We've done a year with OG tutor and OT for handwriting and motor planning. We expected marked improvement!!!
We retested with WJ-III this month and things were worse in most areas. The two areas of big gains are reading fluency and spelling (go OG Tutoring!)
biggest gains in:
-reading fluency. 91-98%
- spelling 73-80%
- applied problem 82-93% (would have been higher but clocks and money issues)
N., although you've titled this "repeated achievement and worse"... truthfully, I think you've seen great improvements, and the improvements correlate to the extra work your ds has had with OG tutoring. So that's all *really* really good.
- he had a drop it passage comprehension from 95-86%. Her thought was both implied text stumped him and she felt he is dropping comprehension trying to go for fluency.
- writing samples dropped a ton from 81-66%.
- math fluency dropped from 96-78%!!!!!
- he had to ask to stop the clock and break after three minutes of writing.
- all his writing samples start to deteriate after a bit...capitalization goes away; reversals pop up; some aren't even sentences; and letter formation was bottom to top on a lot.
Although these "drops" seem frustrating, I like to keep in mind what the WJ-III Tests of Achievement are and why they are used. Each subtest looks at one very isolated skill, and what you get from giving the range of subtests is a broad overview of where your child is at relative to same-age or same-grade peers. It is different from the types of achievement tests that are helpful in assessing where your child is at relative to your school's curriculum and - perhaps more importantly for a child who has any type of LD or challenge - they are typically given without accommodations - so a relatively low score *might* indicate an area that your child is weak in re the actual skill - or it might indicate that another challenge such as poor fine motor, vision, whatever - is impacting your child's ability to either show or learn that skill - and that's *good* information. The trick is to look at the tests in detail, correlate that with that with what you know about your ds, and then put it all together to understand why the scores are what they are. For my dysgraphic ds, it is *very* helpful to group the subtest results together according to response *type* - when you do that, the subtests that require oral response fall in the range of his ability level, the subtests that require handwritten responses fall about 30%iles lower, and the subtests that require handwritten responses and are timed fall another 20%th percentile or so lower. When you look at the list of subtest scores without that type of context (whatever the correlation may be), the scores just look wild and scattered - but thinking through what a students challenges might be and looking at how each subtest is administered as well as looking at what it is measuring, then grouping the subtests accordingly, can help the scatter make sense.
- overall he went from 94% to 95%.
- broad reading was exact same 93%.
- broad math up a point 97% to 98%.
- broad written went down 84% to 78%.
This is the mathematician in me speaking, but I wouldn't put much thought into analyzing or worrying over these broad scores. First, they aren't terribly statistically different across any one group (even the broad written). Broad math and broad reading could be something as simple as statistical range of error. More importantly, broad scores are averages - you'll get more info by focusing on the individual subtest results.
I do not have a dysgraphia or dyspraxia diagnosis but OT is confident there is enough testing data there to support.
It does seem that there is more than enough reason to suspect either diagnosis, and there are a lot of good reasons to seek a diagnosis. You've also had a good series of tests - both earlier and again now after OG tutoring. It doesn't look like you've had a thorough reading assessment (but I could be wrong about that - maybe it's just not something that you've listed here). I'm not sure what the difference is, in this instance of an "ed psych" vs a neurospsych in terms of the type of eval, but it seems that you've gotten most of the tests my children had in their neuropsych evals. What you don't have is a diagnosis... and it's not clear to me if that's because the psych feels the diagnosis is not supported or not clear, or if you haven't seen a psych who can make a diagnosis (?). DId the ed psych give you any kind of DSM diagnosis? (comes with a code!).
Having the actual DSM diagnosis can be very helpful - this isn't the same thing as saying a student has stealth dyslexia, it's a very specific diagnosis defined in the DSM (hence it has credibility when advocating). OTOH, the DSM has specific sets of requirements for any given diagnosis, and it's possible your ds might not fit any one diagnosis but is still struggling. Anyway, I'm not sure if this is making sense, but my dysgraphic ds, for instance is diagnosed with Developmental Coordination Disorder and had an earlier diagnosis of Disorder of Written Expression. He's dysgraphic, but that's not what schools and/or the psych refer to - they refer to the DSM diagnoses.
Just occurred to me - was the "ed psych" private or through the school? Psychs through the schools do not typically diagnose via DSM but instead look for indications of LDs. It's all basically the same issue, just different terminology to fit the situation. I'm totally not explaining this very well (aeh is probably having a good belly laugh right now over a parent blundering through trying to explain it all lol!).
Ed psych says no doubt now...mild to moderate LD . She said she's confident enough to call it stealth dyslexia. The common weakness is in anything with speed or motor graphia. She ask believes visual processing is weak and wants us to check teaming/tracking.
- he was 32% on visual processing Beery
- he cramped after 3 minutes of writing and samples deteriorated quickly.
- he clearly was not using ability while doing it
This is an area where it feels like your ed psych eval fell just short of what you need to tease out to understand what's really up - and you need to understand this in order to appropriately remediate or accommodate and know which you need to do. You've got indications that something is up - could be vision, could be fine motor, could be both - but it's all just "could be" at this point without more info. 32% on visual processing definitely sounds like a potential issue with how the eyes are working together and communicating with the brain. If you haven't had a *regular* eye checkup lately, I'd do that first, and if that's all ok (eyesight is fine and/or corrected adequately with lenses), then I'd get a Developmental Optometrist eval (assesses how well eyes work together to produce adequate vision).
Cramping wrist/hand is not unusual in dysgraphic kids - but it doesn't necessarily indicate fine motor challenges - it probably means he's holding the pencil too tight, which could be from a grip that's incorrect or it could be from frustration at the difficulty of forming letters etc. So I have no idea what's up with your ds, but suspect it could happen from just the response to difficulty with vision if that's the issue or it could be related to fine motor dysgraphia.
The reversals, wrist cramping, etc - all of that was present in our ds who has fine motor dysgraphia as well as in our dd who does *not* have dysgraphia but who had an undiagnosed vision disorder. These all disappeared for dd after her vision issues were remediated through vision therapy. DS' hand pain while writing was eliminated through OT - but - here's the gotcha - it has returned a few years after OT. Dysgraphia is not going to be fully "cured" or remediated - more on that later. If it's a vision issue, it *might* be something that can be fully reversed through remediation and accommodations (lenses etc). That's why it's so important to have an accurate diagnosis and understanding of what the challenge really is - so you don't put time and effort and money into something that's not going to help, and so that you don't miss opportunities to remediate/accommodate when you can.
I would look for additional clues as well as additional testing:
To determine if there is a fine motor dysgraphia issue: what does your ds' posture look like while handwriting? Does he hold his wrist or shift as if he's not comfortable? Is his pencil pressure on the paper uneven? Does he have an unusual pencil grip?
Signs of a potential vision issue: Does your ds hold his head or eyes at an odd position while writing? (My dd used to bend her head to the side or lay it on the table while writing). Does he stop and rub his eyes frequently while writing or reading? Has he struggled with learning to read as well as having writing quirks/struggles? When you are talking to him, does he look at you and make eye contact or does he look off to the side?
Some things you can do at home that are helpful in determining if it's dysgraphia:
Have your ds print the alphabet from A to Z, caps and lower case. Time how long it takes him to do this task and also watch while he does it. Does he form his letters consistently, does he have to stop to think to write letters, are any reversed? Does he make all the caps and lower case letters correctly? When he's done, calculate the number of letters per minute he wrote, then google "letters per minute + (whatever) grade" to get reference ranges for what is a typical handwriting speed at his grade level. Is it reasonably in range and did his letter formation look ok, or does he have errors in formation, did he pause and seem to have to think to form letters, and is his speed slow compared to grade level?
Collect and look at samples of your ds' handwriting from school and at home, current and from past years. Is his handwriting improving or stagnating? Are his papers neat or crumpled? Does he have reversals, lots of eraser marks, uneven spacing or size of letters, does he use the capitalization and punctuation skills that are expected for his grade level, does he run into the edge of the page while writing etc?
Give your ds two writing "assignments" at home - make them similar but not exactly the same thing. Have him complete one using handwriting, and one by telling you while you scribe. Compare the difference in output (number of words plus depth, detail, complexity of thought etc). There will probably be a slightly better story "written" by scribing for most kids at his age, but if there is a marked difference, that is a very strong indication of dysgraphia.
Observe how your ds acts when he has a writing assignment - does he try to avoid it, fight it, get upset? Does he sit and stare at it or start working on it right away? If he has hesitation or stress over writing, is it just "writing" (Language Arts) types of assignments, or does he have the same stress over completing math etc type of assignments when handwriting is part of the work?
School thinks LD for him is hogwash
Re school - some school districts and some schools (this has been my experience - it is absolutely not the same everywhere, but it *is* something to be aware of) - will give you pushback no matter how badly your child might need services or how obviously he will qualify. At one point in time, friends of mine here who work with and see many different students with different needs in their classrooms here in my district have told me quite honestly that to get the services the students need (and are legally entitled to) the parents have to go the route of suing the school district. We face a *lot* of in-your-face pushback from our ds' school staff when we advocated for IEP eligibility after his diagnosis, and when he was clearly struggling in school with written expression. It's easy when your child is working above grade level to listen to a school staff member say something like "he won't qualify because he's working on or above grade level" but you have to just listen and then ignore and move forward. That is *not* correct - and it's important to just keep the conversation focused on what your ds' challenges are and what he needs and what your goals are that you want the school to provide - and all the while be very aware of what your ds' legal rights are and what the school is required to provide.
SO - if your school is telling you "LD is hogwash" (in whatever words they choose to use), you listen, and then you submit a written request for an IEP eligibility review (if you are seeking individualized instruction) or a 504 planning meeting (if you are seeking accommodations only). The school is required by law to respond within a certain time frame - their is a time frame set by the Federal Govt. but there are also shorter time frames in some areas set by either the state or the local school district. Gather your data together, and be prepared to advocate. They have to at least hold a team meeting, and if they refuse to do that they have to give you a written reason explaining why. Every time you run into a road block, you think it through, and you write another request or summary or whatever to explain what you disagree with and what you request next. Does that make sense? It will take work, but you don't have to stop at the start by hearing the "hogwash" type comments and assuming you'll never be successful at getting help through the school. Just keep plugging away, and make all your requests in writing, and document all conversations in writing.
School thinks I'm getting bad advice from Ed psych.
We had our school staff attempt to dissuade us from seeking help for our ds by talking down our neuropsych's advice and report. When you get these types of comments from the school staff, reply simply and concisely "Are you questioning the opinion of a respected local professional?" That puts the onus on the person making the comment to explain why they do not agree with specifics, and in turn gives you something you can address directly. It is also a comment that 99.9999% of the time immediately shut down that line of attack from the school in the team meetings we had.
The only caveat I'd add is - be sure the ed psych who tested your ds has credibility. If there's any reason for the school *not* to trust the credibility of the psych, then that's a reason to consider further testing, in addition to getting a defined diagnosis.
Best wishes,
polarbear