Gifted Issues Discussion homepage Forums Twice Exceptional What are the criteria for a dysgraphia diagnosis?

Hi

We had our DS8.5 in for psycho-educational assessment this week, and got some preliminary feedback today. Previous to today he had already been diagnosed with DCD and convergence insufficiency (almost ready to be discharged from VT). The school recommended having him assessed due to some behavior issues last year and also because to get him assistive technology we need a letter from a psychologist (so they said).

DS's handwriting is poor, slow and laborious, so I was thinking they might come back with dysgraphia. But the psychologist said that his written output was age appropriate (although she conceded it was very slow and there is a gap between cognitive ability and writing). But she told us that because he's not below grade level she can't give a LD diagnosis.

I don't have the testing summary (will take a couple of weeks for them to write everything up and send it to us), but I think the writing sample she showed us was from the WIAT? She said it was un-timed - but noted that one of the sentences took him over 10 minutes to write. She also noted that he mixed upper and lower case letters in his sentences and had to go back to put in the punctuation. He also did not complete all of the sentences - maybe 5 out of 8?

On the other hand, the spelling portion took him up into the 10th grade level, so I know he doesn't have issues with spelling.

Does anyone know what the specific criteria are for dysgraphia? Do you need to be below grade level? Is there another test she should have used?

Can2K, I'm on my phone and don't have time to reply in detail, but an LD diagnosis is a diagnosis for services at school, hence the comment about grades (which also isn't correct)... Is this a school psychologist who did the eval or was the eval specifically for school?

Whether or not your ds qualifies for services thru school, it sounds like he may be dysgraphic - and that's something that impacts his life. Parenting a child with a challenge is a bit like having two challenges to approach - how to remediate/accommodate for life, and how to get what is needed thru school.

Hope that makes sense!

polarbear

It is not clear to me what the criteria are for a dysgraphia diagnosis in a child with DCD, but I do have a friend with a child in early elementary who has been assessed as having writing difficulties due to DCD, but not dysgraphia (maybe a motor issue without an automaticity issue?). Her DC does qualify for AT with this set of diagnoses. Can you advocate for services based on the DCD diagnosis?

It's a rather lengthy piece but might be worth a look:

http://dyslexia.yale.edu/CommentsDSM5ColkerShaywitzSimon.pdf

P.13 discusses the issue of having to be "well below," which must be met to be given the SLD diagnosis.

Anyway, given that your DS already has the DCD diagnosis, that should qualify him for SPED and related services under OHI if the eligibility team agrees that the services are needed for him to receive FAPE.

I'm going to copy the quote I cited in another thread recently, which indicates the standard federal special education law says schools should use. (OCR is Office of Civil Rights. You do not want to mess with them, if you are a school.):

From this: http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201607-504-adhd.pdf

(emphasis mine):

"Someone with ADHD may achieve a high level of academic success but may nevertheless be substantially limited in a major life activity due to his or her impairment because of the additional time or effort he or she must spend to read, write, or learn compared to others.44 In OCR’s investigative experience, school districts sometimes rely on a student’s average, or better-than- average, grade point average (GPA) and make inappropriate decisions."

Substitute dysgraphia (or, more properly, in the school context, Specific Learning Disability in written expression) for ADHD.

BTW, it might interest the reader to know that, despite all the hype about DSM-5, Medicare/Medicaid do not use it for diagnosis, in part due to the controversy regarding a great many disorders. They use ICD-10-CM instead. (https://www.cms.gov/Medicare/Coding/ICD10/index.html)

Dyslexia in the ICD-10 more closely resembles Shaywitz's recommendations (and the DSM-IV):

http://www.icd10data.com/ICD10CM/Codes/F01-F99/F80-F89/F81-/F81.0

So if a clinician says DSM-5 doesn't allow them to give a dyslexia or dysgraphia diagnosis, you may wish to ask them to consider ICD-10 diagnostic criteria.

It's a private psychology clinic (they also provide educational services) and we did request the eval. in order to get recommendations for school.

This was recommended by our (Canadian public) school, even though he does have a DCD diagnosis. They told us they need something from a psychologist to access AT.

The psych we met with seemed to brush aside the DCD diagnosis - told us they don't deal with gross motor. She did do the Beery with him but it didn't show a problem. (As far as I can recall, Visual-Motor Integration was ~30th percentile, Visual Perception 90th percentile, Motor Coordination~30th percentile). Perhaps the VT has brought up his scores since we had the OT eval. last year.

Just as a preliminary finding she was tending towards an ADHD diagnosis. As far as I can tell this was based purely on Connor questionnaire results (ours and teacher's), and her interaction with him over a few hours.

Perhaps it doesn't matter which diagnosis they put so long as he gets the accommodations. However, DH is concerned there may be stigma attached to an ADHD diagnosis.

Thanks - the school did accept the DCD diagnosis, and he has an IEP with some accommodations - but for some reason they wanted a letter from a psychologist to access AT.

Does your school allow a kid to bring/use their own device? Are all kids set up with google accounts?

DS didn't get his school chromebook until the end of grade 4. Until then we sent in an old laptop so he could use it whenever he wanted. He now officially has AT and received some training through the school on various tools but they were all things that were available on his school google account and had been using for years anyway.

Do you agree with ADHD? Our teacher's Connor results were very different than ours. In our case the tester saw more of the side that we see and he didn't come out with a diagnosis. He's since moved into a gifted class and is a model student with no signs of ADHD (shocking!!).

Thanks aeh - we're in Canada, so I'm not sure how much of that would apply, or if that is used up here.

It sounds like what they psychologist told us (about using grade-level for writing assessment) is not best practices, but also not uncommon.

I just wondered if there was another test that would show his writing issues more clearly. I mean if a kid can write at grade level, but it takes a long time and a lot of concentration to do that (10 minutes to write one sentence) - surely that shows a problem??

Also, if he is able to focus on writing one sentence for 10 minutes - how does he have ADHD?