Behavior Issues at Daycare Led to a Surprising Diagnosis: Tyler’s Story

By Jade Waddy

When teachers told Leah Cole her then three-year-old son, Tyler, was having behavior issues at daycare, she was caught off guard by the information. “It just wasn’t how we raised him or his sister and we really didn’t know what was going on,” said Cole. “We were told he was hitting and kicking and it just was not like him.”

Cole talked to Tyler’s pediatrician about his behavior and his pediatrician suggested the family continue to monitor him. Tyler continued to have issues in daycare and after several visits with his pediatrician, Cole decided to take him to visit an optometrist.  “We decided to have his eyes checked because we noticed Tyler had been blinking his eyes more than usual,” said Cole.

The optometrist informed Cole that Tyler was legally blind in his left eye and partially blind in his right.  “Since he was so young, he struggled with verbally expressing what he was experiencing so diagnosing his vision issue helped us understand why he was so frustrated,” said Cole.

Tyler received glasses for his vision and Cole noticed slight improvement in his behavior. However, Cole, a licensed occupational therapist at TIRR Memorial Hermann, continued to notice problems with her son. “I decided to record him walking one day and I noticed he had significant inward rotation from his hip with his right foot and was slightly slumping over,” said Cole. “I shared the video with my colleagues and they suggested getting a recommendation for a pediatric physical therapy evaluation.”

In addition to a physical therapy evaluation, Cole also requested to have a neurological evaluation which included a full spine and brain scan in order to rule out neurological issues for Tyler.

Diagnosed with a Rare Spinal Disorder

During the scan, neurologists discovered a two centimeter arachnoid cyst on his cerebellum and a cyst in the center of his spinal cord that was the length of five vertebras. Tyler was diagnosed with Syringomyelia, a rare disorder in which a fluid-filled cyst forms within the spinal cord causing pressure on  parts of the spinal cord. The disorder can lead to pain, stiffness and weakness in the extremities, shoulders and back.

“It’s uncertain as to how he developed this disorder. It could have happened as he was growing after birth or in utero,” said Cole. “Doctors didn’t see an immediate need for any medication or surgery but they thought physical and occupational therapy would benefit Tyler.”

Tyler was assessed by Dr. Stacey Lynn Hall, pediatric physical medicine and rehabilitation physician affiliated with TIRR Memorial Hermann. Hall completed numerous tests which confirmed the need for physical and occupational therapy. “Tyler had history and examination findings that led me to believe that he could make meaningful improvements with physical and occupational therapy,” said Dr. Hall. “His resilience and hard work paid off. He now has improved endurance, strength, as well as balance and coordination. I am really proud of him.”

Starting Therapy Close to Home

Tyler began physical and occupational therapy at the Pediatric Outpatient Clinic at TIRR Memorial Hermann-Greater Heights, close to the Cole family home. His therapy included significant focus on increasing his strength and endurance on his right side.

“Tyler had a tendency to favor his left leg over his right, so physical therapy focused on general strengthening and forced use of his right leg to improve his strength,” said Lauren Bagley, Physical Therapist II at TIRR Memorial Hermann Greater Heights. “Physical therapy also focused on coordination and higher level balance activities that could be incorporated into age appropriate and fun play! Tyler just needed that extra bit of confidence to do more challenging tasks, and he did wonderfully!”

In addition to physical therapy, Tyler also benefited from occupational therapy sessions. “I saw Tyler for several sessions focusing on his visual strengthening, upper body strengthening, and overall coordination,” said Charita Givhens, Occupational Therapist at TIRR Memorial Hermann-Greater Heights. “Tyler was always very excited to participate in every activity planned every treatment session. Tyler and his family were a joy to work with, and always open to suggestions from therapists. Daily compliance with home exercise program, and encouragement from his therapists, helped Tyler make great overall progress in therapy.”

Therapy Led to Physical and Social Changes in Tyler

Throughout his therapy sessions, Cole noticed positive social changes in Tyler due to the improvements in his strength on his right side. With the improvements due to therapy, Cole noticed Tyler using his right side more and also a stronger desire to keep up with his friends while running and playing. “The therapists were exceptional with Tyler and his issues as they could see so many things that I couldn’t see,” said Cole. “Even though I am a clinician, they could see so much of what I wasn’t seeing in my own son.”

“Prior to therapy, Tyler would just say ‘he can’t do it’ and ‘that it was too hard’ but his therapists really empowered him to try,” said Cole. “Tyler’s therapy team exceeded all of my expectations with customer service, approachability, thoroughness, and their willingness to educate me on what they were seeing and their concerns.”

For now, Tyler will continue annual visits with Dr. Hall and his neurosurgeon to monitor the cysts on his spine. Now that Tyler is 4 years old and getting closer to starting kindergarten, the Cole family is thankful for the improvements and for finally being able to understand what he could not verbalize. Through therapist recommendations, Tyler is now playing tee ball and is continuing at home therapy exercises.

To learn more about the pediatric rehabilitation services at TIRR Memorial Hermann, visit


  1. So proud of Leah and Matt in doing every thing recommended for Tyler. He is a precious little boy and very loved by the family including me. His diagnosis frightens me but I am very grateful to the doctors and therapists at TIRR who do amazing things for their patients.

  2. I was so fortunate to be one of Tyler’s teachers. Tyler is my baby. I commend Leah and Matt so much for not stopping until they found out what was going on with Tyler and when I was told of the diagnosis, things started to make sense. It’s wasn’t easy what they had gone through but they stuck with it, got the answers and I am so glad that he is getting help. He is a sweet heart and I know he is going to be just fine.

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