Gifted Issues Discussion homepage Forums Twice Exceptional OT eval - possible DCD/dyspraxia?

Hi

We recently had a private OT evaluate DS7 (he currently has a gifted IEP and is in gr. 1 French Immersion in Canada). We asked for the evaluation because of various puzzling behaviours, mostly difficulty with handwriting and other fine motor skills, but also some sensory issues and other puzzling behaviours (e.g. high frustration level with certain types of tasks). Other things he does well - e.g. he met or exceeded all milestones when he was younger, he began walking at 11 months, was able to ride a bike at 5 yrs. We were just not sure what was going on, if anything.

The OT used the Motor Assessment Battery (M-ABC2). I watched the evaluation, and most of the tasks he completed fine, but slowly. He had trouble with the ball catching and one-leg balancing (on a balance board).

On Friday we got the results - he came out at the 5th percentile and the OT is suggesting Developmental Coordination Disorder (DCD). DH and I were rather taken aback - I could see he was struggling at some things and figured he would score low, just didn't expect that low! On the other hand, when she tested his printing and copying skils, his writing was legible and the speed was within the average for his age (although some of his letter formations are odd). So, I'm still rather confused - how can this be if he's at the 5th %ile?

I spent the weekend trying to absorb this and (of course) reading the materials she provided and googling.

I am wondering a few things...

What do we share with his school (if anything)? Since we don't have an official diagnosis, what do we tell them? She did give us a really great brochure with school accomodation suggestions (from http://dcd.canchild.ca/en/). I do think some of the items will be very helpful - especially if they are able to modify his gym instruction (he currently hates gym class - now I have a possible reason why).

Would/should this get added to his IEP? Or do we need an official diagnosis for that?

Should we pursue a diagnosis with his pediatrician? How does that work - does the ped. do this or do we ask for a referral?

How do we talk to DS about this? Since it's not an official diagnosis, what do we tell him?

ETA: The OT also suggested DCD was a possible explanation for his observed difficulty with reading - he decodes and comprehends at a high level, but strongly resists reading long passages of text and strongly prefers being read to. He often loses his place in the text and skips words. I am wondering if vision therapy would help with this?

I don't have much for advice but I will say that I'm also in Canada and we have an IEP for DS for his 'probable LD' without an official diagnosis. He was assessed at 6.5 and the Psychologist said that he was too young to be certain but that all signs pointed in that direction. The school was excellent about writing up an IEP and implementing most of it. I say most because most of the time DS is able to compensate quite well and hide the LD related issues so they don't always accommodate (and as long as DS isn't overly frustrated I'm ok with it for now). The school was actually a million times better with his 'probable LD' than with his for sure giftedness but that is a whole other story.

DS is now 8.5 and is currently being retested to confirm/deny the LD and figure out if he qualifies for AT (a laptop) going into grade 4.

DS is close to the same age (second grade) and has a dx of DCD. He was also an early/average walker (he was walking well by his first birthday). I didn't really notice obvious deficiencies until he was around 2. He was having problems hopping up and down and jumping off things. He couldn't keep his feet together hopping off a step, even at age 3. Turns out he has low muscle tone as well as coordination issues (they often go together). With writing, he had an odd pencil grip. He was able to write his name at age 3, but looked really awkward and hardly pressed down on the paper at all. In K other kids writing got rapidly better, but DS's--not so much. Then he fractured his skull and had some obvious brain damage which further complicated the situation. One eye wasn't tracking at all and his motor ability seemed to have deteriorated. Even after his eye started tracking again, I noticed that he had trouble tracking something like a pencil moving back and forth in front of his face, keeping his eyes aligned. Was this from the brain injury? The DCD? Kids with DCD can have problems coordinating eye movements. Was he having problems catching a ball because of his eye tracking? Coordination? I still don't know. The opthamologist was not concerned about his eye tracking, and neither was a neuro-opthamolagist. The problem was that he couldn't track "on command" but did fine with things like reading. Have your DS sit across from you and watch his eyes while he reads. Do they appear to stay aligned? Of course that's not a reliable test but maybe you will see something obviously wrong. I worked as a reading tutor and one kid had problems with tracking. He reported seeing double print. He improved in terms of fluency (I was timing him) when I put a colored overlay over the passage. So that's something you could try.

Keep in mind that kids with DCD can vary dramatically. They may do really well with some things and not others. So DS does well with swimming and riding a bike, but has no idea how to do a jumping jack. Other kids with DCD may be the opposite. He has problems with speech and writing, but other kids with DCD may not. When he was tested in K on the Woodcock Johnson Achievement, he actually had above average scores for writing, even writing fluency was 80th percentile. But his classroom work was a mess.

In terms of IEP, the school at first acted ridiculous and told me to get my own eval. I took him to a neuropsych and he diagnosed him with DCD. That was good enough for the school to write a "physically impaired" IEP, since his motor skills were making him "slow". The last kid to unload his backpack, get in class, get worksheets done, horrible writing, etc. They did make me verify with the pediatrician and get it in writing from her that he has DCD because apparently the dx from the neuropsych wasn't acceptable for the State. That was ironic considering the pediatrician had sent us to the neuropsych. It was actually a pediatric neurologist who first mentioned to us that he probably has DCD, at age 4, but she didn't give him a written diagnosis.

So 1.5 years later, DS is still on an IEP and is getting DAPE (basically physical therapy one on one or in a small group in addition to regular phy ed), OT, pull out for writing from a sped teacher, and speech (he was on a speech IEP before he started kindergarten). With a PI IEP, in our State, at least, they can give the kid whatever services they need after the IEP is written. So instead of havivng two IEPs (one for speech and one for PI), they put speech on the PI IEP. I hope this makes sense. I am in the US and have no idea how things are the same/different in Canada.

Can2K,

I don't have time to answer completely at the moment, but I'll stop back in when I do. My ds15 has DCD/dyspraxia. Just a few quick thoughts:

* Why don't you consider the OT's opinion an "official diagnosis"? Did the OT write up a report?

* What is your ds' existing IEP for? I am not familiar with Canada, but in the US, if a student has an existing IEP and there is something new that becomes clear needs to be added in terms of services or accommodations, the next step would be to call an IEP update meeting and the IEP team would look at the new concerns/data/reports etc and add any additional services/accommodations that were agreed upon to the existing IEP

* Dyspraxia, as blackcap mentioned, plays out differently in each individual. When you see strengths in one area and challenges in another it most likely traces back to different types of muscle groups involved.

* Don't let the "5th percentile" statistic stress you out. Take that as a sign that there's a challenge, and move forward to both understand better what is at the root of it and how it impacts your child, and to make a plan to remediate/accommodate in whatever way makes the most sense.

My gut feeling is you most likely need more depth to your ds' evaluation. Just a guess.

Best wishes,

polarbear

Hi Polarbear - thanks for the feedback

He currently has an IEP that just says 'gifted' and that they are supposed to provide 'appropriate' work for him in class. (Whether or not that part is working is another story...)

From what I've read over the weekend, in Ontario (where we are) OTs cannot diagnose anything. She suggested that if we want an official diagnosis we see his pediatrician (and also to rule out any other causes of motor delays).

Lots of things do seem to fit with him in what I've read. My major concerns going in were reading and writing slowness (and slow to improve). On the other hand, he reported to me yesterday that he doesn't have 'unfinished' work in the "unfinished work box" anymore. So, still a bit confused - it's so hard to know what is actually going on in his class...

Thanks blackcat
That's interesting about the jumping jacks - DS can do them but it always looks awkward.

I will try watching him read some time. He can read fine if I hold something to block the page and reveal one line at a time. But he resists doing this himself.

Thanks Chay - it's good to know that 'unofficial' issues can also be dealt with on the IEP. I've emailed his SRT to try to set up a meeting, so we'll see.

A data point re jumping jacks: DS7 is on a Little League team. Most of the kids are 6-8 years old and neurotypical. FWIW - I took a hilarious video of them warming up on Saturday doing jumping jacks. There was one kid who had the standard form. Every other kid (including my DS) had his own interpretation. One kid (coach's son) was just jumping up and down and punching his hands forward. My DS had the hands doing the right thing and the feet doing the right thing - but not at the same time. Several kids cycled between jumping up and down and waving their hands over their heads. Several others just looked baffled, and two sat down. The coach, bless him, just praised any kid who was jumping and moving hands/feet in some fashion.

Then they moved on to push-ups which was it's own version of wacky.

My point being - I think it's not that unusual for a 6-8 year old not to be able to do jumping jacks.

And that's a good illustration of why parents and teachers don't always "see" dyspraxia in a child - because some of the symptoms aren't obviously delayed until the child is beyond the range that nt kids master the skills in. My ds, for example, looked awkward when he tried to do jumping jacks when he was 7. It was easy for us to think, hey, he's 7, it's normal to not be all that coordinated with jumping jacks. It was also easy to say "he's just not a coordinated kid". Now that he's 15 and still can't do a jumping jack, it's a little more obvious but people who don't know about dyspraxia and don't understand it would look at that one thing and think, hey he's just not terribly coordinated. An OT, however, who's assessed a child and suspects dyspraxia, is most likely looking at a wide range of skills related to motor function, and is looking with the experienced eye of a professional who's seen a wide range of functional abilities in children. So while I as a parent wouldn't look at a kid who's got an awkward jumping jack at 7 years old and think anything other than ti's developmentally typical, as the parent of a dysgraphic child, comparing notes with another parent of a dyspraxic child, I'd consider that the awkward jumping jack is potentially a symptom of the dyspraxia.

Hope that makes sense!

polarbear

OK, I was thinking the IEP was for a challenge rather than gifted - our "Gifted IEPs" in my school district are different from traditional IEPs, aren't inclusive of the same groups of staff members as team members, and don't really operate the same way in terms of updates/etc. So ignore my previous comment about calling an IEP update meeting

[quote\From what I've read over the weekend, in Ontario (where we are) OTs cannot diagnose anything. She suggested that if we want an official diagnosis we see his pediatrician (and also to rule out any other causes of motor delays).[/quote]

It occurred to me after I'd replied earlier that the issue re diagnosis was probably due to differences in the structure of our medical systems (US vs Canada). I have friends here who have had their children diagnosed by OTs, so that's why I was confused at first.

I do think that having a follow-up eval (with ped or whoever the ped would refer you to) is a good idea - if the OT is correct and it is dyspraxia, a eval to follow-up on her supsicions should give you additional insight on your ds' needs and how to remediate/accomomdate/etc. It's also possible that the symptoms the OT saw are due to a different challenge, and if they are, you'll want to know that before going down the road of making decisions based on an incorrect assumption of diagnosis.

Not sure it is of any use, but my ds was diagnosed by a neuropsych. That's where his label of "Developmental Coordination Disorder" comes from - it's a definition in the DSM manual which psychologists and psychiatrists use for diagnosing. Dyspraxia is a term which is essentially the same set of symptoms but not used widely in the US, and I think it is used more often by medical professionals here. DS' neuropsych diagnosis was based on scores on the WISC (IQ) and WJ-III (achievement) combined with his developmental history (provided by parents), review of issues at school, and observations during testing. In addition to the ability/acheivement testing the neuropsych did a visual motor processing test, an assessment to rule out/in ADHD, executive functioning tests, and some brief motor skills tests. She referred ds to an OT and later on to an SLP and they both did their own assessments which showed areas ds was weak in (related to dyspraxia).

Gotta run again - hope that helped!

polarbear

Thanks Polarbear! I am planning to talk to his school to try to get a better picture of how things are going there, and to let them know about the assessment. After that I think I'll have a better idea of what to tell his pediatrician.

It's so confusing though - yesterday I sat with him to do homework and he did it all fine. For math he had to draw pictures (to show his work) and he drew 15 little flowers without complaining (mind you he used our white board, which seems easier for him).

He also showed me a very nice, detailed leprechaun picture which he had drawn a few weeks ago in class - copied from the board (and I had assumed one of his friends drew).

So I don't know - is it possible his motor skills are just delayed? Or he learns them more slowly? I'll see if I can ask the OT about it.

Texture issues around writing materials have often been mentioned on this forum. DD8 is dyslexic but no (known!) fine motor issues, and loves the whiteboard (alternate choice: fountain pen). Her teacher (bless her!) just lets DD go to town on the whiteboard and when she's done, snaps a photo to add to DD's folder. The teacher obviously saw enough difference in output quantity/ quality to encourage this. DD also has visual processing issues, and I wonder if between the two LDs, in addition to texture she may also just find it easier to write on a physically larger scale (the bigger the font the better for reading).

For the record, her clothing-sensitive father will use exactly one kind of pen, and woe betide us if he runs out of them.

Can2K, the motor skills required to draw are different from the motor skills required for handwriting. It's not uncommon to see this in kids with dysgraphia - the ability to draw (even really well) without issues, but struggling with handwriting. When you use handwriting, you have to execute a series of pencil moves in a specific order/fashion, and you lift your pencil up off the paper every time you write a letter. Cursive is often easier for kids who have handwriting challenges because the letters are connected which means you don't have to pick the pencil up as often. For some kids (with dysgraphia) there is a challenge with remembering *how* to draw the letters - it isn't automatic like it is for most people. When they are drawing pictures, though, the need for rote automaticity isn't as important.

The white board might also be easier for any number of reasons - it's a solid surface so a kid who has a poor grip or who exerts too much pressure when gripping might find it easier to write on. The markers are most likely larger around than a pencil is, so they might be easier to control or grip. There aren't any lines so he doesn't have to concentrate on making letters "fit" within lines... etc...

It is possible his motor skills are delayed, and it's possible there might be more of a challenge than just a delay. If you have a comprehensive eval to get more info about whether or not your ds has DCD and what the impact is, you'll learn more about his handwriting ability/speed/challenges if they exist.

Best wishes,

polarbear

Yes, we usually take a photo of DS's whiteboard work and email to the teacher. We've mentioned to her that he seems to work well this way, but I don't know if she implements this in class.

The OT also suggested writing vertically might be good for developing wrist strength.

That's interesting about drawing. It's only very recently that he's done any drawing (or cutting/pasting, painting, etcetera) at all. Usually if I ask about art projects at school he tells me he 'failed' that activity. :-(

With DD10, in preschool and K she brought things home every day - our house was filled with artwork! DS hardly ever brings anything home, which is why I was surprised at the leprechaun drawing.