Mary: treating “dyslexia”
Mary was seven years old when she was referred for help. She was a very bright, articulate, compassionate and fun loving little person. She was also experiencing great difficulties in her first grade classroom.
Emotional reactions and difficulty managing change were longstanding issues for Mary. However, these became especially problematic when she started formal schooling. Her schooldays were punctuated with tears and occasional show-stopping tantrums, as she could become overwhelmed by the sights and sounds of the classroom. The fast pace of the school day proved especially distressing for her and she would sometimes retreat into an imaginary world of her own. Stress was evident as she tore papers into tiny bits or chewed her hair at her desk.
Mary’s thinking was, at times, inflexible. She could get “stuck” on certain ideas, seemingly stubborn to those trying to help her. Once stuck, she found it difficult to devise solutions to her problems until she was able to distance herself from them with time. Attempts to control her environment to reduce her anxiety were construed as oppositional by her teacher.
As if tantrums were not enough to isolate Mary socially, her driving desire to touch things and others caused problems with her peers. Her ever-moving hands during instruction made her appear as if she wasn’t listening and fleeting eye contact made reading social cues difficult for Mary.
Despite her intelligence, Mary was beginning to fall behind her peers academically. Of primary concern was her writing ability. Verbally gifted and with an active imagination, she took pleasure in creating stories and songs. However, committing them to paper was excruciatingly slow and physically painful due to the death grip with which she held her pencil. Even rotating the pencil in her hand to shift from the graphite to the eraser was a task for Mary. She would typically drop the pencil and pick it up again to gain access to the eraser.
She often simply refused to write. When she did write, legibility was impaired by letter reversals, uneven spacing and poor letter formation. As the rest of the class began incorporating accurate spelling into their writing, Mary didn’t seem able to break away from the phonetic “invented” spelling techniques that were taught to her in preschool.
Reading and mathematics were not as problematic, but she often distracted herself during work time as she could not read or work at near point tasks for very long. Weak motor skills and disorganisation lead to additional frustration. Although her teacher appreciated her exuberance and cheery smile, Mary was described as a highly distractible and sometimes difficult child with learning problems related to dyslexia/dysgraphia.
Mary’s birth was normal and she was an easy baby. She became independent at an early age, and her curiosity was evident. She met her developmental milestones early, walking and speaking in multi-syllabic words by nine months. She appeared to be developing beautifully.
As Mary progressed through toddler years, hints of a developmental derailing began to appear, only to be recognised by her parents in retrospect. Since Mary was their first child, they did not realise that her inability to dress herself, inconsistent success with toilet training, inability to peddle her tricycle, indifference to books and puzzles and formidable tantrums regarding her car seat were signs of anything more than Mary’s temperament.
Although her general disposition was enthusiastic and happy, Mary could reach emotional extremes. “Terrible twos” lingered into three, four and five. Mary’s mother recalls her preschool teacher commenting that, at any given moment, Mary was either the happiest or unhappiest child in the school.
“Marching to her own drum” was the theme of her preschool year, and it was recommended that Mary repeat the year to be given some extra time to mature socially and emotionally. Although her second year of preschool was much smoother, the academic demands of first grade set off a downward spiral of poor conduct and poor scholastic achievement.
Mary was evaluated in late March. She performed well on many of the tasks included in the assessment protocol and demonstrated deficiencies in others. Vestibular irregularities surfaced quickly, including the need to move frequently in a rotating pattern, and nystagmus coupled with a sense of dizziness when using her eyes to track.
When asked to wear a pair of glasses with one red lens and one blue lens, Mary’s view was red in one area, blue in another. In rapid succession, Mary saw the white objects in the room as alternating from red to blue, indicating a visual irregularity known as alternating suppression.
Additional tests revealed that the visual functions of tracking and binocularity were not operating optimally for Mary. Her eyes tended to move in a jerky fashion throughout the tracking test and they tired easily when focussing at near point.
An auditory sequencing task indicated a decrease in processing upon hearing specific sounds, and the ILT practitioner noted that she retained last segments best. Overflow movements of her fingers, head and mouth were detected and a whole body reflexive response, which should have been integrated several years earlier, were observed. Mary lost track of her writing when her eyes were closed and she was unable to internalise, through muscle memory, a simple repetitive, movement pattern. Additionally, the assessment revealed a weakness in the integration of the two hemispheres of the brain.
Several factors were identified as contributors to Mary’s difficulties. Central were multiple ear infections and associated high fevers causing weakness in the vestibular system. The vestibular system supports and regulates audition, balance, dynamic use of our eyes, feeling at ease with our bodies in space (proprioception), and having an appropriate state of readiness in our resting muscles. Mary’s history of motion sickness, as well as problems with balance, proprioception and visual functioning reinforced the conclusion that the vestibular system was faulty.
For Mary, this translated to physical awkwardness and she displayed timidity in the performance of motor activities. Consequently, she avoided many typical childhood games, retreating instead to the safety of solo fantasy play. In this, she missed important opportunities for social learning and did not stretch herself to enhance vestibular functioning as most children do naturally through play.
Mary did not spend a significant amount of time in the crawling stage, which is a crucial period for the development of strong integration between the two hemispheres of the brain. This undeveloped area could well have accounted for the many emotional shifts that Mary experienced, and was holding her back from reaching her full learning potential.
She also had unresolved tactile hypersensitivities, many of which interfered with normal grooming. Her parents reported an aversion to tickling, and roughhouse play almost always ended with her physically striking out in a manner inconsistent with the intensity of the game. It was not uncommon for Mary to hit or act aggressively toward other children as a preschooler. She was particular about what she wore, seeking out comfortable clothing rather than fashionable ones. Socks often came home in her backpack rather than on her feet.
Tactile, kinesthetic and proprioceptive irregularities were also found to impair Mary’s abilities to express her thoughts in writing. She had difficulty sensing where her hand was and what movement it had made unless she monitored each movement visually. If she paid close attention to her hand, then she became frustrated at losing the ideas she had wanted to capture.
A weak suck reflex as an infant, coupled again with vestibular weakness, interfered with the healthy development of her visual functions. Academically, she sometimes lost her place while reading, her eyes tired quickly and she had a vexing practice of reversing letters and numbers.
The systems supporting vision and her sense of position in space were not strong enough to support reading, mathematics and general organisation in an efficient way. Visual inefficiencies also caused Mary to be somewhat oblivious to her surroundings. This, coupled with reduced muscle tone, diminished her ability to interpret facial expression and body language so integral to social interaction.
Mary and her parents were taught a program specifically designed to address each of the difficulties she showed. The program was dynamic, changing over time to accommodate Mary’s progress. Recommendation was carefully chosen to treat lower levels of neurological subsystems first, to ensure that higher level systems did not become stressed by having to function without sufficiently strong supporting systems. So exercises to first strengthen the vestibular system, such as rolling slowly backwards then up again from a sitting position on the floor and from one side to the other, were amongst the first on her programme.
Simple activities such as drinking water (sucking) with closed eyes through a straw manufactured with three loops along its length were recommended to help her gently and naturally practice eye convergence, as well as helping to integrate her two brain hemispheres. Specific massages were taught to her parents to help her tactile sensitivity and improve her sense of proprioception.
For Mary, the downward spiral that began in Grade 1 slowed, then stopped, and then gradually shifted direction. Tears and temper tantrums began to diminish. By the end of the grade, she could read for longer periods of time and, consequently, her reading skills began to flourish. Towards the end of the year, the child, who previously cried at the prospect of getting her face wet, was jumping off the diving board and swimming. She learned to ride a bicycle without training wheels, and an 800 kilometre car trip was noticeably devoid of stops for car sickness.
Starting Grade 2 has been a new beginning for Mary. She claims that “this classroom is a lot calmer,” but clearly it is she who is calmer. Well integrated into the rhythm and routines of her day, school is a much less stressful place for Mary. Hair chewing and paper tearing are no longer recreational pastimes. Instead she is listening, reading, writing and computing. Writing is still her biggest challenge, and so she continues with specific activities to strengthen this skill.