Those of you who understand and/or have children with ADHD. Can you tell me about automaticity and does ADHD/ ADHD inattentive impair the ability to attain it to a great degree? One thing, I realize my son is severely deficient in developing "automaticity." Like I have said previous posts, he doesn't have the stereotypical impulse issues, focus, distractability stuff, etc. Not even the zoning out so much. Once he is on task he stays even when bored. He does have HUGE automaticity issues and hence executive functioning issues b/c "automatic" stuff like putting your things away in the morning, ordering your lunch, etc.., never happens for him. He doesn't get distracted so much doing it (at least in my opinion) It's just that it never EVER becomes automatic. If I re-tell him the steps every morning he does al the steps fine - but i have to tell the steps EVERY morning. This is a kid with a decently high IQ so it's not a cognitive deficit, right?

Some background info- He has finally been identified as dysgraphic (the connection that dysgraphics never develop the automaticity of writing has not escaped my notice) and has visual processing issues due to a vision disorder. His working memory is also poor.

If this is a significant part of ADHD or ADHD inattentive, I really think my child may have it after all. Of course more motivation to see a neurospsych but still want opinions and thoughts!

Thanks for any help!

ETA: He also has choice difficulties - he has a terrible time choosing what he wants for lunch and his books for reading.

That's a neat way of pointing out one of my major problems.

I lack automaticity!

I solved the choice problem by making arbitrary choices. It's best to make some sort of decision rather than making no decision at all.

Granted, it cost me $120,000 in debt for tuition...but still, it was a decision.

Has your son ever had an MRI or worked with a neurologist as part of his diagnosis? If not, I would ask your pediatrician if there might not be a central issue that could lead to hypotonia, eye control, fine motor control, and automaticity issues.

I recommend Smart but Scattered to start. Others have recommended Late, Lost and Unprepared.

I also suggest getting dry erase magnetic boards and making magnets with the tasks to put in a To Do and Done column. I did this for my DS last year and it really helped him create/follow his routine (although his issue was more distractibility). Instead of saying did you brush your teeth, did you pack your backpack, etc., I could say go do your chart.

Hey Zen, I have worked with neurologists. I took him to the neuromuscular clinic at CHOP and I was hoping they would give him MRI (just cause *I* want to see his brain!) but they didn't think they had reason enough to sedate him and put him through an MRI. And I felt weird pushing for him to go through it.

LOl so Jon - do you have ADHD? Is that the culprit beghind your major problem?

Deonne - bought the book on Amazon - thanks!

I keep thinking there is a strong resemblance to dyslexia. I'm not a medical doctor, but one leading theory in dyslexia points to a cerebellum related root cause. I've also read of cerebullar roots for hypotonia, eye control, fine motor control, and automaticity. It's the sort of concordance that sets off my spidey sense.

Zen, do you think I should go to his neuro-muscular doc and talk to her about that? see if she'll reconsider giving him an MRI? She knew about my suspicions of dyslexia/dysgraphia at the time (he hadn't been diagnosed), she had diagnosed the hypotonia two years ago, and I told her about the vision issue. We actually specifically went because I also though these were all related... She didn't deny that they probably were but she thinks the way he is functioning is so high that the damage is minor and not worth the risks and troubles of sedating for an MRI. I am not big on sedation either ... he's never been. She said "yeah it'd be interesting I am sure there is some minor damage (throw in some terminology) but he's doing great - continue wit the therapies and get the dyslexia/dysgraphia diagnosed so he can get help with that." I am paraphrasing....

I guess what I am wonderign in terms of ADHD is - is this a big part/symptom of adhd and do adhd meds help with this?

I could use some H to increase my productivity.

I'm glad to know that a central issue has been covered. Just was worried thinking about it.

Here's an article that may be of interest:
http://brainposts.blogspot.com/2011/11/neuropsychology-and-cerebellum-part-ii.html#!/2011/11/neuropsychology-and-cerebellum-part-ii.html

One quote from there:
"Greater decrease in cerebellar volumes are seen in children with ADHD not treated with stimulants suggesting stimulant medication may reduce cerebellar abnormalities in ADHD"

Jon, you make laugh out loud.

hmmm so basically adhd is related to this area of the brain and if he needs meds may good to start with trying the stimulants...

Marytheres - I read some prior posts and it seems like your DS may have several other exceptionalities other than being gifted or ADHD. I think you mentioned dysgraphia and also that he has OT or VT for other issues.

When my DS was being assessed for ADHD, other issues were contemplated and ruled out because many other issues can present like ADHD. My DS did get an ADHD combined type diagnosis - his executive funcition deficiencies are fairly typically ADHD - impulse control, behavior issues, getting bogged down in the bigness of tasks and having trouble breaking them down into something he can manage and, of course, distractibility. His working memory is pretty strong but the tips and strategies in Smart But Scattered have been effective with him. So, I guess what I am trying to say is that there are several accomodations, resources out there that can work for people (even if they don't have ADHD) that might be useful. I would google executive function deficit and/or improving working memory. I think one of the keys is to help him routinize automaticity.

I've enjoyed reading the work of Dr. Daniel Amen who has really been on what I consider to be the cutting edge of psychiatry. He has been using SPECT brain imaging to show how brains are functioning and the structurally visible representations of the disorders that have been previously diagnosed (as they have been for over a century) by rather subjective symptomology checklists. I find his work very impressive. One of his most popular books is Healing ADD: The Breakthrough Program that Allows you to See and Heal the 6 Types of ADD. His website is www.amenclinics.com. I find it fascinating to look at the functioning of the parts of the brain.

marytheres, I don't have a child with an ADHD diagnosis (at the present time lol! we've had one in the past...) but my ds dysgraphic *absolutely* has huge challenges with automaticity - related to his dyspraxia and dysgraphia. For instance, he wasn't able to learn how to tie his shoes until late 4th grade because he doesn't have the same learning-by-repetition-which-quickly-comes-automaticity that neurotypical kids do. You might want to do some googling (in all your spare time, eh? ) on dyspraxia or developmental coordination disorder (basically the same thing; neuropsychs will call the diagnosis DCD). The lack of automaticity in everyday skills (things like buttoning a shirt etc) is different than the symptoms commonly associated with ADHD, but dyspraxic people *do* share some overlapping symptoms - one is challenges with organizational and similar EF skills. The book mentioned above will be helpful in that sense (I read it many years ago, personally I think it has some very good suggestions for helping nt kids with organizational skills!).

Our ds was once diagnosed with ADHD but the diagnosis was largely based on what he was appearing to struggle with in the classroom... and once we had accommodations in place for his dysgraphia and we understood his dyspraxia better those classroom symptoms disappeared and when he underwent both an ADHD-specific eval and a repeat neuropsych eval both found no evidence of ADHD.

So that's just our experience - jmo, but the difficulty with automaticity, my guess, is more likely related to your ds' dysgraphia than to ADHD (whether or not he has ADHD ).

Best wishes,

polarbear

ps - I didn't have time to reply to your post yesterday - but I was so glad to read you had some answers finally!

I am finding it hard to say for sure but I think my child with Aspergers and dyslexia had way more problems with automaticity than my child with ADHD has. She was not an obvious case of ADHD at all, we got called in to the headmasters office to explain ourselves in fact! But as well as all the attention related improvements ADHD medication has marked impact on her hand writing and general control of her body. She has low tone and is hypermobile and while the medication doesn't take this away she's much less "floppy" on medication, less likely to flop all over the place when having her hair brushed for example...

[quote=MumOfThree She has low tone and is hypermobile and while the medication doesn't take this away she's much less "floppy" on medication, less likely to flop all over the place when having her hair brushed for example... [/quote]

This is interesting that ADHD meds affect your daughter's hypotonia... Have you ever looked into why? I am just curious.

Polarbear, what are the hallmarks of dyspraxia? Who diagnoses it? My DS has had a few evals now, sees an OT regularly, etc.... No one has ever mentioned dyspraxia though it seems like he does have some of the symptoms of it. Are there specific tests for it?

Some things I am thinking about doing:

I am thinking I am going to take all of his testing and evals to a neuropsychologist and get her 'take' - so to speak. I am not sure he can go through anymore testing at this point. He gets evals and testing for the vision every so many months too and I think he is getting burned out on testing. And I do want him to do a WISC for the school psych in the spring so I can see if there is any improvement in working memory, processing speed and visual-spatial that I can maybe correlate with the year of OT twice a week and vision therapy. I think the school psych did a pretty thorough battery of tests and included a lot of observations, etc. that a neuropsych could use to look at and see what if anything jumps out at her.

I was also thinking that over the summer he could do a program at one of those LearningRx places http://www.learningrx.com/main-line/. I know it's a gamble but they seem to work specifically on strengtheing DS' areas of weakness processing and memory. Anyone have any opinion on a program like that? I'd just hate to see his low working memory and processing skills hold him back (and if the cause isn't ADD, what else could I do to help him, ykim?). Seems to me that those (WM and processing skills) would be pretty important for success in school just in general. Anyway, it's expensive - very expensive so it's just a thought right now.

ETA: I guess there is always the possiblity that DS is simply developing asynchronously and his WM and Processing skills will catch up with time. Another reason to see if there is improvement in those specific areas from last year's WISC - again give me an idea if with time and therapies those areas are improving.

Absolutely essential. (I thought you already had a neuropsych, or I would have recommended this earlier.) A school psych does not tend to know what a neuropsych knows.


Have the neuropsych do the WISC.


I've never seen any evidence that this kind of program (or Brain Balance, etc.) works-- and there are a lot of people who say it's quackery. I have no firsthand knowledge of their prorgram, but I am skeptical.

My DS likes Lumosity ($100 a year for 5 people to subscribe), which seems to do the same kind of thing. We treat it as a video game, not as therapy, but we don't think it will hurt him.

DeeDee

Hmm. I don't think either of my two have issues with automaticity. DS8 has an ADHD combined type diagnosis and DD10 has characteristics and behaviours but no formal diagnosis. DS8's biggest ADHD Achilles heel is inattention. He's also distractable, impulsive and hyper, but no significant automaticity issues.

Yeah - that was my original plan. BUT, DS likes the school psych, she likes him and he loves to get out of class to do the tests with her. It also seems so much easier on him because she spaces it out over several days instead of one sitting, which seems so much easier on him. I don't know. I am torn - obviously it would be cheaper for me too since the school psych will not cost me money (other than what I am already paying in taxes.
Not sure what to do.

marytheres, most kids seem to enjoy their neuropsych evals. It is another round of testing, but all of the tests are different in some way, most are short in length, and our neuropsych gives children breaks between tests. Some psychs will break up the testing into multiple sessions over several days, but the typical neuropsych eval is done all in one day for a reason - the neuropsych wants to see how your child copes at different times during the day and with increasing number of tasks etc. Our testing was timed to mimic the school day (start, end, lunchtime) pattern - it didn't exactly overlap our kids' schedule, but the general idea was this is an educational exam, and part of understanding how our child is coping at school includes seeing how they cope over the course of a full day of "work".

Re the cost - you might be able to get insurance to pay for at least part of the eval. We were told "no" by our insurance at first, but we were able to get it covered. The keys (for us) were having a referral for the eval from our pediatrician, calling the insurance company to explain that there really were no in-network providers that could provide the same service, and also having the neuropsych's office staff help with codes that would work.

More in a minute....

polarbear

Thanks for weighing in! Yeah - this is what gives me pause too ...DS' challenges do not seem to be attention, distractibility, impulsivity, etc... It's definitely with working memory (although it could be argued one doesn't remember based on one not paying attention in the first place as opposed to something being wrong with his memory). However, the fact that DS can do the digit span test forward really well but not backwards really well - sort-of adds more fuel to my not seeing the memory issues as being related to attention... He scored quite high on digit forward, abysmal on digist reversed. If this were due to attention, it would occur on both - no? Plus, I (as well as others) simply do not see big issues with attention, per se. There are times when he is in creative mode and he needs to get a story out, he is spacey. But I have noticed he is getting better and better on that. Like he sets aside time to create his story and "puits it away" in his head until then. Anyway, the big problems are not that 'DS has trouble staying on task.' Those aren't the notes/emails coming home. The notes home are "DS has three jobs to do in the morning and he can't remember to do them, without reminder." And this is true - I have SEEN this myself and it is very annoying. He used to have somewhat more difficulty "staying on task" before his vision was treated and his writing accomodated.... Now the school and I (as well as he, which makes a huge difference) know the signs of when his eyes are bothering him (his eyes water, hurt, turn red - happening so much less and less now with the VT) and can give him a break, also same with writing - when he gets fatigued (and we now know the signs) he gets a scribe and has no trouble continuing on task. The teacher has said herself - "If he could just remember the things he is suppose to do automatically throughout the day and keep his things organized, we'd be golden!" This is when the lightbulb went off in my head because I got that email the same day Polarbear mentioned on here the fact that automaticity of forming letters never seems to come to a dysgraphic and the day before I believe it was I got the word form the school psych that she sees 'dysgraphia' in DS's testing.

Dyspraxia (more often called Developmental Coordination Disorder when diagnosed in the US) can be variable from person to person. I'd recommend googling dyspraxia+symptoms for some initial info - I'll try to post some useful links later today. I can tell you how it impacts my ds, but it may impact another child in a very different way... it's tricky! For my ds, the most obvious symptom is his handwriting challenge (which, for him, is fine-motor related). Other ways he's impacted might seem like laziness or slowness if you didn't realize he is dyspraxic or didn't understand what dyspraxia is. For instance, his overall movements are simply slow. Not glaringly so, but in the way that if he was usually moving at a speed that is a little more typical, and then you were with him trying to get ready to go somewhere and he moved at the speed he always moves at, you might find yourself hurrying him along in a big way. And he doesn't really see that he's slow, he feels like he's rushing and can be moving at the speed of a glacier. One example - we were late for school one day and I was hurrying my kids along to get into the building fast - when I do this with my other two kids, they speed up. DS wasn't speeding up, and he was lagging farther and farther behind. In exasperation I turned around and told him "Run, ds, run!"... and he (while walking slowly) replied "I AM running!"... and he really thought he was. He's not terribly coordinated at sports and prefers individual sports to team sports - this is getting a bit better as he matures (his enjoying the team sports, not his coordination). He still has a hard time telling which direction is which and confusing left and right. He didn't learn how to tie his shoes until he was in 4th grade, and then he forgot again over spring break when he wasn't wearing shoes that tied. He learned how to write cursive in 4th grade and later forgot how to do it. So for him, lack of ability to develop automaticity of skills requiring brain-to-muscle coordination in the same way most NT kids develop it is a big part of his dyspraxia. Some children with dyspraxia also have apraxia (speech is affected). DS doesn't have apraxia *now* but his neuropsych believes he had apraxia as a young child and no one caught it then. He didn't learn how to talk until he was over three years old, but once he did start talking it was in complete and complicated sentences so we never thought much about the not-talking or not-making sounds earlier as anything other than cute and quirky. He was also late learning how to walk, late learning how to crawl and didn't really want to crawl once he started crawling. There is such a large range of what is developmentally "normal" that we never saw any of his "late" early milestones as anything other than normal until he was older and we had other symptoms that correlated with them into something outside of "normal". DS is also extremely challenged with organization, and infamous for "losing" things that he's standing right on top of.

He also has some odd sensory quirks, and he feels like his stomach is full long before it's full, so he'll eat a tiny bit at a meal, think he's full, and an hour later be starving and need to eat again. I would have chalked this up to just typical kid stuff, except that a friend of mine who lives in another part of the US also has a child with dyspraxia and she had some issues surrounding eating and her dr told her that disconnects between the brain and stomach like this are symptoms of dyspraxia.

Lastly, my ds has an expressive language disorder - he's challenged (extremely) with putting his thoughts into written expression and also to a certain extent with verbalizing some types of expressive language. I think it's possible this is tied in with his dyspraxia.

The thing is - not everyone who is dyspraxic is affected in the same way, not every symptom is going to happen for every person.. so it's complicated!

(ps - sorry that's so long and rambling!)


I think this is an *excellent* idea - and I think it's a good idea to have the neuropsych administer the WISC when you have him retake it.


Per my other reply, most kids find the neuropsych evals fun, although they may come out of it tired at the end of the day. It's very different from the VT sessions and evals - my kids have found those to be exhausting - but they are all "focused" (can't think of a non-eye-related word lol!) on vision, using your eyes, and your eyes get very tired. The neuropsych exams involve so many different types of short-time tests with breaks in between and a lot of talking and movement so that it's not tiring in the same way the VT things are.


I have found private testing to be much more valuable than the school. The main reasons:

1) You get more time and more insight from the neuropsych eval - you have an input meeting and a follow-up meeting to review the report *in detail* after the testing. You can continue to call up, schedule follow-up meetings until you fully understand what the neuropsych found.

2) More in-depth testing - there are tests that neuropsychs administer that school psychs don't. For instance, my ds has an obvious dip in processing speed. At school, they see that for what it is - an obvious dip in processing speed. At the neuropsych, there were additional tests to determine - is it fine-motor related, a visual issue, etc. We came out of the neuropsych knowing not only that ds was dsygraphic, but which type of dysgraphia it was (fine-motor). There were also executive functioning tests etc, and an ADHD eval including behavioral surveys from parents and teachers.

3) The neuropsych eval includes a parent interview which includes a detailed developmental history - this is where all those things we never recognized as parents from the early years and instead just thought of as cute quirky little things... were seen in a totality by a professional who realized that all together they pointed to a history of dyspraxia, not just randomly occurring cute little quirky things.

4) Recommendations that are wider and deeper than the school will give you. The school is only going to recommend services that they are required to provide, which means your child has to fall below a certain level of functioning. They are also only recommending services supplied by the school district or by people contracted by the district. A neuropsych is going to make recommendations based on what your child *needs*, not what the school district can (or is willing to) provide. We were given very specific recommendations for the types of therapies etc that would benefit our ds, as well as recommendations of *which* private professionals would be a good fit, which would be easier to get in to see, which were worth waiting for etc.

5) Our neuropsych also gave us a forward plan for what our ds would need as the years go by - not just for school, but for life.

6) (for us) Help with teasing out issues like "is this ADHD or is it dyspraxia or is it something else".

7) A credible report that we were able to use (and continue to use) when advocating at school.

Lastly, although it's expensive, I'd look at how much you are spending now and may very well have to spend later on for your ds - outside therapies etc add up over time, even when you're only paying a deductible. They are also a huge investment in time (your time and your child's time). For us, having that neuropsych advice to guide us as we made decisions about therapies etc was invaluable.


I don't know anything about this program, and haven't taken a look at the link. Just fwiw, I think that this is an example where it was really helpful for us to have the neuropsych advice *first* before making decisions about programs like these. We were told by our neuropsych that WM an area that can improve over time and sometimes does improve during early-middle childhood, and we saw that happen with our ds *without* programs like this. He's also had a gradual improvement in executive functioning skills, which our neuropsych predicted might happen as he moved toward the early teens. Processing speed, however - our neuropsych believes that is something that most likely won't change... but she had very specific recommendations for how to *cope* with it, how to work-around the challenge, how to remediate what could be remediated, and how to approach AT etc.

polarbear

I don't know how this would play out for a child with ADHD, but fwiw, I am fairly certain there was a discrepancy in this on my ds' testing. I don't have it in front of me at the moment, so I'm just going from memory, but I do remember having the same question!


My ds looked "spacey" too (still does) when he needs to get something out in writing and can't. His 2nd grade teacher thought he was distracted and daydreaming, and that's why she thought he had ADHD. Even two years later when he was having an IEP eligibility eval at school, after we had his neuropsych report outlining his challenges with handwriting (but before we knew he had an expressive language disorder), the school psych tried to explain away the times he was sitting at his desk doing nothing as ADHD rather than what ds was telling us at home - he didn't have a clue what to do so he was just sitting there. He did eventually get distracted because no one was helping him and he didn't know what to do - but he didn't get distracted first, and distraction wasn't what was causing him not to be able to do his work.


This is very true of my ds - more so when he was younger. In 4/5 grade he had *so* many missing homework assignments that I knew he'd completed, I saw them go into his backpack to go back to school, his classroom has a very obvious "homework in" basket, a very set routine, kids come in, put take their coats and backpacks off, put their homework in the basket, teacher gives "reward" for homework turned in etc... ds couldn't complete that loop. There were so many examples of things at home that we had to remind him to do over and over and over again even though they were the same things each day. It was so amazing to me when his younger sisters just seemed to automatically catch on and do those same things for themselves. When he started middle school I went into the building and helped him check his locker every day after school, went through what his homework was and what he needed to bring take home to do it to be sure it was really in his backpack etc. I don't know if these are things that are typical of ADHD, but I *do* know these are things that are very typical of dyspraxic children - they are symptoms of the challenges with developing automaticity. On a hopeful note, repeat repeat repeat and then repeat again - has worked for my ds over the years. Just not anywhere near as quickly as it does for nt kids.


This will get better as he gets older. And it's good that he's got an understanding teacher too. My ds still gets thrown off by changes in schedule, but as he's gotten older he's found some of his own work-arounds for keeping track of things like turning in homework, keeping track of what his homework will be each day and making sure he has everything he needs to do it. It's helped when he's been in classes where the teacher is consistent with routines.

Gotta run - I hope some of my rambling helped!

Best wishes,

polarbear

This board is amazing and Polarbear you especially are gem... I can not tell you how much you have helped me this past year. Thank you.

Yup. THIS is it. This simple thing my DS can not do. I think to myself "this is preposterous - I could train my dog to this." Seriously. Why can't my child? Particularly a child who creates the most amazing stories and 'books' and has amazed people with his his speech, vocabularly and ability to articulate since he was 2. When he was in pre-school all the other children could do it after a few months - not my DS. I used to get so embarassed. Other parents would chat and wave as their child would do the routine. Not my kid, my kid was the only one (as far as I could see) that couldn't put his jacket away and folder in the basket. I was relieved in Kindie when I could just drop him off in the carpool line and not have to deal with this problem every morning. But of course the emails home would report it to me...it seems eventually an aid had to help him every morning. I figured after 2-3 years of having essentially the same routine he'd have it down by now... But, no. Note from teacher justy this week... no he can't do this on his own - she or an aid helps him. every day.

Okay so making an appointment with a neuropsych - technically, he is no longer spoiled for the WISC after April. Fingers crossed that by the beginning of next school year I'll have it "all figured out" (his problems identified and diagnosed, his accomodations and remediations) for my DS

marytheres, your notes about preschool reminded me of another thing - it's been really interesting as my ds gets older because he can now express his thoughts, feelings etc that he didn't really have a way of doing easily when he was so young, so we now have a lot more knowledge of how dyspraxia etc impacts his life. Anyway, your remarks about preschool reminded me of something my ds (now 13) told me just the other day when we were getting ready to go to school and he was putting on his coat. He went to a Montessori preschool where they were encouraging the kids to learn/do things independently from a very early age, so they taught the kids to put on their jackets by laying them out on the floor sorta-upside down, then putting their arms in first and flipping the coat on over their head. DS told me he was so glad that they did it that way in preschool because that way he knew how to put on a coat when he got to elementary school. I know that probably sounds like nonsense or "what's the big deal" to anyone who has an NT child... but things like that are a big deal to kids who don't have the same whatever it is that connects brain to muscle movement. He said he was still putting on his coat the Montessori way well into 2nd or 3rd grade, while the other kids seemed to come into kindergarten just naturally understanding how to and capable of pulling a coat on the regular way.

Which leads to another thing he used to have a tough time with (now he's just slow at it :))... buttons and zippers and changing clothes. He absolutely hates changing clothes because it requires a lot of effort. If only my fashionista dds who used to change their clothes every 10 minutes had a slight tad of dyspraxia lol! Anyway, in addition to ds not liking changing clothes at home, in early elementary he was always struggling with getting ready "fast enough" to get outside with the other kids in class - his teachers used to think he was dilly-dallying at his cubby in the morning when really it took him a long time to get his jacket off, and at lunchtime he used to purposely put on his snow pants etc *before* he ate so that he didn't miss out on any recess struggling to get them on (recess was after lunch). The other kids all took their snow pants and jackets with them and left them on the floor next to where they were sitting while they ate then put them on when they were done. FWIW ds never had enough time to finish his lunch either... ok... way more info than you need on my ds lol!

I think you'll be glad you pursued the neuropsych eval - I wouldn't anticipate you'll have all your answers to everything, and I'd guess you'll probably come away with even more questions... but the info you get will definitely be worth the time and expense.

Best wishes,

polarbear

Polarbear - I looked up symptoms of dyspraxia here: http://www.dyspraxiausa.org/symptoms/early-symptoms/

And DS had none of the first 13 early symptoms... He has many of the others but the symptom "Lack of Imaginative Play," he definitely did not have ... In fact, pretty much all of his play was creative and imaginitive. It was his absolute favorite form of play from as early as he could actually "play." I spent countless hours as Ahsoka (our dog was Java the Hut) and DS was usually Anakin.... He LOVED dress up. I had to go out at Halloween time and stock up on costumes because I could never find dress-up clothes for boys any other time of the year and he loved them! I can't tell you how many times I had to answer the door in a power ranger or in a Star wars costume becasue we had to play dress up. He will pretend anything is something else to suit his imaginitive game - e.g., our bowling pins were often meteors or rockets. For years his action figures were his favorite toys (he still likes them) and he would play imaginitive games all day with them.
Did your DS not do imaginative play? He also is very cautious and dislikes leaving any tasks unfinished. Once he starts he likes to finish. he also always loved Legos but he never did care for puzzles... until recently now he likes them a more.

Anyway, perhaps that is why dyspraxia never really came up. He has many other symptoms though and he sounds a lot like your DS. So perhaps if that is what is going on he has only mildly.

It doesn't answer the bigger overarching questions, but with strong creativity and visualization I'd try mental walking paths techniques for task/sequence memory. Presuming he is good at navigating? If he can vividly walk through your house in his mind, he can build a visual map of specific locations in that walking sequence.

Such as: I walk past the table in the foyer, to the sofa in the living room, to the dining room table, to the counter in the kitchen, to my desk in my bedroom. Or such. Then if he needs to remember a sequence of activities, he visualizes each item into each location like:
1) Get Dressed
2) Eat Cereal
3) Drink Milk
4) Brush Teeth
5) Comb Hair

Becomes a:
1) A pile of clothes on the foyer table
2) A box of favorite cereal sitting down on the sofa (with a remote control in its hand?)
3) A cow standing on the dining room table
4) A wind-up set of teeth bouncing around the kitchen counter
5) A giant magenta wig on his desk

I'm a fan of leveraging strengths.

Oh Nice! Creative I like it... It's worth a shot.

Cool. I can't take credit for it; I learned it 25 years ago in a cognitive psych class. And it goes back a couple thousand years more and is also known as Method of loci or Memory Palace. http://en.wikipedia.org/wiki/Method_of_loci

I'll be curious if it works for him as it may play right to his strengths. Making interesting pictures is an important part of it. Around 10 locations is a good start and the same path can be used for different lists. I find it easiest to briefly close my eyes as I put something in place. I taught it to my DS7, and he was surprised when he remembered 9 of 10 things I had him place the very first time.

MaryTerese just popping in to ask whether I know why the meds appear to held DDs low tone. I don't think they do exactly, I think they help her slow down, think, pay attention and better integrate her mind and body.

When she had her last OT eval (a year ago at 5.5) the OTs advice was that her neurological functioning (in so far as OTs assess it, so I guess applying to controlling her body) was inline with her IQ (3SDs above) and was the only reason her significant low tone and hypermobility were not more obvious. He was astonished by some of the things she could do (monkey bars for example), which he said should not be physically possible, and put it down to a) determination and b) exceptional ability to control her body with her mind despite her physical deficit. And certainly she exhibited this extreme determination to achieve things with her body from 2-3 months old and would work and work and work until she could do what she wanted to do. From my perspective the ADHD medication helps her apply this level of attention to physical tasks that are not fun, engaging or interesting to her and thus bring her ability to control her body while handwriting or having her hair brushed in line with her control when doing monkey bars... Or that's my personal theory anyway...

That said, I am part of a gifted / learning delayed group and I know many many parents find their child's other co-morbid issues are vastly improved (sometimes to the point of being undetectable) by medication for the ADHD. Our paed is certainly of the opinion that a lot of conditions often see with ADHD are symptoms of that global neuro-developmental delay, more than standalone conditions, and does expect them to improve with treatment of ADHD. CAPD in particular is one that every paed I have spoken to does not consider to be a standalone but merely a symptom that should either disappear or radically reduce with medication. DD still chooses to wear her glasses on medication and they do help so clearly her visual integration is not completely improved by medication.

So interesting! Your DD sounds like an amazing girl! How severe is her hypotonia? The hypotonia is a bit of a mystery to me... When I took DS to the neurologists a few months ago after his initial assessments almost about 2 years prior, they were also a bit amazed at how well DS was doing. They said that they honestly would be on the fence about giving him the diagnosis now. I was thrilled but also perplexed as I had always been told that it was not a disorder that one grows out of... They didn;t really an offer any reason as to why they just said "be happy!"

My DS did super well on his tests of auditory processing skills - scoring in the high 90th percentile for all of it (mostly 99%s) with the exception of the reversed digit test. So I supopsoe auditory processing is good .

But he scored quite poorly on the CVLT, which pains my heart.... I am no expert on any of this stuff but it stuck me as I was reading like it's as if he been brain injured or something The report said a lot of things regarding this tests I didn;t quite understand, though. However it was clear he scored low average on parts and extremely low on other parts of it. It did warap it up by saying it doesn't look like DS has a problem encoding the information - he has a problem witht he retrieval especially when there are no visual cues.

Anyway, just rambling.. I guessthis stuff will mean somethign to a neuropsych

Watching a 6 month old essentially do pushups for 10-30 mins at at a time, many times a day, was certainly entertaining :-). I should find the photos to figure out exactly how old she actually was, might have been more the 4-6 month old window.

I haven't been given a measure of how bad her hypotonia is, given she's mostly coping. She spent most of last year writing with a hard brace holding her thumb in place, massive pencil grips and special paper. On medication she has been fine without the brace. And the teacher can tell when she's on or off medication from her handwriting, as can we, if it weren't obvious from how far off with the pixies she is.

Strength helps low tone immensely. And she's surprisingly strong... OT was very surprised by how strong her grip was using a grip strength measurement tool, given how week she is. Which would be why she can do monkey bars.

marytheres, when you say he did well on auditory tests do you mean that he has been tested for CAPD? Or that he did ok on Auditory parts of the WISC? Not the same thing... My other DD actually does have CAPD, she has a major weakness in WM but did fine on many auditory parts of the WISC. Even on the CAPD testing she had some scores in the 98th - but she also had the requiste two related areas below the 2nd... And on her recent CELF4 she has scores spread over more than 4 SDs... Some kids are very very hard to peg...

It looks like the test was called "Test of Auditory Processing Skills - Third Edition" It included Number Memory Foward, Number Memory Reversed, Word Memory, Sentence Memory, Auditory Comprehension, Auditory reasoning, Memory and Cohesion. Not sure if that is for CAPD or not..

Wow you DD really sounds amazing! Sheer determination indeed! My son didn't push up until after 6 months (like right after). I was so relieved I took like 30 pictures. I didn't know then he had hypotonia (and of course didn't want there to be anyting wrong!) But he really worked hard on crawling, which he did at 7 months... However, he only crawled for three months.. he started walking at the end of 10 months. I really think some damage was caused when he stoppped breathing for a just a short time after birth.. I am not sure how long it was - it felt like forever but I don't knwo in terms of seconds/minutes...The doctors rushed him away... However, I am almost positive his father has dysgraphia so perhaps some genetics too.....

No I mean actual push ups, between toes and palms of hands, body like a plank... In fact it was really more like "planking" that you do for your abs at the gym than pushups. She had a back like a body builder at 9 months old, so I was completely surprised when I was told she was hypermobile and had low tone, the two things are not mutually exclusive but it seems like they should be to a lay person. I knew my eldest had hypermobility and low tone, but I thought this one was ok, she's actually worse, just stronger...

Hi all. Just an update. I'll try to make it brief! So, I met with the school psych. really liked her! Basically, in a nutshell, she agrees with me... Something is there in the testing and in his executive functioning it presents like attention BUT he really doesn't seem to have attention issues per se - it seems more of a problem with memory and mental manipulation - the way he attempts to remember is inefficient, his working memory seems stressed, faulty, etc. His long term memory his great... visual clues help his working memory immensely. It's not with the encoding; it's with the retrieval, etc... Her gut feeling *at this point* is also that it is not necessarily adhd/adhd inattentive. BUT something is getting in the way... She said she sees his giftedness, too. She was really impressed with some of his testing, the connections he makes, etc. There was one question that involved inference that she said no other first grader she has tested has gotten. But again, something is in the way in terms of working memory and processing/fluency. She really seemed to see what I see! She also sees that big gaps so that even though in handwriting spelling ect - he is scoring "average" she realizes that there is dysgraphia there and she is going to get him as much help for both his working memory and dysgraphia at the school as possible through his iep (she mentioned something to the effect of this "may make her unpopular but she's not at the school to win popularity contests with the teachers, she's there to help students" I am not sure what that statement meant really ???). She said teacher placement is extremely important and they will be very careful about that because DS needs a teacher who can understand both his high intellect and his struggles/disabilities. We talked about LearningRx/Cogmed type programs and what I could do to help privately in terms of that stuff and she recommended that I stop taking him to where I am getting private OT and take him to this place http://www.atotalapproach.com/ for therapy... She said she has seen students make much better strides at this place, etc. Well, it just so happened I had looked into that place and had already made an appointment with the director there to talk about DS later the same afternoon! After the interview there, the owner/director told me that based on my description and a cursory glance at his testing and evals she says my DS is a classic case of "sensory processing disorder" in the mild-moderate range. She was very optimistic that they could help with their therapies. He needs to go in for a eval there just to do the testing that they do and hasn't yet been done on him and then they will look at all of the testing etc. and recommend therapy for it ... maybe balametrics. The school psych spoke highly for their reading program there also - she said that is the only place so far that she can say she has seen students really make very good progress and that she holds the owner of the place is high-esteem professionally. So, I am very optimistic. Hopefully, this is the thing that will really help DS.


I still plan on seeing a neuropsych for thoughts too.

Does anyone know anything about this "sensory processing disorder" condition? Thanks! I have heard about it here and there but never really gave it much thought. The "A Total Approach" lady said there is no need for him to live like he is and continue like this till he grows out of some it - she said that we can do so much for these type of kids these days. I'd like to hear anyone's experience with this stuff!

There's a lot to read online about SPD, but, as the wiki entry for it points out, it's not an official diagnosis or scientifically recognized condition - http://en.wikipedia.org/wiki/Sensory_processing_disorder

Having said that, I've ready many many stories of kids being labeled with this, receiving therapies and getting better, so hopefully that's what lays ahead for you!

Thanks Epoch.... I hope so! I just want him to feel good and thrive. I am so tired of watching him struggle with *something* standing in the way of his potential.

Hi marytheres,

I'm so glad you have a school psych that understands and cares about getting help for your ds - that's huge! I haven't looked at the website link, but fwiw I've found in our own journey, getting references from professionals who've known other families who've worked with other therapists has been *extremely* helpful and a reliable way of knowing who to turn to when you're spending the $ on private therapies.

Our dd who has the vision challenges also had some extreme sensory challenges when she was younger. Our dysgraphic ds also has a few odd sensory issues... which I think are probably, in his case, symptoms of dyspraxia. Even though it's not an officially recognized condition, sensory OT was very helpful for my dd, and I've used some of the things we learned through it with my ds also.

My one piece of advice would be to move forward with the neuropsych - even if the conclusions and recommendations are exactly the same as the school psych, the neuropsych evaluation will give you (at the least) a report that you'll need through the years as you advocate for your ds. It should also give you more testing to determine what's behind the dysgraphia etc, and it may help you understand better what is a sensory issue vs something else. Plus it will give you official clarity (in the report) re is it or isn't it ADHD - which has also been important to us, as we continue to run into school staff etc who think that the things that *look* like ADHD are ADHD simply because that's what they see more often and are familiar with.

Best wishes,

polarbear