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    #247380 - 07/25/20 08:27 AM MG, DCD, HSD, VT and EF - help?
    ESAK Offline
    Junior Member

    Registered: 07/17/20
    Posts: 2
    After much (very helpful) background reading on this forum I find I still have a few questions arising from DD15’s recent EdPsych evaluation; I hope someone here can advise me.

    Some background:
    18 months ago DD15 finally got a formal dx of DCD based on a 2nd OT report and a neurodevelopmental paediatrician’s exam. The EdPsych, normally part of this diagnostic three-step, went rogue and instead wrote at length about DD’s emotional state.

    DD’s DCD diagnosis came 9 months before she was independently diagnosed with hypermobility spectrum disorder (HSD). At the time of her OT assessment DD was not getting any treatment for her other symptoms which Drs dismissed as anxiety related. DD’s long term health issues are being belatedly addressed but the only medication she takes is a high dose antihistamine.

    DD’s early development was advanced and not especially typical of DCD. Poor balance and mild speech issues were the only distinctive early indicators of dyspraxia. Her difficulties with coordination and EF didn’t stand out until she was 9. An OT assessed her dyspraxia as ‘mild’. While dyspraxia seems to have some effect, DD loves dance, ice-skating, piano, singing and drama. Baking and sewing are her latest pastimes.

    DD is usually happy at her selective UK high school but she had a rough start there with poor academic fit etc. Poor health meant DD missed a year of HS classes, off and on. She is still getting good marks but has random knowledge gaps. DD struggles with essay writing - getting started (she needs to talk through the question) and has difficulty wrangling all her ideas into a standard format.

    DD has high stake exams coming up next year (yr11). We were able to get a SpeLD assessment through school so she should now have the routine use of a laptop in class and exams. The school also suggested a scribe for sciences/math but not extra time. We are looking for alternatives to maintain her independence. All going well we had expected DD would go on to do the IB rather than 3 A-levels (normal for England).

    EdPsych evaluation:
    DD finally got an independent WISC-V evaluation along with some other tests to elucidate some of her learning difficulties.

    Verbal Comprehension 135
    V (18), C (16),S (14), I (15)
    Fluid Reasoning MR (18)
    Quantitative Reasoning 117
    FW (13), Ar (13)
    Working Memory 138
    DS (18) and PS (16)
    Visual Spatial 119
    BD (15) and VP (12)
    Processing Speed 103
    C (11) and SS (10)

    FSIQ 137 (based on V, S, MR, FW, DS, BD, C)

    Beery Visual Perception 106* (66)
    Beery Motor Coordination 94. (34)
    Beery Visual-Motor Integration 101. (53)
    DASH Graphic Speed 95. (37)
    CTOPP Segmenting Nonwords 140. (99.2)
    CTOPP Nonword Repetition 105. (63)
    WIAT Pseudoword Decoding 122. (93)
    CTOPP Rapid Symbolic Naming Composite 113 (81) [107 at earlier SpeLD assessment]
    Single Word Reading Test (SWRT) >130 (98)
    TOWRE Sight Word Efficiency 138 (99)
    YARC Reading Fluency 115 (84)
    YARC Reading Rate 109 (73)
    YARC Reading Comprehension 118 (88)
    Helen Arkell Spelling Test (HAST) 135 (99)
    DASH Free Writing 75 (5) [75]
    DASH Copy Fast 73 (4) [74]
    WIAT Numeracy 124 (95)
    * achieved the maximum score for her age.

    The OT report from 2017 included Beery results:

    VP %ile 81
    VMC %ile 32
    VMI %ile 79

    Her Movement ABC put her at 2nd percentile.

    Four years ago DD’s school ran a cognitive abilities test (GL Assessment) which is multi choice with 141 the max std score:
    Verbal 141
    Quantitative 136
    Non-verbal 141
    Spatial 141

    This has raised a few questions:

    1. how typical of DCD/dyspraxia is DD’s cognitive profile? I had expected VS, WMI and PS to be much lower but does this just mean a ‘mild’ condition with the results indicating the type of DCD? Our EdPsych said she wouldn’t have done any further testing if she’d only seen the WISC-V results.
    2. I expected DASH Free Writing to be slower than Copy Fast. Even if she was tired, shouldn’t there be a bigger difference with free writing slower than copying? Does this mean her real problem is the physical act of writing but not composition?
    3. DD apparently has some issues with visual tracking as her reading rate is affected by her eyes jumping ahead and back. Is poor tracking an aspect of convergence insufficiency? Is VT likely to help? DD’s vision changes often and unevenly with now a mild shortsightedness and an astigmatism.
    4. Given some of DD’s EF difficulties is it wise to do the IB, or should she change course now? She has made improvements on organisation and time management but still loses things and misses deadlines. The EdPsych recommended tutoring for EF but previously when DD’s OT tried (briefly and condescendingly) to coach her on planning and execution, DD’s mutinous response led to the end of OT after just 4 sessions.
    5. DD never got OT beyond assessment and those 4 sessions. If we push for more OT what should we focus on? (We have PT exercises already for muscle strength).
    6. Should we be trying to get DD set up with speech-to-text software instead of extra time for science/math exams? It seems to be hand pain that limits her handwriting.

    Apologies for the length. Thank you for reading this far and for your insights.



    Edited by ESAK (07/28/20 12:39 PM)
    Edit Reason: Length

    Top
    #247412 - 07/28/20 12:39 PM Re: MG, DCD, HSD, VT and EF - help? [Re: ESAK]
    aeh Online   content
    Member

    Registered: 04/26/14
    Posts: 3637
    Welcome!

    Overall, she has very nice skills across the board, other than fine motor tasks, with most academic skills reasonably within the range predicted by best estimates of her cognition. A few exceptions are noted below, in response to your questions. In addition, she also has some discrepant working memory results, with performance ranging from solidly average to the upper extreme. Curiously, repeating lists of numbers was very strong, while repeating lists of word-like nonsense syllables was only average. I wonder if this is related to the early mild speech issues, as nonsense syllables are more like learning new words, while repeating numbers uses familiar, automatic language. It appears her actual memory is at least high average if not above on all other memory-related tasks.

    Now let's get to your specific questions:
    1. Typically, I do see VS and PS to be much lower than VC and FR. WM doesn't always track one way or the other, as it is motor-free (other than the physical act of speaking). I am a bit intrigued by the strength of her BD score, which aligns much better with her (again motor-free) GL assessment (I assume this was the CAT4, much like the CogAT, for NA readers) than her VP score does. However, to your EP's comment, VS -is- significantly lower than VC, and PS is lower still, so it's not all that atypical for DCD. The main atypicality is that she did as well as she did on BD, and no better on VP, which I think supports further discussion in response to your question #3.

    2. Yes, most likely. Or at least, for easy writing, yes. More on this in #4. You should be able to see some evidentiary support for this hypothesis by comparing her speech-to-text compositions to her written or typed compositions, or by comparing her oral responses to her written responses.

    3. I had wondered about the average reading rate, given her excellent decoding and word calling skills. This is probably also mildly depressing her reading comprehension performance. Notice how much better she did on the TOWRE with word calling efficiency (speed) than on the YARC. One of the big differences is that the TOWRE consists of columns of single words, so there is very little tracking involved (and it's in a different direction). The YARC is more naturalistic passage reading, so horizontal tracking issues would impact it more. I'm not an expert in convergence insufficiency, but everything you've reported about her vision, in combination with the testing profile, would certainly suggest that that is a direction there may be value in investigating further. Others in this community have found convergence/divergence/visual tracking to be a significant factor in academic performance and skill development. And there are interventions for it, if it turns out to be relevant to your child. You will want to look carefully for the appropriate developmental optometrist, though, and do due diligence with checking their credentials and references.

    4. OTs are good for a lot of things, within their practice area, but aren't necessarily the right fit for most EF interventions outside of motor. Planning and execution for motor skills likely won't address the needs of someone with the cognitive profile of your child. I would suggest a higher-level EF approach, from a more academic perspective, rather than functional/medical. I like HOPS, which is a school-oriented EF curriculum designed to be coached/instructed by a teacher or counselor, but which can also be used by parents:

    https://www.nasponline.org/books-and-products/products/books/titles/hops-for-parents

    But it might be a bit to ship from NA. Or you can take a look at this classic on developing EF skills:
    https://www.amazon.co.uk/Smart-but-Scattered-Teens-Executive-ebook/dp/B00AYI838E/

    Of course, she has to be willing to engage in the process, which I would suspect would be closely related to her personal investment in the IB diploma. It sounds like she is able to keep up with the work, outside of the medical difficulties she had. How does she feel about it? If she's willing to give it a try, and her health is more stabilized now, there isn't necessarily any harm in letting her do so.

    Now to my delayed comment on writing: EF weaknesses can affect writing not only at the pure motor planning and coordination level (which would be what the OT would be best equipped to remediate), but also at the language organization level. In a short, simple writing exercise such as comprises most writing fluency tasks, negligible organization is needed. Essays and research papers are a different question altogether. If switching to AT for written expression resolves deficits in brief written products (one or two sentences, less than a paragraph), but does not fully resolve written expression gaps in extended writing (multi-paragraph or multi-page), then that suggests that there may be impacts from EF on the actual organization of complex language products. You report that she is making high marks in an academically demanding program, which suggests that this is not a concern for her, and that the EF impacts are more at the task level (e.g., initiation and completion).

    5. Hard to say from your eval data. She's also at an age where the focus generally shifts to AT and functional adaptations, rather than basic skill remediation. This is likely why she found the last OT condescending. Their remediation strategies are usually used in young children. If you can get a good AT specialist (who may be an OT, SLP/ST, or other), that might be a direction to consider.

    6. My experience with STT vs scribe vs extra time for STEM exams is that scribe is better than STT (some students experience the technologies as awkward and nonintuitive, particularly for math), and that extra time depends a lot on the extent to which hand pain and test fatigue may inhibit her from expressing her thinking to its fullest extent, vs the challenges of vocalizing her mathematical thinking to another person instead of thinking on paper. If she has STEM interests, long-term she should start exploring different math AT, and try to find one that she feels comfortable with. (Note: the STEM field as a whole is slowly shifting toward electronic lab notebooks, so this may very well be just standard by the time she reaches post-secondary. I am waiting for the day that AT is not a specialized accommodation for anyone past grade three.)

    BTW, if she by any chance finds lengthy passage reading fatiguing, you might consider letting her try audiobooks, to maintain access to high-level text. Practically everything you might need is available on Audible or similar.

    Top
    #247414 - 07/29/20 12:32 AM Re: MG, DCD, HSD, VT and EF - help? [Re: ESAK]
    MumOfThree Offline
    Member

    Registered: 04/07/11
    Posts: 1628
    Loc: Australia
    AEH is the expert and I am not even going to try to address specific test results as she has.

    I have extensive in family experience with HEDS, POTS and dysgraphia that is primarily physical and due to the HEDS.

    Q2: I can't speak to the actual tests like AEH can, but having three children with dysgraphia due to HEDS, one of who seems to also have more typical dysgraphia... All of whom are gifted and don't necessarily look THAT bad on OT tests. What their OT has done has explicitly assessed and reported the difference between handwritten tasks (as the standarised test require) and the same task performed with typing.

    For two of my children all problems are resolved by moving to typing.

    In fact for one of these children there is no easily measurable problem with handwriting on standardised tests, they produce legible handwriting at good speed. Only professional observation of declining grip, obvious pain, etc lead to an opinion that it is cruel to expect the child to hand write volume at speed. Repeating the test with typing did however produce a massively improved output on the same type of test (either copying a set sentence or free writing), further demonstrating the impact of handwriting on their output.

    For the third child typing helps enormously, but it does not resolve all problems, there is still difficulty formulating thoughts and getting product "on paper". Typing is a necessity, but their difficulty goes beyond the physiological problems with their hands caused by HEDS. This child has the worst hands, needed the most therapy to learn any handwriting (we were told not to even bother by the OT when they were 4 "be happy if they grow up able to sign their name and tick boxed"). But the actual writing is a problem too.


    Q3: Please do your own research, but I think you will find tracking issues common in EDS.

    Q4: One of my children recently completed the IB. They loved it. They were granted extra time and typing for anything beyond short answers (ie typing for history and english, handwriting for math and chem short answer questions, but typing for things like prac reports). The organizational load is significant, but it is a wonderful program, I know nothing about the British system so I can't tell you how it compares but I am not convinced that the IB requires THAT much more organization than other approaches to senior high school certificates.

    Q6: what is your daughter prepared to learn to use? My child who will NEED some sort of AT for math/science exams at that level is currently completely refusing to learn any options that might help.

    Feel free to send me a PM if you have questions you don't want to share publicly. Or that you think I might not want to answer publicly.

    Top
    #247418 - 07/29/20 08:20 PM Re: MG, DCD, HSD, VT and EF - help? [Re: MumOfThree]
    ESAK Offline
    Junior Member

    Registered: 07/17/20
    Posts: 2
    Thank you so much aeh and MumofThree for taking the time to write such detailed answers. They have reassured me and given me a clear course of action.

    Yes, aeh, CAT4 was exactly the test I meant, thanks.

    Regarding the odd working memory discrepancy, I’m beginning to wonder if all the memory games we played with DD did more good than we realised. Things like ‘mastermind’ and ‘my aunt packed her trunk...’ which we played while walking because DD has to always be doing something.

    As it is, word acquisition, itself, never seemed to be an issue for DD (early speaking) but poor articulation of ch, sh, j sounds needed speech therapy. Otherwise she seems to do well (and enjoy) learning languages so I’d have thought repeating nonsense words would be a stronger skill than her test reflects.

    DD did a GL Exact speed of typing test with std score 109 - average but definitely an improvement on handwriting speed and something we can build on. We have typing games on our list for summer.

    DD reports a fairly chaotic process of typed writing under test conditions (history)- reorganising as ideas occurred to her. She says trying to hand write the same thing she would have lots of crossing out and would make fewer points having forgotten them in the writing. The end result got the job done with better marks than I expected. I think the words are coming but planning and more practise on structure and technique will be necessary.

    Having watched DD agonising over writing an English essay for homework I would agree that initiation and completion are issues. She has plenty of ideas but can’t decide which to use and where. Perhaps perfectionism is playing a part here?

    I’m sure it has helped DD see that her problems with writing and organisation are real and not from lack of trying. sure it has helped DD see that her problems with writing and organisation are real and not from lack of effort or care. So we’ll start with ‘smart but scattered’ now and see how she goes. I’ve also looked out a Study Skills tutor used to gifted and SpeLD, just in case DD is less enthusiastic about working through the process with me. We will try scribing some practise tests over the holidays. See how that goes while researching AT options. I’ve made notes on the maths programs mentioned here. Not sure what would be best over all for science but will see how electronic lab books work.

    I’m so glad to hear your DC enjoyed doing IB, MumofThree. DD appears keen to do the IB and I’m anxious to make sure she has what she needs and isn’t left high and dry. Since she has a track record of teaching herself when necessary eg typing I’m hoping she will give her best to mastering the skills to help her succeed. She has a strong desire to prove herself having been ‘held back’ for years.


    I also appreciate your observation of the co-occurrence of EDS and visual tracking issues. I’ve done a lot of research since realising DD is hypermobile and found she has a number of issues that also seem to co-occur. Alas, experience suggests we have to work through each specialism’s common diagnoses before they will consider anything else.

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