When Smart Kids Cry – Part 1

One of my more recent posts – Diffusing The Bomb – Managing Opposition In The VT Room –  offered some suggestions and ideas for navigating the less than optimal times with patients in the Vision Therapy room.  It’s always curious to me, maybe even a bit comical, how when sharing my ideas on a topic, an event occurs shortly after to reinforce my thoughts. Such was the case yesterday.

My friend “April” is nine and a half years old and has been in VT for close to three months now. April also had VT a few years back with a different doctor in a different clinic. Her original diagnosis back then was a small angle esotropia with amblyopia. Her depth perception was poor, her academic performance was poor, and her overall self concept struggled mightily.  Her previous doctor did marvelous work and after a full year of VT, decided April’s skills were solid and graduated her. Three years later, as her daughter hit a major growth spurt, April’s mom realized that April was beginning to demonstrate a lot of the same mannerisms as before her VT and decided to have bring her to our office.

As an aside, mom mentioned early on that her previous doctor recommended annual follow-up visits after graduation stating that some home maintenance may some day be warranted, but mom admits to never following up.

So here is April. Almost 10 years old, great personality, good depth perception, eye turn and amblyopia mostly resolved, working to re-tune her visual intake and perceptual skills so she can conquer the world. In reviewing her home activities, April pulled out the Hart Chart and asked if ‘she could be done with this?’ before we even started the activity. Some might contend that her question was a sign of boredom, and they could be right. But honestly, with most patients I’m always suspect if claiming boredom is just their euphemism for overwhelming difficulty.

April: “Can we be done with this?”

Robert: “Let’s see how you do first and then we can talk about it.”

April: “But I hate it!!”

I catch a quick glimpse of mom who is rolling her eyes.

Robert: “You hate it? Wow, can you tell me why?”

April: “It’s boring and I just hate it.”

I turned my back to April briefly to grab my metronome and by the time we were facing each other again, tears were flowing.  April is crying before we even started the activity…time to stop everything.

A long time ago I learned to never fear the tears. Without sounding sadistic, tears in Vision Therapy usually are a good thing, and if nothing else, it should tell you that you’re on to something important. I had April sit down and gave her the chance to collect herself – an important step in my mind –  by fetching her a cup of water from our reception area. Very few people enjoy becoming upset in front of relative strangers, and children should be allowed to maintain their dignity too. A moment to catch her breath without my staring at her or breathing down her neck was a good place to start.

By the time I returned, she half stopped crying and wiped most of the tears from her cheeks. As always when this happens, I began with an apology for causing her grief. Was it my fault? Probably not. Nonetheless, in the event she decides to blame someone for her current challenge, I would much rather her blame me than herself. It’s a hit I take happily for my patients. Apparently, April’s burden is great enough as it stands.

We sat and talked about frustration for a few minutes, and April finally admitted that what she was being asked to do was too hard, even though her mom kept telling her that “it was easy” and “she should be able to do it.” April and her mom exchanged verbal barbs while disagreeing on the given task’s level of difficulty. It quickly became evident to me that April’s mom, in trying to encourage April, had become part of the challenge. I made stern eye contact with mom as if to say “please stop talking”. Point taken. Mom covered her own mouth with her hand and was quiet from that moment on.

Wanting to respect April’s feelings, and seemingly serving as the mediator for the moment, I asked her how she felt about coming to VT. She just shrugged her shoulders. Feeling like she had something to say, I pushed a little further with:

“April, I know your mom loves you and wants you to succeed, but I am curious about your thoughts. (a subtle reminder to mom that it was April’s turn to talk) Are there ever times in your life, maybe in school or when you’re talking to your friends, that you feel like coming here makes you not smart?”

She didn’t answer, but judging by the new crop of tears she produced, I’m guessing it was a ‘yes’.


Posted on June 3, 2014, in From My Perspective.... Bookmark the permalink. 1 Comment.

  1. Gary J. Williams, OD

    These aspects of therapy are as important as knowing the techniques possible with the Hart Chart. When we discuss vision therapy in the office, we emphasize that the therapy components are just as important as the vision components.
    Gary J. Williams, OD


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