Gifted Issues Discussion homepage Forums Twice Exceptional Advice on Beery VMI + OT Treatment Diagnosis

Hello everyone!

I posted here a few times over a year ago about my son - now age 12 and dx'd with dysgrphia and dyslexia. Here's the prior thread in case anyone wants to backread:

http://giftedissues.davidsongifted.org/BB/ubbthreads.php/topics/235651/1.html

Everyone was so knowledgeable and helpful previously. Hope I can rely on this community for some input and advice again.

His prior school denied my initial request for testing for dysgraphia--and put my son in an "OT observation" process that resulted in the school OT saying he was "making progress" (and that his handwriting was at the 90th percentile for legibility despite never having done a test. Still baffled about that one )

I sought an outside neurospsych eval for him. He was diagnosed with dysgraphia and (mild) dyslexia last summer. I approached the district again with the test results--and was denied again (both IEP and 504) due to his good grades and high scores on state-mandated testing.

Along the way, he was also denied gifted services, despite having passed the district's gifted screening benchmarks. The said he was an "enigma."

After a few painful months, lots of tears, many school refusals on his part, and an agreement to do a 504 eval after threatening a complaint and going to the school board (it turns out the district didn't have a 504 policy at all in violation of Federal law!)...I decided to pull him to homeschool him.

That's been going well. He's much calmer and happier. We're taking it pretty easy, but it's the clear right choice for him, right now. He's opened up a lot about how hard school was for him and how he felt "dumb" due to the poor quality of his written work.

I got an OT referral from our pediatrician, so he recently had an assessment using the Beery VMI. I could use some help understanding the results, the "treatment diagnosis" and next steps.

Beery VMI

Raw Score: 23
Standard Score: 89
Scaled Score: 8
Percentile: 23

Below Average

Visual Perception

Raw Score: 23
Standard Score: 85
Scaled Score: 7
Percentile: 16

Below Average

Motor Coordination

Raw Score: 14
Standard Score: 45
Scaled Score: 1-
Percentile: .02

Very Low

****

Treatment Diagnosis

R27.9 Unspecified Lack of Coordination
R41.842 Visuospatial Deficit

****

He's started weekly OT. He does have handwriting "goals," although I don't expect too much progress there. He also has "organizational" goals since he displayed some signs of being scattered on the neurospych testing (some signs of ADHD, but not enough to be ruled out). I think the big benefit for him right now from OT is support and acknowledgement of his challenges--which was one of the reasons the denials at school were so hard on him.

Any thoughts on what I should seek or expect from OT?

The OT recommended he see a developmental optometrist. There weren't specific suggestions for vision therapy--but the only developmental optometrists I can find all focus on vision therapy. I don't mind having an assessment, but not sure about vision therapy. I've heard glowing anecdotal reports and heard others say it's a waste of time (and money). I haven't received any input (or read any research) specific for dysgraphia. It seems to be rejected as a therapy for dyslexia.

Any thoughts? Is a developmental optometrist the right professional to approach or are there other avenues to get more information on the visual component?

{A kind-of aside: I have a daughter with convergence insufficiency so have looked into vision therapy before. I had an optometrist and pediatric ophthalmologist advise against it, so we haven't done it. She's been doing better with "pencil push-up" exercises and self-monitoring while she reads. I'm still considering it for her.}

I know the diagnoses are for billing purposes, but wondering if there's more that I need to investigate. I'm especially curious about the "Unspecified Lack of Coordination" diagnosis.

Is there testing we should pursue to get more clarity?

I think that's all my questions for now. I feel like every answer leads to even more questions. Appreciate any input you can provide.

Thanks.

Nice to hear from you again! And very pleased that you've found homeschooling to be a good solution for you and him.

Your DS's OT eval results do explain why he scored so much lower on the nonverbal portion of the OLSAT than on the verbal section, as that is very much a perceptual reasoning task. In reading over your prior thread, I also notice that his academic history is a familiar one, as I often see something like that in students with a profile that could be described as a nonverbal learning disability. Literacy is a challenge earlier, until decoding is finally mastered to fluency, and the instructional demands become comprehension rather than decoding. Math is often an early strength, but sometimes becomes a later challenge (especially in geometry), as demands change over from arithmetic to higher-level problem solving. (Math may not, of course, have actually followed this trajectory for your child.)

At this age, honestly, you should be able to tell within a relatively short time if OT is going to impact handwriting or other functional skills. With regard to handwriting for function, I would actually focus on assistive technology, such as the one that all of us use to post on this forum. Long-term, it will be of more value to him to become fluent with keyboarding and speech-to-text than to invest excessive time and effort into Handwriting Without Tears. (Not that this is a bad intervention, by any means!) My personal standard for functional handwriting is being able to sign your name, complete a form, and write a short note (such as of thank-you note length).

It is not a bad idea to see a developmental optometrist (IMO), especially if the OT suspects a vision issue. Obtaining an assessment does not mean you have to follow their treatment advice.

Does he have any other coordination issues? Such as gross motor ones? If so, there might be value in having a PT or neurologist look at him for other coordination disorders (such as DCD-developmental coordination disorder). Sometimes these mimic ADHD symptoms. There's a lot of overlap between DCD, NVLD, and ADHD in terms of presentation (although not necessarily in origins or interventions).

Thank you for all the helpful insight, aeh! I hadn't made the connection between his OT results and OLSAT results, but that does make sense.

I have been wondering about DCD because he has some characteristics that seem to fit. He's not generally "awkward," but he's "slow" in some ways (if that makes any sense). For example, he is a very (very!) slow runner and swimmer (although he can do both for a very long time) and just doesn't seem to be able to coordinate his all the movements his body needs to make to pull off those tasks efficiently. It's almost painful to watch him, since I know he's expending so much energy and covering so little territory! He does play baseball (has for years)--and is a decent first baseman, but can not bat well at all. He's also "lost" if he has to play another position. I've assumed he's just not a great natural athlete, but always wondered if there's more that's going on with him.

The big question I've have about him and DCD is that he does have an (diagnosed but very obvious) speech difference. He can't make "r" sounds at all. It seems to have gotten worse in recent years--so much so that other kids ask if he's from another country and comment on his accent. The school district's SLP listened to him a few years ago and said his differences weren't enough for speech therapy and that they'd work themselves out in time.

Am I right in understanding that speech issues can be part of DCD?

I'm curious about NVLD too. He seems to do fine making friends, so I'm not sure about social skills deficits. The other pieces seem to fit though.

His OT goals are pretty basic. They're aiming to get him to write a "legible" (or at least functional) signature and be able to make simple lists for his own purposes (like shopping lists). They haven't worked on handwriting much yet--more on fine-motor activities and some visual activities.

We're focusing on keyboarding and speech-to-text at home--and making that a priority was one of the big reasons I decided to homeschool. His school didn't have computers in most classrooms and couldn't take a keyboarding class until high school. He was required to do a lot of note-taking by hand because he can't keyboard fast enough to take notes. It was all exhausting and painful for him.

Some of my caution about vision therapy is that the one local developmental optometrist practice seems to bill themselves as dyslexia specialists. Every authoritative source I've read seems to say that vision therapy is not the answer for dyslexia. I've heard good things about the practice from people I trust though, so I'm torn. I may think about taking him out of the area for an assessment. I want to do one, but just don't want to have the wrong focus.

Hmmm. More to consider! I think I will talk to his pediatrician. I'm sure he'd have no problem with referrals to a PT, neurologist, or SLP to help us get more information.

Not sure if this will help, but check out LEARNING TRIANGLE: Without the Vestibular, Visual and Auditory Working Together, Learning Fails
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I would definitely ask his pediatrician about a DCD diagnosis. My DS10 got this diagnosis at age 7 (based on a different motor skills test by an OT).

Many of the things you mention are very familiar - moving slowly, difficulties with writing, and so on. My DS doesn't have speech difficulties, but I have read that some DCD kids do. ADHD symptoms also overlap with DCD symptoms.

DS was also diagnosed with convergence insufficiency. I was skeptical about the vision therapy (and so was the pediatrician), however he had a lot of difficulty reading so we gave it a try. It was clear during the initial VT testing that he was skipping words, skipping lines when reading. In our case, the VT did help - with both reading and with ball skills - DS can now play basketball tolerably well, where before he had trouble. I thought of the CI as just another aspect of the DCD, by looking at the eye coordination as another fine motor skill he needed help with. I know that VT won't cure dyslexia though - I would avoid any VT that claimed this was the case.

Perhaps look again at the SLP as well - possibly it is similar in helping the fine motor skills required for speech...

Yes, speech can be part of DCD. Oral expression and speech articulation are both closely tied to fine oral-motor coordination skills. Challenges here can also affect reading decoding skills, as they create a mismatch between the speech sounds a child produces for words, and their written representation, which interferes with sound-symbol correspondence.