Gifted Issues Discussion homepage Forums Twice Exceptional SLP role re:disorder of written expression

Thought I might as well move this to its own thread...

Things aren't going as well as anyone hoped they would (504 has been in place for about a month), and while the SLP at school didn't find anything remarkable in her observation of DS, I'm thinking that we should revisit that (either through school or a private SLP).

I'm hoping that you'll be able to share some of what your SLP has done in working with your DS--I don't know enough about this to ask specific questions yet.

Whoever I next find myself talking to, I think it would be helpful if I could at least say "I've heard that working with an SLP on [specific deficit] by doing [specific exercise] can help kids like DS with their writing", or offer to share some relevant articles--admit I haven't done a pubmed search on this yet...

They've given him noise-cancelling headphones, which aren't helping. I don't think any sort of assistive technology has been introduced.

His teacher says she can't spend all of writing time working one-on-one with him (understandable!), and the next thing she's planning on trying is sending him into the kid's kitchen to work one-on-one with the assistant teacher.

Reading between the lines, it sounds like she's getting frustrated that he's not applying himself and working efficiently--I heard a lot of that last year, but this is the first time I've heard it from her.

Thanks, polarbear--I don't know anyone else IRL who is dealing with this particular learning disability. You folks on this board are it!

Mo

Mo, what information and resources do you have already? Have you had a neuropsych eval that documents strengths and weaknesses?

This sounds to me like the school is not putting adequate resources into the situation. If you had an IEP instead of a 504 you could get OT for the writing and/or pushed-in or pullout special ed support for written expression, both of which seem highly relevant.

What I know about disorders of written expression makes me think, "of COURSE he's not working efficiently; he's working against the disability" but it may be hard for the teacher to see that unless she is shown how to see that and work with it.

DeeDee

We added SLP once I was able to argue that DD's speech was impacting her writing because she was sounding out words and spelling them the way she pronounced them. For example 'bright' would be 'bwite'. Not sure if that's what you're dealing with though.

At this point we also have OT, a para to scribe, accommodations allowing oral responses as needed and limits on the amount of written work she is required to do. Our situation is more complicated than 'just' Disorder of Written Expression but that is one of the many things DD has been labeled with.

Hi DeeDee,

We had a private neuropsych evaluation in the spring, and the school has a copy. The folks at school do know his strengths and weaknesses, and I believe that they really do want to help. His handwriting has improved quite a bit, but it's the thought-generating-writing-it-down process that needs constant prodding.

The fact that the 504 accomodations as implemented aren't having the desired effect is *probably* going to be enough of a reason for them to willingly switch over to an IEP. I hope I'm not jinxing myself by saying that.

I have a feeling that whatever polarbear's DS has done with his SLP would stand a good chance of helping my DS too. So I'm looking for some specifics.

Mo

Hi Pemberley,

Here's a quote from polarbear that describes issues very similar to what I'm seeing in DS:


His articulation is fine, and his spelling is not too shabby. There's nothing obvious that would make a person think that speech therapy would be helpful.

Mo

My DS8 uses these and finds them helpful (ADHD, language disorder, partial APD, possibly HFA).

He spends time once a week with a SLP at school and they work on things like story sequencing. The goals for these sessions include increasing his expressive vocab, describing, sequencing, summarizing, predicting, creating, comprehending, etc etc. The SLP we have is new this year and she's going to create a "homework" book for him (which I haven't seen yet, but she has a ton of kids on her roster and is very busy).

His diagnoses include language processing, which affects written output (O.M.G... does it ever). He has no formal "written output" dx but he shouldn, imho.

FYI - I make up stuff for him to do as well. I have him look up words in the dictionary and then write a definition in his own words, for example. This gets him a) reading, b) printing, c) comprehending the meaning of the word, and d) using expressive written output to communicate the meaning.

It's quite amazing what he can do. The key is LOTS of breaks. Because he's compensating against his disabilities, he gets tired often. It's as if... he summons up all the will and strength he can, and then blasts right through whatever brick wall is in front of him... then he needs recovery time.

As for his spelling... eesh. Not good. Slowly getting better though.

Familiarize yourself with the language of RtI, which is now the legally recognized process. If an intervention isn't working, I believe they have to try something else. It should help...

DeeDee

Thanks, CCN!

I've been reluctant to make him do extra writing work outside of school other than things like writing short notes, making lists--the kinds of things one actually must do in everyday life.

He'll write down numbers if he's doing math for fun. He'll write me notes in secret code for fun. Give him a writing assignment, though, no matter how simple, and it's probably going to be a long and painful process. I can understand why teachers get frustrated.

Mo

Yep, DeeDee, good point about the RtI. I've been to one of those meetings in person, one on the phone. I have to say they are my least favorite, but whatever--do what you gotta do

Hi Mo,

This is probably going to get broken up into two (or more? lol) replies, because I only have a little bit of time at the moment, and I also have quite a bit of this pushed back into my long term memory so it takes awhile to recall

The test that our SLP gave my ds that showed discrepancies is called the CELF-4. If you want to know about any of the testing details, let me know.

The first thing that ds' SLP did when she started working with him was spend time evaluating the different initial steps in the writing process. Our school district and area are heavily into the "6 Traits of Writing" so if you're looking for a way to try to think of writing in steps, you can google 6 Traits and find some info to start with. There are more steps-within-the-steps, but it's a good starting point. DS' primary challenge is generating ideas, so once the SLP understood that she focused on working on generating ideas and that's what they spent most of his first year of speech therapy working on, and even though she's added in additional skills over time (organizing, adding descriptive detail, etc) they still work quite a bit on generating ideas.

I don't remember the very first set of types of exercises they worked through, but I do actually still have them in a notebook, so I'll take a look for you. The SLP learned a few things about ds from that worked that help - he needs a bit of a "jump start" for his brain to get set in motion so she worked on finding ways for ds to first, be jump-started (talking to another student to brainstorm was the first), then worked to where she realized it was just talking that helped with the jump-start (didn't have to be about the writing assignment), then realized that just moving his mouth helped (go figure?) so if he chews on gum or a granola bar or something that can be a help... which is something he can do at school at his desk without making any noise.

The other thing the SLP did at the very beginning was to research dysgraphia and written expression challenges. She used a book written by Virginia Beringer to come up with ideas (I think it's called the Source Book for Dysgraphia... but will have to dig my copy out to be sure). One thing she took from Beringer's book was the idea that dysgraphics are challenged with automaticity in more ways than just the act of handwriting, so any of the steps of writing that are taught in the classroom and most kids pick up on quickly might take repetition + repetition + repetition + and on and on for a student with dysgraphia. This is one thing that continues to be a challenge for us in school - writing concepts are shown as an example in class, the students practice that idea on one written assignment, then next week they are given an entirely different type of writing skill to learn and they practice that - and that works ok for NT kids who aren't challenged with written expression, but it meant that for a kid with a written expression challenge and dysgraphia my ds would *maybe* clue in just a bit (with a ton of help and support)... and then instead of getting that same type of assignment to practice again (and again and again until he truly "got" it)... wham, the class has moved on to something else and he was always lost. I think that's something that's especially difficult for teachers to understand with a gifted kid, because in math/science/any kind of class discussion about history/social studies, whatever, ds has that osmosis-capability of understanding and remembering everything the first time he hears it.

One thing that helped ds (and wasn't with our SLP) was a school assignment during 4th grade. Every Monday morning the first thing the students were supposed to do when they came into school was write one paragraph about what they did over the weekend. The paragraph had to have 2 sentences. The teacher had a graphic organizer that listed "topic sentence" and "detail 1" "detail 2" and "concluding sentence". It took the *entire* year for ds to get to where he could write that paragraph, but he was able to eventually write it because a) there was a very clear set of directions, b) the directions never varied so he was able to practice practice practice until he understood how to do it and c) he spent his weekends literally making sure he did two things so he would have two ideas to put down in that paragraph.

Back to his SLP work... one of the things that the SLP did with ds a lot early on when they worked on generating ideas was to play games with him (board games, kid games, the type of games that two people can play together). They were either games that had word-generation as part of the actual game, or they would take turns having to generate whatever words they were working on whenever he or she lost a turn on the game (or won a turn). We've continued to use this technique for generating ideas on homework assignments for several years, although ds is slowly needing it less and less.

I'm going to pull out ds' SLP notebook and come back and list some of the other specific types of work they've done together.

One other thing I would keep in mind when advocating is to realize that your ds is probably very unique. Our SLP had never worked with a student like ds before.. and she's an SLP who's worked for many years in our school district and has always worked exclusively with young children). I suspect there really *aren't* that many kids with 2e expressive language challenges.

Gotta run - more later!

polarbear

Oh! I just thought of something else that I used to do for DS8 last year...

I'd use handwritingworksheets.com (print style, paragraph, size 1, portrait) and I'd compose the paragraph and simply have him trace it. His TA at that time was getting him to trace individual letters and it was making him crazy, so instead I wrote paragraphs that were relevant to him, like about our pets, his hobbies, etc.

My goal was to try and enhance the path that goes from the ideas and events in his brain to his language output centre and finally to his hands. He wouldn't have the stress of composing the language himself but he was still getting exposure to translating ideas and concepts into written language. I explained this to his grade 2 teacher and she thought it was a fabulous idea. (I approached it from a proactive "I'll solve it myself" standpoint rather than saying "the letters you're getting my kid to trace are making him stir crazy - he needs above grade level content, not below.")

On an unrelated side note, sometimes the diagnosis of ADHD is a blessing because rather than hounding the gifted issue (which makes some teachers roll their eyes), I can approach it like: "it's that darn ADHD - we need to challenge him to keep him focused" ...and voila, they're all happy and supportive. lol.

polarbear and CCN, THANK YOU! I'm planning on gathering much of what you're saying into a text document to help me with talking points. And CCN, your tracing idea, that's positively brilliant! I want to give that a try. Sounds like it would be fun for me and not so bad for him. Maybe I can come up with some math jokes

Coming down with the gunk that's been going around town, so I'm heading to bed...I may not get back to the board before Sunday (in-laws, Hanukkah) but keep it coming! If you feel like it, that is

Mo

We've been doing handwriting OT (or hot housing, depending on whether you speak to the OT or the school) for my 6yr old all year. I find it makes a huge difference to mix up what we are doing:

sometimes we are writing the alphabet (teacher insists that being able to write it upper and lower case at speed is important for automaticity),

sometimes writing "The quick brown fox jumps over the lazy dog" (the whole alphabet but out of order).

sometimes she writes from memory, some times she copies.

some times she's working on her dotted thirds paper focusing purely on neatness, sometimes she's writing on a single sheet over a towel and working on pressure control (neatness goes out the window).

Once she started ADHD medication it started being possible for her to compose for herself so somedays she does that, the next day I get her to copy my re-written version of her paragraph which has the spelling corrected.

sometimes we doing spelling lists.

I never through to try CCN's approach, which is great, but certainly she would have gone mad and been completely non compliant without some variety.

There has been a significant shift through the year from copying to actually writing, from struggling with forming the letters to thinking about spelling/composing.

We have huge pencil grips to correct her grip, we also had a brace for the first half of the year.

We use dotted thirds paper (which our school does not use or encourage)

We use mechanical pencils to teach pressure control

Then mechanical pencil on a single sheet of paper over a towel, to REALLY teach pressure control...

The better all this has made her handwriting the more she is able to use her brain for the writing... Also the ADHD medication has a profound impact on both handwriting and writing.

10 mins a day at home working on the handwriting with me has been possibly the single most important educational experience she has had this year and I think she would have made zero progress at school without my intervention.

Very interesting that your ds's handwriting got worse over the years MON but is now improving. DD's has improved with OT and practice but it is still very, very difficult. Forget difficult - writing is pure torture for her. Now that she is in the middle of 2nd grade and about to turn 8 her handwriting is probably close to what her peers were doing in kindergarten. It is still painful, though, and she definitely needs the help of her para to scribe. Keyboarding should be getting started soon now that the AT eval was completed.

I just wanted to mention something the spec ed teacher said yesterday. Last week she was working with DD on an assessment for their recent science unit. She said "I have been doing this for 38 years and have done this assessment with more kids than I can count. THIS one was a pleasure. I just read the questions to her and acted as scribe for her answers. I didn't change her words or explain anything. Her understanding was amazing! She explained the concepts so clearly. It really showed how getting these disabilities out of the way and just allowing access to the curriculum can work." I guess that's the goal in all of this isn't it? Just getting the disabilities out of their way...

Dysgraphic kids come in many different flavors - from the root of the challenge to how much they will be able to overcome handwriting difficulties. OT was very successful in achieving legible handwriting, much less hand/wrist pain, good posture while writing, good pencil grip, and even pencil pressure for our ds. OTOH, it did not take away dysgraphia - no matter how great his handwriting worked or how correctly he was able to complete it, his handwriting was still extremely slow and it was still not automatic, hence any time he has to use handwriting it uses up a hugely disproportionate amount of his working memory which in turn impacts writing.

That aside, the original question in this post was about SLP work for written expression, so I just wanted to clarify one thing - we weren't using an SLP to remediate for dysgraphia. Our ds is dysgraphic, but once we had accommodated for his dysgraphia we found he had an *additional* challenge of an expressive language disorder, and that is what impacts his ability to generate ideas and get his thoughts on paper, organize those thoughts, etc. These are things he has difficulty with whether or not he's using handwriting, keyboarding, voice-to-text, scribing, whatever. For a child who is impacted only by dysgraphia with no involvement re written expression, you should see a vast difference in the amount of output when you ask them to "write" verbally vs with handwriting, and you should see their written output improve as they move to typing (as long as their fine motor skills will support typing).

There are also different levels of how far to "push" a child with dysgraphia to practice handwriting. I love CCN's idea of tracing following a story because I can see how that would have really helped my ds be exposed to the concept of how to write a simple story - yet it would have taken him all his energy and patience to have traced maybe 5-6 words before he would have to quit due to wrist pain when he was in early elementary (before handwriting OT). Even after handwriting OT, I think he would have been so focused on the actual act of tracing that I'm not sure there would have been any secondary benefit from exposure to the story.

Just a few thoughts about the complexity of understanding what's up with a child with LDs....

polarbear

Some more rambling thoughts from our experience - *naming* a diagnosis seems to be tricky and variable (and I don't even want to think about what happens when DSM-V comes out lol!)... for instance, our ds was diagnosed with Disorder of Written Expression in his first neuropsych eval (at 7), but after working with his SLP for approximately one year he lost that diagnosis when he had a follow-up neuropsych eval prior to middle school. When I asked the neuropsych why he no longer had the diagnosis (yet was clearly still struggling with written expression) her answer was that he no longer fell below average on one of the WJ-III Achievement subtests (I think it was the test where you're given two pictures or two words and have to make a sentence from them (can't remember for sure exactly how the subtests worked). It made absolutel sense that his scores on that test had improved significantly, because that was one of the skills he'd been working on with his SLP for, um, about a year. He was still clearly a kid who struggled with written expression.

Our ds also appears to have random ups and downs in what he's able to produce with written expression - some types of written expression are easier than others. He can more easily list factual information and write scientific notes etc than he can come up with creative writing (although he has a very creative imagination). Give him an open-ended writing assignment with no guidance and aaarggh.... might as well just send him directly to a padded cell

polarbear

Just making sure I understand the difference, MON-- is dysgraphia a problem with the mechanics of handwriting, and DWE the organizing of verbal content to be put down on the page?

DeeDee

In our case neuropsych labeled my DD "NLD-ish", including dysgraphia, but psych labeled DWE. I frankly don't see the DWE because she can indeed formulate her thoughts - she just can't execute the writing so it comes out in a very simplified form if she has to write it out. DD is good about punctuation, capitalization, etc. She knows all the rules she just can't seem to do it physically. I therefore lean more towards the neuropsych's interpretation of dysgraphia than the psych's DWE. Then again I may be totally wrong... I wonder if the actual label is a matter of interpretation based on field of expertise. i.e. only the neuropsych could label NLD - from what I understand it doesn't exist in the psych's playbook so she had to give it a different label.

Thanks-- very interesting thread, I'm learning tons...

DeeDee

I just wanted to say thanks for giving me so much to think about Polarbear, did you do any work with a private SLP, or has it all been in the school?

Mo

hi,
this is a great thread and something i was concerned about with my DS6 but didn't realize it was an actual real thing- i'm talking the handwriting difficulties.
whenever i mentioned it to a teacher etc, i was told DS was fine, age appropriate etc,
however way back when,
yes he did receive OT, (he hasn't rec'd OT since he was 4) incl specifically for fine motor weakness specifically in the intrinsic muscles of his hand- his "palm" not his fingers.... so he didn't have strong grasp etc, and he's always had a problem with lack of pressure.

ok, since teaching him at home, i have realized he holds pencil wrong and holds his arm wrong as well. i ment'd to OT i met @ a school, who suggested use of a 'slant board' but that OT stated this didn't require OT services.
so what i am seeing with DS are mechanical issues? (arm position?)
and these are specifically signs of dysgraphia?

which i am still trying to figure out, between the dysgraphia and the DWE.
because same as others above, now i am doing language arts/writing with DS? he can read on his own, he can then discuss in depth with me what he read, showing full comprehension and retelling in his own words, and discussing other things related to what he read etc etc,
but when it comes to writing it down?
FORGET IT!
this has been beyond frustrating for me.
he keeps complaining of his hands are too tired.

he can't seem to get started past the first word.
can't seem to form a thought to put on paper, i mean- after discussing verbally- when he picks up pencil to write down- he seems to blank out.
so IS THAT descriptive then of DWE??
*DS see's a SLP for pragmatics. and his IEP specifically states just pragmatics as his Speech goal.

is there a test to specifically test for dysgraphia and DWE, to determine which he may have? would the SLP administer? or ?

i'm worried he may have a bit of both? or do they sort of overlap in areas? so maybe he is just DWE?

(i'd like him to be neither!)

i have noted also, when i just barely touch his hand, not guiding in anyway, not even applying the appropriate amt of pressure for writing, but just a very light touch, he is able to form his letters very well and with good pressure...he even seems to write the letters in the right direction! still not able to write his own thoughts though. but the mechanical issues seem to clear up.
*have any of you noted this with your own child?
also,
mumof3-
thanks so much for all the ideas to help with handwriting!
i plan to try to implement these myself!!
i have been giving him letters to trace, but he quickly complains of being too tired, again there is a lack of pressure, and even with tracing, he is not able to stay on the lines to form good letters!
and also polarbear! thanks for your explanations of what these are, i am still somewhat unclear, but i have had so much going on,
it is only NOW actually fully teaching him myself that i am learning just what an impact his writing (or lack of) is all about.

because i am still with the district doing independent study- sadly they don't accept him doing verbal answers/discussions-- where is my evidence my "support teacher" keeps asking. sheesh.

thanks for this thread. very informative