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    Joined: Feb 2016
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    Ocelot Offline OP
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    My son, who is on the older end of 4, had an independent OT eval after his pediatrician diagnosed him with dyspraxia based on his exam and the school OT report. I just got a copy of her intake assessment, which included a Beery VMI at the 18th percentile and a PDMS--2 VMI at the 50th percentile. Is anyone familiar with these tests willing to hypothesize about why they would be so different, or to what extent they are assessing different things? Honestly, I was expecting percentiles in the single digits, so I am a bit relieved to see this, but would like to understand the differences between the VMI scores better. My impression of him is that he is a very good spacial thinker when motor is not involved, so maybe one test allow him to compensate for motor deficits more than the other? Thanks for your thoughts.

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    I don't know what the PDMS is but DS scored in the 65th percentile on the Beery VMI a couple years ago and he just did it again, but only the motor coordination section, and was at .02 percentile. He also did the BOT and had subtest scores ranging from around the 5th percentile to 30th or 40th percentile (the motor coordination section of the Beery should have been very similar to one of the subtests of the BOT, and there is a big difference between .02 percentile and 5th percentile!). I'm not sure what to make of these tests but I do know it's better to look at individual subtest scores than whole test composites. Whenever DS does motor skills testing there are always really large gaps from subtest to subtest and his overall score isn't necessarily that low. He also has dyspraxia (and probably dysgraphia). Hope this helps.

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    aeh Offline
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    I don't administer the PDMS-2, but I do know that its upper limit is age 5, whereas the Beery is normed from age 2 through 18+. It may be that the spread at this age range (which is in the upper end of the test range} of the PDMS is not as finely graded as that for the Beery (which is far enough from the lowest ages to reduce concerns about floors, and plenty far from the upper end of the range). The PDMS VMI subtest also includes other hand skills, besides pencil-paper copying; he may have done better with some of them. Given what you report about his motor-reduced spatial ability, it would also have been interesting to compare to the Beery (motor-free) visual perception supplementary subtest scores.


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    Ocelot Offline OP
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    Thanks to both of you for your replies.

    Blackcat, it sounds like you have experience a lot of variability in scores over time with your DS. It is helpful to know that happens. I've been reading the 2e posts here for a while and it is so nice to hear stories of older 2e kids -- it feels less lonely.

    AEH - your comment about the age range on the PDMS is interesting. I think 50th percentile is unrealistically high. But it is also true that his writing is worse than his other skills, or at least there is less room for creative compensation (I saw him cut out shapes during one of the tests and while the end result was a nicely cut out shape, it looked super awkward, and the OT was worried he was going to cut himself). I too would be interested in the motor-free subtlest, but she didn't administer it. I suspect we will pursue comprehensive neuropsych testing in the next 1-2 years to understand the little guy better, but we're not yet sure of the best timing. He sees a neurologist next week, mostly to rule out underlying neuromuscular issues mimicking dyspraxia. I've made the statement at a school meeting and also to his pediatrician that I think he has a 4-5 SD difference between his strengths and weaknesses, and instead of being called crazy I get vigorous nodding, which is both legitimizing and a bit frightening 😬.

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    What neuromuscular testing would they do? DS had something like this in preschool just to rule out certain things like muscular dystrophy. The strange thing about DS was that his motor skills were normal as an infant and toddler and then he just failed to make progress. I have a photo of him standing up without holding onto anything for support when he was 8 months old. He started walking at 10 mo. old. Now he has developmental coordination disorder?
    Anyway, I remember the same thing with the scissors and how he could pass those tests, and was techinically "on track" for his age, but he was incredibly awkward and it took so much more effort than what would be normal. DS is now 9. I wish I had better news about how things have turned out so far. His main issue is his handwriting. It got a lot better for a time when he had a teacher who worked with him a lot, but then back downhill.

    He did have visual perceptual testing with the OT when he was 6 and had a brain injury which caused his eyes to not be aligned (Test of Visual Perceptual Skills?), and all of his scores were above average, and he hit the ceiling of the test on a couple things, like visual spatial ability and visual memory (even though the test is normed up to adult age). The neuropsych stated that any test that combines physical and mental abilities may not show a deficit. I think that's why he did so well on the Beery before but when he was only given the motor coordination part of it, the problem became apparent. When he had neuropsych testing he did a test called the "Grooved Pegboard" which was also purely physical and his scores were poor.

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    Originally Posted by blackcat
    I don't know what the PDMS is but DS scored in the 65th percentile on the Beery VMI a couple years ago and he just did it again, but only the motor coordination section, and was at .02 percentile. He also did the BOT and had subtest scores ranging from around the 5th percentile to 30th or 40th percentile (the motor coordination section of the Beery should have been very similar to one of the subtests of the BOT, and there is a big difference between .02 percentile and 5th percentile!).

    My dyspraxic ds had both the Beery VMI and BOT when he was first diagnosed... I'm not so sure that the difference between the .02 percentile on the Beery and 5th percentile on BOT is significantly different... first, they are both very low scores (please know I'm not stating that to be negative, just descriptive!). Second, the Beery is designed to test the integration of visual/motor skills, and to tease out (via the two separate subtests) where a challenge is rooted - visual or fine motor. The BOT is a measure of gross and fine motor skills. My ds, for example, had the Beery first during a neurospych eval, then a few months later and the BOT through an OT. Based on the neuropsych's findings, I'd expected the OT testing to come up with similar scores, but instead his BOT scores were much higher than his Beery VMI (motor). The explanation from his OT was that this didn't negate the Beery, but meant that his fine motor ability (without the visual motor integration included) was high enough to indicate he was a candidate for successful handwriting and fine motor OT. Handwriting OT did help him - a lot, but it didn't "cure" his dyspraxia or dysgraphia.

    Best wishes,

    polarbear

    ps - this is getting a bit off-track, but fwiw for bluemagic, I think the reason OT helped ds is that it was a very targeted form of what ds needs re learning motor skills due to dyspraxia - lots and lots and lots of repetition.

    Last edited by polarbear; 07/21/16 01:04 PM.
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    Originally Posted by Ocelot
    My son, who is on the older end of 4, had an independent OT eval after his pediatrician diagnosed him with dyspraxia based on his exam and the school OT report. I just got a copy of her intake assessment, which included a Beery VMI at the 18th percentile and a PDMS--2 VMI at the 50th percentile.

    Ocelot, did you received a copy of the subtest scores for the Beery? They are very useful in determining whether or not the challenge is visual in nature or fine motor. I'm sorry I don't know anything about the PDMS.

    [quote[My impression of him is that he is a very good spacial thinker when motor is not involved [/quote]

    This is very similar to my dyspraxic ds - he is definitely a visual spacial thinker, he visualizes when he thinks, sees movies in his head, and is really super-capable drawing 3d objects etc, even though he has some fairly severe fine motor challenges related to his dyspraxia. The key is that dyspraxia is related to the connection between brain and muscle action, rather than just an isolated case of a muscle not being able to work, such as if you'd torn a ligament connection muscle at a joint etc. The muscle can function, but the signal to trigger the motion is challenged. Hope I'm explaining that ok - I'm not a professional, just a parent lol!

    Did the OT make any recommendations for therapy?

    Best wishes,

    polarbear

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    Ocelot Offline OP
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    Blackcat- I think the neurologist is just going to do a detailed exam and then decide if testing for things like muscular dystrophy are warranted. My son is similar in that early motor milestones were normal but then we started noticing things like trouble drawing and not jumping until he was 3.

    Polarbear - The OT only did the Beery VMI and the PDMS VMI and grasp. I think she was really only doing a brief intake assessment as a start to working with him. He has done a few sessions with her so far and I think he's figured out how to push her buttons already. He is very defensive and avoidant with motor skills that he finds difficult. DH took him to the last session and said DS just cycled between ignoring instructions, "misunderstanding" instructions, finding a loophole in the instructions, and just lying down and saying he was too tired to continue. DH said the OT stayed professional but was visibly rattled and dismissed him early, so I'm not sure how this relationship will work out.
    The OT also recommended PT, but I'm really not sure what that would achieve, and I am internally struggling with the balance between helping him with things that will cause frustration (like writing) and not trying to "fix" everything thereby undermining the message that it's ok to be different. The writing definitely needs work. I know the neurologist and respect her a lot, so I am awaiting her opinion on this.

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    We had DS in PT and I think it actually helped more than OT. The OT seemed like it was borderline quackery. The only reason I took him (and am doing it again now) is because he is more cooperative with strangers than with me. If hypotonia or muscle weakness is a concern, the PT helps build core strength which then helps with writing. I haven't been able to get DS in for a PT assessment yet (he was exited a long time ago but clearly needs to go back in), however he obviously has a problem with muscle tone, for instance when he writes he holds his head up with his left hand and isn't even holding down the paper. So the OT played Battleship with him last time, making DS lie on his stomach propped up w/ his elbows. The idea was to build up muscle tone so he's not all slumped over when he writes. Sounds silly but it is difficult for him to lie that way and I don't think he'd do it here at home. If I can get him back into PT I'm hoping the PT can do exercises w/ him (sit ups, etc) so we're not wasting time w/ it in OT.

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    Ocelot Offline OP
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    We had our neurology appointment today and we are relieved to hear confirmation that a serious neuromuscular disorder is unlikely.

    I thought some of the parents on the board could relate to this anecdote from the visit:
    I know the neurologist. So when I described DS as "intense, strong-willed, and gives people a run for their money," she immediately replied, "So he's just like you." The resident with her looked horrified. I laughed and agreed.😄

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