Gifted Issues Discussion homepage Forums Twice Exceptional School services for Dysgraphia?

Sorry if this has been covered before. DS has an IEP meeting tomorrow and I'm planning on suggesting to them that he has motor dysgraphia, as related to his developmental coordination disorder. They have been fighting me on giving him any kind of OT services, even though he already has an IEP for speech. Is Dysgraphia something that qualifies a child for school OT? What about a 504? I realize maybe this is different depending on the state, but just wondering what others' experiences have been.

I think this is something that will vary from school district to school district, even within one state. Our ds' dysgraphia did not qualify him for OT through our schools. We were able to find out that this was likely prior to talking to the school, which was helpful. Our neuropsych was familiar with our school districts' requirements for qualifying, and our local advocate was able to give us the specifics. Our school district *does* offer services, but in order to qualify a student has to score extremely low on the fine motor OT tests, and our ds didn't score low enough.

If your ds doesn't qualify, one thing you might do is to ask the school's OT to give you some suggestions of fine motor strengthening exercises you could work on with your ds at home, and also have her give the teacher suggestions of things to help him with in class. The school OT should be able to help informally with pencil grip and posture etc.

Has your ds had an OT eval through school yet? If not, I'd definitely request it.

Good luck!

polarbear

When he was initially evaluated for the IEP at around age 4 he had a brief OT assessment as a part of the eval and he did not score low enough. He could trace things, draw circles, etc. However she noted in her report that he had to put an enormous amount of effort into writing and was slow, awkward, strange pencil grasp, etc. and would likely have problems later in school.
The problem with DS and getting him help is that he does just fine with visual motor integration because his visual spatial ability and visual memory is off the chart. So he can use that to compensate and look reasonable on these sorts of writing assessments that don't last very long and are more mental than physical. If you give him a pegboard, on the other hand, and time him screwing pegs into the board, he is well below the first percentile. Screwing pegs into a board has nothing to do with mental ability. The same thing happens if you ask him to pick up coins with one hand and put them in a cup, and time him. He just can't do that. But I suppose the school doesn't care about a pegboard and him not being able to coordinate his hand movements in a timely fashion, they just care about how he writes in a 5 min. block of time. Other kids his age are still struggling to remember how letters look and may be slow because of that, but he has no problem with that, he's slow because of coordination. So he looks average for his age. I may be better off just pushing for them to classify him as "physically impaired" as a result of DCD rather than as having dysgraphia.

Is it possible they don't know what dysgraphia is? We had the IEP meeting and when I brought it up I got blank stares from everyone (incl. the school OT). The special ed director who was there to kind of mediate (since the last meeting was a disaster) immediately wrote it down but I saw no signs of recognition on anyone else's faces. How would they evaluate him for that if they don't know what it is? I am worried he's going to get a sub-par eval.

Yes. Though the school psychologist should be doing the testing and be very aware of it. However, let me give you my experience. I first had DS evaluated for dysgraphia and dyslexia by his school. Yet, it got me basically nowhere because the school psych simply would not use the word dysgraphia at all... there is really nothing in the report about it, etc. I point blank asked her if he has dysgraphia and she said something like "I can certainly see your concern re dysgraphia" but she would not tell me directly that he has dysgraphia. I felt like the school eval was a bit worthless because of that - i.e., that I couldn't get any kind of direct confirmation that he is indeed dysgraphic. When I finally took him to the neurpsych, she said it was really obvious he has dysgraphia. It has been obvious to me for years now but it should have been more obvious to the school at least by last year. Now, I will have the dysgraphia dx (actually it will be called "developmental coordination disorder affecting fine motor and handwriting" (or somerthign like that) in the report because, the neuropsych said, school will not recognize dysgraphia but it has to recognize DCD. I am not sure how much I will even use that to get accomodations now anyway - it seems like the EDS diagnsosis is taken much more serious by the school (so far at least) and the accomodations are essentially the same so I fidn I just rely on his EDS to get necessary accomodations. When we do 'slip' and refer to the disgraphia we get blank stares. DS's teacher also told me whe has never heard fo dyspraxia or DCD befre either .

Anyway, I hope that helps you in yoru decsion process some...

The DSM IV calls it a 'disorder of written expression', aka a written output disorder. If you try that language they might show a glimmer of recognition. We use 'dysgraphia' casually, but on anything official it's 'written output'.

OT is on the parents, not the school, in our jurisdiction, but we have multiple accommodations in place for written output.

I would second that they probably have never heard the term Dysgraphia. "Dysgraphia" is not in the DSM and is instead termed "Disorder of Written Expression", so some will only know it by that term if they know it at all.

Ultimately all the manifestations of the Dysgraphia seem to be potentially covered in the DCD diagnosis and that is one they have usually seen before. My son's diagnosis states "DCD w/ dyspraxia and hypotonia" with a prior reference to "R/O Disorder of Written Expression" in a previous report.

My DS gets great OT and accommodations from his school - and it makes me so sad to read some of these posts to deny services - but even with an open and welcoming school and administration - my DS's IEP says nothing about dysgraphia or disorder of written expression - I will have to look it up - but I literally think it says writing issues!

DeHe

Dysgraphia and dyslexia are (neuro)psych diagnosis and neither something school "psychologists" (many of which are not phDs) are qualified to diagnose (they aren't qualified to diagnose anything) nor something special ed law recognizes.

From the school's perspective a diagnosis is meaningless (ask me about ours!) if it doesn't lead to issues in the classroom that meet the criteria for a disability under IDEA. The details are state-specific to some degree, but federal law provides a framework. For "pure" dysgraphia the IDEA category would be "specific learning disability", and the Department of Education framework is here:
http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,23,

Potential pitfalls for you:
"Must not require the use of a severe discrepancy between intellectual ability and achievement for determining whether a child has a specific learning disability"

along with "The child does not make sufficient progress to meet age or State-approved grade-level standards [...]; or the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade-level standards, or intellectual development, that is determined by the group to be relevant to the identification of a specific learning disability"

Also "not primarily the result of: A visual, hearing, or motor disability".

With a diagnosis of DCD or EDS and a child performing academics above grade level you might be better off pursuing qualification under Other Health Impaired.

And this: http://legalclips.nsba.org/?p=1369 is disheartening.

Yes this is the basis of my son's IEP - "other health impairment"

Ugh this is so scary

I think that there could be several things going on here that would contribute to the "blank stares". Dysgraphia (and dyslexia) are never mentioned specifically on IEPs etc in our school district - the terminology used is "Specific Learning Disability - Writing" or "SLD - Reading" etc. When children qualify for IEPs under SLD, the bar is pretty tough to get underneath in order to qualify, and it would be really tough at your ds' age to qualify here for OT for the reasons you mentioned.

Like Irena's ds, our ds' diagnosis from his neuropsych eval was not "dysgraphia" but "Disorder of Written Expression" and "Developmental Coordination Disorder" (rather than dyspraxia). These are diagnoses defined in the DSM-IV and terms recognized/acknowledged by school districts.

I suspect the reason Irena is meeting with less resistance to the EDS diagnosis is that it's a medical diagnosis rather than qualifying under a learning disorder. I don't understand *why* that is, but we were told early on that if we could get a medical diagnosis of ADHD for our ds it would make the whole IEP process soooo so much easier - he would have qualified without any question and recieved the same accommodations and services and instruction as he did under SLD. But - he doesn't have ADHD.

The other reason you might be receiving blank stares and no acknowledgement is something we ran into (head on, like 100 miles per hour into a brick wall). Our school staff knew very well what dysgraphia and DOWD is - I found out by networking that there were other students at the school with accommodations via 504 and the same diagnoses. However, our school district is extremely stressed to provide services for all the students who need them, and the specific school we were in was trying their best not to qualify students for services. It took me awhile to realize that the staff did indeed understand and was aware of exactly what I was talking about, but they were not going to agree to anything or suggest anything unless I brought it up first. That essentially meant I had to know what the policies were, had to know what was commonly already done for kids with handwriting etc challenges within the district and at the school, and I had to have a lot of proof to argue against any of their arguments they tried to put forward suggesting our ds was "just fine".

The things our ds worked on when he went through private OT for handwriting included things like putting pegs into pegboard, working with resistant clay, learning proper grip and posture etc. All of it helped at that point in time with eliminating wrist pain, and his handwriting legibility improved quite a bit. If you can't get the OT through school, you might try to get a referral for private OT from your ped if your insurance will cover part of it. I do think it was useful - yet at the same time it wasn't crucial. Within a few years, when writing load increased, my ds once again had wrist pain. And we're not talking about a lot of writing - he had completely switched to typing almost everything at that point in time, but was experiencing pain just from filling out worksheets that were short-reply type answers. The lessons in posture and grip stuck, and the OT helped quite a bit with reducing the excess pressure he was placing on his pencil which resulted in crumpled messy torn-up papers as he wrote.

What really helped us the most in advocating was having an outside private evaluation and diagnosis (from a neuropsychologist). I am not sure that if we'd started with a private (or school) OT we would have understood the need for OT to be honest - even though our ds' OT eval showed he "was an excellent candidate for handwriting remediation". The numbers on his OT tests were not low - but had that large discrepancy similar to the dip in processing speed on the WISC. The OT report phrased everything as anywhere from "average" to "superior" and didn't list a diagnosis, other than listing the codes ds had been given by the neuropsych. It listed ds as "an excellent candidate for handwriting OT" but didn't mention anything that sounded enough of an alarm bell for me as a parent (had I had no other info) to have thought "Yep, this kid has an issue and I need OT".

I can't remember if your ds has had a neuropsych or psych-ed eval (either privately, or a full eval through the school)? What was the speech issue that he qualified for an IEP with - articulation or something else?

polarbear

WOW!! Should I be glad that my child's report card shows him consistently "below grade level" in PE? Thanks so much for this useful post! As we are in the IEP process now as homeschoolers this is pretty relevant info.

Thanks for all the input. I find it so frustrating that these so called "professionals" may have never heard of the term dysgraphia but we ordinary parents have. He originally got an IEP when he was 4, just for speech. At the time, they said it was for articulation and his voice pitch. Now I know that the issues with his speech were because of DCD/dyspraxia. His main issue now with speech is fluency and prosody. For instance he'll either talk in a monotone or like mickey mouse. And very slow. Speech therapists with the school have no clue what to do about any of that, but that's another post I guess. They evaluated him back then for fine motor but it was just one test and it was a visual motor integration type test so he did just fine. The OT back then noted that he wrote very slow/awkwardly but insisted that he could not qualify for anything because he wasn't scoring low enough.

This last spring I took him to a neuropsych after a brain injury. He did a Grooved Pegboard test which is timed and DS scored horribly (like 0.1 percentile). But was something like the 65th percentile for Beery VMI. Neuropsych diagnosed him with DCD, indicated that any motor test with a mental component will yield average results, and recommended school OT in his report, because of the fine motor issues as seen with the Pegboard.

The school has the neuropsych report but they don't seem to know about the different special ed categories or how he would qualify. At first they were acting like only kids with autism or cognitive disabilities would qualify. Now they know there are more categories than that (sounds unbelievable they could be so clueless, right?). I will look at "Other Health Impairments" again. I really hope that they are just clueless and not trying to get out of things or being deliberately obtuse just because of funding.

I have been taking him for private OT and PT for about a month. Not sure how long our med. insurance will cover it.

I'm also not clear on how many of DS's issues are due to the brain injury, because last summer he was doing fine and exited private OT and PT, but I believe some of his motor skills are actually worse now (despite having a year of coloring, gluing, cutting in kindergarten). His 1st grade teacher brought in examples of his cutting to the meeting and it looked like a 3 year old did it. He has never cut that poorly in the past (at least, not since he was 3 or 4). So it could be the TBI is causing some of the issue (for example it exacerbated the DCD), but I'm not sure how anyone would sort out what is TBI and what is DCD that was always there.

Hugs to you Blackcat. I hope you get it sorted out in a workable way soon - I know it is so frustrating

Wow, I hope so too but really someone there, like director of special ed at least, should really know such things.

I hope so as well. He didn't say much at the meeting but was writing things down. He said he would make sure DS has a decent eval to me on the phone about a month ago but we haven't talked since then.

I don't know if I'll be able to get services added to his IEP or not, but can probably get a 504. What kinds of modifications should I ask for? One thing I don't want DS to take is the timed, written CogAt next year to qualify for gifted programming. It was a ridiculous test for DD with her ADHD and I'm sure DS will do poorly on it as well. I'm not sure if they need to fill in a bubble sheet, or write things down on scratch paper or anything, but if there is any chance he will be at a disadvantage due to not being able to write (or slow), I don't want him given the test. His WISC IV GAI is above the cut off but they will probably consider that test too old by that time.

I agree with you here. So far, in my experience the WISC IV is the best test for our types of kids because the PSI can be taken out and the PSI is what is greatly affected by their disabilities. My DS scored absymally on his PSI - really really low (it was classified as "extremely low" and is in the 1st %ile All those years of OT (and months of VT) and his coding and symbol search are off the charts low. BUT they can be disregarded with the GAI and should not get in his way of getting gifted services. I think the same sections (PSI) are greatly affected by ADHD (not an expert though but that is my suspicion). I think for getting gifted for him you would need to get a private WISC IV and the get the school to take that. Do you know how long is "too old" for the school to use by any chance? I am just curious when WISC IV scores are no longer considered current.

I think the website said testing from the previous or current school year is accepted.

I wrote on a different thread somewhere on this site about how DD didn't even finish half of the CogAt (probably because of the ADHD and her immaturity and it was tightly timed--but she also has an extremely slow processing speed/working memory when not medicated properly). The district gifted coordinator (who is now gone) told me that she can take an IQ test but would leave it up to the school psych. The school psych wants to give her a Weschler non-verbal ability test. It has sections like coding and visual sequencing and I just don't know how she would do on something like that. I don't think there's a way to separate out those sub-tests if there are gaps like you can with a GAI. Debating whether to argue with the school psych or just let DD take the test and hope for the best. She needs to get a composite score of 132 (or 139 if her math/reading achievement test scores are not both in the 98th-99th percentile). But those scores are based on the CogAt which might have different percentiles than the WISC. It all gets very confusing, and the people with the school district don't seem all that bright.

Since DS has an IEP I'm hoping they don't fight me on giving him another IQ test later on, rather than the CogAt.

Coding was DS's lowest score on the WISC, but strangely he still got a 10. Nine points less than his highest score though. I assume this is a large discrepancy.

9 points actually isn't considered to be a large discrepancy, but if it's the only discrepancy and the other subtest scores are all within 2-4 points of each other, then combined with other indications of ADHD or dysgraphia etc, it's significant. Most psychs will only consider a discrepancy of either > 1 SD (15 pts on the WISC) or 1.5 SD to be statistically significant and meaningful.

Re the CogAT, my ds was given the CogAT at school *with* the accommodations of oral response, individual testing in a quiet place and extended time. The reason we were able to get those accommodations was that he already had an IEP in place with similar accommodations in the IEP, and he was given similar accommodations on testing in his regular classroom. I think that right now, I'd focus on being sure your ds has the testing accommodations he needs written into his IEP. Your district might be different than ours and use a 504 for accommodations, but I think it's typical for children who have disabilities and an IEP to have the accommodations written into the IEP and not carry a 504 while they have an IEP.

I wonder if the reason the school is offering up the Weschler non-verbal is that is a test the school psych is licensed to give or that the school district has licensed and possibly the WISC isn't? Or simply that it's a shorter test? Was your ds given the WISC as part of his IEP eligibility process?

I found having the WISC scores (ours was through a private professional, but having one through the school would have worked ok too) was really helpful in advocating. Our school gave only the verbal (or maybe non-verbal, I can't' remember which) version of the CogAT and ds' outside the box answers, while well thought out... didn't mesh with what the test wanted for answers and he scored significantly lower than he did on the WISC. When the school came back and told us they'd have to try another ability test because of ds' CogAT scores, it was so helpful to have those WISC scores in our backpocket so we could question *why* did the school insist on testing again when it was clear from a widely used, reliable standard IQ test that ds was qualified for the program. Something in my tone of voice when I mentioned that must have sounded either ominous or desperate... because it worked lol.

Good luck advocating!

polarbear

[quote=blackcat] I'm not sure if they need to fill in a bubble sheet, or write things down on scratch paper or anything, but if there is any chance he will be at a disadvantage due to not being able to write (or slow), I don't want him given the test. /quote]

Since these are concerns, I think it's really important that you get accommodations for them written into his IEP now - these are concerns that don't only impact whether or not he takes the CogAT - they are going to come up again and again with testing both in the classroom and on state/etc testing and eventually college board exams.

pb

Thanks polarbear. I'm not sure why the school psych seems so insistent on not giving her the WISC but I assume it's because of time or funding. Since she's so against it, I'm not sure I trust her to even give the test in an appropriate way if she finally agrees to it.

DS has never had any sort of cognitive testing with the school. Just speech assessments (articulation) and very brief fine and gross motor evaluations.

Here are his WISC scores if anyone can make sense of them or what they mean in terms of being 2e:
Block Design 13
Similarities 12
Digit Span 10
Picture Concepts 19
Coding 10
Vocabulary 13
Letter Number Seq 14
Matrix Reasoning 18
Comprehension 13
Symbol Search 13

DS was very squirrely during the testing according to the report, and there are concerns about ADHD. I noticed when he did a perceptual vision test with the OT (which I was allowed to watch), he was at times impulsive with his answers and kept changing his mind after she had recorded his answers. Since he has always had speech output issues (similar to apraxia) I'm not sure if the verbal subtests are valid, reliable scores of his verbal ability or not. His verbal comprehension score is only 114, while Perceptual Reaonsing is 141. That's a huge gap. I'm not sure if I should bring up this issue with the school or demand any other testing because of this gap. His working memory is 110, and processing speech is 109--so all the scores are in the average range except for Perceptual Reasoning at 99.7 percentile and neuropsych said that's an underestimate because of block design, which involves fine motor. He noted in the report that there are large discrepancies between scores. Full scale IQ is 126 and GAI is 133.

Is block design a test of visual spatial ability? Because when the OT did visual testing, he scored above the 99th percentile for visual spatial ability and visual memory. For that test, there were no little blocks to manipulate, he was just looking at a book.

The school pretty much dismissed the IQ testing and the entire neuropsych report. They do admit that he is 2e, and are now looking at the recommendations because of the special ed director getting involved. But at ths point they are totally focusing on the disability and not the giftedness. DS's teacher finally said she would give him third grade level math instead of first grade, but I'm not sure how that's going to work. Is she planning on teaching the math or just giving it to him? I'm also very worried about the writing that will be involved.

Blackcat, I apologize - I misread (misunderstood) your note about the discrepancy between subtests, plus... I hadn't had my morning caffeine yet when I answered! 3 pts = 1 SD on a subtest... I was thinking VCI vs PRI vs PSI cum scores, not subtest scores when I made my totally incorrect remark!

9 point differences on subtests are significant. Absolutely And the difference between his VCI and PRI is really large. I am guessing that, like many of us 2e parents, what you are embarking on is a journey that isn't going to be magically resolved or understood overnight (as you have already found out!). It usually means simply moving forward, making the best decisions you can with the data you have, advocating, seeing how it all works out, then tweaking and advocating all over again.


(VCI vs PRI)

If you are seeing impacts at school or at home in homework etc that may potentially relate to the gap in PRI vs VCI, then yes, bring it up as a concern - but don't just mention the IQ, bring up the concern via the academic examples and then have the IQ scores as the backup for your concern.


Our school also did their best to dismiss the neuropsych report, and there are a ton of different reasons school staff might appear to be dismissive of outside testing -from not wanting or being able to provide needed services to needing to validate what they do provide within the school to egos to not understanding to simply not wanting to bother to read it. And lots more. Not one of those reasons means that it's not a valid data point and it isn't a reason to not keep mentioning it whenever you find it's a good backup for what you are advocating for at school.


While this may not sound encouraging, this has been the experience of many of us here with our 2e kids - and even though it's not what we see as ideal, it can work out ok. The reality is often that our kids *do* need to focus more time and energy on remediation, learning how to use accommodations, getting used to being comfy in their own skin, during those first years of elementary school. It's tough to race ahead in math or whatever when you can't easily use handwriting to show what you know (this is just one example grabbed out of the air, that impacted my ds in a huge way those first years of school). Try to focus on knowing that all the hard work you put in now advocating for accommodations etc and all the hard work your ds is putting in now just going to school and getting by and learning how to use his accommodations, going through OT/PT etc - that hard work *is* going to pay off in a large way once he's further along in school and able to more easily show/share his knowledge. Our ds really didn't get any type of true differentiation until he was in middle school, but the flip side of that is - if our primary focus during elementary school hadn't been on understanding his disability and how to accommodate for it he would not have had access to accelerated courses in middle school, and if he'd been allowed in, he most likely would have fallen hard and quick due to lack of being able to keep up with *output* (not lack of ability to comprehend). So yeah, it was beyond frustrating and yes, we after-schooled a bit, but it is what it is. It sounds like you are way ahead of us in success with at least getting your ds' school to acknowledge he needs differentiation, so keep at it!

Best wishes,

polarbear

Good points. As long as he is not complaining about school, I'm not too worried about it. He's just happy to be there with his friends and is willing to put up with some nonsense. For the last month of school he has been bringing home 2+2 homework for math--number partners up to 6. It has been painful to see when he already knows all the multiplication and division facts and can add and subtract negative numbers, understands fractions/decimals, etc. I am opposed to subject acceleration in math (as in, actually moving him to a different grade for math), because of my worry about the writing and that there just won't be enough time for math after being pulled for speech, OT, Adapted PE, etc (assuming he gets OT and physical therapy). So I just want the teacher to differentiate the best she can, working around the handwriting issues. I told her I want him to work to his ability level in all areas and not be held back in certain subjects just because he has a disability. I suggested iXL on the computer in the classroom to do while the other kids are listening to the boring number partner lectures, and gave her his password but so far he has not been on there. We'll see what she comes up with in terms of math and what he brings home. If it seems too difficult for him, I'll ask her to give him less or a lower level.
The neuropsych did write in his report that DS's perceptual reasoning is so advanced that he processes information differently than other people and is at risk for not doing well in a traditional school setting. Gifted services should be considered. I'm not even sure what he means by that (how he processes information differently? Is this like saying he is a divergent thinker? Visual thinker?). But he has a point on not just neglecting that side of him and I'm glad he put it in the report so I don't look like a crazy pushy tiger mom.