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?
Has vision therapy improved their academic achievement?

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Books Your Child Should Read, According to Neil deGrasse Tyson

13 Books Your Child Should Read Recommended by Neil deGrasse Tyson

Science nerds know Neil deGrasse Tyson for his passionate pursuit of all things outer space and of objective knowledge grounded in well-born facts.

For those of you less familiar, Dr. deGrasse Tyson is a Harvard-educated physicist who headed presidential commissions charged with charting a new American course for space exploration. He’s written numerous books and been on television shows featured around the world. And, he’s funny, too. He created StarTalk, a comedy-based podcast for people who don’t really dig science.

Over the years, deGrasse Tyson has recommended books that all children and adults should should read. We’ve compiled a list of those books for you.

On the Day You Were Born by Debra Frasier
In 2013, deGrasse Tyson told the New York Times that he’ll probably never write a children’s science book because he does not think he could ever top Frasier’s science writing.
There’s No Place Like Space: All About Our Solar System by Tish Rabe
It might be Dr. Seuss, but the publishers sure were on the ball updating the book back when Pluto got demoted from its planet status.
Gulliver’s Travels by Jonathan Swift
It’s an all-time favorite novel for deGrasse Tyson – especially the misguided scientists who spent too much time looking for answers to all the wrong questions about life.
Pinocchio by Carlo Collodi
Pinocchio was a read-aloud book in the deGrasse Tyson house for its strong message on what bad behavior looks like and why making better choices is important. Spoiler alert: Jiminy Cricket doesn’t last long in the original story.
Mathematics and the Imagination by Edward Kasner and James Newman
Filled full of stories and puzzles, this oldie but goodie takes topics from pi to logarithms and boils them down to an understandable level that even young teens can grasp. As deGrasse Tyson said, this was one of the books that helped him understand “the general power of mathematics to decode the universe”.
One, Two, Three . . . Infinity by George Gamow
Considered to be one of the most influential books he’s ever read, One, Two, Three is an easy-to-read, albeit a bit meandering, conversation-style book about math, science, its origins, and all kinds of curious questions physicists were grappling with 50 years ago.

In a well known Reddit Ask Me Anything session, deGrasse Tyson shared another list of books – this one for every single intelligent person on the planet. In sharing this list, he said, “If you read all of the works you will glean profound insight into most of what has driven the history of the western world.”

The Bible
“To learn that it’s easier to be told by others what to think and believe than it is to think for yourself.”
The System of the World by Isaac Newton
“To learn that the universe is a knowable place.”
On the Origin of Species by Charles Darwin
“To learn of our kinship with all other life on Earth.”
The Age of Reason by Thomas Paine
To learn how the power of rational thought is the primary source of freedom in the world.
The Wealth of Nations by Adam Smith
“To learn that capitalism is an economy of greed, a force of nature unto itself.”
The Art of War by Sun Tzu
“To learn that the act of killing fellow humans can be raised to an art.”
The Prince by Niccolo’ Machiavelli
“To learn that people not in power will do all they can to acquire it, and people in power will do all they can to keep it.”

Have you read any of Neil deGrasse Tyson’s recommended books with your kids? Tell us how it went!

Playing With Words

The process of learning how to read begins long before kindergarten, phonics instruction, and Bob Books. Pre-reading skills include:

  • Differentiating between the many different sounds that make up our language
  • Knowing that symbols (ie- letters) can represent words and have meaning
  • Retelling a story to include a beginning, middle, and end
  • Understanding that words are read from left to right; and
  • Building a large vocabulary to express ideas and concepts

We have a fancy word to describe the skill for learning about the sounds that make up the English language: Phonological Awareness. It might sound intimidating, but Phonological Awareness is about learning to identify syllables (clapping out the word al-pha-bet); rhyming words; playing alliteration games (Peter Piper picked a peck of pickled peppers); and eventually learning to manipulate individual sounds within words.

In other words, teaching pre-reading skills is really just learning how to play with oral language – and learning to associate happy, confident feelings with the process. Teaching pre-reading does not require an expensive curriculum. It’s a skill set that can be worked on as you walk to the playground or even while you’re grocery shopping.

As kids develop Phonological Awareness, they work backwards from thinking and using whole words to working on phonemic sounds – the smallest units of sound we use in our language. We might have 26 letters in the American alphabet, but we have 46 phonemes (like “b”, “sh”, short-a, and long-a) that we use to pronounce our words with.

Even though Phonological Awareness skills are taught in the absence of printed words, there is a handy tool you can use to help kids stay focused on the task of playing with their sounds.

An Elkonin box (named after the psychologist who developed the instructional tool) is a simple series of 2-, 3-, 4-, or 5- boxes drawn on a piece of paper. As a child breaks a word down into its basic sound components, a single colored chip is placed in each box. For example, the word “cat” is made up of 3 sounds:

/k/       /a/       /t/

Remember, Phonological Awareness is different from spelling. Even though the word “white” is spelled with 5 letters, it is only represented by 3 sounds:

/wh/       /i/       /t/

Elkonin Box In Action
Initial Consonant Deletion Task

How to use an Elkonin box.

When you work on Phonemic Awareness (a subset of Phonological Awareness skills), you want to take your time so your child can master one skill set before moving on to a more difficult level. The order of tasks that you’ll move through, from easiest to hardest, are:

  1. Phoneme Segmentation
  2. Phoneme Identification
  3. Phoneme Blending
  4. Phoneme Deletion
  5. Phoneme Substitution

Elkonin boxes are a great tool for developing essential pre-reading skills. They can even be used with struggling readers who need to revisit basic reading skill building, while also building their confidence that they can be successful with words.

Check out Everyday Learning’s Elkonin Task Cards for 625+ words, grouped into targeted phonemic skill building sets.

Have you ever used an Elkonin box?
How did it work with your kids?

Early Reading Myth #2: When Your Gifted Child Doesn’t Read Before Kindergarten

Children who read before starting kindergarten tend to impress most people. You see a 5-year old reading The Hobbit and you think, “Dang! That kid is S.M.A.R.T.”

Gifted, they most certainly are; but, early reading does not always guarantee astounding achievement in high school. Last week I blogged about early readers who don’t always reach the academic potential that parents and teachers expected back in first grade.

For some kids the expectations were just a wee bit too high. For others, an underlying learning disability hadn’t been diagnosed, yet. And then there’s the group of gifted kids who intuitively learned the fundamentals but still needed direct instruction in some part of the reading process before they could continue to move ahead with their learning.

When you read research on the topic of early reading, it’s easy to be swayed by the notion that precocious reading is a requisite skill for later high achievement. Consider some findings reported over the last 90 years:

  • 43% of Lewis Terman’s Genetic Study of Genius adults (that began in the 1920s) were reading before age 5.
  • 80% of 13- and 14-year olds who scored a 580+ on the SAT Verbal section were reading by age 5, as reported by Joyce VanTassel-Baska from College of William and Mary.
  • 90% of profoundly gifted students (including Terence Tao) followed by Miraca Gross’ longitudinal study in Australia were reading before age 5.

So, what about gifted children who were not early readers? Are they not as smart as their precocious reading friends? Is academic success not in their future?

In an interview with Northwestern University’s Center for Talent Development, Dr. Nancy Robinson, a noted scholar and founder of the University of Washington’s Early Entrance Program for profoundly gifted children, frames it this way. “Early reading is clearly a sign of being at least “medium bright,” she says, before going on to note that it is not a skill exhibited by all gifted children.

Some highly and profoundly gifted children are capable of becoming early readers but choose not to develop the skill. The reason may be as simple as not wanting to give up the special snuggly reading time they’ve come to enjoy with their parents – yet, that very same child goes on to graduate high school at age 14.

Visual-spatial children – those who seem to learn things in whole chunks rather in a more linear, step-by-step fashion, have also been noted as late-readers. Visual-spatial children, as a group, tend to memorize whole words, rather than learn phonics skills.

A number of other reasons can account for why an otherwise brilliant child may not be reading before the age of 5. The following checklist may help parents tease apart if non-early reading is part of their child’s normal developmental path.

  • Playing With Sounds and Words
    Does your child like to make rhymes or play alliteration games, where they use the same first sound for every word in a sentence? Playing with oral language like this demonstrates an inherent understanding of essential phonological skills and provides critical practice that leads to eventual reading success. Children who have had a large number of early ear infections have been found to be delayed in acquiring phonological awareness skills. This does not mean the child won’t become a successful reader, but they will need some extra help in gaining skills they missed when they were sick.
  • Reading Environmental Print
    Environmental print includes corporate and sports logos, street signs, and other visual images that contain print and communicates information. Children may “read” environmental print when they see a fast food sign and tell you they’re hungry for a hamburger. Such reading and responding shows us that the child understands that symbols, letters, and words communicate ideas, which allows people to interact with the world and each other.
  • Rich Vocabulary
    Decades of research tell us that children with a large vocabulary in their younger years tend to have higher reading achievement in middle and high school. You don’t have to count every different word your child speaks to know if they’re at that 20,000 word “rich” level. Instead, throw in the occasional big word in your own conversation. Or, read vocabulary rich picture books together. See how your child responds to unfamiliar words. Can they deduce meaning? Do they connect the new word to words or ideas they already know? Do they begin to use the word in their own vocabulary? Seeing a child use these skills lets us know they’re thinking like a reader.
  • Complex Sentences
    Reading a paragraph is very different from reading a pack of flash card words. In order to understand the paragraph, a reader must be able to sound out every word – and then remember what each word means within each sentence – and how the meaning of each sentence links together within the paragraph. That takes a lot of brain power for a 6-year old. Young children who use and understand complex spoken language show us that they have the cognitive ability to remember and access the language skills that will eventually be used when they learn to read. So, what is a complex sentence? It’s the ability to correctly execute a 3-step command at the age of 4, such as “Go upstairs. Get your shoes. And ask Dad to put them on for you.” Or, it’s the ability to listen to a story and retell the beginning, middle, and end with little or no prompting.
  • Healthy Vision
    Children who appear clumsy and knock into furniture as they walk through a room or become disoriented when surrounded by lots of visual patterns (think a busy rug pattern) may have a visual impairment, such as lazy eye, cross-eye, convergence insufficiency, or even nystagmus (a condition that causes the eyes to be in constant motion). Visual impairments do not cause dyslexia but they can make learning to read a difficult task. Treatment may be something as simple as an eye patch or as complex as surgery. Rarely is vision therapy the correct treatment option.

For many gifted children, non-early reading is not the same as late reading. Learning to read at the typical age of 5 and 6 does not necessarily mean the gifted child will fail to thrive in school or that a learning disability exists. It may simply be that child’s “normal”.


Parents with nagging concerns about reading ability should talk with their pediatrician or a reading specialist for help in gauging when to pursue testing to see if an underlying problem is holding their child back.

Tell us about your experience!
Was your child a late reader? Did you discover a problem later on or was it developmentally normal for your kiddo?

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