Gifted Issues Discussion homepage Forums Twice Exceptional Dysgraphia..who can diagnose it?

We are relatively new to the whole gifted and 2e world (1 year). I think my daughter might have dysgraphia but I am not sure who would be able to confirm this? Is this a doctor, OT, or neuropsych? She has seen 2 neuropsychs and an OT for some hand strengthening. She was born with a hand defect on her right hand so uses her left hand to write. She has absolutely horrible penmanship and still gets some letters mixed up like D's and B's. She is 10. Any thoughts on what type of resource we should see? We are in Washington state but we will go any where in the US for an experience resource.

Thanks
Laurie

A number of types of professionals can diagnose dysgraphia in some form, including neurologists, neuropsychologists, and clinical or school psychologists. If school-based (in particular), they may not use the same terms, because of the need to align them to IDEA classifications. So dysgraphia might become "specific learning disability in written expression", or "disorder of written language (or expression)". OTs might diagnose fine-motor coordination disorders.

I would suggest, though, that instead of seeking a diagnosis of a specific disorder, it is more objective to see where the data lead...for example, there may also be dyslexia, or there may be other coordination disorders.

Neither of the neuropsychs brought up dysgraphia?

No, neither of them did, but apparently the docs we went to were not very thorough (had consult with Dr. Silverman last week who pointed out some problems with each). Our daughter's OT said he thinks "she could write correctly if she were just motivated" and that she has the hand strength to do so. Admittedly I am relatively new to this whole space but at 10 years old, wouldn't she be able to differentiate between B's, D's, etc. and my bar for penmanship is low (used to be a nurse and had to read MD notes) but I can't make heads or tails of her writing.

Ditto to what aeh said.

I also wonder if the neuropsych evals didn't mention dysgraphia because they specifically mentioned the hand issue with different words. For instance, my dysgraphic ds had a diagnosis of "Disorder of Written Expression" from his first neuropsych, which essentially meant he has dysgraphia but the specific word dysgraphia wasn't mentioned in the report or in the follow-up parent interview. I found references to dysgraphia online after the follow-up appointment, and called back specifically to ask the neuropsych if he had dysgraphia and she said yes he does - but she specifically worded her report to fit both a psychiatric DSM manual diagnosis and also to match what the school system was expecting to see in the report. DS has had an IEP and 504 at school specifically to address the impact of his dysgraphia, but the word dysgraphia has never appeared in any of his IEP or 504 documentation.

I'm not a psychologist, so take what I have to say next with a huge grain of skeptical salt... but fwiw, I wonder if what your dd has is actually dysgraphia, or if it falls under a different diagnosis. The impact may be very similar, but also subtly different if the impaired handwriting ability is due to a physical challenge (per your reference to "hand defect") vs a neurological wiring issue, which is essentially what dysgraphia is. One of the impacts that might be different would be the lack of ability to develop automaticity which accompanies dysgraphia.

In any event, your dd most likely has a need for accommodations for handwriting at school, and the goal is to understand the extent of her need, as well as successfully advocating for accommodations and/or additional OT as needed. If you feel you are seeing things beyond simply handwriting challenges, I'd want to go for a broad eval as aeh suggested above. In either event, I wouldn't put a limiting description on what you're seeking as in looking for a dysgraphia diagnosis. Keep your focus on what you need to accomplish (understanding vs accommodations advocacy etc).

Hope that makes sense!

Best wishes,

polarbear

Did Dr. S. point out what tests would be needed to complete the eval? One could just do those...


Has the OT *measured* the hand strength? There are tools that can be used to measure both grip strength and pinch strength. This can be amazingly revealing-- but most OTs do not have or use these tools.


I think you're right to pursue it. The language used by the OT ("she's just not trying") can be quite damaging if she IS trying and can't. Better to know what's up.

Laurie, I sent you a PM.

I had a developmental pediatrician diagnose, mostly after minimal samples and a thorough OT eval. Our neuropsych and ed psych were not helpful except to recommend OT, not for diagnosis. Our neuropsych was not thorough, however.

ITA with thinking about getting another OT. How in the world could a child write well if they were only motivated? Are there fine motor delays in the hand she is using? Sounds like strange wording at least, possibly a negative demeanor.