Next steps for a kid who finds it very hard to concentrate on reading
September 20, 2023 3:04 PM Subscribe
My sixth grader can read fluently and has great comprehension. But he hates reading, says it "hurts his brain", and can barely make himself read more than a page or two at a time. Comprehensive eye exam turned up nothing. We strongly suspect he has ADHD, but don't yet have a formal diagnosis. I am looking for advice on the best next steps: ADHD evaluation, some more specialized reading evaluation (but what?), vision therapy providers, wait it out, or something I haven't thought of?
First off, my son loves stories. We've always done lots of reading aloud to him, and he loves this (although sometimes he does get fidgety.) This summer, he discovered audiobooks, and he loves them too. But I'd like for him to have joyful access to the world of written materials.
My son was a slightly late reader, but it clicked between first and second grades. For several years after that, he was able to read well out loud but complained that he couldn't read and understand at the same time. The last few years, he's been able to read and understand what he's reading.
However, in the last year and a half, especially since he's started reading books with more words on the page, he's complained about reading "hurting his brain". I thought that this was metaphorical, but he tells me that it's an actual physical pain. He says it hurts even when he reads a graphic novel that he loves.
Overall, my son is doing very well in school. He's a very smart kid, and has always been successful at anything he's tried. However, he finds it very difficult to persist at any task that's at all boring. He's prone to getting distracted, and finds it much easier to focus when he's moving his body. He gets his homework done fast and sometimes slapdash during spare moments at school. I recognize much of myself in him, and I was recently diagnosed with ADHD, so it seems likely that a diagnosis will be his his future as well.
My primary goal in this process is to understand whether there are any interventions which can make it less unpleasant for my son to read. A secondary goal is to understand and document any broader neurodiversity, so that we will be prepared and can pursue IEPs/medications/accommodations as necessary as he gets older.
I've spoken to my son's school about all of this. They gave me several suggestions, but I'm having trouble navigating the different options. Perhaps the hive mind can help? Chicago-specific suggestions are also welcome.
Option 1: Get an evaluation through the public school system. (My son attends a small private school, but they can help us through this process.) This would be free, but perhaps not very comprehensive, and maybe not well suited to unpacking difficulties that are not (as yet) causing problems at school. It would help us to establish an IEP for when he might transition to public school in the next few years.
Option 2: Get an evaluation through his pediatrician. I don't love this option, because I suspect she'd just give us the same screening forms I've already completed online, give us a diagnosis, and send us on our way. However, this would be fast and would potentially let us trial whether medication helps with reading and other focus issues.
Option 3: Get a full neuropsych evaluation. This would include IQ tests and some reading-specific tests, and perhaps highlight if there are discrepancies between his different abilities. They'd be able to tell whether he has ADHD and whether his IQ will qualify him as 'gifted'. But I'm not sure they'd be able to pinpoint why specifically reading is so hard, especially since my son is able to read just fine. I'd be particularly grateful for insights on this point.
Option 4: Get an evaluation with a behavioral ophthalmologist, to see if perhaps he has... eye tracking problems or something? I'm wary of this one, because most practitioners seem to want to sell vision therapy services, and the science behind this seems shoddy.
Option 5: There are plenty of practices which advertise specialized dyslexia evaluations. I have no idea whether this would be appropriate or helpful in our situation.
Option 6: Just keep offering books? Or get a reading tutor? See if he grows out of it?
Thanks for any help or ideas!
First off, my son loves stories. We've always done lots of reading aloud to him, and he loves this (although sometimes he does get fidgety.) This summer, he discovered audiobooks, and he loves them too. But I'd like for him to have joyful access to the world of written materials.
My son was a slightly late reader, but it clicked between first and second grades. For several years after that, he was able to read well out loud but complained that he couldn't read and understand at the same time. The last few years, he's been able to read and understand what he's reading.
However, in the last year and a half, especially since he's started reading books with more words on the page, he's complained about reading "hurting his brain". I thought that this was metaphorical, but he tells me that it's an actual physical pain. He says it hurts even when he reads a graphic novel that he loves.
Overall, my son is doing very well in school. He's a very smart kid, and has always been successful at anything he's tried. However, he finds it very difficult to persist at any task that's at all boring. He's prone to getting distracted, and finds it much easier to focus when he's moving his body. He gets his homework done fast and sometimes slapdash during spare moments at school. I recognize much of myself in him, and I was recently diagnosed with ADHD, so it seems likely that a diagnosis will be his his future as well.
My primary goal in this process is to understand whether there are any interventions which can make it less unpleasant for my son to read. A secondary goal is to understand and document any broader neurodiversity, so that we will be prepared and can pursue IEPs/medications/accommodations as necessary as he gets older.
I've spoken to my son's school about all of this. They gave me several suggestions, but I'm having trouble navigating the different options. Perhaps the hive mind can help? Chicago-specific suggestions are also welcome.
Option 1: Get an evaluation through the public school system. (My son attends a small private school, but they can help us through this process.) This would be free, but perhaps not very comprehensive, and maybe not well suited to unpacking difficulties that are not (as yet) causing problems at school. It would help us to establish an IEP for when he might transition to public school in the next few years.
Option 2: Get an evaluation through his pediatrician. I don't love this option, because I suspect she'd just give us the same screening forms I've already completed online, give us a diagnosis, and send us on our way. However, this would be fast and would potentially let us trial whether medication helps with reading and other focus issues.
Option 3: Get a full neuropsych evaluation. This would include IQ tests and some reading-specific tests, and perhaps highlight if there are discrepancies between his different abilities. They'd be able to tell whether he has ADHD and whether his IQ will qualify him as 'gifted'. But I'm not sure they'd be able to pinpoint why specifically reading is so hard, especially since my son is able to read just fine. I'd be particularly grateful for insights on this point.
Option 4: Get an evaluation with a behavioral ophthalmologist, to see if perhaps he has... eye tracking problems or something? I'm wary of this one, because most practitioners seem to want to sell vision therapy services, and the science behind this seems shoddy.
Option 5: There are plenty of practices which advertise specialized dyslexia evaluations. I have no idea whether this would be appropriate or helpful in our situation.
Option 6: Just keep offering books? Or get a reading tutor? See if he grows out of it?
Thanks for any help or ideas!
finds it much easier to focus when he's moving his body
For what it's worth I do my best reading when walking my dogs or taking a shower (kindle fits nicely in a quart size freezer ziplock).
posted by phunniemee at 3:13 PM on September 20, 2023 [1 favorite]
For what it's worth I do my best reading when walking my dogs or taking a shower (kindle fits nicely in a quart size freezer ziplock).
posted by phunniemee at 3:13 PM on September 20, 2023 [1 favorite]
Can he read while moving? I’m the opposite - reading is easy for me but listening to audio hurts my brain. I still enjoy a podcast or audiobook while walking or cooking, but I’d go insane sitting still and trying to process one. Maybe he can try with a treadmill, exercise bike, or even while treading water?
posted by wheatlets at 3:14 PM on September 20, 2023 [5 favorites]
posted by wheatlets at 3:14 PM on September 20, 2023 [5 favorites]
If you can do a neuropsych evaluation, that can, at the very least, rule out various neurological conditions (or let you know if they're an issue). It's been a bit since I've seen any, but my memory of them is that they're much more detailed than just an IQ test. They're really looking at which areas of the brain seem to be working ok and which aren't. If he were just having pain then I'd say it might but excessive testing, but it you're going to want an evaluation for ADHD eventually anyway then it seems like a reasonable way to get the most insight into things that might be happening, even if just to rule them out and then move to more specialized tests (e.g., ophthalmology).
posted by lapis at 3:26 PM on September 20, 2023 [4 favorites]
posted by lapis at 3:26 PM on September 20, 2023 [4 favorites]
Definitely pursue this now. I would be worried that he will struggle even more with extra cognitive load that happens around 9th grade when students are expected to think more abstractly about the materials that they are reading.
I would try for an assessment with someone is expert on the full range of learning differences. We all know about dyslexia but there are other problems that can impact reading ability in a more subtle way. Many of these are co-morbid with ADHD so you might as well get that check out as well.
Once you have a better understanding of nature of his problem, you can find experts to help him develop customized strategies. For example, tools that change the font size, the color of the paper, or highlight a single line of text are helpful to some people. When my daughter (who loved reading as a child) was in college, she was offer the option to get all of reading material as a pdf that she could read on screen (with options for enlarged text and/or highlighting individual lines) plus a text to voice reader so could both read visually and hear the textbook at the same time. I was surprised how much of a difference this made - her scores on the chapter quizzes jumped for 70% to 90-100%.
posted by metahawk at 3:32 PM on September 20, 2023 [7 favorites]
I would try for an assessment with someone is expert on the full range of learning differences. We all know about dyslexia but there are other problems that can impact reading ability in a more subtle way. Many of these are co-morbid with ADHD so you might as well get that check out as well.
Once you have a better understanding of nature of his problem, you can find experts to help him develop customized strategies. For example, tools that change the font size, the color of the paper, or highlight a single line of text are helpful to some people. When my daughter (who loved reading as a child) was in college, she was offer the option to get all of reading material as a pdf that she could read on screen (with options for enlarged text and/or highlighting individual lines) plus a text to voice reader so could both read visually and hear the textbook at the same time. I was surprised how much of a difference this made - her scores on the chapter quizzes jumped for 70% to 90-100%.
posted by metahawk at 3:32 PM on September 20, 2023 [7 favorites]
And for what it's worth -- my clients were generally pursuing neuropsych testing to diagnose things like traumatic brain injury or other physical issues with their brains. It's not just a super-fancy ADHD test, at least in my experience.
posted by lapis at 3:36 PM on September 20, 2023 [1 favorite]
posted by lapis at 3:36 PM on September 20, 2023 [1 favorite]
While you get this workup, is there anything he likes reading enough that he is less distracted by it hurting his brain? Comics come to mind: both narrative comics and comic strip collections. Choose your own adventures. Text adventure video games? Propulsive genre novels. Anything he will focus on?
posted by latkes at 3:46 PM on September 20, 2023
posted by latkes at 3:46 PM on September 20, 2023
I'd like for him to have joyful access to the world of written materials
Is that what he wants? As a sixth grader, he gets a bit of say about whether or not this is something that he wants to work on. You can no longer force interventions onto children this age.
I would support ADHD screening. I would also encourage you to challenge your assumptions about how your son should engage with words. Would it really be so bad if you requested audio versions of any long-form reading assigned in class?
posted by shock muppet at 3:53 PM on September 20, 2023 [2 favorites]
Is that what he wants? As a sixth grader, he gets a bit of say about whether or not this is something that he wants to work on. You can no longer force interventions onto children this age.
I would support ADHD screening. I would also encourage you to challenge your assumptions about how your son should engage with words. Would it really be so bad if you requested audio versions of any long-form reading assigned in class?
posted by shock muppet at 3:53 PM on September 20, 2023 [2 favorites]
Response by poster: @lapis, can you clarify a bit about what sort of tests the neuropsych evaluations might do? We have just today finished appointments for my younger son, who is being evaluated for different issues (anxiety, possible ASD); from what I could glean behind closed doors, they were doing IQ tests and some social cognition things but nothing that would really be able to pinpoint which brain areas are problematic. Anyways, your comment made me wonder if I am not really understanding what neuropsych can entail.
And to address @shock muppet's point, yes, my older son does want to pursue this. I should have said so. He's skeptical that anything could change the way reading feels for him, but he's quite aware of how his attention difficulties are making other things in life hard, and actually broached the idea of an ADHD evaluation himself. Thank you for bringing this up, though, because I know that adjusting to his increasing maturity and independence will take some work!
OK, done thread-sitting. Thanks again everybody!
posted by wyzewoman at 4:23 PM on September 20, 2023
And to address @shock muppet's point, yes, my older son does want to pursue this. I should have said so. He's skeptical that anything could change the way reading feels for him, but he's quite aware of how his attention difficulties are making other things in life hard, and actually broached the idea of an ADHD evaluation himself. Thank you for bringing this up, though, because I know that adjusting to his increasing maturity and independence will take some work!
OK, done thread-sitting. Thanks again everybody!
posted by wyzewoman at 4:23 PM on September 20, 2023
My son sounds a lot like your son. He had hellacious ADHD symptoms around second grade when we got a full neuropsych evaluation done. His reading complaints were similar -- he could read, loved stories, but print on a page really started being hard for him to read. And that's unfortunately just gotten worse -- he's 17 now and we've had a second neuropysch evaluation done before he started high school.
We've gotten a lot of information from those tests about his ADHD (pretty bad!) and his IQ (pretty high!) and a diagnosis of dysgraphia ( he can't write very easily). We have not gotten a very clear diagnosis about what is happening with the reading part, however. I've heard and read enough about this co-occurring with ADHD that I definitely think it is a part of the same batch of brain stuff. But I don't know that there is a name or official DX yet.
What we've done to cope is lean heavily into audiobooks for him. It's not always easy to find (especially since he doesn't have a clear impairment that allows him to qualify for some programs) but it's working ok.
Good luck to you - I remember well what all this feels like.
posted by pantarei70 at 4:55 PM on September 20, 2023 [2 favorites]
We've gotten a lot of information from those tests about his ADHD (pretty bad!) and his IQ (pretty high!) and a diagnosis of dysgraphia ( he can't write very easily). We have not gotten a very clear diagnosis about what is happening with the reading part, however. I've heard and read enough about this co-occurring with ADHD that I definitely think it is a part of the same batch of brain stuff. But I don't know that there is a name or official DX yet.
What we've done to cope is lean heavily into audiobooks for him. It's not always easy to find (especially since he doesn't have a clear impairment that allows him to qualify for some programs) but it's working ok.
Good luck to you - I remember well what all this feels like.
posted by pantarei70 at 4:55 PM on September 20, 2023 [2 favorites]
I'm not a psychologist, so I don't really feel like I can explain neuropsych testing adequately. My understanding is that patients generally do a bunch of things that kind of resemble an IQ test (or at least how IQ tests were when I was a kid, I don't know if they've changed) but the reports that come back are fairly detailed about what any mistakes/deficits could mean in terms of the actual structure of the brain, at least if there are any problems indicated with the structure of the brain. (Which there very well might not be, which is why I think it could be a useful way to rule some stuff out, too.)
posted by lapis at 4:57 PM on September 20, 2023
posted by lapis at 4:57 PM on September 20, 2023
This may be a wild shot in the dark, I know, but since a lot of physical issues can accompany neurodiversity - is it possible it's the way he holds himself while reading that's causing physical pain?
In addition to ADHD/neurodivergency being linked to things like migraines and EDS and the like, a lot of my neurodivergent circle, myself included, fall into small physical habits without realizing it. Some examples include writing with a pencil always hurting our hand until we realize we're holding the pencil in an unusual way, a couch suddenly causing back pain only to realize it's the specific way we've started sitting while playing a new video game, clenching our teeth during certain tasks without even knowing it, all sorts of stuff.
Maybe while pursuing the other planned ideas, explore narrowing down what the pain feels like and where he feels it and how quickly he feels it. Then check if it could be linked to a physical issue other than something eye/visual related. Holding and reading books, even light ones, can stress several parts of the body other than the eyes especially for those of us with proprioception issues or low vagal tone.
posted by Saucy Possum at 5:39 PM on September 20, 2023 [6 favorites]
In addition to ADHD/neurodivergency being linked to things like migraines and EDS and the like, a lot of my neurodivergent circle, myself included, fall into small physical habits without realizing it. Some examples include writing with a pencil always hurting our hand until we realize we're holding the pencil in an unusual way, a couch suddenly causing back pain only to realize it's the specific way we've started sitting while playing a new video game, clenching our teeth during certain tasks without even knowing it, all sorts of stuff.
Maybe while pursuing the other planned ideas, explore narrowing down what the pain feels like and where he feels it and how quickly he feels it. Then check if it could be linked to a physical issue other than something eye/visual related. Holding and reading books, even light ones, can stress several parts of the body other than the eyes especially for those of us with proprioception issues or low vagal tone.
posted by Saucy Possum at 5:39 PM on September 20, 2023 [6 favorites]
I really feel like this has been checked, but just to be absolutely sure... is his eyesight ok/ does he need/need new glasses? Having to overly focus to get through the page might be part of this (or at least an easy issue to rule out)
posted by zara at 5:41 PM on September 20, 2023 [4 favorites]
posted by zara at 5:41 PM on September 20, 2023 [4 favorites]
Neuropsych testing varies based on the needs of who is being tested and what diagnoses might be applicable to them. Testing can screen for autism, adhd, mental health conditions, learning disabilities, sensory processing disorders, and/or behavior disabilities. Ideally you will get a psychologist who can be thorough based on the challenges your son is having with reading.
I am an elementary teacher and not a psychologist, but my two cents is to seek screening for ADHD, specific reading disabilities (also known as dyslexia) and visual processing disorder.
posted by mai at 5:42 PM on September 20, 2023 [2 favorites]
I am an elementary teacher and not a psychologist, but my two cents is to seek screening for ADHD, specific reading disabilities (also known as dyslexia) and visual processing disorder.
posted by mai at 5:42 PM on September 20, 2023 [2 favorites]
Options 2, 5 and 6.
Get a dyslexia assessment as well. I have three kids with dyslexia, one also with ADHD, and your kid sounds like mild dyslexia. They might have been powering through reading issues with other skills until now. Dyslexia isn’t cured but instead they identify the specific language skills your kid struggles with and work with them to strengthen our find alternatives.
I would do the screening and trial medication. The medication has a very short effect and you can see the difference pretty quickly if it is ADHD. Going on meds doesn’t mean you have to stay on meds. You’ll have more data for when/if you decide to go for a full evaluation.
In the meantime, audiobooks, comics, subtitles on every show! Step down their reading to lower grade books so they can enjoy reading.
posted by dorothyisunderwood at 5:43 PM on September 20, 2023 [3 favorites]
Get a dyslexia assessment as well. I have three kids with dyslexia, one also with ADHD, and your kid sounds like mild dyslexia. They might have been powering through reading issues with other skills until now. Dyslexia isn’t cured but instead they identify the specific language skills your kid struggles with and work with them to strengthen our find alternatives.
I would do the screening and trial medication. The medication has a very short effect and you can see the difference pretty quickly if it is ADHD. Going on meds doesn’t mean you have to stay on meds. You’ll have more data for when/if you decide to go for a full evaluation.
In the meantime, audiobooks, comics, subtitles on every show! Step down their reading to lower grade books so they can enjoy reading.
posted by dorothyisunderwood at 5:43 PM on September 20, 2023 [3 favorites]
Also, regarding public school screening for private school students in Chicago specifically which is a thing I have gone through with some of my students - it isn’t generally as thorough as a private assessment and they will sometimes only be willing to screen for things that relate to poor academic performance. I really think it’s worth the money to have it done privately if you can afford it.
University of Chicago behavioral health has a good reputation.
posted by mai at 5:48 PM on September 20, 2023 [1 favorite]
University of Chicago behavioral health has a good reputation.
posted by mai at 5:48 PM on September 20, 2023 [1 favorite]
Best answer: Ask your son to close one eye and try a few pages; if he notices an improvement in his reading experience, talk to your ophthalmologist about convergence insufficiency (which is associated with ADHD).
posted by Iris Gambol at 7:00 PM on September 20, 2023 [4 favorites]
posted by Iris Gambol at 7:00 PM on September 20, 2023 [4 favorites]
Get a pair of sunglasses, tinted very dark and see if he feels more comfortable reading while wearing those.
Enlarge the print back to primer level. - Pick up some large print books at your library and see how he does with those.
You could do both of those things this week, before you could even make a neuropsych appointment, and either one of them might make a big difference and give you some data you can work with.
Drop him back to the easy books he was on before. Many kids go through a stage where they read some easy series books over and over, that are a level or two below their tested reading level. The reason this is good is because binging easy to read books trains for fluency instead of training for a larger vocabulary and more advanced reading skills. You want him to describe the books as easy and fun-to-read. If that means letting him take a couple more years enjoying picture books do that. No more than 10% of his reading should be what he considers difficult.
Keep in mind that kids develop skills very unevenly and will frequently plateau or even briefly regress. If your kid is having neurological growth in some other areas - such as math and abstract reasoning - the new connections he is making may make it harder for him to access the connections in his brain that he had previously just acquired.
Also keep in mind that if he just got back to school he may be adapting to some completely different expectations, and he may have forgotten some of what he had mastered at the end of last school year. If his class has already moved on past review he may need to review for a little longer.
The important thing is that he should find learning fun, and reading fun, and be able to have a lot of say in how the challenges he faces are handled. Finding things difficult is not bad. Learning to handle difficult things makes us confident and helps us develop personal problem solving skills. Finding things miserable is bad. The fact that he suggested getting an evaluation is a good sign. It means he's trying to figure out how to solve the problem and comfortable making suggestions and experimenting, and you are listening to him.
posted by Jane the Brown at 9:35 PM on September 20, 2023 [2 favorites]
Enlarge the print back to primer level. - Pick up some large print books at your library and see how he does with those.
You could do both of those things this week, before you could even make a neuropsych appointment, and either one of them might make a big difference and give you some data you can work with.
Drop him back to the easy books he was on before. Many kids go through a stage where they read some easy series books over and over, that are a level or two below their tested reading level. The reason this is good is because binging easy to read books trains for fluency instead of training for a larger vocabulary and more advanced reading skills. You want him to describe the books as easy and fun-to-read. If that means letting him take a couple more years enjoying picture books do that. No more than 10% of his reading should be what he considers difficult.
Keep in mind that kids develop skills very unevenly and will frequently plateau or even briefly regress. If your kid is having neurological growth in some other areas - such as math and abstract reasoning - the new connections he is making may make it harder for him to access the connections in his brain that he had previously just acquired.
Also keep in mind that if he just got back to school he may be adapting to some completely different expectations, and he may have forgotten some of what he had mastered at the end of last school year. If his class has already moved on past review he may need to review for a little longer.
The important thing is that he should find learning fun, and reading fun, and be able to have a lot of say in how the challenges he faces are handled. Finding things difficult is not bad. Learning to handle difficult things makes us confident and helps us develop personal problem solving skills. Finding things miserable is bad. The fact that he suggested getting an evaluation is a good sign. It means he's trying to figure out how to solve the problem and comfortable making suggestions and experimenting, and you are listening to him.
posted by Jane the Brown at 9:35 PM on September 20, 2023 [2 favorites]
In the very short term, as you are seeking the best path for evaluation and diagnosis, I would try a few different things to address the pain. First, ask him to pinpoint it and describe it more thoroughly. You might need to give him a list of words used to describe different types of pain (read these out loud and define them for him), and have him keep track of where the pain happens, how long it takes to start and how long it lasts after he stops reading, if it lasts longer if he pushes himself to read more or if it lasts the same amount of time after he stops after different amounts of reading. All of these things can help you both explore what is actually going on with his body, if it’s an eye tension headache or a mental stress thing or a postural thing or so-on.
If it turns out to be at least partially eye tension, you could try revisiting the optometrist, or even experimenting with run of the mill readers. If there are posture issues, you might buy or make a stand for his books and a nook for it where he is well supported and doesn’t end up scrunched into a pretzel. Talk about good lighting for reading, too; a light on the page as well as ambient light around him can make a big difference.
It’s also completely okay to read in short chunks of time - you could help him set a timer for ten minutes, and then he gets up and wiggles/has a snack/hangs out with family, then goes back for ten more minutes of reading. Set up his space so he has choices of other quiet things to do during his breaks at night and other times he needs or wants to stay tucked away. Experiment with the length of time he can read before he feels any pain, and if it’s cumulative or if taking breaks helps. All of this can be helpful information for future medical professionals and model for him how to navigate life as a neurodivergent adult with new and evolving challenges.
I’d definitely look into Libby and try really big font sizes as well as alternating between audiobook and written word. If he is into comics, comixology is a good app for that and would let him zoom in and save his place frequently. Some people with dyslexia have little hacks like putting something below each line they are reading (like a ruler or blank page), or switching to special fonts. Also, introduce him to different types of short form writing. Poetry, short stories, and layperson science articles are really valuable and richly varied these days. Not all reading is dense chapter books; in fact most of it isn’t.
My point is, he is not stuck doing nothing about this as you pursue diagnostics. You can involve him in problem solving and self evaluation without any kind of big changes or risks.
posted by Mizu at 9:43 PM on September 20, 2023 [1 favorite]
If it turns out to be at least partially eye tension, you could try revisiting the optometrist, or even experimenting with run of the mill readers. If there are posture issues, you might buy or make a stand for his books and a nook for it where he is well supported and doesn’t end up scrunched into a pretzel. Talk about good lighting for reading, too; a light on the page as well as ambient light around him can make a big difference.
It’s also completely okay to read in short chunks of time - you could help him set a timer for ten minutes, and then he gets up and wiggles/has a snack/hangs out with family, then goes back for ten more minutes of reading. Set up his space so he has choices of other quiet things to do during his breaks at night and other times he needs or wants to stay tucked away. Experiment with the length of time he can read before he feels any pain, and if it’s cumulative or if taking breaks helps. All of this can be helpful information for future medical professionals and model for him how to navigate life as a neurodivergent adult with new and evolving challenges.
I’d definitely look into Libby and try really big font sizes as well as alternating between audiobook and written word. If he is into comics, comixology is a good app for that and would let him zoom in and save his place frequently. Some people with dyslexia have little hacks like putting something below each line they are reading (like a ruler or blank page), or switching to special fonts. Also, introduce him to different types of short form writing. Poetry, short stories, and layperson science articles are really valuable and richly varied these days. Not all reading is dense chapter books; in fact most of it isn’t.
My point is, he is not stuck doing nothing about this as you pursue diagnostics. You can involve him in problem solving and self evaluation without any kind of big changes or risks.
posted by Mizu at 9:43 PM on September 20, 2023 [1 favorite]
After reading just your intro and glancing over at my reading-hating, dyslexia-having husband, definitely get him evaluated for dyslexia. There are some dyslexia-friendly fonts you can set up on a computer/smartphone or an ebook reader to see if it helps.
posted by gakiko at 4:22 AM on September 21, 2023 [3 favorites]
posted by gakiko at 4:22 AM on September 21, 2023 [3 favorites]
Lots of great suggestions above regarding how you can experiment with different adaptations and modifications and I just wanted to pop in to say how you frame this with him is important so that he understand you are going to try different things that may or may not change his experience, and that is all good and fun! Reading with sunglasses? What fun!
Does he also struggle with reading things like tests in school (that typically take longer than 10 mins) Or is it just sustained independent reading?
I also want to stress that until you figure this out with specialists, it's OK for him to read in short bursts. There are tons of things for his age like 3-minute mysteries and short stories that can be done in short sittings to help him retain his love of reading. If he has to read chapter books for school, he can read for 5 minutes, jot down some annotations about what he read, take a break, come back for 5 mins, etc. and not lose any thinking about the text as he goes. He can also have a printed text of something audio and switch back and forth. Read for a short bursts, then switch to audio, then switch back. Even with a diagnosis, not every strategy works for every person the same, so what a great opportunity to help him discover himself as a learner and thinker and develop strategies for adulthood that work for him and maybe him only.
Bravo to you for listening to him and digging in deep to support him!
posted by archimago at 6:00 AM on September 21, 2023
Does he also struggle with reading things like tests in school (that typically take longer than 10 mins) Or is it just sustained independent reading?
I also want to stress that until you figure this out with specialists, it's OK for him to read in short bursts. There are tons of things for his age like 3-minute mysteries and short stories that can be done in short sittings to help him retain his love of reading. If he has to read chapter books for school, he can read for 5 minutes, jot down some annotations about what he read, take a break, come back for 5 mins, etc. and not lose any thinking about the text as he goes. He can also have a printed text of something audio and switch back and forth. Read for a short bursts, then switch to audio, then switch back. Even with a diagnosis, not every strategy works for every person the same, so what a great opportunity to help him discover himself as a learner and thinker and develop strategies for adulthood that work for him and maybe him only.
Bravo to you for listening to him and digging in deep to support him!
posted by archimago at 6:00 AM on September 21, 2023
I have ADHD and get migraines from overstimulation, which has many triggers but is often caused by light that is too cool/blue and too bright. They can also be triggered by taking in too much information at once, as with reading for too long. The main warning sign I have that a migraine is incoming is that reading becomes difficult and then impossible—my eyes feel hard to focus, sometimes the words swim, and eventually the head pain begins.
You might try reducing other overwhelming stimuli in general, and specifically around his reading environment, and see if it makes a difference. Similarly, you might see if he has the same difficulty at different times of day or locations—if reading is more possible in the morning at home when things are calm and he feels balanced, that might be instructive. And as previously mentioned e-reading can also be really helpful, both by reducing the number of words and making them larger but also by giving a darker background. (I often find it less stimulating to read on a tablet with a black background/white text than to read a printed book where the light bounces off the white page.) I also read comic books on a tablet or laptop in “smart panel”or “guided view” mode where you see only a single panel at a time, because it reduces visible stimuli and helps me focus.
On preview, I really want to second archimago—you are doing great by listening to him and working with him on this. I was raised in a “toughen up and tough it out” home, and I was needlessly miserable and down on myself for so long. Your son is lucky to have you, and I hope you both find some answers and workable strategies soon.
posted by CtrlAltDelete at 6:19 AM on September 21, 2023 [2 favorites]
You might try reducing other overwhelming stimuli in general, and specifically around his reading environment, and see if it makes a difference. Similarly, you might see if he has the same difficulty at different times of day or locations—if reading is more possible in the morning at home when things are calm and he feels balanced, that might be instructive. And as previously mentioned e-reading can also be really helpful, both by reducing the number of words and making them larger but also by giving a darker background. (I often find it less stimulating to read on a tablet with a black background/white text than to read a printed book where the light bounces off the white page.) I also read comic books on a tablet or laptop in “smart panel”or “guided view” mode where you see only a single panel at a time, because it reduces visible stimuli and helps me focus.
On preview, I really want to second archimago—you are doing great by listening to him and working with him on this. I was raised in a “toughen up and tough it out” home, and I was needlessly miserable and down on myself for so long. Your son is lucky to have you, and I hope you both find some answers and workable strategies soon.
posted by CtrlAltDelete at 6:19 AM on September 21, 2023 [2 favorites]
Complete anecdote from an adult who only identified their ADHD/neurodivergence in their 30s — managing my brain is about constantly modulating my overall stimulation level. Sometimes I need to reduce my overall stimuli (light changes, headphones), but almost more often, I need to *increase* my stimulation in a non-clashing way to be able to focus. Sometimes this means an audiobook I can dip in and out of, sometimes it means having a simple craft (repetitive knitting), sometimes it means actively taking notes even if I’m not studying. People have mentioned comics—my partner really wants me to read sandman. I’ve been most able to focus on reading it when I had a sketch pad nearby and did my own doodles of some panels as I went.
I get most of my fiction through audiobooks now. It’s not great for dense texts where I want to re-read passages, but it’s great to listen to fiction while going for walks, doing chores, and small projects that don’t require a lot of brain power. Starting a new printed-book by sitting down in a chair/on a couch sounds almost impossible, but if I had a stationary bike to cruise on, I’d pedal and read quite happily. There might be a point where I’d get absorbed enough in the book that reading it sitting in a more normal situation, but for the early parts, before I was invested, extra stimulation would be a must.
posted by itesser at 6:50 AM on September 21, 2023 [1 favorite]
I get most of my fiction through audiobooks now. It’s not great for dense texts where I want to re-read passages, but it’s great to listen to fiction while going for walks, doing chores, and small projects that don’t require a lot of brain power. Starting a new printed-book by sitting down in a chair/on a couch sounds almost impossible, but if I had a stationary bike to cruise on, I’d pedal and read quite happily. There might be a point where I’d get absorbed enough in the book that reading it sitting in a more normal situation, but for the early parts, before I was invested, extra stimulation would be a must.
posted by itesser at 6:50 AM on September 21, 2023 [1 favorite]
Has he had a head injury? When I had post-concussion syndrome, reading actually caused pain. It can still flare up if I read when I'm too tired. (I have ADHD, but the headaches weren't an issue until after my head injury.)
posted by The corpse in the library at 11:47 AM on September 21, 2023
posted by The corpse in the library at 11:47 AM on September 21, 2023
I want to add one more 'try this, it's a weird option but it might work' from an ADHD-diagnosed adult who adores stories and reads print books and ebooks often. It seems counterintuitive, and might be a non-starter, and that's fine. If your son's problems are more on the dyslexia side of the coin, this will make it worse!
But: reduce the font size.
My brain likes huge swoops of information, very fast. Reading line-by-line and having to perform the memory/concentration task of holding the story in my head while moving very carefully forward is actively painful, kind of like what you're describing your son feeling. It may help him to be able to 'see the entire object' - to take in a paragraph, or a whole sentence, all together on the page.
While 'add more information' seems backwards to the problem, some ADHD failure states are about calibrating the stimuli (words, in this case) to the working speed of memory/vision (fast, easily distracted). Might be worth a one-time experiment.
posted by byzantienne at 11:50 AM on September 21, 2023 [2 favorites]
But: reduce the font size.
My brain likes huge swoops of information, very fast. Reading line-by-line and having to perform the memory/concentration task of holding the story in my head while moving very carefully forward is actively painful, kind of like what you're describing your son feeling. It may help him to be able to 'see the entire object' - to take in a paragraph, or a whole sentence, all together on the page.
While 'add more information' seems backwards to the problem, some ADHD failure states are about calibrating the stimuli (words, in this case) to the working speed of memory/vision (fast, easily distracted). Might be worth a one-time experiment.
posted by byzantienne at 11:50 AM on September 21, 2023 [2 favorites]
Response by poster: Thanks all! We have a plan of action now. I'll get my son on a waiting list for a neuropsych eval. Then make an appointment with a psychiatrist so that, presuming we get a diagnosis, we can start trialling meds. In the meantime, we can experiment with all the really awesome suggestions here, keeping records of what helps and what doesn't. If we feel like we've come to a good enough understanding of what's going on, we can always cancel the evaluation.
We'll also look into what accommodations might be helpful now at school, such as audiobooks for his class readings.
posted by wyzewoman at 10:01 AM on September 22, 2023 [3 favorites]
We'll also look into what accommodations might be helpful now at school, such as audiobooks for his class readings.
posted by wyzewoman at 10:01 AM on September 22, 2023 [3 favorites]
Response by poster: Update: We spent several days trying out various ideas people had suggested here. The one that had a tremendous effect was covering one eye while reading -- this made my son's headaches go away. This made me think that his eyes weren't working well together, and we decided to go back for another eye exam to test for convergence insufficiency.
I found an excellent nonprofit practice near our home that specializes in child visual development disorders. They offer vision therapy, which it turns out does have a solid evidence base, just very specifically for the treatment of convergence insufficiency.
We had our visit there today, and sure enough, this is his issue. The optometrist said it's likely to resolve with a few months of the therapy. Of course, there may still also be ADHD -- but it will all be easier if his eyes don't hurt.
I am so grateful to the Metafilter community for helping us out here. And I'm also grateful for the existence of our provider, the Plano Child Development Center; while our family would be able to afford to seek out care at many providers in the city, Plano provides services to many children here on the south side of Chicago who would otherwise be unable to afford it. I'm feeling so relieved and hopeful for my child, and I'm happy that other parents are able to feel this same relief through this organization. Just by chance, tomorrow is their big annual benefit -- I plan on making a donation.
posted by wyzewoman at 6:29 PM on October 5, 2023 [7 favorites]
I found an excellent nonprofit practice near our home that specializes in child visual development disorders. They offer vision therapy, which it turns out does have a solid evidence base, just very specifically for the treatment of convergence insufficiency.
We had our visit there today, and sure enough, this is his issue. The optometrist said it's likely to resolve with a few months of the therapy. Of course, there may still also be ADHD -- but it will all be easier if his eyes don't hurt.
I am so grateful to the Metafilter community for helping us out here. And I'm also grateful for the existence of our provider, the Plano Child Development Center; while our family would be able to afford to seek out care at many providers in the city, Plano provides services to many children here on the south side of Chicago who would otherwise be unable to afford it. I'm feeling so relieved and hopeful for my child, and I'm happy that other parents are able to feel this same relief through this organization. Just by chance, tomorrow is their big annual benefit -- I plan on making a donation.
posted by wyzewoman at 6:29 PM on October 5, 2023 [7 favorites]
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I love reading. I am A Reader. Books are my friends. My ability to read more than doubled after I got a kindle and customized those settings.
I have no vision problems, no ADHD, no dyslexia. It's just frickin easier to read when there's less shit on the page. (Technical term.)
My friends make fun of me for my big kindle font and I don't even carrreeeee
Edit to add: I mean obviously go ahead and pursue diagnoses, etc, if you think your child may have an issue. But in absence of any other problems, this is a pretty easy thing to try.
posted by phunniemee at 3:09 PM on September 20, 2023 [8 favorites]