Monthly Archive for July, 2009

AAP and AAO on vision therapy


Interview with: Walter M. Fierson, MD,
Chair of Learning Disabilities Subcommittee
of Ophthalmology Section, American Academy
of Pediatrics

In “Groups Assail Vision Therapy as Remedy for Learning Disabilities,” Crystal Phend of MedPage Today reported that the American Academy of Pediatrics and American Academy of Ophthalmology jointly issued a statement calling the use of well-known vision therapies unfounded and ineffective.

SAN FRANCISCO, July 27 — Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics.

The academy came down hard on these “scientifically unsupported” alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations.

The AAP, which has published many valuable statements about Learning Disabilities in the past, made unequivocal statements about the problems with these therapies. In the accompanying audio clip, Dr. Walter Frierson provides good explanation of the rationale for the recommendations.

Learning disabilities, including reading disabilities, are commonly diagnosed in children. Their etiologies are multifactorial, reflecting genetic influences and dysfunction of brain systems. Learning disabilities are complex problems that require complex solutions. Early recognition and referral to qualified educational professionals for evidence-based evaluations and treatments seem necessary to achieve the best possible outcome. Most experts believe that dyslexia is a language-based disorder. Vision problems can interfere with the process of learning; however, vision problems are not the cause of primary dyslexia or learning disabilities. Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioral vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended.

Pediatrics 2009;124:837–844

Faithful readers of LD Blog will remember that there have been perhaps a half-dozen posts here on the mistaken (at best) therapies promoted to families of individuals with Learning Disabilities. It is valuable to have prestigious organizations such as the AAP and AAO issue statements that support the observations presented here.

Teachers, psychologists, and school administrators: Please advise the parents of your students with reading problems not to waste time and money on colored lenses, eye tracking and eye teaming, and other similar therapies.

Read Ms. Phend’s report. Download the full statement by the AAP. Visit the AAP Web site, especially its section on Learning Disabilities.

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Think Aloud redux

Over on Twitter, friend of LD Blog Liz Ditz retweeted this:

RT @Includekidswdis: Stop, Think, Do a program by Lindy Petersen http://is.gd/1FQ0h which can really help children with #ADHD

I took a quick look and immediately remembered the work of Bonnie Camp and her colleagues (especially Mary Ann Bash) during the previous millennium. Dr. Camp and her group developed, researched, and refined methods for teaching children with learning and behavior problems, including attention deficit disorders, to manage their behavior. The Think Aloud program was at the forefront of the cog-mod mania that swept through child clinical psychology and special education in the 70s and 80s.

THINK ALOUD is a psychoeducational training progtam designed to enhance social and cognitive problem solving skills for increasing prosocial behavior and decreasing impulsivity. Much of the program content was chosen to correct cognitive deficits displayed by young aggressive boys. (1,2) Research on verbal mediation indicated that before internal controls could be established, many children needed first to establish effective control by verbalizing aloud then fading to a silent level. The Think Aloud Program was designed to teach children a problem solving process (including problem identificaton, generation of alternative solutions, predicting consequences and evaluating outcomes), how to verbalize aloud, how to apply this process in both cognitive and social situations, then move to silent direction and control of behavior. The original research with the program was conducted in two controlled trials and one refresher program with pairs of 6-8 year old boys rated as hyperaggressive by their teachers. (3,4,7,8,9,12) The manual for this program, along with details of research findings, is presented in Think Aloud: Small Group Program (11).

The numerals in the quote are footnotes (not surprisingly). They refer to only a few of the dozens of sources Dr. Camp provides.

Although it is a bit rough as a Web site, Dr. Camp has created an Internet site for Think Aloud. It features citations for those sources as well as some of the original materials. In addition, she has made some new materials for the program available as downloads.

Link to the Think Aloud site.

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Dyslexia in Science

Professor John Gabrieli of the Massachusetts Institute of Technology has a paper in the current issue of Science discussing dyslexia. Here’s the abstract.

Gabrieli, J. D. E. (2009). Dyslexia: A new synergy between education and cognitive neuroscience. Science, 325, 280 – 283

Reading is essential in modern societies, but many children have dyslexia, a difficulty in learning to read. Dyslexia often arises from impaired phonological awareness, the auditory analysis of spoken language that relates the sounds of language to print. Behavioral remediation, especially at a young age, is effective for many, but not all, children. Neuroimaging in children with dyslexia has revealed reduced engagement of the left temporo-parietal cortex for phonological processing of print, altered white-matter connectivity, and functional plasticity associated with effective intervention. Behavioral and brain measures identify infants and young children at risk for dyslexia, and preventive intervention is often effective. A combination of evidence-based teaching practices and cognitive neuroscience measures could prevent dyslexia from occurring in the majority of children who would otherwise develop dyslexia.

Link to the article

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Preschool attention predicts early literacy skills

Christie Walcott and colleagues reported that children whom preschool teachers rated as having attention problems had lower scores later on phonemic awareness, letter knowledge, and rapid naming. Here’s the abstract.

Objective: The link between significant attention problems and reading difficulties among school-age children is clear, but few have examined the impact of early inattention on preliteracy development. This longitudinal study examines this link. Method: A total of 47 children had repeated measures of teacher-rated attention problems and three key preliteracy skills (phonemic awareness, letter knowledge, and rapid naming) in both preschool and kindergarten. Results: Teacher-reported attention problems in preschool significantly and negatively predicted both phonemic awareness and letter naming scores 1 year later, even after controlling for initial language ability and preschool performance on these tasks. Levels of preschool inattention did not significantly predict rapid automatic naming 1 year later. Likewise, preschool preliteracy scores did not predict attention problems in kindergarten. Conclusion: Early attention problems may interfere with the acquisition of certain preliteracy skills. Implications of these findings and directions for future research are presented.

Walcott, C. M., Scheemaker, A., & Bielski, K. (2009). Research brief: A longitudinal investigation of inattention and preliteracy development. Journal of Attention Disorders, 13, [online first, so no page numbers yet]. doi:10.1177/1087054709333330

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About on Irlen

Whoever writes the section of About on Learning Disabilities provides support for Irlen Syndrome. Although there are two sentences expressing reservation and it doesn’t flatly commend the idea, there are 100s of words describing it and making fact-like statements such as “It often runs in families and typically goes mis-diagnosed as a learning disability or dyslexia.”

Here are the two disclaiming statements:

  • “Research in this area, however, is quite limited.”
  • “It is important to note that Irlen syndrome and visual treatments are unproven and not recognized by the major academic Pediatric Organizations in the US(AAP, AOA, and AAO.)”
  • At least there are those two sentence. Still, why report all the other stuff uncritically? But, perhaps I’m misreading the entry or over-reacting. I invite readers to check it (link to the entry) and then vote in this poll.

    How favorably does the About entry on Irlen Syndrome treat the topic

    View Results

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    Functional Disconnection Syndrome

    Here’s one for the faithful: “functional disconnection syndrome.” Let Dr. Kurt W. Kuhn, D.C. and Ph.D. explain:

    Functional Disconnection Syndrome is a condition where there is a functional breakdown in the neurological pathways of the body causing the brain and its neural net to function asynchronously, at a decreased frequency of firing or at a functional level that is below that required for higher cognitive and health requirements.

    A quick review of the medical literature will find the term “functional disconnections” used for all sorts of conditions that are the affect [sic] of neurological dysfunction. Symptoms ranging from behavioral and learning problems to pain and conditions of reduced general health. Functional disconnections can be caused by genetic, environmental, nutritional, stress, toxins, spinal subluxations and other causes.

    Just for grins, I took the challenge. I searched the health sciences databases available via EBSCO, the venerable information management system that says it works with 79,000 publishers. I found one citation referring to “Functional Disconnection Syndrome”; it was a case study describing a psychiatric problem of a 23-year-old woman (Simon, Walterfan, Petralli, & Velakoulis, 2008, Neuropsychobiology, 58).
    Continue reading ‘Functional Disconnection Syndrome’

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