Gifted Issues Discussion homepage Forums Twice Exceptional Dysgraphia or Fine Motor Delay?

I just found this site today, and I am delighted.

My son is 7-1/2 and in 2nd grade. He's being evaluated for special ed services or a 504 plan. Everything is fine with him except his writing. He reads 6th grade level books (although is teacher said his DRA was 28 at the beginning of the year), he's great in math, but his handwriting is terrible. He does not (and never has) reverse letters, and he does not mix upper and lower case inappropriately, and his spelling is pretty good; however, the spaces between words are sometimes not there, he uses the lines as suggestions not as a place to rest the letters, and his letters are not formed correctly. I can usually make out what he's written, particularly if he writes big.

He's had an OT evaluation, and his visual motor speed is in the 2% percentile. His manual dexterity is also below average. He tested very superior in visual perception.

I was hoping the school would give him a 504, but they want to do further testing to see if he qualifies for an IEP. This school district doesn't like to give OT services with a 504, so I may have a fight on my hands if that's what he ends up with. Meanwhile they have until the middle of April to do the testing they need to do.

Our insurance won't pay for private OT, and it's about $100 an hour. We may be able to afford 2 hours a month out of pocket. So here are my questions:

1-How do I know if he has a delay or if he has dysgraphia and does it matter?
2-Should we start OT now and risk him improving too much to qualify for help at school, or should we wait and waste the whole school year?

Thanks!

Wow! Great questions... my DD is in a similar situation in 3rd grade. I can't wait to find out what advice you get

I am planning to have her privately assessed for dysgraphia in a couple of months.

The school doesn't like to provide OT for students on 504 plans because they do not receive any funding for section 504. They do receive some funding for students on IEP's, however. That may actually work in your favor if he clearly needs the services, they would probably rather have him on IEP.

Cathy

Hi Keet,
Welcome!
I would see if they are going to do a individual IQ test such as the WISC as part of their assesment, so that you get a 'free' IQ test out of this aggrivation, and maybe so you can argue 'well his handwriting isn't a problem for a child of average IQ, but given his actual IQ the handwriting really needs to be stronger - please give us services - although this rarely works.

It sounds to me like (as a mom) the problems are exactly what Handwriting without tears helped my son with. Bright kids need to look at things analytically to use their minds to help out thier weak areas. So for about 20 dollars you can by their special paper and Printing Power Price: $6.35 Code: PP Grade: Gr. 2 and throw in Can-Do Print for 5th graders if you boy is cute-phobic and hates being talked down to.

For 50$ you can order the Print tool which fully analyzes printing, (I'm still waiting for mine) or for 200$ you can attent the print tool workshop yourself and learn all the insider tips and teach him yourself.

I would start now, and start with typing lessons as well. Wait and waste is a pretty good characterization of what happens in public school environments, and if your home lessons don't help, well then that's one less avenue to go down. Trial and error is the state of the art, BECAuse each kid is different.

Prepare yourself - things that seem difficult and mysterious to all the people at school are not nescessarily going to seem difficult OR mysterious to you. I would try the HWT route at home first before shelling out for the private OT IF your child doesn't seem to have other small and gross motor difficulties. There may be tears though.

My son also had the "the spaces between words are sometimes not there, he uses the lines as suggestions not as a place to rest the letters, and his letters are not formed correctly." thing going. He got tremendous improvement using HWT 5 minutes a day for 5 days at age 10, and it took about a year to show up. I think it was a maturity plus being able to start using his intellect. Maybe if we had done it more, the improvement would have shown up sooner, but it was a very busy year.

Smiles,
Grinity

Hi Keet.
I'm an OT and also a parent of a GT kid. Has your son had his vision checked? Did the OT test fine motor skills specifically? Are there other motor coordination issues? Is the psychologist at the school testing for dysgraphia?

Typically, scores on standardized tests that are in the 15th% or lower will get someone's attention and be considered a delay. As for waiting or taking action privately, I would base that decision on whether or not your son is succeeding, relatively speaking, at school. If the handwriting is causing undo stress and he is frustrated, failing or struggling then you maybe should do whatever you can afford to do right now. But if he is getting by and you feel the school isn't going to drag it out too much longer, then waiting is fine. Just remember that he won't get any services from the school over the summer.

Is there anyone at the school you can call on as an ally? Perhaps the OT could advocate for the staff to get their testing completed sooner rather than later.

I didn't realize there's no funding for OT under a 504. Can we legally push for it if that's all that's warrented?

We had his vision checked, and he's pretty normal. The tests and results from the OT (private practice) are as follows (I don't know how to make the columns line up, sorry):

BOT-2
Subtest - Scaled Score - Descriptive Category - Age Equivalency - Percentile Rank
Fine Motor Precision - 16 - average - 7:9-7:11 - N/A
Fine Motor Integration - 16 - average - 7:9-7:11 - N/A
Fine Manual Control - 53 - average - N/A - 62
Manual Dexterity - 9 - below average - 5:6-5:7 - N/A
Upper Limb Coordination - 15 - average - 7:0-7:2 - N/A
Manual Coordination - 43 - average - N/A - 24


DTVP-2
Subtest - Standard Score - Percentile - Age Equivalency
Eye-Hand Coordination - 10 (average) - 50 - 7 years 4 months
Position in Space - 13 (above average) - 84 10 years 7 months
Copying - 11 (average) - 63 - 8 years 7 months
Figure-Ground - 15 (superior) - 95 - >11 years 2 months
Spacial Relations - 8 (average) - 25 - 6 years 11 months
Visual Closure - 15 (superior) - 95 - >11 years 2 months
Visual-Motor Speed - 4 (poor) - 2 - 4 years 2 months
Form Constancy - 15 (very superior) - 98 - >11 years 2 months

Composite - Quantitative - Percentile
General Visual Perception - 110 (average) - 75
Motor-Reduced Visual Perception - 132 (very superior) - 99
Visual-Motor Integration - 88 (below average) - 21

In the report, she said he had difficulty with poximal stability, and his muscle tone is low normal.


The social worker in the meeting mentioned dysgraphia, so I guess the psychologist will test for that. He's supposed to have a psych evaluation and an OT evaluation (I don't know why they won't accept the one we have). I don't know if there are other motor coordination issues. He falls down a lot, but I always thought he was just messing around. He will only wear velcro shoes, pull on pants, and shirts without buttons. He is able to play computer games, zip his coat, and unlock a door with a key.

I may not have any choice but to let the private OT wait. I'd figured out a way to pay for some, but the OT where we had the eval won't have an opening until May. I called another place, and they have a 2-month wait.

I don't know how much the writing issue bothers him. He has expressed some frustration, but he never tries to get out of going to school.

Thank you for all your help.

From the test scores you listed, the comments from the OT and your description of him falling down a lot, my first opinion as an OT is that he has low muscle tone which is impacting his hand skills. You need good proximal stability (aka: core strength or trunk control) in order to develop good hand skills - especially higher level skills such as in-hand manipulation and handling tools (ie: pencil). What does his pencil grip look like? When he falls does he often make a joke about it or seem like he almost throws himself on the ground as part of play? Does he often fall and then say, quickly, "I'm all right!"

When he uses scissors does he pull the paper and scissors close to his body? Does he hold activities such as lacing cards, stringing beads or crafty type things close to him when doing the activity? Does he wrap his legs around the legs of the chair he sits on or sit with one leg sort off the chair so that one foot always touches the ground, if the chair is too big? Does he sit cross legged on the floor, "w-sit" on the floor or prefer to sit in a chair? Can he put his shoes and socks on in the middle of the floor without leaning up against something?

Does he have difficulty with eating at all? Is he a messy eater or take really small bites? Does he limit foods to certain textures or temperatures? Does he handle fork, knife and spoon appropriately? Can he blow out candles, blow bubbles, suck from a straw, blow his nose?

From a nutritional standpoint, some of these kids benefit from increasing the protein in their diet. You can do that with the protein drinks that body builder/work out types get at the drugstore. Protien bars can help too. Most kids with low muscle tone also have low tone in their jaws and just don't eat enough meat - unless you count chicken nuggets as "meat!" And if a child has low tone, they aren't likely to ever eat enough protein in their diet and probably need more than the average person, so you can supplement with a protein powder drink or bars. Protein and all the things it contains are necessary for building muscle, which of course is necessary for having core stability.

From an activity standpoint, you can encourage him to do lots of vestibular activities - movement based play. Riding toys, swings and climbing are all great for developing proximal stability. The more the better!

It might be that some home activities could increase his foundation of proximal or core stability, thereby improving his hand function. Sort of like building a good solid brick fuondation on a house, so that the top floor doesn't collapse.

It doesn't sound at all like dysgraphia to me. But that's just my opinion via message forum! Having not ever met or evaluated your son, please be advised that my suggestions here do not take the place of any advice or recommendations you have received from health care professionals! Just my thoughts based on what I'm reading here.

Debbie, thanks for your input.

I always thought he had good core strength. He rolled over (back to front) the day after he was born because he spent so much time arching his back before he was born. He takes gymnastics and seems to be pretty strong...

However, you pegged him almost exactly. When he falls he does seem to throw himself to the ground then either says, "I'm all right!" or he claims somebody tripped him. He sits with one leg touching the ground on a chair that's too big. He's a messy eater, but he can handle a fork and spoon okay. His knife skills could use some work, though. He can blow out candles, blow bubbles, suck from a straw, and blow his nose.

He doesn't eat a lot of meat, but he eats a lot of peanut butter. He's not very big, and someone once told me that the only thing that would keep him from growing taller (other than genetics or illness) is lack of protein, but she seemed to think he was getting enough from peanut butter. At that point, PB&J was the majority of his diet. He's cut down some, but he still averages 1 sandwich a day.

I'll have to observe his cutting more closely. I was thinking he could put his shoes and socks on in the middle of the room, but now that I think about it, he usually does it in the doorway.

The more I read, the less I think he has dysgraphia, but we'll see what the experts decide.

Thought I might hit it right! All the questions I asked are behaviors typical of a low tone child. Sometimes kids "look" strong to parents. Kids are programmed to succeed and are masters at compensating for weaknesses when motivated to do something. So, a lot of times they are able to accomplish a task, but by compensating or working harder. We don't always notice the means or the effort to get to the end product. I'll bet that improving his core stability will ultimately make handwriting much easier. Although his hand may NEVER keep up with his brain!!!!!


I just recently was looking for guidelines about protein needs for kids. I found the following info at a website about kids nutrition http://nutritionforkids.com/emlnews/FK-JulyAug00.htm

This indicates that a 50 pound child would need about 22 grams of protein in his diet per day. Kids with lower muscle tone need more than that. If you have concerns about how much is too much, check with your doctor or a nutritionist. The nutritionist who taught a class I attended about this topic suggested that most kids with mild to moderate low tone benefit from drinking just one protein drink per day, in addition to protein in their diets. A typical protein drink has 20 grams in one scoop of powder.


"The following values reflect the 2002 Dietary Reference Intakes (DRIs) updates from the Food and Nutrition Board of the National Academy of Sciences.

Age Recommended Protein Intake
(grams/kg body weight/day)

Birth to 6 months 1.52 grams
6 months to 1 year 1.5 grams
1 to 3 years 1.1 grams
4 to 13 years 0.95 grams
14 to 18 years 0.85 grams

Source: Dietary Reference Intakes: Macronutrients, Institutes of Medicine, 2002

To convert a child's weight to kilograms (kg), divide weight in pounds by 2.2. For instance, a 79 pound 10 year-old would need around 34 grams of protein per day (79 divided by 2.2, multiplied times .95)

For reference, a cup of milk or yogurt has about 8 grams of protein, 1 egg provides 6 grams, 2 ounces of lean deli meat provides 20 grams and 2 tablespoons of peanut butter has 7 grams of protein. Protein is also found in plant-based foods including beans, grains, nuts, seeds and many vegetables.

Note: This article was updated on 11/8/2007."

I'll be looking for an update as to how things work out. Take care!

I bought ds some protein bars. He didn't like most of them, but we've settled on some that have 10 grams of protein each. He takes them for his snack at school every day. I don't know if he's getting the rest in his diet, but this is a start.

As it turns out, we didn't have to wait as long as expected to start OT (private). Of course, the school system is still logging their 65 days of stalling. We went for the first OT appointment today. She said he has wrist and bicept weakness, low tone, his proximal stability isn't what it should be, and his endurance isn't either. She said it would probably take between 3 and 6 months of weekly therapy to correct (I'm not sure correct is the right word). Anyway, there goes all our spare money. I sure hope it helps.

I hope it helps also Keet, bucause if it does it will pay dividends for the rest of his life! We saw big results from our DS's 6 months of private plus school based OT. Let me tell ya' there is a huge difference between bottom 2% and bottom 25% in day to day living. ((I'm making up the numbers.))

Think about a child who is early in developing it's mental abilities - the differences tend to get bigger and bigger over time, yes? Now reverse the image. KWIM?

Anyway, I hope your OT is fun and 'gets' your kid and can help.
((prayers))
Grinity