When 1+1=3 – Part 2
“The absence of evidence is not evidence of absence” ~ Carl Sagan
Prior to entering Vision Therapy, Caroline completed a perceptual testing battery, as most patients do. This testing revealed very few deficiencies, in fact, had it not been for slow reading speed and efficiency as her chief complaint, she may have been referred elsewhere once her eye movements were addressed. Her test scores were at age level or above, her grades were definitely in the upper of half of her peers. There was no reason to suspect she was perceptually bound; least of all in math. I’ve written in the past that testing tends to be a snapshot, and can be influenced by many factors including time of day, patient’s interest level, what or if they ate, how much they’ve slept, and so on. It’s a means for demonstrating VT’s potential value and impact, and over the long term, perhaps a way to mark forward progress; but it’s still a snapshot. Passively, effective Vision Therapy will always prove or disprove what testing has revealed. Just because testing results lean one way or the other doesn’t mean the child is not struggling in that area. They could be guessing, the could be improvising, the could be compensating, or they could have just been lucky. In this way Sagan’s words are quite apropos, the absence of evidence is not evidence of absence. We should always be aware to the idea that there may be more.
When I asked Caroline to add 1+1 in her head, she answered “3”. I pulled the blocks back out and showed her in concrete form what 1+1 looked like, and she corrected herself. A few minutes later after reviewing some other simple equations whose answers were 5 or less, the original equation was repeated. Again, she answered “3”. So we counted again, reviewed again, and again the information was lost within several minutes. Something wasn’t adding up – pun fully intended – but what was it? She’s 7 years old, close to an “A” student, but simple math is beyond her. Nonetheless, I had stumbled onto something that needed to be addressed; a void in her perception.
Caroline carefully reviewed all the areas of 1:1 correspondence again, my attention this time focused on possible compensations or work-a-rounds that she was using. Stealing a line from Dr. Harry Wachs, I asked:
“Lots of people have different ways to add. Some do it in their heads, some use their fingers, some even guess and get lucky. Since I cannot see inside your brain, can you explain to me how you do it so I can write it down?”
Sometimes she guesses. Sometimes she just knows it by memory. Sometimes she picks her favorite number. Sometimes she picks the number that is closest to the biggest number she hears. Sometimes she asks her friends for help. Most times she gets it wrong. Our session was nearing its end, but this was too important to leave hanging. I pulled mom from the reception area into our VT room and asked Caroline to count backwards from twenty to zero. She started with 20, 19….threw out about six more digits and smiled. “I’m finished!” She couldn’t do it.
I excused Caroline and asked her mom how in the world she was passing 2nd grade math with an “A” when simple skills like counting backwards or adding single digit equations was beyond her. She was getting the answers somehow! Quickly, her mom asked if our testing looked for or revealed any of these issues? Ummm…no. I found it completely by mistake.
“Well, I guess nobody has been looking for it” offered mom.
Touche. It seems Mr. Sagan was on to something.