Out Of The Box Inside School

Last October I blogged about clincial insights obtained through our probes that reveal “out-of-the-box” thinking by children.  You can read about it  here.  There are children who are sufficiently out-of-the-box (OTB) whose intellect becomes apparent after just a few moments of evaluating them.  These are instances in which how the child approaches a task may be more insightful than a standardized score.  They are also the qualities that are de-valued when the child is younger, and become highly valued when a child is much older, and increasingly so in the workplace.  Lucas. who I evaluated this morning, is one such child.


Here is an image of a Red Maddox Rod with a built-in Risley Prism.  We asked Lucas to look at a white fixation light, and with the rods held vertically what he should see is a thin, bright red line horizontally and a white light.  What we’re looking for in this case is that at the zero prism diopter level the red line appears to pass through the middle of the white light.  He was one of those children who tended not to respond immediately, almost as if he were a perfectionist, wanting to make sure that he got the answer correct.  But Lucas actually had something else in mind.

Here is the typical response that we’d expect.  If there is no vertical phoria, the patient indicates that the red line passes through the middle of the white light.  If the patient has a right hypophoria, the red line is perceived to be above the while light, we turn the rotary prism in the base up direction move the line downward until the patient says “stop”, and the is measured vertical phoria.  If the red line is perceived to be above the while light, we turn the rotary prism in the base down direction.  With children we normally begin with the vertical measurement, because there is tyically less confusion about up/down spatial projection than there is about left/right spatial projection, as must be done with horizontal phoria measurement.  When I held the prism at zero, and asked Lucas if the red line was going through the middle of the white light, above it, or below it, he reported that more of the red line was to the left of the white light than to the right of the white light.

I looked over to his mother with a knowing glance, and commented that this 7 year-old was quite perceptive.  He was giving me an answer about something interesting he was observing – that the line had drifted horizontally (due to his lateral phoria projection).  I said to him mom that I could imagine the frustration, both on his part and the part of his teacher, that she would ask him for an observation related to factual information she was presenting, and Lucas would be pre-occupied with what he found of interest or of significance.  Tests like the TVPS, while reliable in standardizing visual perception in terms of percentile rank, cannot quantify how perceptive a child is.  Since it is the former that is more valued in school, we work on those skills which are considered as stepping stones to better academic performance.  Yet it is Lucas’s out-of-the-box thinking that will likely make him successful once he survives formal schooling, and a factor that drives some parents toward home schooling.






5 thoughts on “Out Of The Box Inside School

  1. “once he survives formal schooling” … You’ve got that right! I’m waiting for the day when the technology that allows individualized learning (that adults use every day) makes it into the classroom!

    But I am so thankful you are able to see his perceptiveness and give him clear normal vision at age 7. We need this kind of intervention in every county in the country!

  2. Ok, I’m going to start here. I have an amazing 3 year old. She had Infantile large angle esotropia , nystagmus and head turn. We had her in glasses at 3 months, surgery at 5 months and again at 8 months resulting in consecutive exotropia. Vision therapy by mom with red/green glasses games started at 20 months. She walked at 8 months, is very coordinated, has low level depth perception. She said her first sentence at 17 months and recognized the whole alphabet by 18 months. Her eyes are not reliably straight ( we are revisiting surgery) but pop to straight when she is interested in something. I’m looking for ideas to help her keep her binocular vision strong and to help her keep her eyes straight especially when she looks at a distance. I know she is doing great for her condition and her age and I don’t want her to miss time developing just because she is doing so well. Any comments?

    • Susan – ideally you’d want to be guided by someone experienced in optometric vision therapy with children your daughter’s age. I wasn’t clear whether that has occurred in her case. Generally speaking we probe with binasal occlusion – which translucent tape applied in a specific way based on her glasses based on the position of her eyes. In addition to red/green procedures, there are polarized 3D procedures. Generally speaking you want her to master bilateral integration, as strabismus is a head-to-toe issue, not just an eye issue in isolation. Anything done to encourage bilateral integration, such as the reciprocal eye movements used in “Angels in the Snow” or similar movements may contribute toward bialteral integration of the eyes. Some of this is subsumed within the concept of primitive reflex integration.

  3. She has seen our local developmental vision doctor who is amazing. They generally don’t do vision therapy with children as young as she is but they recommended the red/ green toy box where I got the games she loves to play with me. Her physical bilateral integration is fantastic as she is master earlier than most kids. I will check into the binasal occlusion you mentioned. ( is there a way to do it for exotropia) and the polarized games. I believe she is doing so well partly because of her own good skills but also because she had very early recognition and intervention. I hope she will be an inspiration to other families

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