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Clinical practitioner
Information for: Clinical practitioners [e.g. optometrists, speech therapists, audiologists, medical practitioners etc]
Optometrists.
Let us consider an everyday scenario.
A child is referred to you by his teacher because of his poor reading. Sam is 11 years old, believes himself to be an average reader and a poor speller. His mother agrees and has demanded an eye examination because his reading doesn't seem to be progressing and secondary school is now only a year away. "Perhaps its his eyes."
The refraction is unremarkable. 20/20 vision in each eye. Distance retinscopy R & L + 0.75. Near retinoscopy add 0.50. Accommodative reserves are sufficient to compensate at least for the duration of the examination. Cycloplegia reveals +1.25 R & L. He has no headaches or eyestrain symptoms. He has no symptoms and sees perfectly well. His self-esteem is already low and he doesn't want to wear spectacles. Your appointment book is full, the mother and the teacher await your opinion and your next free appointment is two weeks away. Would you prescribe spectacles or not?
If you do, there is a chance that the parents and the teacher may then assume that poor vision was the cause of his literacy problems and therefore delay getting further opinions for a couple more years. You will then have contributed to his problems for, in two years time, his hopes that secondary school would be better will have begun to fade, puberty will be setting in and his self-esteem will be falling. That is a dangerous combination with possible life-long consequences.
You need one more piece of the puzzle; you need to know WHY his reading is poor.
The most common causes of poor reading are early confusions between letter names and sounds leading to inaccurate blending of sounds into syllables and generally poor phonic skills leading to an inability to read long and unfamiliar words and to poor spelling . The second common cause is a low VAS (see VAS Theory) level that is pushing the child towards unreliable whole word guessing. The third common cause is confusion between the letters b, d and p.
Theharrisontest will give you most of those answers in less that 4 minutes together with a written report including teaching tips for relaying back to the referring teacher.
Now you are in a better position to determine the value of prescribing spectacles. For example if you found that the child had poor phonic skills, inaccurate word guessing or bdp confusions, you will know that spectacles are not going to change any of those factors. However if the child is going to receive extensive extra tuition from a tutor, you might decide that the extra periods of study might lead to fatigue and loss of concentration and that spectacles might offset that fatigue during the tutoring period. But at least you have not given the false impression that spectacles will fix the problems; they are, at best, merely part of the solution.
Speech Therapists.
Audiologists.
Medical Practitioners.
Your reception staff have scheduled ten minutes for seeing this child. He sits on the chair next to your desk and looks down at the floor while his mother lists the poor reading, the worse spelling, vague parent-teacher discussions and even more confusing school reports.
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