I was wondering if lack of hemispheric dominance is another cause for hypotonia, SPD, dysgraphia.

DS8 is ambidextrous in that he uses either of his hands to eat and write. While working with a kinesiologist, she mentioned that he has mixed dominance - his left leg is dominant, as is his left eye. He recently went for bone conduction therapy for his APD. It did improve his dichotic hearing, but response time from his ears did not improve (worsened actually). What was surprising was that regardless of which side sound input came through the earphones, he'd think it came from the left. ie, if it came from the right side of the earphones, he'd still think he heard on the left ear. His right ear processing speed is really slow, way slower than his left.

I'm wondering if his issues (sensory processing, visual processing, poor sports coordination, auditory processing, poor handwriting although this has improved significantly) are partly a result of mixed laterality? It does seem like there is some connection.

I am not sure of the scientific research, but my son has had a very similar experience. On the other hand, his uncle has mixed dominance and was an amazing student in all areas as well as a skilled athlete (played baseball at the college level).

Does your child cross the mid-line? If not, I know that this is a risk factor that is often used to diagnose SPD and motor issues. You raise a good question - I'd love to know if there is any data supporting what we have seen with our children.

I have one strongly right dominant twin who is hypertonic--> resulting in great gross motor function and athletic skills but poor fine motor control. Easily beats her twin in a running or swimming race but falls way behind her twin at piano or scissor or pen control (although compared to her peers is still normal in these functions)

My other twin is hypotonic and only became truly right dominant at 4 yrs of age--> gross motor slow and tiresome but fine motor well advanced, precision handwriting years above her age, excellent piano fingering. Will never be a gymnastic though

My 12 year old son with hypotonia, motor dysgraphia and sensory issues but no problems with auditory processing is still somewhat ambidextrous.

Mich, DS indeed doesn't cross the mid line. He eats with a spoon in either hand but rarely a fork and spoon in both hands. I'm not sure why nearly 3 years of weekly OT hasn't resolved this- we've changed therapists in any case. Will crossing the midline help significantly?

In my very layperson mind, I'm thinking that the right side of his brain is very wired up, and possibly his left side too. But they're not very wired to each other. He's very emotional, super imaginative and highly intuitive. He's also very good in languages and math, but they all seem to exist to serve his imaginary worlds. Probably because sports and movement requires coordination between both sides of the brain, he does poorly.

Lori, it does sound like your son has some mixed dominance as well since he's still ambidextrous. Maybe there are different outcomes for each individual, depending on the exact wiring for that person (mich's uncle is an example). Come to think of it, all my relatives who are ambidextrous have turned out to have fine careers, although no one is into sports.

I wonder if working actively to establish dominance will resolve some issues. Or create more...

I think my son used to have a little trouble crossing the midline. Up until about age 7 or 8 he looked like he was afraid he would fall down when he had to stand with one foot crossed over the other in his musical theater class. His piano teacher would tell me that he often played the left hand notes more easily than the right even though most of her other students would have found the left more difficult. His half-brother is left handed. I have always been curious about this.

He got a total of six weeks of OT and about the same in PT. Insurance would not pay for therapy and I would have had to take him out of musical theater and piano to pay for therapy. I think we made the right decision. I think dance and piano have helped improve that part of his wiring that involves coordination even though he still has lower endurance than most kids. When his right hand gets tired, he can switch to his left to finish writing.

Blob,

I would venture that the mixed laterality and the SPD, hypotonia, motor and coordination issues, and processing problems probably all arise from underlying differences in neurological development, and that the mixed laterality is a result, not a cause.

As for his issues with midline crossing, etc. not being resolved in three years of weekly OT, what methodologies and approaches has his OT been using? What kind of home program has the OT been having you do? Has he been assessed for retained infantile reflexes?

Don't despair, and don't hesitate to switch therapists if your OT can't give you good reasons grounded in sound clinical evidence for why your child is not progressing. It took us four years of 3x/week OT and 2x/week PT using a multi-pronged approach with a team of specialized therapists along with a fairly intensive home program for my son to make functionally significant progress in these areas, although we could see changes in relevant measures on a fairly consistent basis during the whole process. He was just starting from a point where he has to make a lot of gains to see an improvement in his ability to actually do things. According to my son's therapists, swimming, horseback riding, and bicycling (if coordination allows at this point) are all very helpful in neurological repatterning, with the bonus that they are often not perceived as "therapy'.

Interesting point, aculady. This is a different take that makes sense.

Yeap, we've stopped at the first OT. No home program except to bring him into their offices more often. The initial 2 years, it was 2x a week mostly. We're now with a kinesiologist specializing in neuromuscular coordination, 3x a week. It's early days yet but I see him using both hands together at mealtimes without a reminder from me. That is a vast improvement! DS finds it tough going but he is game.

I'm struggling to understand where his APD affects him. In functional tests, he's a disaster. But there is no effect academically as far as I can tell. I'm tempted to ignore the diagnosis but worry about what I could be missing out. According to the speech therapist, the pathways for change close at 12yo. Would anyone know if simply improving on functional skills like dichotic listening help anywhere?

Blob,

The good news is that in an academic environment, there are usually multiple pathways to take in information, and bright kids can often compensate for weaknesses in one area by using areas of relative strength instead, so overall academic achievement may stay at levels that are average or even well above. The bad news is that this takes a great deal of mental energy that could otherwise be used for things like emotional regulation or higher academic mastery.

Just because you don't see academic deficits at this point doesn't mean that these issues are not making your child's life a lot harder in the classroom than it would be if processing was not impaired. I would guess that if he ever gets into a situation where a great deal of the information he is required to master is coming solely from lecture or discussion without a text to refer to, the impact of the APD will become more evident. My own thought on the question of whether to work on deficits that are not causing evident problems has always been to do everything we can to give my son as solid a "neurological toolkit" for the future as we can, even if he is coping adequately at the moment. You, of course, need to take your own family's circumstances and personal needs into account when doing cost (including time cost and energy cost)/benefit calculations. My husband and I are both self-employed,and we homeschool our son, so we have more time and flexibility than many other families.

Edit: I just want to clarify that "doing everything we can" includes recognizing that sometimes there is nothing that we can do. We recognized, for example, that no amount of OT was ever going make my son fluent in handwriting, so after we had gotten what gains we could within reason, we focused on improving his keyboarding skills, which is far less demanding for him.

aculady - I agree whole heartedly. Even if a child is compensating, it may be at a cost - draining energy for example. As the child moves through school and the demands increase in terms of volume and complexity - it may difficult for even a brilliant child to keep up.

I always try to balance treatments with maintaining a full life for my child. When the progress stalls and tapers off, and we determine it isn't because of the practitioner or program, we reassess. Is it time for a new approach that would result in better gains? Or, is his skill as good as it is going to get and now it is time for plan B (typing for example). On one hand my son is fully aware of his challenges - he needs to understand so he can self advocate and employ compensatory strategies. But at the same time, I never want him to feel broken or like a project.

One last thing - we found that martial arts was a great way to address many of my son's motor issues. The strength and conditioning, sequencing, and, yes, crossing the midline was a very enjoyable way for him to work on some of his weaknesses. Like swimming, biking and horseback riding - it has the fun factor. For us, swimming has always been a huge chore; that difficulty with bi-lateral coordination and upper body strength has been a huge barrier. But, since it is a safety issue, he's had private swim lessons since age 5. As soon as he gets his BS Swimming Merit Badge, I think we can drop the lessons (which are very much like therapy to him). Luckily he loves to bike (once he finally learned at age 8)

Tks aculady. Its so true about arming him for when he needs it. Who knows? I will soldier on. And it's certainly true about life being hard in the classroom. He enjoyed his accelerated math in school because that involved working in front of a computer without input from the teacher. But once it was regular work where he had to pay attention to instructions, he was lost. We pulled him out to homeschool last year shortly before we knew about his APD. Not that we needed the decision to be affirmed, but everything became crystal when he was diagnosed.

Mich, we tried martial arts for a year. He really hated it. Swimming- it's at least 4 years of private lessons. We switched him to group to make the lessons less intense and more interesting when he became water safe. But yes, this is hard going. Biking- no balance yet. The kinesiologist has a gradual plan to work all these in. At home, we try to play ball sports.

It's a good reminder not to belabor his weaknesses. Luckily we live in an area where, for lack of a better way to put it, nerds rule. He's a very confident boy . People wonder why I put so much emphasis on sports. But it's a very enjoyable and natural part of life that I don't want him to miss out on.

blob-
We've found that individual sports work best for my son. Field sports are overwhelming for - it is too hard for him to know where he is in space, to anticipate and to react. He has found that he can be very successful in sports like Archery, golf, hiking, track and field. He competes against himself, can follow a routine and doesn't have to deal with the confusion of field sports. He even enjoys climbing - although this is more of a challenge for him.

Blob,

My DS couldn't really swim or ride a bike until he was 11, but he wanted to do both of those things very much, so we kept at it. I believe that the horseback riding primed him to be able to make the leap in both of those. Don't get discouraged, even when it seems slow going. For our sanity and his, we really tried to keep the focus on having fun, and disguised "therapy" as games where possible. Straddling floats and having to keep upright while shooting water pistols at each other in the pool develops core stability, balance, and hand-eye coordination, but I can't say that my boy ever complained about doing that kind of therapy, even when it was really hard.

Individual sports played for fun have been much more successful here, for the all the reasons mich covered above.

I'll also risk losing my "Good Mommy" credentials here by being saying unabashedly that video games have been a great asset in developing visual processing skills and fine motor control for my son.

Can we move to your neighborhood, please?

My eldest was reticent to try a bicycle at ten. We tried the following approach, and it worked quite well for him:

1. Buy Razor scooter; let child become proficient at balancing on the scooter. Knee pads and are a must (plus the helmet, obviously). Elbow pads help too. Remember to tell him to watch ahead of himself, and not to look down.

2. Once he was proficient on the Razor scooter, we introduced an undersized bike (low enough that his knees bent somewhat when his feet were flat on the ground). We let him glide on it down a small, gentle hill (we used our driveway). We encouraged him to pick his feet up while he glided and to attempt to steer.

This wasn't such a big deal because he already had momentum from the hill (but not so much that he was going scary-fast). Remember to tell him to watch ahead of himself, and not to look down.

3. When he got good at this, we encouraged him to pedal.

Remember to tell him to watch ahead of himself, and not to look down.

4. When he looked ahead most of the time, could pedal, steer, start, and stop, we got him his own bike. We let him ride it with the seat a bit low initially. This made stopping and starting easier because he could put his feet flat on the ground.

HTH; I have no idea if this method would work for someone else.

Val

You gave me goosebumps Val. This is EXACTLY how my son learnt to ride the bike!

Tks guys! The advice and support is invaluable!

He can't scoot yet. But the low bike is a great idea! Val, how did you know he tends to look down instead of ahead? <grin>.

The good thing about sports is that it's fun enough for some self motivation to happen.

Tks once again .

That is too funny!

Justed wanted to pass on info about a therapy that is supposed to address bi-lateral integration issues. "Brain Gym" uses exercises to help overcome mid-line, dominance issues. It was recommended to us when we had my son fully evaluated by a private OT. We decided not to embark upon yet another therapy, so I cannot comment on the efficacy. But, it is something to consider.

http://www.braingym.org/

Thanks for this, mich. We too are cutting down on therapy. Just finished 10 straight days of bone conduction, groan. Fired the speech therapist because I suspect she hasn't worked with with APD kids before despite what she told me ("He can't understand my instructions." Duh! ).

I have a book on Braingym somewhere and will look it up. For now, we'll just relax, focus on sports and have fun .

I am so excited to find you all. I scanned the discussion and want to add a few comments.

1. My experience mirrors all of yours
2. My son could not ride a bike until after he took horse riding lessons. "Hmmm really" you say. Well he had issues with torso strength/stability and the balance required to stay on top of a large moving animal gave him not only the strength but maybe even the feeling/muscle memory ... also maybe providing the confidence. Maybe the horse provided the resistance or push back he needed with all of the safety precautions such as stirrups, helmets, reigns, mane, gentle empathetic horse etc. etc. Pardon the comparison but horses are used around here for physical therapy for severe needs folks ... the complexity of motion of a walking horse is impossible to duplicate... besides it is a very enjoyable activity ... very calming vs the tension associated with the fear of scraping your knee from falling off a bike. Hope this is helpful to some. Pardon if I am in the wrong discussion string