Gifted Issues Discussion homepage Forums Twice Exceptional What to Address First?

I'm feeling a bit overwhelmed at choosing for my DS7 which areas to address first. The neuropsych report came with over four pages of recommendations. He was diagnosed with DCD, and most likely has dsygraphia -- although has not been officially diagnosed. I know that the more you can address when they are young, the more impact it can have. But where to start and how to choose? I don't want him overscheduled, and our insurance doesn't pay for anything so it is all out of pocket expenses for us.

Key areas we know where he needs help/therapy:
* fine motor - especially handwriting
* written expression
* gross motor
* sensori-motor
* core muscle strength
* coping skills
* visual-spatial
* being challenged academically - gifted pull-outs don't start at school until 3rd grade, and he was NOT challenged last year in any way

We have already decided to work with a learning specialist to help with the written expression as this is causing so much difficulty at school and really holding him back. She also does a bit of visual-spatial work with him as well as handwriting. Last year he was in OT for fine/gross motor, and then we switched it to a handwriting/social group. But we really can't take on that additional cost right now. He does a one day a week afterschool karate class (gross motor, core) and chess (visual-spatial / cognitive challenge). But I don't feel that these are often enough/intense enough to really help make much progress for him. I have enrolled him in a weekend gifted class which I think he will really like and should challenge him.

How do I choose? How do I not feel guilty that I can't give it all to him?

Not everything requires a therapist or instructor to make progress. Fine motor skills could be practiced with something like a Rainbow Loom or Legos or such. Core strength can come from regular calisthenics, stretching, and practicing his katas.

I don't know where I read it, but you ideally work from the middle out for writing; so, focus on core strength and writing posture first.

I would start by trying to ensure he has accomdations for writing. I am not sure what written expression problems are though but it sounds like both the physical writing and the organisational side of writing are a problem and they seem to ramp up quickly.

--teach him to type and be comfortable with writing software on the computer/ipad/whatever device.

--engage him in rewarding activities that work on the motor skills and core strength (swimming, martial arts, horseback riding, etc.). These don't necessarily feel like therapy, but they work like it. I think karate will be great for a kid like this, as long as it's an encouraging program (not hyper-focused on achievement).

I would not recommend stretching exercises for a kid with DCD until you've had an eval for connective tissue disorders-- stretching can make joint hypermobility worse.

I am right there with you on trying to fit it all in. Just found out I'll have my full report by Wed AM. And got a run down. It's still overwhelming, DS has only so much time in a day and he needs DOWN time as well.

That really is a hard list to pick and choose from.

Having had a child with gross motor problems/core mussel strength, I would say that needs to stay a fairly high priority. Can you figure out some activities that you or another family member could do with him that won't cost or require dragging him anywhere to add to Karate? How is he on riding a bike, or a scooter, or skateboard? How about just swinging on the swings at the park? One of the take home things I learned from when my DD did PT as a toddler, was swinging on the swings is a very excellent activity for core body strength.

And BTW psychologist just mentioned that using a keyboard vs. writing by hand would be useful for my son written language problems. (My DS has no handwriting problems.) So addressing the tablet/typing issue could possibly help both of these issues.

Thanks for all the great advice. A few comments to questions...

- written expression is around organizing your thoughts and getting them down on paper. Ask him to tell you about anything or make up a story, and he can verbally go on at length. If he needs to put it down on paper, it is a big struggle to get the words together on top of the struggle to handwrite.
- we have been working on typing this summer, and he is making good progress. It will still be awhile before he can be proficient, but he much prefers typing over handwriting. When he is able to type versus handwrite, it is much easier for him in all aspects.
- the karate program he is doing is FANTASTIC in that the teacher is very encouraging and does what it takes to connect with each child.
- he does love to be on the playground climbing, sliding, swinging. This summer he has become much more comfortable on a bike, and we have been trying to ride as much as we can. Luckily we are in a town where we can ride a lot.

When the weather is nice, he probably has some sort of outdoor time everyday that involves playstructures, riding a bike or scooter. But when the weather is cold (which it is here a long time), I don't know how to get in that same level of activity. The indoor movement activities aren't as fun for him, and I don't want to turn it into "you need to do these because you need to get stronger." He is very sensitive and would have a hard time with that. He isn't motivated by reward systems, either. I am happy to do the exercises with him to make it a family thing, and when it is new he would probably join in. But after some time, I think he will just resist.

For gross motor / core, how much time per week do we need to devote to this to really make progress? How do I know if he is making progress and getting stronger?

I'm not an expert on this, and I would SO hate having to do it myself, but...

I think doing it together is a very good idea. I think, as good as martial arts are overall, an hour a week of core is probably not going to move him forward very quickly (of course, every little bit helps), and you're going to want a few more sessions of something. I've found that gymnastics, especially once they pass an hour and a half a week, has been really good for my kids in terms of core and upper body strength (and flexibility and coordination). But studio time, group or individual, can be expensive. If you want to focus on building up core strength, I would think that the basics are still the way to go--and all those variations of crunches don't cost any money. Maybe you can mix up the specific exercises? Or ask him to be your exercise buddy, to keep -you- motivated, so his goal is to improve your health?

My observation is that kids start to enjoy gross motor play more as they get stronger (it's less struggle, and more fun). And stamina for fine motor seems to go up, too.

I know what you mean by written expression. My DS15 has just been diagnosed by a written language processing disorder. I don't have all the details of what they psych suggestions are as I won't have the written report till Wed. We are going to work with an educational therapist, and the psyc has some specific suggestions for her. For my son this is a TOP concern, as is his anxiety.

I don't know how much you really need, but I imagine more than an hour a week would be helpful. I had my daughter in dance class at this age and that was only an hour a week. But we also did other things. I sorry I can't help much about the what to do with indoors during the winter as I live in CA. Perhaps the Karate teacher can give him some exercises to practice at home. Does it snow in the winter, or is it just cold. There are outdoor winter activities like sledding, or skating, or just shoveling snow. One of my earliest memories is deciding I was going to go ice-skating by myself at 4 on the pond at the park next door, and I ended up with a broken arm. (We lived outside Chicago when I was 4.) Do you have a Y or something with a indoor pool? No necessary for lessons but where the whole family could play.

The most effective exercises for core strength development are those that involve resisting torsion through the saggital plane, like a simple pallof press or wood/cable chops, not flexion through the frontal plane.

Other great exercises that recruit the full core and posterior chain are heavy squats and dead lifts.

Some isometrics, like planks, are deceptively simple and effective at recruiting the full rectus.

When I was a kid, my cousins had a simple, cheap playroom in the basement, consisting of a rope swing suspended from a hook in the ceiling, and a big pile of old mattresses for jumping on. In lieu of jumping on your actual bed. Good for hours of entertainment (and gross motor play).