[00:00:00] Dr. Rosalie Hopkins: Vision is not just here. Vision is here, but it’s also here. This is going into our regular routine eye exams. We sit behind the little phoropter thing, we’re looking through these little holes, we find the prescription and we write it out for you. For the majority of people, that is working out fine. For the people who have difficulty, especially with some of their vision out here, that testing is not looking at this vision out here.

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[00:00:36] Gretchen: Good afternoon, everyone. Welcome to this very special episode of The Demme Learning Show. I am so excited today to sit down and have an in-depth conversation with Dr. Rosalie Hopkins. I have chased her down and pestered her into doing this because I’m just so grateful. I need for you to hear from the perspective of a practitioner in the field how vital and important it is to get to the root of a child’s binocular vision dysfunction.

As I’ve told you in the past three episodes, this is the fourth episode, the cherry on top, if you will, of our conversations. We started with Dr. Karen Holinga talking to us about what happens when a child doesn’t emerge as a reader the way they’re supposed to. Then we talked with our own Lisa Chimento about the placement challenges she encounters with families when they present with challenges for their students. Then we went further, and we spoke with Amanda Capps talking about her own family and the challenges that she has seen with four of her eight children because we wanted you to have a personal perspective.

Dr. Hopkins is going to be our concluding conversation today, talking from the perspective of a professional who deals with these kinds of things all the time. I think you’ll find her wisdom gratifying and valuable. Dr. Rosalie, would you please introduce yourself, and then we’ll get to the meat of our conversation.

[00:02:11] Dr. Hopkins: Well, thank you, Gretchen. I’m Rose Hopkins, Rose for short. I’m an optometrist that specializes in vision development, vision rehabilitation, vision therapy, and neural optometry. What does that mean? How am I different from other eye doctors or other optometrists? Everyone knows about 20/20. The one thing is that everyone thinks that 20/20 is perfect vision. Well, 20/20 is just one skill, one visual skill out of probably over 30 different visual skills.

We use many, many visual skills, these over 30 visual skills, every day to basically function in school, function at work, when we’re driving, when we’re playing sports. I look at all the different skills that the smallest line on the eye chart doesn’t look at. That’s what I do when I work with people of all ages, from babies on up until the elderly folks, too.

[00:03:17] Gretchen: Right. What we’re going to talk about today in some degree of depth is eye movement disorders. In other words, not can you see 20/20, but do your eyes work together the way they’re supposed to over a period of time? As a parent who had two children with eye movement disorders of different kinds, one who had to have remediation before he could even learn to read, and one who didn’t present with challenges until he hit puberty, I can tell you that they’re as different as they are with fingerprints, but it’s up to us as parents to recognize when something’s not right.

As a parent, you know your child better than anyone else. You know when something isn’t the way it’s supposed to be. Today, we’re going to talk a little bit about what that could be at the root cause here. Dr. Rosalie, when someone comes to you and says they have a child who’s struggling, what are the kinds of things they present to you as far as when a child is not emerging as a reader or having behavioral issues because of undiagnosed vision issues?

[00:04:37] Dr. Hopkins: Yes. Usually, a lot of times, by the time they’re in my chair, they’ve gone through a lot of other testing or had their eyes checked, look at a regular eye doctor, and had their eye health checked, and everything seems to be perfect and looking good. Yet they’re still struggling in school. They might say, “Well, my child seems to be seeing just fine. He or she could see the board just fine, watches television just fine. They know their words. They seem to understand when they pick up individual books, perhaps. Looking at the isolated words, it’s fine, but when they have to look at a page, it becomes harder for them. They can’t track along a line of sentence, or if it’s a paragraph of words, or if it’s a lot of print on a page, they lose their place a lot.”

I think parents often will say, often too, if they notice that their child’s reading aloud, they might insert words or they might skip around, or they might make up a word. They’re looking at the context of the picture and trying to make up what they think should be there.

[00:05:43] Gretchen: Kids are clever, and they’re resilient too. They will go to extraordinary measures because, for starters, they don’t know you don’t see the world like they do. They don’t know there’s dysfunctionality there. One of the things that is often a trigger for us here at Demme Learning is when a family says that they have a child who’s very emotional. They can be engaged academically for a period of time, and then they melt down. Can you talk a little bit about why that would be the case? Because I know, but I’d love to hear it from your diagnostic perspective.

[00:06:16] Dr. Hopkins: Yes. A lot of times I’ll ask, when do you notice them melting down? Is it specific to paperwork or schoolwork that they’re doing? How are they when you read them a story? “Oh, they love it. They love when I read them a story.” “How’s their comprehension when you read them a story?” “Oh, really good. They understand. They could tell me all the little details, and they remember this, and they remember that.” “Well, what about when they’re reading?” “Comprehension’s really poor when they’re having to read. They might sit down for a minute or two, and then they might start to get upset, or they might start to get frustrated.”

You might have some that it might not be so obvious where they get upset real easily. They might try to push through and read for a little bit, and they’re reading, they’re saying the words, and they’re reading, but sometimes if vision is not working well, they might be working really hard to try to read so that they don’t have much energy left to comprehend what they just read. Now, for the person, the child who gets emotional and very upset, quite likely what’s possibly happened is that if there is a visual dysfunction going on, perhaps they’re losing their place a lot, or perhaps things are blurring in and out of focus, or perhaps things like the print might be dancing around on the page, and they’re really working hard to try to keep everything focused and clear.

A lot of times too, if you have two eyes that are fighting each other and not working well together, but you’re working hard to try to make them work together, that can create strain, and that can create headaches and a lot of visual discomfort. For the child who is not the fighter, who’s going to push through, they’re going to run away the opposite direction. They’re going to be upset, and they’re not going to want to focus on their work. They’d rather do something else, like clean their bag.

[00:08:13] Gretchen: I vividly remember working with a family who said their son had attention deficit disorder. He just couldn’t stay focused. When I asked the mom to explore a little bit more in-depth about whether vision was a mitigating factor for him, ultimately, it turned out that it was. Once they remediated his vision, they also found that his attention deficit was not nearly as acute as they thought it was. The vision was actually making him sick. He looked like he was distracted, but it was because he just couldn’t attend any further to the page. Tell me, what are the kinds of things, how is it different when I come to you than when I go to a standard optician for an eye exam?

[00:09:05] Dr. Hopkins: Most eye doctors or most routine eye exams are going to be looking at your eye health and looking to see whether you’re nearsighted or farsighted and whether you could see 20/20. A typical exam is going to be booked for anywhere between 15 to 30 minutes to make sure eye health is good, that everything is functioning, and no holes or no detachments. Then they want to see how small you can see. If you can’t see the 20/20 line, they’re going to do something called a refraction to try to help you see 20/20.

A lot of this test is typically done at a distance. Some doctors may do near testing. The typical exam doesn’t always include near testing, which for our children and our students, a lot of the things that we do are up close and on the computer. We want to get an idea of how their vision is functioning at near.

How I’m different or what we do with my exams, a lot of times people have come through and already had their eye health checked. I’m going to be looking at all these other skills outside of what’s the smallest line that you can see because I want to make sure that this child in this chair has all the skills needed to be able to read a book, to comprehend, to be able to process what it is that they’re reading. The exam is going to be a little bit longer because, to dive deep into all these different skills, it’s very difficult to try to look into all that within 20 or 30 minutes. It’s a longer assessment typically.

[00:10:41] Gretchen: When you have a child who tends to become more emotional when you’re looking more deeply into how their eyes are functioning together or in tandem, how do you work around that? Because I know that this diagnostic is somewhere between 60 and 90 minutes in length. What do you do with a child who just hits that “I can’t do anymore” point very early on in a diagnostic session?

[00:11:10] Dr. Hopkins: The testing that we do, a lot of times when these children get emotional, we’re asking them to read, and we’re asking them to look at a bunch of words on a piece of paper. During an evaluation, when they come in, we might have some pretesting where they might have some tracings or drawing, and we have some that is almost like a video game a little bit that’s doing some eye tracking. The testing, when they come into the exam room with me, we do some testing with the eye chart.

I’m not having them read paragraphs. I do testing using the eye chart so they’re looking at individual letters, so it’s not as taxing. When we start moving towards– after distance testing, I’ll move them towards near testing and just the duration of things. With the duration, they do start to fatigue a little bit. If they’re needing a break, no problem. I’ll let them get down to have a movement break or drink a water, come back refreshed or whatnot. Most children are able to get through that testing.

I had a handful where the visual dysfunction was just so obvious and so significant that I couldn’t, and I didn’t have to finish the evaluation because it was just so obvious that they were just so fatigued, and you could just see it in their face and see it in their eyes. It just was so obvious.

[00:12:32] Gretchen: Knowing that the diagnostic is going to be longer, I’m sure that you set parents up to answer that question in the beginning. This may take us longer, but we will know more about what’s going on. Can you talk a little bit about, you don’t always find the same thing with every child? You have to really tailor the therapy to the individual child in front of you, don’t you?

[00:12:57] Dr. Hopkins: Generally, we look at certain things. I have a wonderful office coordinator who does a great job of talking with the parent ahead of time and letting them know what to expect as far as the evaluation time and if anything is found. Whether what my recommendations may involve, if I do find a visual dysfunction, that vision therapy may be a possibility. Yes, depending on each child is different. There’s different types of visual skills that we look at.

There’s visual efficiency skills, which deal with eye movements, eye teaming, and eye focusing. It really deals with the skills that our eyes do to capture what it is that we’re looking at. Then there’s visual processing skills, which is once our eye sees that information, how does our brain process this information? Does it understand that that’s a D and that’s not a B? Is it able to find in a massive, a bunch of letters and print, are they able to find a certain word? There’s a lot of different visual processing skills that are involved, but we also need to make sure that our eyes are able to track the words and see it clearly and coordinate and see it single before our brain gets that information to try to process what that information is seeing.

The quality of the incoming information also affects just what we understand because if we have good information coming in, if our eyes are working well together, the print is clear and single, that’s great. Then our brain has good information to work with. If the child is still struggling, that may then be more of a visual processing issue. However, if we have blurry and doubling, words that are moving around, the quality of incoming information is poor, well, the brain has poor information to work with, so it’s already going to be at a disadvantage.

Depending on if a child has visual processing issues, but also visual skill dysfunction, that’s a double whammy. If a child has good visual processing skills and it’s just the poor information that’s coming in, then we’re dealing with the visual eye movements dysfunction and the visual focusing and eye teaming and eye movements.

[00:15:17] Gretchen: My middle granddaughter, her parents said three years ago that it was just exhausting. She would come home from school and almost every day was a meltdown. I suggested to her parents that maybe that was a red flag, that maybe they should look a little bit more thoroughly into whether her eyes were tracking together. It turned out that she did have a binocular vision dysfunction. She did go through vision therapy. Now she reads above grade level, and I got such a kick out of her. I gave her a four-book series for her 10th birthday.

I talked to her about four days after the books arrived, and she said they were wonderful. I said, “What do you mean they were wonderful?” She said, “Oh, I read them.” I said, “All four of them?” She said, “Yes.” She said, “It’s summer break, and I can read for as long as I want.” This was a child who wouldn’t sit down to read for 10 minutes with her parents before she had vision therapy. I have seen the personal success there of creating that. Parents often say to me, “Well, I looked into vision therapy, but it was so expensive.” I think it’s a cost that we do need to count. I want to talk about why it’s expensive because it’s so singular.

Can you talk about how every child that comes to you gets an individualized plan? It’s not just a blanket that you throw over this issue to create a solution?

[00:16:49] Dr. Hopkins: Before I go into that, I’d like to back up a little bit about the child that comes home upset and dysregulated. That little girl had a visual problem, and she was successful with the vision therapy. Something else to consider too is that sometimes children might just have a really strong prescription. Maybe just like your regular eye exam potentially might uncover that, and maybe just getting glasses can be helpful and might help to mitigate some of that temper at the end of the day or that exhaustion.

I’m not saying that if there’s a visual dysfunction, that the glasses are going to take care of that, that’s not the case. If there’s a refractive error and there’s a really strong prescription, where it’s causing strain on the child’s vision, it can be helpful for that. Of course, sometimes people, oftentimes children, will have a refractive error, but also may have some visual dysfunction. In cases like that, it would need to be a combination of perhaps glasses and vision therapy because if they have eye movement issues, glasses are not going to fix an eye movement issue. I just wanted to say that piece.

[00:18:00] Gretchen: No, I appreciate your saying that because I think it’s very important. My middle daughter, who’s in her mid-30s, she’s a research biologist, had years and years of migraine headaches. She’s worn glasses her whole life. It turned out, though, in the diagnostic process with her glasses, no one looked at whether her eyes were on the same plane or not. When she got glasses to pull her eyes into the same plane, it mitigated the number of migraines and actually cut them in half.

[00:18:33] Dr. Hopkins: I can’t speak to what other practitioners would do, but generally, at least for our practice and for many, it’s tailored towards the individual person, typically. Some practices may have an overall guideline as far as what we want to take care of. Generally speaking, when people come in with visual dysfunction, we want to work with eye movements. We want to work with eye focusing. We want to work with how the two eyes are teaming and coordinating together.

Then ultimately, we want to start, if there’s visual processing issues, we might also integrate or incorporate visual processing activities with the visual, either eye-tracking activity or eye-focusing activity. Ultimately, what we want to take the child or the individual towards is being able to use all these skills while they’re up and moving and walking and chewing gum and all these things. We don’t want them just sitting at the chair and just working, like just being able to cross their eyes and uncross their eyes where they’re having to think about it. We want kids to be able to do these visual skills at an unconscious level. We want these visual skills integrated with all of our other sensory motor skills. It takes time.

It’s not something that happens overnight. Your child’s been having issues for several years, and for some people, many years. It’s going to take time to undo bad habits, learn new habits, integrate the new habits and integrate it to a reflexive level so that you’re not having to think about it. That’s where you can read for comprehension because you’re not having to work and think about keeping things clear and not losing your place. We want all those things to be automatic.

[00:20:15] Gretchen: What is the typical age that you see as far as a student who comes to you who needs remediation?

[00:20:21] Dr. Hopkins: Anywhere between the ages of, say, 6 to 18 for grade school, but we also see young adults. We see adults. We see elderly. It’s not just the school-age people. We do see adults who come in for other reasons. Any neurological issue, a lot of times, often can affect vision. We’re working with people a lot with that. We do see young children, like young, young, young children, like toddlers sometimes, if they’re mature enough. If they’re not quite ready to come into the office, we may work on some things at home initially until they’re mature enough to come into office on a more regular basis.

[00:21:07] Gretchen: You sometimes have children whose parents come to you, and then they look at the cost of vision therapy. How do you help them weigh the cost? Where I really want you to go with this is I want parents to understand, if your child has a dysfunction, it’s not something they’re going to get over. They can’t fix this themselves.

[00:21:30] Dr. Hopkins: I think that’s what a lot of parents want. They hope, and they want to hear is that their child is going to outgrow it. They will say, “Is this something that my child will outgrow?” The truth is, people learn to compensate. You’re not really going to outgrow it. I’ll see adults, children who might have had needed therapy, but maybe perhaps didn’t get it when they were younger. I’ll see them as adults. They still struggle. I have had some adults more recently where their jobs are limited to what they can do. I don’t think parents see that far ahead or are thinking that their visual problem can affect the trajectory of what their child’s possibly going to do later in life.

We’re so ingrained with this 20/20 vision that my child has perfect vision. We’re not thinking about how a visual dysfunction can affect the child’s confidence or a child’s self-esteem and how he or she is doing in school relative to his or her peers. That child that usually struggles in school takes a long time to try to get his or her work done. They see their friends finishing up really fast, and here they are, they’re struggling to keep up. That can take a toll on a child’s self-esteem because they think perhaps there’s something wrong with them. It’s not really them. It’s something that could be worked with the visual dysfunction.

As far as how do we talk about the value of trying to work with this visual dysfunction, it’s all these things. It’s the potential. What is the potential that you want for your child as they grow up into an adult? Right now, these are the formative years where their confidence, their esteem, how they feel about themselves is going to be huge to take them somewhere. If a child’s going to not feel good about themselves or not be willing to take risks or not try things, that has the ability to stump their potential as far as what they can do later on in life.

[00:23:36] Gretchen: This is a question I don’t think I’ve ever asked anybody, but can you remediate adults who have had vision dysfunction for years? Can you still improve their quality of life?

[00:23:48] Dr. Hopkins: Absolutely, for sure. Neuroplasticity is like a buzzword right now, right? Definitely, very much so.

[00:23:58] Gretchen: That’s awesome. Nobody wants to see their children struggle. Often, when I have these initial conversations at conferences with parents, what I’ll hear is, “But my child passed the pediatrician’s vision exam.” That’s the lowest bar here as far as it doesn’t measure very much. It’s not very indicative of whether they’re having visual success.

[00:24:24] Dr. Hopkins: No. Again, this is going back to that 20/20. It’s just how small can you see? Vision is not just here. Vision is here, but it’s also here. This is going into our regular routine eye exams. We sit behind the little phoropter thing, we’re looking through these little holes, we find the prescription, and we write it out for you. For the majority of people, that is working out fine. For the people who have difficulty, especially with some of their vision out here, that testing is not looking at this vision out here.

This type of testing tests 6%, maybe, of our entire vision. They’re not really checking their functional skills. They’re not looking at their near-vision testing. What can my child see up close? How well can a child read the words in a straight line and not lose their place? That is very different from, say, looking at a chart and just reading off a line. If you were to read a paragraph of lines, you would see your dah-dah-dah-dah-dah, ding. Then when it comes down here, it’s got to come down to the next line and not lose your place. Then we’re going across again. Then it’s like, ding, another typewriter, and it’s going across.

These are really fine, accurate movements. If someone who has poor eye-tracking skills, they might come somewhere and they might be searching around to try to find that next line. They might go to the wrong line and start reading. If you’re jumping around, you’re not going to take in the information in order or in sequence like you should. Is that person going to remember what they read?

[00:26:11] Gretchen: I have parents who will say to me, when I ask them about binocular vision dysfunction, they’ll say, “Oh, you mean convergence insufficiency.” Well, I don’t know what I mean because I’m not a diagnostician. A lot of parents have heard that, so they assume that that’s what I’m talking about. Can you explain what that means for our audience? I think it would be helpful for people to understand that that’s just one measure of a whole bunch of things we’re looking at here. It’s one that parents have heard, and so they tend to glom onto that particular term.

[00:26:52] Dr. Hopkins: Convergence insufficiency is a type of binocular vision dysfunction. It’s one of many different types. Binocular vision dysfunction is a broader, bigger term for just dysfunction of how the two eyes are working together. Convergence insufficiency is difficulty being able to pull the two eyes or to point the two eyes together inward, essentially. When we look off into the distance, ideally, both of our eyes are aiming straight. When we look at things up close, somebody’s going to turn this way, when we look at things up close, our eyes need to pull in to aim at things up close.

It’s not just the inability to be able to do it, but it’s the inability to be able to sustain, or the inability to be able to switch the flexibility to be able to look out and then quickly jump back in to look out and then quickly jump back in, which is simulate what our eyes would do in a classroom. When we’re reading up close for a while, sometimes you might have people and say, “Well, I don’t have convergence insufficiency because I can go ahead and I can do this. I can cross my eyes and bring my eyes all the way up here.” Okay, well, that’s fine. You could do it once. You could do it twice. Can you do it five times? Can you do it 10 times? Can you do it 20 times? Can you do it for over a period of 20 or 30 minutes as you would need to do in a book? That’s a very different story.

Yes, some people can do this for a little bit, but then they can’t sustain it. After a few pages of reading, they may experience strain or blurry, possibly doubling maybe. That’s what convergence insufficiency is.

[00:28:38] Gretchen: Well, thank you for explaining that. I always think it’s valuable for parents who are listening to this conversation to know maybe someone has said that to them about their children, for them to have a greater understanding of what’s happening with their child because that fatigue becomes so real. Is it possible to have vision skills regress? A child who perhaps has been through vision therapy, successfully negotiated vision therapy, but then have issues arise later.

[00:29:12] Dr. Hopkins: Definitely possible that that can happen. Think about it like a bike skill, like learning how to ride a bike. If they’ve been through vision therapy, they’ve learned the skills. The skills are there. Sometimes if we’re not using the skills for a while, like perhaps a person graduated from school and they weren’t having to read for a while, and then all of a sudden they got to get back into reading, that can happen.

[00:29:37] Gretchen: Or even over summer break.

[00:29:39] Dr. Hopkins: Yes, it can. I like to talk about visual skills a lot, almost like exercise or maintenance, if you would, or even brushing your teeth. You don’t brush your teeth once and then say, like, “Okay, yes, I did my goal, and I don’t ever have to brush my teeth again.” I go work out, and I’ve toned up, and I’ve got to this certain weight, you’re not done forever. You still got to have some maintenance. You still got to do some of that work to build that or to make that habit or to keep it as a habit.

[00:30:12] Gretchen: Well, you have provided us with such terrific information today. What questions should I have asked you that I haven’t asked?

[00:30:21] Dr. Hopkins: I think going back also to you about why the cost of vision therapy, why it’s so expensive. Vision is our dominant sense for most of us. We use vision, and we don’t think about this because we take vision for granted, because it’s unconscious when it’s working for us. When it’s not working for us, that’s when we feel it. When vision’s not working for us, we use vision to guide us as far as how we move through space and how we walk through life and so much. Isn’t it valuable because of that? Also, and again, I mentioned just how dysfunctional vision can affect a child’s trajectory later on in life potentially. That’s so important. We want to try to give our children just max potential if we can.

The second thing also, too, is just the programming and just the education that goes into learning about vision therapy. It’s not something you can just have a book and just learn it from a book. There’s years and years of learning this and understanding this that go into it, and then also training the therapist to do it. There’s continuing education. You can’t just go to just some random building or some place that offers this type of education. It’s very specialized groups that will offer this education. We typically have to find a way to get there essentially to have that education, and then to also make sure that we have the time to train our therapist and to pass on that knowledge as well.

There’s a lot of time. It’s not just the time that’s spent with the child in therapy, but it’s also the time outside of the actual therapy session itself. There’s a lot of time that goes into programming and planning vision therapy for the children.

[00:32:22] Gretchen: You also have to tailor each program to the child in front of you because each one is going to be different.

[00:32:30] Dr. Hopkins: Right. They’re going to respond differently to different activities, especially– a younger child is not going to be able to do the more cognitive type of activities that an older child or an adult would. The older adult will probably still like the games that the younger kids will do, but the younger children, we’re going to need to have more age-appropriate activities.

[00:32:54] Gretchen: In your personal journey, you became a doctor of optometry, but then because you chose to go into this specialty, that was what? An additional three years of training?

[00:33:04] Dr. Hopkins: Going through optometry school is four years. I did a residency specific to vision rehabilitation. That was a year after that. Everything that I know now has been decades of learning. It wasn’t just like a program of like, “Okay, I did this and then now I know everything.” I’m constantly going to meetings and meeting with other colleagues and learning from them. It’s ongoing. It really is.

[00:33:32] Gretchen: Absolutely. Well, as we learn more about the neuroplasticity of the brain too, I would expect that every time you think you’ve arrived, you find another journey you have to go on.

[00:33:43] Dr. Hopkins: You know what? It is so true. It is so true. Yes.

[00:33:49] Gretchen: I want to thank you so much for spending this time with me. This was just such a valuable conversation. The thing I want to leave parents with, and then I’ll ask you for your final thoughts, is I want parents to understand this is as vital as oxygen to get a diagnosis, to get a resolution. Because when your child struggles, it hurts your heart. It’s so important to level the playing field. It’s so important to level the playing field for our children and to see that they have every advantage. I can’t imagine that you would have ever had a parent say that it was not worth it to be able to remediate their child and help their child to be able to see more clearly.

[00:34:35] Dr. Hopkins: I would think a good source to give them would be the doctor locator. The international group that does the certification for doctors and therapists for vision rehabilitation is OVDRA. It’s the Optometric Vision Development Rehabilitation Association, formerly known as COVD, which was formerly known as College of Optometrists and Vision Development. The website is still www.covd.org. If you go there, you can find a doctor locator for the closest doctor who can do– What this is, the evaluation that’s needed to examine or evaluate all the visual skills needed to learn in school is called a Optometric Developmental Examination. That’s what you’re looking for.

[00:35:31] Gretchen: I will tell you, as a parent who has gone through this with four different children now, one of my children as an adult was in a head-on car accident, and she lost her peripheral vision after that car accident. She needed someone like you to help restore that peripheral vision for her. It’s not just necessarily a reading dysfunction that we’re looking for, but we’re looking for the health of the whole child.

I have had the privilege now to know you for a couple of years and refer families to you and hear how families have done, how successful they have been, and how grateful they have been to make your acquaintance. I just want to say thank you in the middle of a day when you’re working with patients to be able to step aside and come and have this conversation with me. I don’t take it lightly, and I’m very, very grateful that you were willing to do that.

[00:36:27] Dr. Hopkins: Thank you so much, Gretchen. I really do appreciate your passion on all this. I told you earlier, but I truly mean it, Gretchen, that you really inspire me with the passion that you have about this.

[00:36:42] Gretchen: I just want to see the kids be successful. I know that this is the key to a lot of locks for a lot of kids. Thank you so much. I really appreciate it. I appreciate your time. I want to thank our guests who’ve listened to us today. I hope you find virtue in this. Dr. Hopkins’s contact information will be included in the show notes, but she may not be geographically where you need her to be. Again, that doctor locator, we’ll make sure that’s in the show notes as well because you want to find someone who really knows what they’re doing to remediate this successfully. Thank you all so much for joining us today.

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