.

State-based Prevalence Data of Children with a Current ADHD Diagnosis Receiving Medication Treatment (2011-2012)
Source: CDC Study Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated ADHD: United States, 2003—2011
State-based Prevalence Data of Children with a Current ADHD Diagnosis Receiving Medication Treatment (2011-2012)

ADHD is a real medical issue, but, unfortunately, we do not know what precisely causes it. No single test exists to say that yes, a child absolutely has ADHD. Instead, doctors rely on a checklist of behaviors. Consider the diagnostic criteria for ADHD and consider how easy a 15-minute doctor visit can result in such a label.

ADHD-Inattentive Diagnostic Criteria

  • Doesn’t pay close attention to details and/or makes careless mistakes
  • Can’t pay attention for long periods of time either in schoolwork or play
  • Doesn’t seem to pay attention when spoken to
  • Seems to lose track of completing tasks
  • Trouble organizing self to complete tasks
  • Trouble staying focused and thinking through tasks
  • Easily loses things
  • Easily distracted
  • Forgetful in everyday activities

NOTE: Not all the following criteria must be met in order for a diagnosis to be made; but the symptoms *must* be present in at least 2 different settings, such as school and home.

Not everyone believes that ADHD is truly growing at the reported rate. Sure, the diagnoses are increasing in number and more and more children are being medicated – but some people wonder: Are we dealing with a chronic misdiagnosing problem?

We know that some of the classic symptoms used to diagnose ADHD can be caused by other issues.

Executive Functioning Disorder leads to an array of disorganization, which can cause a child to lose track of completing tasks. Profoundly gifted children often have a hyper-focus on topics of interest, which allows them to be easily distracted and not hear when they are being spoken to. Sports-related concussions (diagnosed or not) can result in a mild traumatic brain injury, which will leave a person forgetful in everyday activities.

Recently, a resident doctor from inner-city Baltimore made an observation while working at Johns Hopkins Hospital.

[C]hildren diagnosed with ADHD also experienced markedly higher levels of poverty, divorce, violence, and family substance abuse. Those who endured four or more adverse childhood events were three times more likely to use ADHD medication.

Now, just because two factors seem to be related, we cannot jump to the conclusion that one factor automatically causes the other to happen. Instead, we have to try to answer the old chicken-or-the-egg question. Does ADHD and poorly managed behaviors lead adults to be less successful in their jobs, wind up living in poverty, and have children who also suffer from ADHD? Or, is it possible that living in poverty can somehow lead to the development of ADHD?

Dr. Nicole Brown, the Hopkins’ resident, thought it worthy to ask an entirely different question. She began with the astute observation that children living in poverty, surrounded by street and/or home violence, are in fact, suffering from a form of post-traumatic stress. Is it possible, then, that a segment of children are being misdiagnosed with ADHD because many of their PTSD behaviors look so much like inattention?

Adults and children suffering from PTSD experience a variety of symptoms as they cope to get past their trauma. These symptoms include:

  • Recurring, intrusive memories. (May be seen as repetitive play or “daydreaming”)
  • Nightmares and/or Flashbacks
  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Being extremely careful to not get hurt or in trouble
  • Problems sleeping
  • Poor self-image
  • Blaming oneself for the traumatic event and its consequences
  • Loss of interest in activities that were enjoyed prior to the trauma
  • Strong emotional reactions to trauma triggers
  • Feeling alienated from other people
  • Hard time feeling happy or positive emotions

Nightmares, flashbacks, and recurring intrusive memories, for example, can cause extreme sleep problems. Even just one night’s lack of a good sleep can lead to distractibility and other problems. Compound that by weeks or months of restless sleep and it’s easy to see why children with PTSD have problems concentrating in a classroom.

We all dream of finding a quick fix for off-task behaviors. (If we’re truly honest with ourselves, some distractible kids are just downright annoying.) But, as parents and educational professionals, we owe it to our students to look past the behaviors we want to wish away and look deeply for what truly may be happening within a child.

Medicating the manifesting behavior may help a child become a more compliant student. But, looking deeply and addressing the core issue within a child will help them become a more functional and self-reliant human being.

Do you think it’s possible that PTSD is mistaken for ADHD in some children?
Tell us what you think.

Grade Equivalent Score Fallacy

What Do Grade Equivalent Scores Really Mean

Grade Equivalent scores remain one of the most misunderstood and misused pieces of data from educational testing. Rarely explained in a test report, parents who see “GE > 18.0” sometimes come away thinking their child is achieving at a post-graduate school level.

While a child who obtains such high GE scores is intelligent, no doubt, it is unlikely they are ready to jump into graduate level courses on their own – especially if they’re only 12 years old.

The National Association of School Psychologists explains Age and Grade Equivalent scores simply:

[I]f Jacob’s performance on the test of reading comprehension is equal to an age equivalent of 8.7 years and a grade equivalent of 2.6, this means that his obtained raw score is equivalent to the same number of items correct that is average for all 8-year, 7-month old children included in the norm group on that particular reading comprehension test.

Let’s take a look at a couple of hypothetical test profiles to better understand Grade Equivalent scores.

Grade Equivalent Score Comparison Chart

Before I talk about these numbers in detail, let me give you a quick primer on some of the terminology.

Standardized tests do not report scores as simple percentages of right answers. Instead, a student’s Raw Score (the number of questions that were answered correctly on each subtest) is transformed into a Standard Score. A Standard Score of 100 is considered Average. Standard Scores can run high or low, in either direction.

If you want to compare a score to other test takers of the same age or grade, you can look at the Percentile Rank. For example, a Standard Score of 100 equates to a 50th Percentile Rank. Put another way, if you lined 100 kids up with highest to lowest Standard Scores, someone with a 100 would be right in the middle of the line – with half the students achieving less than them and the other half achieving more.

Grade Equivalent scores, on the other hand, allow us to compare the total number of correct answers the average test taker got. For example, an average 12-year old taking the 3 subtests that make up the Broad Math portion of the Woodcock Johnson-III Test of Achievement would need to get a total of 141 correct answers out of a total of 268 possible questions to score at the 50th Percentile. How that test taker got those 141 correct math answers will depend upon the individual, but more than likely, the average person got some questions wrong as they worked their way through the test.

So, back to the chart. Mary is our typical 12-year old girl. When we look at her math achievement scores we can feel rather confident that she’s achieving at grade level and is most likely doing well in her actual schoolwork.

Abby, on the other hand, is 7-years old, the typical age for a 2nd grader. Her achievement scores suggest she’s a pretty smart cookie. Some people may even take a look at her Grade Equivalent scores and think she’s a candidate for radical acceleration – but that’s not necessarily the case.

With Percentile Ranks of 99.9, we can say confidently that Abby is achieving, hands down, beyond expectations for 2nd grade. Abby would be an excellent candidate for gifted programming and probably even at least one grade skip.

However, just because her GE is in the 6th grade range in Calculations and Applied Problems, it does not mean she’s achieving at the 6th grade level – or even that she’s capable of accomplishing 6th grade level work, as of today.

Let me explain why.

The WJ-III, just like the Wechsler Individualized Achievement Test (WIAT-III), samples a person’s level of achievement across broad content areas. Neither test was designed to exhaustively assess if a person has learned all the goals, objectives, and content usually taught at each grade level. Tests like the Terra Nova and the Iowa Test of Basic Skills do that.

Take for example the Calculations subtest on the WJ-III. On this subtest, students have the opportunity to answer up to 45 math questions that range from basic addition to calculus. However, 22 of those questions focus on the four basic operations using only whole numbers. Only 2 questions assess calculus knowledge.

In the case of our hypothetical 7-year old Abby who answered 21 questions correctly on the Calculations subtests and earned a GE of 6.2, it’s possible that she aced all the basic operation problems, but failed to get one fraction or decimal problem correct, let alone even attempt a pre-algebra or higher math question. That doesn’t take away the fact that Abby is clearly ahead in math, but, at the same time, it doesn’t make the strongest case for saying that she should be in 6th grade math.

Grade Equivalent scores can be used to compare the number of correct answers children of different ages or grades received on the same test. Those Raw Scores, however, will lead to different Standard Scores based upon the test taker’s actual age or grade. Grade Equivalent scores do not tell us that a child is actually achieving at a specific grade level.


A high GE score tells us that a child has been able to correctly answer far more questions than his or her peers – but it tells us nothing more. At the same time, a high GE allows us to infer that the student more than likely has the ability to handle a greater breadth or depth of material than they are currently encountering, if they are in a typical age-grade placement.

Just how advanced the material should be is a question better judged by examining work samples and talking directly to the child. If you are attempting to advocate for a grade skip through a school, requesting that your child take the end-of-year assessment test for a specific grade level subject will provide you with stronger data.

Alessa Giampaolo Keener, M.Ed. works as an educational diagnostician in Maryland. She holds a Masters degree in Education from Johns Hopkins University and is recognized as an expert witness on matters of educational best fit for special student populations. Alessa also works with families and schools to better understand test data and how that information can help educational planning.

What’s been your experience with Grade Equivalent scores?
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