Gifted Issues Discussion homepage Forums Twice Exceptional Dysgraphia Testing?

I am currious how your children were tested for dysgraphia? Mine has been confirmed to have dyslexia, but there really are lots of things that point to dysgraphia too. They did take a writing sample when I first had him screened. Even though the psycologist couln't rule out dysgraphia based on the writing sample, they scored it in the average range. I am not sure how that is possible when there were lots spelling mistakes, inversions, spacing, punctuation issues, etc. My son is really struggling with writing. He is in the 5th grade. He has a hard time getting his thoughts on paper and gets fatigued really quickly. What is the difference between dyslexia and dysgraphia? Is there a reason to have a confirmed diagnosis for both?

Thanks so much for your help.

Welcome to the forum cathy! Was your ds diagnosed with dyslexia through a neuropsych eval, through private reading specialist testing, through the school, or other?

FWIW, I have a child with dysgraphia and another child who is dyslexic, but my dysgraphic ds is not dyslexic and my dyslexic dd is not dysgraphic - although her handwriting looked dysgraphic early on, and she continues to be extremely challenged with spelling. The differences in handwriting that were very noticeable between my dysgraphic ds and my dyslexic-but-not-dysgraphic ds were/are:

* handwriting caused wrist pain for my ds - he didn't say his hand hurt when he was little, but he would rub his wrist frequently while writing and refuse to write for more than a few minutes at a time.

* my dysgraphic ds had a very odd pencil grip and weird posture while writing (before he went through handwriting OT). He would bend over his paper, and also hold the elbow on the hand he wrote with using his other hand in order to keep his arm steady.

* my dysgraphic ds made (and still makes) tons of mistakes when copying, either from the board or while doing a math problem etc. This didn't seem to be an issue for my dyslexic dd.

* papers handwritten by my dysgraphic ds, in early elementary prior to handwriting OT, were extremely messy - crumpled up, soft-dark pencil marks etc - due to uneven pencil pressure.

* most significantly, handwriting caused my dysgraphic ds a *ton* of frustration and it didn't really seem to bother my dyslexic dd, it was just sloppy and full of reversals and misspellings etc.

* there was a notable difference in ds' verbal output vs written output - significantly different. My dd, otoh, could write for a longer period of time and the sentences she composed sounded like the things she would tell us verbally.

The similarities in their handwriting were: in early elementary, both had very sloppy handwriting, uneven spacing, mixing up caps and lower case, letter reversals, and lots of challenges with spelling. Around 3rd/4th grade they *both* had a sudden increase in handwriting legibility, but both continued to reverse letters and numbers.

Another thing that has come up as they moved along in school: my dysgraphic ds had fluctuations in test scores before he was given accommodations for handwriting while testing, but the fluctuations clearly tracked where you would expect a handwriting-challenged person to have issues. My dyslexic dd has test scores that fluctuate all over the place and don't seem to have any kind of reasonable pattern. From working with her on homework, my suspicion is that the variable test scores are related to challenges with reading.

Re testing and getting a diagnosis:

My dysgraphic ds was diagnosed through a neuropsych eval. If your dd has had a neuropsych eval, you can look for a few things in the test scores: a discrepancy greater than 1.5 SD between processing speed subtests on the WISC (coding, symbol search) and the other WISC subtest scores. A similar discrepancy on WJ-III etc achievement subtests if you separate out the tests that require oral vs written response. Discrepancies or low scores on tests of visual-motor skills (Beery VMI is a commonly used test for this and helps determine if a challenge is related to visual processing or fine motor skills). There are tests called "finger tapping" which are used to diagnose fine-motor related dysgraphia. Although our neuropsych didn't use this type of test, you can also time how long it takes to produce handwriting and there are a lot of sources for comparing letters/minute to grade level expectations. All of these tests (except handwriting speed) were used in combination with a look at ds' handwriting samples as well as the parent interview where I was asked questions about behaviors etc surrounding written work (things like holding his elbow, frustration, refusal to complete worksheets we knew he knew how to do etc). DS' dysgraphia is also severe enough that you can watch him writing and realize something's up - he is just extremely extremely slow.

DD's dyslexia diagnosis was made through a reading specialist prior to neuropsych testing. The challenge that impacts dd's ability to read is clear from her ability testing. OTOH, when she later had neuropsych testing, her scores were not easy to directly translate into scores impacted by reading challenges and the discrepancies between high and low scores didn't fit into easy-to-correlate patterns. As I mentioned earlier, the scores on neuropsych testing were clear-cut for ds - it was obvious that his low scores were directly related to timed tasks requiring handwritten output. I am not sure if dysgraphia would have been as noticeable through neuropsych testing (the achievement vs ability testing) for dd as it was for ds, simply because the reading challenge seems to cause an added layer of complications in interpreting the test scores. Some of the tests, such as the Beery VMI and the finger-tapping tests, wouldn't be impacted by reading challenges.

FWIW, it sounds like dysgraphia might be an issue for your ds. We've seen in both dysgraphia and dyslexia in our extended family, sometimes occurring together in the same person.

If you can let us know more about the testing your ds has had, it might help us with further advice.

Best wishes,

polarbear

I'm still wondering about dysgraphia for DD. I took her to an OT who gave her the BOT for fine motor (which tests coordination as well as visual-motor ability, copying patterns, etc). And she did fine. But when you look at her writing, like copying spelling words, she makes tons of errors. She catches them though, and writes over the errors. She doesn't like to erase. So it looks like a mess. There are some letters or words that she writes over about 5 times.
I was talking about this to the OT so she told her to write the alphabet. With some letters she hesitated a few seconds like she was trying to figure out how to write them. Or she would start writing them, do it wrong, stop, and write over them. Her handwriting does look very neat when she is trying, so it is very inconsistent.
The OT didn't seem to think her alphabet writing was abnormal in any way, although it didn't look normal to me. So we are back at square 1.
Her coding score on the WISC was an 8 so there was something like a 60 point gap between processing speed and GAI.
The 504 coordinator for the building wants to write a 504 for processing speed, but just have modifications like increased time to do work. I don't know if this is sufficient if the problem is dysgraphia.
One of the other OTs told me that if you trace a number or letter on the back of a child and ask them what you wrote (with your finger) a child with dysgraphia would have trouble figuring it out. DD didn't have trouble. Not sure how "accurate" that test is.

This the first time I'd ever heard of this... and fwiw... my first thought was... I couldn't possibly id a letter traced on my back, and I'm for sure not dysgraphic lol! Seriously, though, dysgraphia means there is a disconnect in the ability of the brain to control either fine motor or visual processing in a way that prevents a child from developing automaticity of handwriting. I don't see any connection with how the brain interprets a letter traced by someone else on your back, other than demonstrating that the brain is recognizing the form and able to remember it as it is traced - *by someone else*. I don't think it really touches at all on the issue of dysgraphia.

polarbear

Sorry I'm replying a bit backwards to your post - the thing with the tracing on your back just sorta jumped out at me lol!


Can you define "fine"? Does BOT stand for something like Burtenesky? I'm sorry I don't have time to look it up right now, but fwiw when my ds was assessed using the Burtenesky (sp?) his fine motor skills were all above average (if I remember correctly) - but the Burtenesky isn't assessing dysgraphia, it is assessing fine motor skills and the ability to use fine motor. I know that *sounds* like dysgraphia but it isn't the same thing. Many dysgraphic individuals are able to draw amazingly well (my ds included) and have the ability to do other fine motor tasks well, but the act of handwriting falls apart because of the complexity of the task and the need to develop automaticity. So what you learn from the Burtenesky is the potential for the dysgraphic person (if they *have* fine motor dysgraphia) to benefit from handwriting OT. If a person scores average or above, then there is a chance that handwriting OT will be successful - it won't take away the dysgraphia (which is a whole 'nother post re why it's important to keep that in mind), but it can help with developing legible handwriting, good posture, reduce wrist pain etc. If a person scores very low on the Burtenesky, I think that is most likely an indication that they don't have the fine motor skills potential to benefit from handwriting OT.

It's also a good idea to look at the scores on the Burtenesky to see if there are discrepancies. My ds had large discrepancies on it - so while his scores were all technically above average, there were some that were high and some that were hovering right at average.



I wouldn't take this alone as a sign of dysgraphia - and this is one reason that sometimes dysgraphia is tough to identify. Lots of kids your dd's age (at least a lot of the kids in my kids' classes) have sloppy handwriting, make mistakes when writing, and don't like to erase. It looks messy, but it doesn't necessarily look different than many other neurotypical students' handwriting if the dysgraphia isn't hugely severe. One thing you might want to do though, is to look back at your dd's early early elementary writing samples if you still have any and look for signs of dysgraphia there... as well as look at how your dd's handwriting has improved over the years - do you think it's steadily improved or stagnated?


My suggestion to add some info to what you were trying to look at here is to:

1) Have your dd print the full alphabet out, upper and lower case, in order, and time her. Calculate her letters/minute and compare that to other students her age and grade (you can find that info by googling things like "letters per minute + 5th grade"). My dysgraphic ds comes in significantly below grade level on this task.

2) Ask your dd if she has to think about how to form letters when she writes. My ds will tell you he has to remember things like where to start his letters etc, and that he likes numbers better than letters because there are only 10 of them to remember. Neurotypical kids don't make comments like that!


My ds' handwriting also looks neat when he's not stressed or hurried. What's important to look at though isn't the legibility of the handwriting as much as the *content*. Is she still making punctuation or spelling errors? Reversing letters? Mistakes when copying? Is the written content comparable to the output she'd produce if talking or recording or typing? *THOSE* are all signs of dysgraphia - when a child doesn't have automaticity of handwriting and has to consciously rethink how to form letters as they write, they run out of working memory that is used by nt folks to take care of all those other tasks.


IMO, this is the biggest red flag for dysgraphia you've mentioned. You will no doubt read or hear that a discrepancy between processing speed and VCI/PRI etc is not uncommon, especially in gifted children, but the magnitude of the gap combined with the issues you listed above all suggest, jmo, that it would be worthwhile to have follow-up testing specifically looking at dysgraphia. The tests I'm thinking of are tests a neuropsych would typically offer as part of their eval, with the goal of understanding why the coding speed was so much lower than other subtest scores. The Beery VMI is one of the tests that is typically given, as well as finger-tapping and other executive functioning tests. Has your dd had any of those through her previous testing?

polarbear


The 504 coordinator for the building wants to write a 504 for processing speed, but just have modifications like increased time to do work. I don't know if this is sufficient if the problem is dysgraphia.
One of the other OTs told me that if you trace a number or letter on the back of a child and ask them what you wrote (with your finger) a child with dysgraphia would have trouble figuring it out. DD didn't have trouble. Not sure how "accurate" that test is. [/quote]

I thought the letters/numbers on the back was strange too. I tried to google it and didn't come up with anything.

Here's a description of the test that was done. http://www.pediatricapta.org/events/ACP/2012/handouts/pedsfwdcampbell2/BOT-2MG.pdf
I think that her lowest score was something like 24th percentile for manual dexterity and it involved things like picking up and transferring coins, maybe placing pegs in a board. I don't remember. But she was also quite yappy and off-task during the test since she wasn't fully medicated. So she was talking/giggling while she was doing the test and some of it was timed. Overall the OT thought she did very well and they (there were two of them) did parts of the tests with her that most kids never get to. I asked for a score report and never got it. I should ask again. I asked if it's possible she could do well on the BOT2 and still have dysgraphia and didn't really get a clear answer but I don't think she thought that was a strong possibility.
I think that in the past I tried to google how fast she should be writing and didn't come back with much but I will try your suggestion.
I am taking her to a new primary doctor tomorrow and will ask about this. I really want to get some input on the ADHD as well. I know there is a large overlap between ADHD and handwriting issues too, and she does seem to do better with writing when she's medicated. I think seeing a neuropsych is a good idea but I also need someone who can prescribe medication.
So far she's just had the WISC and the BOT2 for fine motor. Also the BRIEF for executive functioning, and of course that was abnormal because of the ADHD. I think her overall fine motor is good but the finger tapping doesn't look quite right to me. Of course, I have no idea what's normal for her age either.
The OT did say she qualifies for services (because of the abnormal BRIEF) and that she can do "metronome therapy" with her and other things to boost processing speed. But I don't know if that's supported by research or if it would be a waste of time/money.

We have never had any fine motor skills test done or the test you described. We have a processing speed issue, timed versus untimed. He does much better on untimed. Regarding the writing, I would say he has gotten better over time. He is now 11. When he wants to write neat, he uses alot of brain power. He takes a long long time to copy and is extremely fatigued once he does. He also still has spacing issues, writes his letters pretty big compared to peers. Upper and lower case letters are now proportioned, P B D and G being the biggest culprits, the ones he used to invert but doesn't anymore. The biggest thing I noticed is how he writes the least possible words he can. The physical task of writing anything makes him really tired. He has gotten faster as time has gone on. Should I try the timed alphabet thing? Would that give me some useful info? It sounds like we really didn't get a screening for dysgraphia at all.

Thanks for the great responses.

Sorry not proportioned...writing looks off. Also, lots of spacing between words. The letters take up multiple lines. It defintiely still looks a little different than his 5th grade peers. His teachers are also mentioning that he is fatigued during the day. I know about the dyslexia, reading thing, but is writing also dyslexia, or is this something different? He also was never diagnosed as ADD, but his teachers notice him not focusing and tuning out alot. I really think this has to do with his being extremely tired from writing, let alone reading. What do you think? Is it worth more testing?

I will add that if you're thinking dysgraphia, that word can also be too narrow. We have one who is not technically dysgraphic, but sure looks like it-- it's actually Developmental Coordination Disorder and ADHD that cause most of his issues.

ITA with DeeDee - I only mentioned the dysgraphia-specific pieces of my ds' eval above, but fwiw, the fine motor issues that result in his dysgraphia are actually due to Developmental Coordination Disorder. DS has a dysgraphia diagnosis, but it's DCD that best defines his overall set of challenges.

FWIW, when my ds was still struggling in the classroom without appropriate accommodations and remediation he often zoned out - he's told me since then that the issue was when he was sitting during writing sessions with no idea what to put on the paper and/or when his hands hurt from writing he had nothing to do and no idea where to start, so anything and everything else in the classroom would distract him - he'd start thinking about some really goofy things! There were times when it felt like the chicken-egg thing with advocating for him - we knew he was distracted because he didn't know what to do, and the school claimed he didn't know what to do because he was zoning out. Once we had handwriting accommodations in place and were able to give him specific instructions in writing the daydream-zoning-distraction issues disappeared.

He does get very fatigued, both by the physical part of handwriting and because of the enormous amount of brain work and concentration it takes him to write legibly when he has to use handwriting. My dyslexic dd gets incredibly fatigued from reading - really, I think we all get fatigued from having to work at things that are difficult to us. The letters you mentioned above were the toughest letters for my ds to write correctly when he was your ds' age.

polarbear