Enter the Therapy Zone

At the Spectrum Center, listening therapist Alison Welsh helps Jacob Yount, 5, read. The Washington area is a major center for innovative treatments for children with neurological and behavioral problems, but do they really work? (Lucian Perkins - The Washington Post)

"We took my child to UCLA when he was 6 and they told me he was severely mentally retarded and I needed to get a grip," the mother told me in the next room, her voice defiant. "They said I was trying to find answers that weren't there and I just had to accept mental retardation. . . ."

Wachs, who flew 35 missions as a B-24 bombardier during World War II, is blunt and outspoken. He graduated from optometry school in Pennsylvania in the 1940s but got tired of selling glasses. He took courses and opened an optometric center in Pittsburgh in 1952 to fit contact lenses, treat retinal problems and do vision training.

He built up a huge practice, but wasn't satisfied. He was increasingly preoccupied with ways to prevent children from failing rather than treating them after they already needed remedial help. He started studying Swiss developmental psychologist Jean Piaget's theories about the nature and development of thinking, and began working with one of Piaget's colleagues on an educational innovation. In 1991, Wachs opened the center in Washington featuring developmental optometry based on a Piagetian approach. His visual-cognitive therapy regime is based on the premise that "visual-spatial knowledge" -- how we understand and manipulate what we see -- plays a major role in the way children live and learn.

"Vision is a misunderstood word," he said. "A parent who says, 'My child's vision is 20/20' should be saying, 'My child's sight is 20/20.' The difference is tremendous. We look with our eyes -- looking -- we see with our brains -- sight -- and we understand with our minds -- vision."

As with other interventional approaches, vision therapy is practiced in varying ways, and it is controversial. "Visual problems are rarely responsible for learning difficulties," reads a policy statement by the American Academy of Pediatrics. "No scientific evidence exists for the efficacy of eye exercises ('vision therapy') or the use of special tinted lenses in the remediation of these complex pediatric developmental and neurological conditions."

The American Optometric Association counters that "vision therapy is not used to strengthen eye muscles but rather to improve the coordination, efficiency and functioning of the vision system. It helps people "achieve maximum levels of performance."

Vision therapy can be tedious, requiring weekly sessions for years. It's also expensive -- $100 an hour at the Vision and Conceptual Development Center. Hailey has been doing it for several years.

On this day, Hailey sat in a therapy room, with three other children working at separate desks. Her tasks included eye coordination, movement and tracking, finger dexterity, gross motor and fine motor skills, and logical and visual thinking. To strengthen her fingers and grip, she plucked rubber bands from a block. To enhance eye movement, she tried to beat the clock while punching flashing lights on a board. To increase eye-tracking skills and body awareness, she dodged a moving ball suspended from the ceiling while standing in a hula hoop.

During the second hour of therapy, Hailey put on special glasses to help relax her eyes and began to work on a logics puzzle. As the work grew harder, she became frustrated and cried. Tina, who had been watching, came over to stroke her hair and rub her back. "Relax, it's okay," she said.

They moved onto math skills, and then added expressive and receptive communication skills. Hailey arranged a geometric pattern out of small wooden shapes and described it to her therapist, who had to duplicate the pattern without seeing it. Then she said it was Hailey's turn to listen and build.

The room was full of activity. Hailey was having a difficult time concentrating, especially as the directions got more complex.

"I can't do it!" Hailey moaned. "You're tearing my brain apart!"

Things weren't normally this hard, said Tina. "Today is a miserable day," she said.

Stop 4: Speaking of Treatments

We drove to their apartment for a short break, and then went to the office of Metropolitan Speech Pathology. I used to bring my own daughter here years ago to work with speech therapist Kathy Hosty. I was amazed at how much the office has grown.

Hailey got to work on reading and language therapy with Crystal Payne, who sat behind a desk nearly empty except for a candy-pink iMac.

The first exercises are to build decoding and encoding skills using Phono-Graphix, a reading program that worked wonders for my own daughter.

"Say the word 'code' without the 'C,' " Payne said.

"Say the word 'bird' without the 'D.' "

"Say 'snake' without the 'N.' "

"Excellent listening! Good work!"

Payne uses Reading Naturally, a fluency-building program, to gauge how quickly, smoothly and accurately Hailey can read a passage out loud. She gave her a story about animals, because Hailey loves them.

"Let's see what kind of timing you can get," Payne said. "Using your magic finger, keeping your eyes on the words, go!"

"The roadrunner is a bird that almost seems to like being chased by dogs or coyotes," Hailey read. "This is no joke. The roadrunner lives in the desert in the southwest. . . ."

"Try again."

" . . . in the southwestern United States."

"86! You did better this time. Good job!"