I have long suspected dysgraphia to be an issue with my DD11 (6th grade) -- poor handwriting, horrible spelling despite a very high reading level, complaining of arm pain when she writes. She also shows some signs of anxiety under timed situations and some sensory avoidance issues (hates shoes that actually fit, hates anything tight around her waist, has to turn socks inside out, etc.) Additionally, her processing speed, while average, is 26 points below her VCI on the WISC-IV.

The clencher came yesterday when she brought home a grade in typing (a.k.a. "Keyboarding") that kept her off of Principal's Honor Roll. While she makes 100s on almost every typing test and is accurate, the majority of the class grade comes from a lesson series that will not let you save your work if you don't fully complete the lesson in the alloted class time.

I am at the point of seeking an OT evaluation and asking for 504 accomodations. I know to ask about dysgraphia. Are there other diagnoses I should be looking for?

Thanks for your input.

Sensory Integration Disorder jumps out at me. (shoes, tight, socks)
That's a whopper of a subscale score difference. ((LOL, my DS14s is a similar)) I hate to say it, but that would be enough to make me want to made sure ADD isn't an issue.

((With my son I worried about http://en.wikipedia.org/wiki/Absence_seizure but that seems like going overboard, as this only affects 1 in 10,000 kids in the US according to a quick Internet search. He just does seem to spend a lot of time staring off into space. ))

Those are just my 'off the top of my head thoughts' - I would consider hothousing the keyboarding at home...it's a wonderful skill to have. My spelling is awful, but once I learned to keyboard spell check became my good friend.

Best Wishes,
Grinity

If you are seeking services from the school, don't specify "an OT evaluation"-- write them a letter where you lay out all the specific difficulties and ask them to evaluate her in all of these areas. This casts the widest net and gets you more thorough testing.

Many schools do not recognize the term "dysgraphia"-- you might mention instead that you suspect a "disorder of written expression" and give them examples of tasks she struggles with.

Best,
DeeDee

Update:

After much discussion with the school counselor and AIG teacher, I finally stopped procrastinating and took DD for an OT eval last week. Obviously, I don't have a report yet but had an interesting conversation with the owner of the OT practice after she observed a portion of the eval. There is definite issue with pencil grip/handwriting and upper body strength/core muscles. She also mentioned the possibility of a NVLD. I had already dismissed any thought of NVLD simply by looking at the symptoms. I was wondering if any of you had any thoughts on this.
Her SB-V scores show an issue in non-verbal working memory, but also a strength in non-verbal quantitative reasoning.

Thanks for your thoughts!

An OT isn't qualified to diagnose a learning disability like dysgraphia or NVLD. If it were my kid, I'd try to see a neuropsych for a second opinion about the sensory and motor issues.

DeeDee

PRI is is much lower than VCI, which is one characteristic of NVLD, and that score is low not because of a single subtest but because two of the subtests there are more than 1 SD below the 15s that she has consistently in verbal and conceptual areas. Remember that in gifted people, scores that are in the average range but significantly below areas of strength can still indicate that there is a disability depressing functioning and scores. A gifted kid with NVLD is not going to look the same as a non-gifted kid with NVLD.

I agree with DeeDee that an OT is not the person to diagnose this. I would add that IQ score scatter is not sufficient to determine a diagnosis either, although this score pattern would certainly make me want to investigate the possibility further. A workup with a neuropsych who is familiar with 2-E / gifted children would be my next step. I say this as someone who has BTDT.

I can't recall off the top of my head if James Webb's "Misdiagnosis and Dual Diagnosis of Gifted Children and Adults" covers NVLD or not, but it would almost certainly be worth reading anyway

What I have read as symptoms of NVLD include "difficulties perceiving non-verbal behavioral or facial clues; and poor social and interactive skills" -- this is certainly not my daughter. The funny thing is also that, even though her Spatial-Visual subtest scores on the SB-V were lower, she is the poster child for the "spatial-visual" learner as discussed by Silverman (http://www.gifteddevelopment.com/Visual_Spatial_Learner/vsl.htm).

I have personal issues with that list, as people have used it through the years to try to tell me that my very-much-not-a-visual-spatial-kind-of-person son is "just a visual-spatial learner", primarily on the basis of him being wildly creative, terribly disorganized, having difficulties with math facts, and needing to use a keyboard to write. He's PG, AS, NVLD, and has a disorder of written expression, but he's not a visual-spatial learner!

At least half a dozen or more of the items on the "visual-spatial" side of that list are potential indicators of disabilities and problems with executive functioning that do not bear any relationship to having a preference for "thinking spatially". Another subset of the supposedly "visual-spatial" characteristics are general characteristics of the gifted. In fact, giftedness and creativity are even listed on the "visual-spatial" side. In a lot of ways, the left side of that list describes neuro-typical kids, and the right side of the list describes kids who are 2-E. I completely understand the neuro-diversity position, and I think that it is important to reframe challenges, emphasizing strengths. I just don't know that landing at "visual-spatial learner" is a terribly useful level of information to have when you are trying to develop interventions to help your child succeed, particularly if the things that really stand out on the list are not the exclusively visual and spatial items, but things like creativity, conceptual learning, disorganization, and poor handwriting, as with my son.

If you can, I second (or third, I think?) the recommendation to see a neuropsychologist. My 11 year old has dysgraphia, and the report from the neuropsychologist has been useful not only in diagnosis by in several IEP meetings when trying to determine treatment and intervention. My oldest, now 20 and in college, was just diagnosed with a mild form as well as ADD - but her IQ and heavy sports activity allowed her to be successful enough in school that intervention has just now been required as she is seriously struggling in college. How I wish I'd taken her to the neuropsychologist sooner!

Update: Just received OT eval - they didn't actually diagnose anything, since they cannot diagnose. There are definite handwriting/core strength issues and working memory issues, which came as no surprise.

I was given Beery scores of VMI - 4th percentile, Visual Perceptual - 91st percentile, and Motor Coordination of 91st percentile. Any info on what this means? Thanks~

It means that there is a problem with integrating or coordinating the motor system with the visual system.

in practice, this means that tasks that require using vision to guide motor output will be very difficult.

NVLD isn't one of those sorts of challenges where every kid has every challenge. It's more a cluster of difficulties that 'tend' to co-occur. So this sort of reasoning isn't helpful.

Better to make a list of issues where your child is being held back, and work on each one in turn, from the most 'pressing' to the least. It sounds to me like you are doing that by taking her to the OT and starting work on the issues that have got her down. Did she even learn typing?

I think that there is a lot to be said for getting the whole work up and also there is a lot to be said for using the same resource (time and money) to treat the obvious issues. Just keep moving forward one way or the other, ok?

BTW - so glad you dropped back in to give us the update! How is she feeling about life and school and friends?

Love and More Love,
Grinity

Grinity, thanks for asking. Overall, she is doing great - making straight A's and is in the top block for her school, and is the top academically in her class. She just placed 2nd in a county-wide speech contest. She is doing well socially other than typical 7th grade "girl drama," which is occuring mainly because some of the girls are jealous of her academic success. Her closest friends outside of school are gifted.

Her main struggles continue to be handwriting, spelling, careless mistakes in math (taking Algebra, and teacher assures me that she knows the concepts), and any time she has to write an essay without keyboarding. Overall, she continues to function in the school setting as HG+ even though she doesn't test it. (Funny thing, though, she does come out in the 4 range when I look at Ruf's levels.) But, I think with the information from the OT, combined with knowing what her low subtests were on the WISC and SB, the puzzle is beginning to make a lot more sense.

The dips in processing speed (and the specific subtests) and the description of your dd's challenges at school with handwriting etc are very similar to my ds who does have a diagnosis of dysgraphia. Were any of the IQ tests your dd has had given through a neurospychologist? If you haven't consulted with a private neuropsych yet I'd really recommend it because that's where you can get an official diagnosis, plus the neuropscyh can include other types of tests that will help determine the root cause of dysgraphia (or help further understand whatever challenges are in the mix). You already have a wealth of testing on your dd, so you might not have to pay for the full neuropscyh workup which usually includes ability vs achievement, and for both of my kids included the Beery VMI.

I don't have the Beery tests from my kids handy at the moment, but fwiw they both had discrepant scores but in different directions. For my ds, the issue was visual integration impacting fine motor skills, for my dd (who does *not* have dysgraphia but who did have sloppy handwriting that looked dysgraphic) - the low scores on the Beery were due to vision issues (undiagnosed double vision, lack of peripheral vision, and tracking issues).

FWIW, I also think my ds had relatively low score on visual-spatial on ability testing, but there is no question he's a visual spatial learner - I'm not basing that on Silverman's list, but basing it on how he describes how he thinks.

polarbear

I just relooked at her WISC and her Working Memory scores jumped out at me - Wow - the spread between WM and Verbal is 2 standard deviations!!! (Her processing speed of 115 is 15 points above average - 1 standard deviation, and by itself 'weak' but still stronger than most folks (67% plus half of 33%, I think)

Without super strong Processing speed to balance out the average WM, she's got some challenges. Look into what WM tests in depth. Every sort of WM issue can be strengthened, and worked around, but that needs to be taught if it's not going to take a long time to learn through trial and error. I've got super fast processing speed but 'average WM' and I'm the queen of all the 'extended mind' tricks: programing reminders into my phone, taking notes at all times, writing things down on paper, making little 'concept maps.' All that 'Getting Things Done' by David Allen sort of stuff. It's been a lifetime project for me to do what comes easily to most people. Luckily I can easily do what is difficult for most people. ((shrugs)) I like Chess (at a low level) because one can see all the pieces and their locations right in front of one, cutting down the need for working memory - and yeah, If allowed, I'll write down 'possible ideas' to follow up on later and check them every turn.

The nice thing about low working memory is that life contains so many delightful surprises! and it's really low percentage to hold a grudge - too much work for so little reward. Boy was I surprised while raising my son who is quite strong in WM and quite average in Processing speed!

I'm not anywhere near as bad as http://en.wikipedia.org/wiki/50_first_dates
but I do have that flavor. I cried so hard at that movie, it sort of illustrated the struggle of my sweet 'living in the moment' life. Perhaps too scary for your daughter, but sneak off and watch it when you get a chance.

Has ADHD-I (Inattentive) been looked into? (Spelling, sloppy handwriting, careless Math are classics for a lot of things, including ADHD-I - and stimulant medication does help that 'working memory weakness' in many bright kids.) Also I've read that about 50% of kids with ADHD have 'co-morbidities' that is: Learning disabilities or anxiety or other challenges. Some people think that ADHD-I is precisely a deficit in Working Memory. How can an average score be called a deficit? Well, it's probably more of a "bottleneck" which is a term we nurture here to describe a relative deficit that is big enough to cause internal discord when the highs are very strong and the lows are average.

BTW - small motor challenges (handwriting) is one of the 'cluster areas' of NVLD.

Congrates on the speech contest. Good luck with the OT. If you already have a 'Nintendo DS' type machine in the house, pull out the game brain age, or something like it and start playing around with it. http://brainage.com/launch/index.jsp

Also get a soft ball you can play with in the house and start playing 'catch' etc, as a fun break. Koosh makes a nice one. Or try and learn (yourself) to juggle with silk scarves and see if DD gets enticed to try and learn.

http://en.wikipedia.org/wiki/Katamari_Damacy is also said to be good for practicing eye/hand/speed connections.

What does she do for fun? Anything that requires movement or speed? Maybe we can think of some ways to riff off what she already loves?

Love and More Love,
Grinity

Just wondering, on the WISC does the Digit Span test more non-verbal and the Letter-Number Sequencing more verbal working memory? In other words, is this pretty much consistent with verbal v. non-verbal working memory on the SB-V?

I honestly haven't ruled out the possibility of ADD-Inattentive in my own mind, and in fact, I have always said that I think have undiagnosed ADD myself.

The frustrating thing is that I feel like I'm crazy to even keep pursuing this, but I've known there was something just not matching up ever since I saw her COGAT scores in 3rd grade. These scores are the main reason I had her tested on the WISC. Then, the ed psych says there's no LD since everything is at least average. I just understand that if we don't have accommodations in place, especially for dysgraphia, there will be a point we will run into a brick wall, i.e, AP English classes.

The WISC WMI has been described to me as a measure of "auditory" working member - generally auditory is more closely linked to verbal skills.

Just to update:

We're now waiting on our 504 determination hearing, which we are going to with no official diagnosis of "dysgraphia" but very low Beery VMI scores and a list of suggested accomodations.

The OT says she can't diagnose because OTs can't give a medical diagnosis. The pediatrician says she can't diagnose because dysgraphia is an OT diagnosis. The original ed psych said no dysgraphia since WM and PS scores were at least average. The second ed psych referred us to the OT to begin with, and then the OT referred us back to the ed psych. I feel like the hamster running on the wheel! I guess I'm going to have to foot the bill for a neuro- psych after all. UUUGGGGHHHHH!!!

Do any of you have a dysgraphia diagnosis for your child from anyone other than a neuro-psych? If so, who gave your child's diagnosis?

My son has a diagnosis of Disorder of Written Expression from an educational psychologist.

You might want to look over this page, and share it with the professionals who have evaluated and who will be evaluating your child.

aculady, that's a very informative page. Thank you. It's very helpful.

Revmom, my daughter is now in the midst of a neuropsych exam with an educational psychologist for suspected dysgraphia. He is billing insurance under ADHD/autism evaluation.

Update:

I don't know how we managed it, but we were able to get a 504 based on the O.T. report and the Beery VMI scores without an official diagnosis of anything.

Revmom, that's as it should be. Based on identified need, not diagnosis. Good advocacy on your part!

DeeDee