Gifted Issues Discussion homepage Forums Twice Exceptional Psychologist's diagnosis for sons school

The following is a small tidbit of my sons report from a psychologist's office regarding my 9 year old son:

"Results of that evaluation indicate
(Ds9) possesses very superior, gifted intellect. Results further indicate he meets clinical criteria for:

314.00 Attention-Deficit/Hyperactivity Disorder (ADHD), Inattentive Presentation, Moderate
315.9 Other Neurodevelopmental Disorder (previously Learning Disorder Not Otherwise
Specified), Executive Function Deficit (impairment in automation of routines and
sequences)
315.2 Specific Learning Disorder with Impairment in Written Expression (Semantic
Dysgraphia)
315.4 Developmental Coordination Disorder (Motor Apraxia)

his difficulty with written expression and handwriting appear to interfere with his ability to
adequately express himself and his learning in writing, given he displayed very superior, gifted
ability to verbally express his intellect (WISC IV VCI – 98th percentile)"

I understand what ADHD is. I understand what Dysgraphia is. I'm still wrapping my head around Executive Function Deficit and Motor Apraxia. Any recommendations?

Thank you in advance.

Peg Dawson's accessible expert advice on EF:

http://www.amazon.com/Smart-but-Scattered-Revolutionary-Executive/dp/1593854455

Her website, with more info:

http://www.smartbutscatteredkids.com/

Dyspraxia association website, has a list of readings:

http://www.dyspraxiausa.org/

Cola, my ds has diagnoses of dysgraphia and Developmental Coordination Disorder (which is essentially the same thing you'll see referred to as "dyspraxia"). He also has a diagnosis of SLD/written expression. I'm going to give you a bit of a dump from my brain here - this is all related to my ds - your ds may have an entirely different set of impacts - but if anything here sounds familiar and you'd like more info, just ask!

Dyspraxia impacts each individual in different ways and in different degrees. For my ds, the most obvious impact is handwriting - and (jmo) I suspect his fine motor dysgraphia is really related to his dyspraxia. As you may have read, dysgraphia is a neurologic challenge in which a person doesn't develop automaticity of handwriting. My ds, who is 15 years old, still has to think about how he forms letters and numbers when he writes. This means his handwriting is too slow and too illegible to rely on to show his full knowledge. An impact that isn't quite as obvious, but is very real, is that his full working memory is taken up by the act of producing handwriting, hence nothing is left over to focus on grammar, spelling, punctuation, etc.

Dyspraxia is also a neurologic challenge in which automaticity doesn't develop for other types of fine motor and gross motor skills. My ds, for instance, didn't learn how to tie his shoes until he was in 4th grade (and it wasn't for lack of trying, he just couldn't figure it out). Then he had spring break, didn't wear tie shoes for a week, and he forgot. Little things like that. He learned how to write cursive in school but forgot over summer vacation. He has to think when he writes his name - you can watch him and see that he's slow and he's thinking about how to do it. When he has to sign his name in cursive, he usually practices it a few times first to be sure he gets it correct. He's slow with things like zippers, buttons, etc. He doesn't really move fast in general, and when he was younger, when I'd be in a hurry and ask him to run because he was shuffling along looking like he wasn't in any hurry - he'd honestly think he was already running. He doesn't like to play team sports because he's not coordinated with catching balls etc. He *loves* individual sports like mountain biking and skiing.

Another area that people with dyspraxia are sometimes impacted is speech. It wasn't obvious to us when our ds was younger, but his issues with written expression (he also had the diagnosis of disorder of written expression) was tied into an expressive language disorder, and speech therapy addressing it was tremendously helpful. We also realized as he grew that he has a tendency to speak in a monotone voice but he didn't realize it, and again, speech therapy helped. We also realized as he got older that the inability to fully express himself wasn't solely limited to writing assignments - he had the same difficulty with certain types of speech - but it wasn't obvious when he was younger because he talked *so much* and in such depth about things he really knew a lot about (mostly factual things).

There are other little odd quirks here and there. For a long time he didn't really have a good sense of being either hungry or full. He was very disorganized for a long time (homework, room, etc) - but that's gotten better as he's gotten older and started to put some structures in place himself to get around those challenges.

Hopefully none of that sounds bleak! What it does mean, though, is that accommodations are necessary at school, he might benefit from structure at home, and he'll need to know you are his advocate and that you are there to support him in a way that will help him become independent. We started our ds keyboarding right away after he was diagnosed. I scribed for him when he had written assignments for homework until he was fairly proficient at the keyboard, and I still scribe when he needs to get an assignment done quickly. Re written expression, we did a lot of work with his speech therapist determining where his challenges were, we practiced a lot and implemented tips the SLP came up with for him, and I scaffolded his writing assignments like crazy.

Repetition is a key for our ds - he needs to repeat the skills that are impacted by his dyspraxia over and over and over again to get them into his muscle memory (and even then, they are usually slow compared to the pace at which neurotypical kids move). When he was first diagnoses I read as much as I could find on each diagnosis (in books and online) and that was really helpful. We also had an AT evaluation in which the wonderful OT who did the eval pointed something out to me that I didn't realize - and it's really an important thing to understand for a kid with dyspraxia - you'll read about how kids with dysgraphia all of a sudden become proficient at writing simply by replacing handwriting with a keyboard. That did *not* happen with my ds - one reason was his expressive language disorder, but another very important one was - his dysgraphia was related to fine motor dyspraxia, it wasn't *just* an issue with automaticity of forming letters. He was able to learn how to type, but his typing is not as fast as a neurotypical child is able to learn to type, hence written homework still takes him a longer time than most students even when he's typing (which is why I scribe for him at times). Voice-to-text really is the quickest way for him to get his thoughts out, but the output requires careful proofreading and editing, and he's just not that thrilled with it at the moment.

I've gotta run - hope that all makes sense!

Hang in there,

polarbear

ps - our neuropsychologist has a chart (that she pulled from some literature somewhere - sorry I don't have a link!) showing the overlaps between dyspraxia, adhd, and autism spectrum disorders. There really is a significant overlap in symptoms for all three. Our ds was diagnosed with adhd at one point in time but it was later considered to be an incorrect diagnosis. One thing I've read about and pondered quite a bit is the relationship between ADHD and written expression - it's not uncommon to see children with ADHD diagnoses struggling with written expression. Did the evaluator recommend trying meds for your ds' ADHD or seeing a dr who could go through that decision with you? It's possible that if his ADHD diagnosis is accurate and you're able to find some way to mitigate the impact of the ADHD, you might see his written expression challenges lessen.

OK I have to ask - how wonderful is Polarbear??? Such an amazing asset to this board <3

Cola there is a great deal of overlap between your DS's profile (and Polarbear's DS) and my DD. (My DD also has dyslexia and math disability thrown into the mix.) We are still awaiting the report but the most recent evaluator suggested i read up on Sluggish Cognitive Tempo. From what I have read it appears that it could be a match for my DD and perhaps for some of the other slow moving, multiple diagnosis, ADHD-I kids I have seen described here. It might be worth reading about it even if it doesn't perfectly match your DS. It wasn't included in the DSM so kinda sorta fits under ADHD-I but from what I understand most likely will eventually be either it's own ADHD category or its own separate diagnosis.

Just as Polarbear described my DD needs *a lot* of therapies and supports. She is in out of district placement at a spec Ed school where her day is filled with OT, speech, reading intervention, math intervention, AT support, etc along with reading comprehension 4-5 grade levels ahead plus additional enrichment to keep her high level side engaged. This is a complex profile so buckle up and get ready for the ride...

From my experience the slow moving nature of these kids tends to trigger a lot of frustration in adults who don't "get it". My DD, who is incredibly focused and hard working, was constantly being ridiculed, called lazy, etc by adults in her local public school. She was often minimized or marginalized in extra curricular activities because of her clumsy appearance and weak fine motor/LD challenges. Some people are convinced all she needs is more discipline (and its up to them to provide it), others are convinced there's nothing wrong with her that a little more time and maturity won't fix. Or they see her as this little special needs kid who should just be happy to be allowed to participate. No - actually she has neurological challenges but is a smart, hard working, sweet child that needs to sometimes do things in a different way.

I have had to be consistent in my support - encouraging her independence while also being there as a safety net to make sure she doesn't get either overwhelmed or overlooked. Once adults get it, though, they have amazing respect for her. It takes a bit of effort to see past the slow moving appearance and really see the high level of understanding and strong work ethic. Once this happens, though, she is not only accepted but is often seen as a role model.

I guess all of this is to say these are not just going to be learning challenges but also life challenges - for you as well as him. You will need to educate yourself big time because you will likely spend a lot of time educating others. You will probably need to help him navigate his way through a combination of remediation, accommodation and work around solutions. Things that work for Polarbear's DS may or may not work for my DD or your DS. For example repetition works for Polarbear's DS but just frustrates and exhausts my DD. Her DS did well with keyboarding while its been a slow, arduous process for my DD.

You will find joy in his accomplishments and sadness in his challenges. Know that throughout it all you can always come here to vent, ask questions or share information. You have other parents who understand and have been there.

Good.luck!

Thank you so much everyone! I began my research as soon as I found out the diagnosis but of course it overwhelmed me. We are currently working on IEP information. The specialist sent over a 10 page report with "suggestions" of what D's needs and the full report which should be about 100 pages will be sent in a couple weeks. The one thing I loved was her constant notations of using positive reinforcement and the fact that he can't control it so any hard work on his part regardless of the outcome should be praised.

I wonder if a ct scan of the head is warranted? Some of my research suggests there could be a correlation. I have severe sinus issues caused by valley fever and a small brain tumor called an acoustic neuroma. So of course I can't help but wonder if my poor boy could be suffering from the same.

Early on we had 2 neuropsychs concerned about the possibility of structural causes for DD's unusual numbers and severe migraines so she had an MRI and more EEG's than I can count. They didn't find anything though. If it makes you feel better then ask for a referral to a neurologist just to rule out these issues.

Exactly what I think every time I see one of her detailed, rich posts. Polar bear, you've probably helped many more families than just the ones who post. Thank you!