Gifted Issues Discussion homepage Forums Twice Exceptional how important is a correct diagnosis

I posted recently in the scores forum about my son's recent testing. In the discussions about his scores, his 2e status with a sensory processing diagnosis came up (his processing score is at least 50 points lower than his verbal score) and someone mentioned dysgraphia as a possible issue, either rather than or in addition to sensory processing problems.

DS will be getting OT both at school and outside (we have an eval with an outside facility next month). He is on an IEP and will be having accommodations in class. All of this is wonderful. But I'm suddenly wondering if the dysgraphia angle was explored fully, and if not, if a fully correct diagnosis is needed there? Is that something an OT diagnoses, or a psychologist?

Thanks so much for your insight and patience - I'm pretty new to all this!! :-)

Dysgraphia is diagnosed by a psychologist. DD9 has a dysgraphia diagnosis, but she has made such strides in writing this year that I'm really starting to think that it may be another manifestation of her SPD, rather than a "true" diagnosis. (Current handwriting example, done for fun at home.)

If he's already got an IEP and receiving the appropriate services I'm not sure it matters much to have the official diagnosis.

Elizabeth, your dd's writing sample was just TOO cute!!!! Loved seeing it

But - fwiw - just because a dysgraphic child's hw starts becoming legible and looking neat doesn't necessarily mean the dysgraphia wasn't really dysgraphia or that it's gone away - you need to be sure that your dd is not only continuing to progress in how legible and neat her handwriting looks, but also be sure she's writing at a speed that is comparable to her age/grade level peers, and that there isn't still a discrepancy in how well she uses puncutation/spelling/correct grammar etc with hw vs keyboarding - as well as be sure that the stories and information she's getting down via hw are comparable to the detail and length of what she's capable of telling orally.

Dysgraphia is more than just legible handwriting

polarbear

Wow! her writing looks nice! The Eides said something like often times dysgraphia is caused by sensory integration problems and the hands not getting/giving the proper amount of sensory input or something? I am actually looking into that aspect with a therapy place with my son on Tuesday but just saying that you may certainly be on to something with that!

FWIW in my experience having official diagnoses does help. Whenever I get push back I pull out the official dx paper/reports/evals and push-back tends to melt away....I'd be nervous not having it as they are always trying to find a way to take away my son's accommodations by saying he doesn't 'need' it anymore.

Thanks for the caution, polarbear! I know that the dysgraphia is not just about neatness (or not). But she's much, much more willing to write than she was a year ago (as evidenced by the fact that she wrote that page just for fun!), and she's writing at an appropriate speed now, too. She still sometimes skips letters when she's in a hurry, but I think it's in an age-appropriate way. She can still "tell a better story" orally than she can in writing, but isn't that age-appropriate at 9 anyway? Or am I inferring too much from the fact that I would talk your ear off at that age but avoided writing?

In some cases, I'd agree with this. Here I wouldn't agree, because understanding the correct diagnosis is needed to understand what's needed long-term for accommodations and remediation. If this is SPD, there's a chance that OT is going to remediate the issues with handwriting fully and accommodations aren't going to be needed long-term. If it's dysgraphia, chances are good this child will need to rely on keyboarding or voice-to-text for the majority of written work moving forward in school and life, and getting a head start on that is important.

Having a correct diagnosis and understanding potential symptoms/challenges associated with it can also help you ferret out information from a younger child - for instance, hand and wrist pain are sometimes associated with dysgraphia. We didn't have a clue that our ds' wrist hurt when he wrote, but once we knew to ask about it, he told us absolutely it hurt! It's just that being only 8 years old, he didn't anticipate that we, as his parents, didn't already know that. My dd otoh, had some fairly severe sensory challenges and went through sensory OT as a child. I don't remember pain ever being mentioned as a potential symptom - so if our ds had been diagnosed with SPD and not with dysgraphia, we never would have asked about the hand pain.

Having a correct diagnosis can also be important for helping a child understand what's going on with themselves.

On the flip side, I can't really see a situation where having a diagnosis is going to hurt or cause harm in any way, so if there's a question I can't imagine it wouldn't be a good thing to move forward and really get to the root of a diagnosis.

polarbear

ps - fwiw, my ds has some sensory challenges too which I understand from his neuropsych are part and parcel of his overall diagnosis (Developmental Coordination Disorder) - I don't think it's unusual to see both dysgraphia and SPD in the same child.

This is another good reason to have an official diagnosis, and having the correct diagnosis is going to help when you're advocating, because even with the official diagnosis, many of us have to advocate like crazy and be able to show examples of how a diagnosis is impacting our child - having the incorrect diagnosis or missing a diagnosis isn't going to help with advocacy.

polar

Elizabeth - I didn't mean to suggest that your dd does (or doesn't!) have dysgraphia, just wanted to point those things out to other parents who might be reading and hadn't been through the journey yet

I do think it's something I'd watch with her though - it's really tough to tell sometimes in those early elementary years what's a challenge and what's completely typical development. If she starts struggling again when middle school and larger loads of writing demands start happening, I'd look at the possibility of dysgraphia again.

Best wishes,

polarbear

I'd think the closer you are to the core diagnosis, the more accurate the therapy will be. At a symptom basis my DS could be diagnosed with dysgraphia and visual processing disorder, but it is more hand eye coordination delay because of his vision issue. Now that the vision and amblyopia is corrected we are anticipating the other aspects to catch up (though literal catching may be a ways off, if he ever learns to not flinch.)

So some visual work and hand-eye work is his current path. If we don't get progress then we'd seek a formal diagnosis to get accomodations and OT.

Yup , yup and yup to each of polarbear's posts! But how awesome that she is better and not as reluctant... so WISH for that for my son. It brings tears to my eyes just thinking how over the moon I'd be if I could report the same in two years (regardless if he has dysgraphia or not, ykwim?)

I hesitate somewhat to post this, since I am treading in unfamiliar territory here, but I am VERY sure my DD9 does not have dysgraphia (she has beautiful handwriting, draws beautifully, and produces voluminous writing) but I would say she probably still can tell a better story than she can write. She's very verbal and the words just spill out a lot faster and more fluently than she could write them down. At the same time, her writing is way above grade level as well.

My DD8 also has a 50+ point difference between her processing and verbal scores. At our IEP meeting the other day the district ordered several new evaluations, including a Sensory Integration evaluation. She has been getting OT in school for more than a year and had been getting it privately for more than a year before that. She has had 2 neuropsych evals as well as a full eval by the school psychologist. It was the Assistive Technology evaluator that recommended this evaluation. Obviously we don't know yet what the results will be but if there is a possibility that there is a sensory issue that can be addressed to help overcome the challenges she faces you bet I want to know.

(By the way I don't think we really have a good diagnoses at this point. The neuropsych diagnosed dyslexia, dysgraphia, dyspraxia, math disability and anxiety-nos along with verbal scores above 99th percentile. He put them all under an umbrella of "Nonverbal Learning Disorder -ish". She doesn't really meet the criteria for NLD but "it's a useful diagnostic concept." He also labeled ADHD-Inattentive which we totally disagree with - we think he simply measured the results of her shutting down from anxiety. Yes I want to get a correct diagnosis but at least for now we have specific issues identified and are trying as best as we can to have them addressed.)

Dysgraphia diagnoses aren't made simply on speed of oral vs written fluency - I suspect telling stories orally is faster for most kids at that age (or any age). Typing is also faster for almost everyone than handwriting is - that's not the same thing as dysgraphia - and that's one reason why having a professional diagnosis when dysgraphia is suspected can be very important.

polarbear

What I mean is that it isn't just faster orally, but the detail is richer and it's more fluent, because she doesn't lose the thread due to having to write. I think this is generally true of younger kids. Which isn't to say anyone here doesn't have dysgraphia!--just that I was surprised that it would be considered typical to have written work be comparable to oral output at this age.

DD is in a GT school and I see kids who are soooo verbal and articulate in person but whose writing skills are just nowhere near that (DD's mismatch is less profound). Of course, maybe some of those kids are dysgraphic. I notice that writing is really all over the map for these kids.

Oral is compared to written for dysgraphic kids, but it's in combination with other symptoms, and the difference is much more profound than it is for typically developing kids. I'd describe my dd11 as a gifted writer - her words simply flow - beautifully, and she loves loves loves to create stories. Her handwriting when she's creating a story is much sloppier than when she's telling a story (and probably looks several grade levels below her current grade), and her spelling, caps etc all fall too pieces while she's writing a rough draft etc. She will add more detail if she creates the story by telling it than by writing. So - in a post, here, that may sound like a wee bit of dysgraphia, but it's not. She's been through a neuropsych for other reasons and none of her testing and none of the reviews of her writing samples hinted at dysgraphia. She has never in her entire life hesitated to write or complained about it. My dysgraphic ds, otoh, if you were to watch him compose with handwriting in real life - especially sitting next to a NT developing child - it's really obvious he has some type of challenge going on putting his thoughts down on paper.

There are also different reasons for dysgraphia (fine motor, visual processing etc) - and those reasons will manifest in other types of symptoms. For example, my ds wasn't able to learn how to tie his shoes until 4th grade. He is very slow with buttons and zippers - not just slow but the kind of slow that you notice slow. The lack of automaticity that is part and parcel of dysgraphia shows up in other areas of his life. He will tell you things like "I like writing numbers better because there are only 10 of them I have to remember how to make" (and he's 13 years old). His hand used to hurt like crazy when he wrote. Dysgraphics often need help developing a proper pencil grip. A ton of different things going on.

Sorry I hope that didn't sound like a lecture - it wasn't meant to be! Just wanted to explain better how there is a difference (very noticable usually) in dysgraphics output via hw vs oral/keyboarding etc - and how it's different than the difference you see in typically developing children.

Best wishes,

polarbear

ElizabethN, what do you think caused her to get so much better in her handwriting? Was it sensory integration therapy? Or simple OT therapy. My son doesn't seem to be progressing at all with regular OT.

Honestly, I think it was just maturation. It probably helps that she has accommodations for the SPD at school so she does not spend a lot of time in intolerable (to her) circumstances. But she's growing up and getting better at tolerating discomfort. I wish I could put it down to a particular type of therapy or something, but I think it's just taking a little longer than average for her to "grow into her own skin."

No worries! I realize I was sticking my head in where I didn't belong, which is always a foolish plan, really--just I thought, "Huh, DD can STILL tell a better story than she can write..."