Gifted Issues Discussion homepage Forums Twice Exceptional Dysgraphia Testing?

I am currious how your children were tested for dysgraphia? Mine has been confirmed to have dyslexia, but there really are lots of things that point to dysgraphia too. They did take a writing sample when I first had him screened. Even though the psycologist couln't rule out dysgraphia based on the writing sample, they scored it in the average range. I am not sure how that is possible when there were lots spelling mistakes, inversions, spacing, punctuation issues, etc. My son is really struggling with writing. He is in the 5th grade. He has a hard time getting his thoughts on paper and gets fatigued really quickly. What is the difference between dyslexia and dysgraphia? Is there a reason to have a confirmed diagnosis for both?

Thanks so much for your help.

Welcome to the forum cathy! Was your ds diagnosed with dyslexia through a neuropsych eval, through private reading specialist testing, through the school, or other?

FWIW, I have a child with dysgraphia and another child who is dyslexic, but my dysgraphic ds is not dyslexic and my dyslexic dd is not dysgraphic - although her handwriting looked dysgraphic early on, and she continues to be extremely challenged with spelling. The differences in handwriting that were very noticeable between my dysgraphic ds and my dyslexic-but-not-dysgraphic ds were/are:

* handwriting caused wrist pain for my ds - he didn't say his hand hurt when he was little, but he would rub his wrist frequently while writing and refuse to write for more than a few minutes at a time.

* my dysgraphic ds had a very odd pencil grip and weird posture while writing (before he went through handwriting OT). He would bend over his paper, and also hold the elbow on the hand he wrote with using his other hand in order to keep his arm steady.

* my dysgraphic ds made (and still makes) tons of mistakes when copying, either from the board or while doing a math problem etc. This didn't seem to be an issue for my dyslexic dd.

* papers handwritten by my dysgraphic ds, in early elementary prior to handwriting OT, were extremely messy - crumpled up, soft-dark pencil marks etc - due to uneven pencil pressure.

* most significantly, handwriting caused my dysgraphic ds a *ton* of frustration and it didn't really seem to bother my dyslexic dd, it was just sloppy and full of reversals and misspellings etc.

* there was a notable difference in ds' verbal output vs written output - significantly different. My dd, otoh, could write for a longer period of time and the sentences she composed sounded like the things she would tell us verbally.

The similarities in their handwriting were: in early elementary, both had very sloppy handwriting, uneven spacing, mixing up caps and lower case, letter reversals, and lots of challenges with spelling. Around 3rd/4th grade they *both* had a sudden increase in handwriting legibility, but both continued to reverse letters and numbers.

Another thing that has come up as they moved along in school: my dysgraphic ds had fluctuations in test scores before he was given accommodations for handwriting while testing, but the fluctuations clearly tracked where you would expect a handwriting-challenged person to have issues. My dyslexic dd has test scores that fluctuate all over the place and don't seem to have any kind of reasonable pattern. From working with her on homework, my suspicion is that the variable test scores are related to challenges with reading.

Re testing and getting a diagnosis:

My dysgraphic ds was diagnosed through a neuropsych eval. If your dd has had a neuropsych eval, you can look for a few things in the test scores: a discrepancy greater than 1.5 SD between processing speed subtests on the WISC (coding, symbol search) and the other WISC subtest scores. A similar discrepancy on WJ-III etc achievement subtests if you separate out the tests that require oral vs written response. Discrepancies or low scores on tests of visual-motor skills (Beery VMI is a commonly used test for this and helps determine if a challenge is related to visual processing or fine motor skills). There are tests called "finger tapping" which are used to diagnose fine-motor related dysgraphia. Although our neuropsych didn't use this type of test, you can also time how long it takes to produce handwriting and there are a lot of sources for comparing letters/minute to grade level expectations. All of these tests (except handwriting speed) were used in combination with a look at ds' handwriting samples as well as the parent interview where I was asked questions about behaviors etc surrounding written work (things like holding his elbow, frustration, refusal to complete worksheets we knew he knew how to do etc). DS' dysgraphia is also severe enough that you can watch him writing and realize something's up - he is just extremely extremely slow.

DD's dyslexia diagnosis was made through a reading specialist prior to neuropsych testing. The challenge that impacts dd's ability to read is clear from her ability testing. OTOH, when she later had neuropsych testing, her scores were not easy to directly translate into scores impacted by reading challenges and the discrepancies between high and low scores didn't fit into easy-to-correlate patterns. As I mentioned earlier, the scores on neuropsych testing were clear-cut for ds - it was obvious that his low scores were directly related to timed tasks requiring handwritten output. I am not sure if dysgraphia would have been as noticeable through neuropsych testing (the achievement vs ability testing) for dd as it was for ds, simply because the reading challenge seems to cause an added layer of complications in interpreting the test scores. Some of the tests, such as the Beery VMI and the finger-tapping tests, wouldn't be impacted by reading challenges.

FWIW, it sounds like dysgraphia might be an issue for your ds. We've seen in both dysgraphia and dyslexia in our extended family, sometimes occurring together in the same person.

If you can let us know more about the testing your ds has had, it might help us with further advice.

Best wishes,

polarbear

I'm still wondering about dysgraphia for DD. I took her to an OT who gave her the BOT for fine motor (which tests coordination as well as visual-motor ability, copying patterns, etc). And she did fine. But when you look at her writing, like copying spelling words, she makes tons of errors. She catches them though, and writes over the errors. She doesn't like to erase. So it looks like a mess. There are some letters or words that she writes over about 5 times.
I was talking about this to the OT so she told her to write the alphabet. With some letters she hesitated a few seconds like she was trying to figure out how to write them. Or she would start writing them, do it wrong, stop, and write over them. Her handwriting does look very neat when she is trying, so it is very inconsistent.
The OT didn't seem to think her alphabet writing was abnormal in any way, although it didn't look normal to me. So we are back at square 1.
Her coding score on the WISC was an 8 so there was something like a 60 point gap between processing speed and GAI.
The 504 coordinator for the building wants to write a 504 for processing speed, but just have modifications like increased time to do work. I don't know if this is sufficient if the problem is dysgraphia.
One of the other OTs told me that if you trace a number or letter on the back of a child and ask them what you wrote (with your finger) a child with dysgraphia would have trouble figuring it out. DD didn't have trouble. Not sure how "accurate" that test is.

This the first time I'd ever heard of this... and fwiw... my first thought was... I couldn't possibly id a letter traced on my back, and I'm for sure not dysgraphic lol! Seriously, though, dysgraphia means there is a disconnect in the ability of the brain to control either fine motor or visual processing in a way that prevents a child from developing automaticity of handwriting. I don't see any connection with how the brain interprets a letter traced by someone else on your back, other than demonstrating that the brain is recognizing the form and able to remember it as it is traced - *by someone else*. I don't think it really touches at all on the issue of dysgraphia.

polarbear

Sorry I'm replying a bit backwards to your post - the thing with the tracing on your back just sorta jumped out at me lol!


Can you define "fine"? Does BOT stand for something like Burtenesky? I'm sorry I don't have time to look it up right now, but fwiw when my ds was assessed using the Burtenesky (sp?) his fine motor skills were all above average (if I remember correctly) - but the Burtenesky isn't assessing dysgraphia, it is assessing fine motor skills and the ability to use fine motor. I know that *sounds* like dysgraphia but it isn't the same thing. Many dysgraphic individuals are able to draw amazingly well (my ds included) and have the ability to do other fine motor tasks well, but the act of handwriting falls apart because of the complexity of the task and the need to develop automaticity. So what you learn from the Burtenesky is the potential for the dysgraphic person (if they *have* fine motor dysgraphia) to benefit from handwriting OT. If a person scores average or above, then there is a chance that handwriting OT will be successful - it won't take away the dysgraphia (which is a whole 'nother post re why it's important to keep that in mind), but it can help with developing legible handwriting, good posture, reduce wrist pain etc. If a person scores very low on the Burtenesky, I think that is most likely an indication that they don't have the fine motor skills potential to benefit from handwriting OT.

It's also a good idea to look at the scores on the Burtenesky to see if there are discrepancies. My ds had large discrepancies on it - so while his scores were all technically above average, there were some that were high and some that were hovering right at average.



I wouldn't take this alone as a sign of dysgraphia - and this is one reason that sometimes dysgraphia is tough to identify. Lots of kids your dd's age (at least a lot of the kids in my kids' classes) have sloppy handwriting, make mistakes when writing, and don't like to erase. It looks messy, but it doesn't necessarily look different than many other neurotypical students' handwriting if the dysgraphia isn't hugely severe. One thing you might want to do though, is to look back at your dd's early early elementary writing samples if you still have any and look for signs of dysgraphia there... as well as look at how your dd's handwriting has improved over the years - do you think it's steadily improved or stagnated?


My suggestion to add some info to what you were trying to look at here is to:

1) Have your dd print the full alphabet out, upper and lower case, in order, and time her. Calculate her letters/minute and compare that to other students her age and grade (you can find that info by googling things like "letters per minute + 5th grade"). My dysgraphic ds comes in significantly below grade level on this task.

2) Ask your dd if she has to think about how to form letters when she writes. My ds will tell you he has to remember things like where to start his letters etc, and that he likes numbers better than letters because there are only 10 of them to remember. Neurotypical kids don't make comments like that!


My ds' handwriting also looks neat when he's not stressed or hurried. What's important to look at though isn't the legibility of the handwriting as much as the *content*. Is she still making punctuation or spelling errors? Reversing letters? Mistakes when copying? Is the written content comparable to the output she'd produce if talking or recording or typing? *THOSE* are all signs of dysgraphia - when a child doesn't have automaticity of handwriting and has to consciously rethink how to form letters as they write, they run out of working memory that is used by nt folks to take care of all those other tasks.


IMO, this is the biggest red flag for dysgraphia you've mentioned. You will no doubt read or hear that a discrepancy between processing speed and VCI/PRI etc is not uncommon, especially in gifted children, but the magnitude of the gap combined with the issues you listed above all suggest, jmo, that it would be worthwhile to have follow-up testing specifically looking at dysgraphia. The tests I'm thinking of are tests a neuropsych would typically offer as part of their eval, with the goal of understanding why the coding speed was so much lower than other subtest scores. The Beery VMI is one of the tests that is typically given, as well as finger-tapping and other executive functioning tests. Has your dd had any of those through her previous testing?

polarbear


The 504 coordinator for the building wants to write a 504 for processing speed, but just have modifications like increased time to do work. I don't know if this is sufficient if the problem is dysgraphia.
One of the other OTs told me that if you trace a number or letter on the back of a child and ask them what you wrote (with your finger) a child with dysgraphia would have trouble figuring it out. DD didn't have trouble. Not sure how "accurate" that test is. [/quote]

I thought the letters/numbers on the back was strange too. I tried to google it and didn't come up with anything.

Here's a description of the test that was done. http://www.pediatricapta.org/events/ACP/2012/handouts/pedsfwdcampbell2/BOT-2MG.pdf
I think that her lowest score was something like 24th percentile for manual dexterity and it involved things like picking up and transferring coins, maybe placing pegs in a board. I don't remember. But she was also quite yappy and off-task during the test since she wasn't fully medicated. So she was talking/giggling while she was doing the test and some of it was timed. Overall the OT thought she did very well and they (there were two of them) did parts of the tests with her that most kids never get to. I asked for a score report and never got it. I should ask again. I asked if it's possible she could do well on the BOT2 and still have dysgraphia and didn't really get a clear answer but I don't think she thought that was a strong possibility.
I think that in the past I tried to google how fast she should be writing and didn't come back with much but I will try your suggestion.
I am taking her to a new primary doctor tomorrow and will ask about this. I really want to get some input on the ADHD as well. I know there is a large overlap between ADHD and handwriting issues too, and she does seem to do better with writing when she's medicated. I think seeing a neuropsych is a good idea but I also need someone who can prescribe medication.
So far she's just had the WISC and the BOT2 for fine motor. Also the BRIEF for executive functioning, and of course that was abnormal because of the ADHD. I think her overall fine motor is good but the finger tapping doesn't look quite right to me. Of course, I have no idea what's normal for her age either.
The OT did say she qualifies for services (because of the abnormal BRIEF) and that she can do "metronome therapy" with her and other things to boost processing speed. But I don't know if that's supported by research or if it would be a waste of time/money.

We have never had any fine motor skills test done or the test you described. We have a processing speed issue, timed versus untimed. He does much better on untimed. Regarding the writing, I would say he has gotten better over time. He is now 11. When he wants to write neat, he uses alot of brain power. He takes a long long time to copy and is extremely fatigued once he does. He also still has spacing issues, writes his letters pretty big compared to peers. Upper and lower case letters are now proportioned, P B D and G being the biggest culprits, the ones he used to invert but doesn't anymore. The biggest thing I noticed is how he writes the least possible words he can. The physical task of writing anything makes him really tired. He has gotten faster as time has gone on. Should I try the timed alphabet thing? Would that give me some useful info? It sounds like we really didn't get a screening for dysgraphia at all.

Thanks for the great responses.

Sorry not proportioned...writing looks off. Also, lots of spacing between words. The letters take up multiple lines. It defintiely still looks a little different than his 5th grade peers. His teachers are also mentioning that he is fatigued during the day. I know about the dyslexia, reading thing, but is writing also dyslexia, or is this something different? He also was never diagnosed as ADD, but his teachers notice him not focusing and tuning out alot. I really think this has to do with his being extremely tired from writing, let alone reading. What do you think? Is it worth more testing?

I will add that if you're thinking dysgraphia, that word can also be too narrow. We have one who is not technically dysgraphic, but sure looks like it-- it's actually Developmental Coordination Disorder and ADHD that cause most of his issues.

ITA with DeeDee - I only mentioned the dysgraphia-specific pieces of my ds' eval above, but fwiw, the fine motor issues that result in his dysgraphia are actually due to Developmental Coordination Disorder. DS has a dysgraphia diagnosis, but it's DCD that best defines his overall set of challenges.

FWIW, when my ds was still struggling in the classroom without appropriate accommodations and remediation he often zoned out - he's told me since then that the issue was when he was sitting during writing sessions with no idea what to put on the paper and/or when his hands hurt from writing he had nothing to do and no idea where to start, so anything and everything else in the classroom would distract him - he'd start thinking about some really goofy things! There were times when it felt like the chicken-egg thing with advocating for him - we knew he was distracted because he didn't know what to do, and the school claimed he didn't know what to do because he was zoning out. Once we had handwriting accommodations in place and were able to give him specific instructions in writing the daydream-zoning-distraction issues disappeared.

He does get very fatigued, both by the physical part of handwriting and because of the enormous amount of brain work and concentration it takes him to write legibly when he has to use handwriting. My dyslexic dd gets incredibly fatigued from reading - really, I think we all get fatigued from having to work at things that are difficult to us. The letters you mentioned above were the toughest letters for my ds to write correctly when he was your ds' age.

polarbear

Ok, I was playing around with both my kids, and ended up doing a timed writing test for fun. He had no idea, I was trying to gather information. I had him write the ABC's for a minute to see how many letters per second he could write. He is 11, just turned in October, and was able to write 55 letters per minute. From what I can tell from googling it. This is normal? However, there was a huge range. My 7th grade daughter was able to do 100 plus. I also pulled up some information about pencil grip. He has the four finger grip. I am not sure if this is something that is a problem or not.

There is definitely a visual spacial thing going on with his writing, lack of margins, lots of space between words, large letters, some mix up of lower and upper case, not being able to stay on the line without alot of effort. He also takes a long long time to copy things. However, if I read them to him and he just writes, he does much better. Reading off of one paper and copying on to the other, is an extremely exausting time consuming task for him.

What do you think? Just dyslexia with visual spacial things or possibly some dysgraphia sprinkled in?

I'm trying to pinpoint the "fatigue" thing. They asked me about add and adhd yesterday, but I really don't think he has any of that. I think he is tired and zoned out because of what you describle polarbear. He doesn't know how to even get started with what they want him to do. I had a long conversation with the school about that too. Give him smaller more manageable tasks he can complete and be successful at and built up. Don't say, write this..and wonder why he is daydreaming.

Have you considered a vision test from a Vision Therapy doctor? My 8 yr old had some problems with writing, staying on the lines, not seeing all of the numbers in a math problem, etc, and she was diagnosed with Strabismus (very slight) and a convergance problem. She's getting eye therapy and has improved quite a bit. Just a thought that it might be eyes and not motor skills or brain-related.
http://www.covd.org/?page=Symptoms

Yes, I did have vision tested with a regular optometrist. Nothing was found. He does really well in math, no problems.

cathym, I don't have time to google around, but did a quick search and the first link I found re lpm showed 55 lpm to be 4th grade avg level.

FWIW, I have a dd who has vision issues (muscle weakness, very similar to strabismus), and she tested a-ok at the regular optometrist with 20/20 vision in 3rd grade, but was struggling with reading in school. She went through a neuropsych eval and the neurospcyh's firs comment, when looking at her handwriting samples (before the actual testing) was "Oh wow, you have another child with dysgraphia!" - due to irregular spacing and generally very messy looking large print (this is the same neuropsych who diagnosed my ds who does actually have dysgraphia). DD's actual testing showed she did *not* have dysgraphia but had a vision issue - she totally bombed two of the WISC subtests that rely heavily on vision, and one of the Beery VMI subtests. If your ds hasn't had the Beery VMI, it might be really useful to separate out whether or not there are either fine motor or visuo-motor challenges. Both can cause dysgraphia or other challenges that potentially impact handwriting, but knowing which is at the root of the challenge is really helpful in approaching how to remediate and also in setting up accommodations.

FWIW, my dd with the vision issues didn't appear to have any issues in math at all - in fact, it was her favorite subject at the time (she's since changed her mind lol!).

polarbear

I also wanted to come back to this (again!) to mention something I didn't think to mention previously - it's really helpful to have the neuropsych eval and be able to know - is it dysgraphia, is it DCD, is it something else... For instance, most students with dysgraphia are able to use typing as an accommodation and they take off and fly with typing. For my ds with DCD, the DCD impacts his typing ability as well as his handwriting ability - so typing *is* faster than handwriting and it is an accommodation he uses and needs, but it doesn't give him speed, and we've been told he'll need to move to voice-to-text eventually.

polarbear

Thanks everyone. This is very helpful. I really knew so little about the testing when I got it done over a year ago. I received the test results and diagnosis of dyslexia, but never really understood the individual testing results that much. I am now looking at the additional challenges we have had as he gets older and what is not being corrected by itself. We do have intervention for dyslexia, Wilson Method, but have done nothing else for any other issue.

So, help me with this. I know he didn't get a "dysgraphia" screening. His processing speed shows up as 67th percentile total, comprised of 37%ile visual matching, decision speed 88th, and rapid picture naming 42nd. The diagnosed him as dyslexic based on large discrepency between IQ and reading performance, decoding, spelling etc. There are more tests on this report. However, what does this processing speed mean?

How do they test for ADD? Is processing speed part of it? I do notice him zoning out and me having to repeat directions to him. I just thought it was an 11 year old boy thing. I have to repeat myself alot. They see that at school too sometimes.

Thanks for the info about DCD and vision testing. I am trying to get an idea of what to look for because it seems like more is going on than just dyslexia and reading.

It sounds like your ds had the WJ-III Cognitive Abilities test from the names of the subtests you mentioned. My ds has had both the WISC and the WJ-III Cog, so here's what we saw that pointed to dysgraphia in each:

WISC - Processing Speed score (combined score), Coding was low (around an 8, median is 10, all other subtest scores for ds were way high).

WJ-III - Most scores were really really high, some were scattered around but still high, and visual matching was down around 34th percentile.

I don't remember the specifics of the visual matching subtest, but I believe it's the test on the WJ-III that most closely correlates with the coding subtest on the WISC. The coding subtest is timed, and requires the child to copy symbols that have a directional component to them. It's not an easy task for a dysgraphic child. I don't know that it would be an issue for a dyslexic person - my dd who has a dyslexia diagnosis actually gets a relatively high score on this type of test.

If I have time later today I'll pull out my ds' WJ-III test scores and see what his scores were for rapid picture naming and decision speed.


Reading performance is measured from the achievement tests not the cognitive tests (IQ is derived from the cognitive WJ-III). There are typically additional reading-skill-specific tests for decoding, spelling etc in a dyslexia screening.


My understanding (and 2 of my kids have been screened for ADHD, my ds has been screened three times), is that a low processing speed score isn't used to diagnose ADHD, but it is often lower than other subtest scores in children who have ADHD. However, it can be lower for many other reasons too.

I am sorry I can't remember back to the beginning of this thread - but did your dd have private testing when she was diagnosed with dyslexia or school testing? If she hasn't had a private neuropsych eval, it might be really helpful to pursue one.

Best wishes,

polarbear

The dyslexia was diagnosed with a private neuropsych evaluation. I really went there with mostly reading issues, but that was end of 3rd/early 4th grade. We were screened for ADD but they didn't think further screening should be pursued. The writing problems weren't really looked into at that time. Now his school is asking if we screened for ADD. I really don't think that is the issue.

Issues in school are:

writing
reading - decoding/spelling
spelling
grammar
daydreaming/zoning out
organization
turning in work

It seems like lots of diagnoses have similar symptoms. I think maybe switching to keyboarding might be a good idea for him. Also, changing the expectations and helping him with organization.

I really don't want to pay for additional testing, but will if my son would benefit from another therapy. Also, I just checked, my vision screening did check for those issued. My sister is an optometrist, so it was easy to ask her