Help me understand dysgraphia

[Mom28GreatKids]

Hello ladies, 

 

I need some help understanding dysgraphia.  Is dysgraphia essentially a handwriting problem?  Or is it a disconnect between getting thoughts on the paper?  For some reason I thought it was more the later, But it sounds like it can be or is more the former?  Or is it both?  So, with that in mind, do most kiddos that have fine motor delays have dysgraphia?  DS has a pretty good fine motor delay.  He cannot hold a pencil with even a 5 finger grasp for more than a few seconds.  He routinely uses a fist grasp when he colors, even though he exhibits the ability to have great control for that grasp (ie. attempts to color in the lines).  We are nowhere near a tripod grasp.  He also cannot hold his scissors correctly.  He uses both hands to make them open and close.  When me or the OT makes him hold them correctly, he tries and then says it hurts to do it that way.  This is to be expected with his Apraxia.  I am totally aware that motor planning problems show up other place than just speech.  I guess I am just trying to understand dysgraphia as a disorder.   Is it more than handwriting?  Why did I think kids with dysgraphia actually had a disconnect with what was in their heads to what they could get down on paper?  I am sure you all can help me sort this out.  Obviously DS is too young to know whether he can get anything on paper.  But are his fine motor delays indicative to more problems to come?  Thanks so much for always being available for my questions.  :-)

[PeterPan]

Uh no, apraxia is motor planning of speech.  My ds had no issues with scissors at that age and was actually just the opposite, unusually ADVANCED with a pencil!  So whoever is telling you the apraxia is the explanation of his overall motor planning delays is, well I have to stop because I'm just not polite enough this morning.  But I get so TIRED of stuff like this, kwim?

 

So tell us again why he's showing global delays, overall motor planning problems maybe, and the developmental ped is like oh, who cares??

 

I don't think they're going to diagnose dysgraphia in a 3 yo.  As you say, it's the disconnect with getting thoughts out.  It's not technically the fine motor itself.  

 

I'm concerned that doing the OT activities hurts.  This was old OT or a new OT?  Let me send you a name of someone who specializes in things.  Your SLP has the name, but they're not giving it to you apparently.

 

At some point you're going to need a better explanation for this, because apraxia of speech ain't it.  Call it DCD, ASD, CP, whatever you want, but I'm just saying it's not correct to say oh apraxia of speech as a diagnosis explains everything.  It doesn't.  

 

Fwiw, what ACTUALLY happens with apraxia of speech (and ASD and...) is brain re-direction of energy.  That's not a technical term.  The brain has tons of energy zooming around it that the body wants to, in normal development, spend on lots of areas!  This is a time of super rapid growth!  So the brain has energy to send to social, energy to send to fine motor, energy to send to intellectual, energy to send to speech, etc. etc.  When something is GLITCHED and the brain energy isn't GOING THERE, then that brain energy RE-DIRECTS.  

 

Again, I don't have swanky terms.  That's how it was explained to me, and that's what I've seen in my ds.  So, what happens is if you ramp UP one area, you're redirecting energy FROM other areas.  You CANNOT do everything at once!  The kid only has so much energy to go around!  But the flipside is, that's why you get these wicked brilliant surges and strengths, because you have kids whose energy that should have been spread out to speech and gross motor and academics and...  gets funneled into less areas.  It's not rocket science.  

 

So my ds had the fine motor of a 5 yo when he was eval'd at newly 2.  I kid you not, and I'm NOT pulling your leg.  At 9 months he could sit on my lap and pull the pins from my sewing as I sewed up to them on the machine.  He would use his pincer grasp, pull them out, and place them in a styrofoam bowl.  Over and over and over.  

 

Extreme development in one area, because the energy was being diverted from another.

 

So that means that we're probably not going to get everything at once, not if we're working very intensely on everything.  I actually stopped our speech therapy to let him work on reading.  Other people have said the same thing.  We're getting social this summer, and we've done nothing with language or reading.  And you can say oh you're busy, but it's more than that.  There's no brain energy left to work therapeutically on everything at once!  

 

Now therapists will TRY.  I've got everybody and their brother wanting to work with him, but is it SANE?  Is it doable?  Or do we really have to stagger?

 

So to me, I'd ask why xyz is slowed down, what else is getting that energy, and whether you want to pull that into balance.  Yes, you could do some therapy and work on that.  You might make some progress.  You could do lots of things sort of evenly or pick 2 or 3 areas to really focus on.  It's just choices.

 

If they haven't worked on gross motor with him, they're out of order developmentally.  If he was getting OT and the OT was trying (the same one who was flipping him out for behavior, right?), then maybe she was missing the clue phone on this.  Maybe back up, focus on overall strength and gross motor.  Wheel barrows, strength, motor planning, obstacle courses.  Or put him in gymnastics.  :D  You know my answer, put him in gymnastics.  Our Y has rat pack.  If your Y has it, it would be worth a LOT to you for him to be in there.  

 

Gross motor before fine motor.  So painting, wheelbarrows, overall.  How old is he?  He should probably still be writing in a sand tray if he's writing at all.  Or trace sandpaper letters and then rearrange those to build words and then trace those again with his fingers.  And meanwhile, get on a list for some comprehensive evals, because you've got so many global things going on here that it's mindboggling that somebody can't get you a diagnosis.  

[OneStepAtATime]

What OhElizabeth said.  :)

 

As for what dysgraphia is, in a nut shell dysgraphia essentially can be anything that makes writing hard beyond the normal developmental expectations and does not improve with normal instruction and practice or only improves a little.  It can be a disconnect between thoughts and getting those thoughts on paper.  It can be the challenging physical side of actually forming the letters and the spacing and anything else with the physical act.  And it can be all of that and more.  

 

Many kids can have a poor grip and not be able to color well when they are little but do fine as they mature and are taught how to write.  Fine motor skills can take quite a bit of time to mature.  DD, for instance, did the fist grip for coloring and her coloring was usually a giant scribble on the page until she was closer to 6.  Now?  She sketches and draws and paints and has excellent fine motor skills.  She just needed more time and more patience to develop the skill set.  Her handwriting is still a bit slow compared to many peers and her letter formation is a bit larger than many of her peers but she writes just fine.  Very legible.  And now that she has done quite a bit of Barton for the dyslexia she can get her thoughts onto paper pretty well, too.

 

Also, as OhE said, kids may have fantastic fine motor skills as a little one but still not be able to write as they get older.

 

DS12, for instance, did pretty well with his grip as a toddler and his letter formation in Kinder was better than many of his classmates.  Sometimes picture perfect.  However, he has dysgraphia.  He fatigues easily when writing.  His writing speed is incredibly slow.  He struggles with spacing, sizing, and layout terribly.  When he was in 4k/kinder since everyone else was just learning, too, no one thought much of how slow he was.  As he progressed through 1st grade it started to be more of a problem because he needed to write more quickly, which he really couldn't do.  Then he hit 2nd grade and they switched to COLLEGE RULE paper (because the teacher was new and clueless).  They also had to do a lot of copying from the board.  He just couldn't do it.  Eventually we pulled him out of school.  He was miserable and the teacher did not understand.

 

When we started homeschooling, the only way he could write anything legible was if he was writing on the large tablet paper with the guide lines. He had been explicitly trained to write on that particular paper in 4k/kinder/1st and his writing when I go back to those days isn't bad at all even though it was VERY slow. I eventually moved him to a tablet with narrower lines but still the guides and he is able to use that paper now.  If he doesn't have the guide lines he has a terrible time keeping his letters of a consistent size, and even with those lines if he is tired his spacing is all over the place.  He locks up when trying to get his thoughts from his brain to the paper, too.  If I scribe for him he functions at a much higher level, but he still struggles to organize his thoughts.  

 

In other words, the issues you are seeing right now with your 3 year old do not automatically indicate he will have dysgraphia.  Not at all.  I agree with OhE, the OT should be working on gross motor skills and getting his core stronger.  Can you talk to them?

 

 

[Lecka]

http://www.handwriting-solutions.com/dysgraphia.asp

 

This is the link to the page that the school OT printed out and gave to me when my oldest was in 3rd grade.

 

On this list of 5 types, the OT said she considers my son to have signs of 3: dyslexic, spatial, and phonological.

 

Motor? Not so much with him.

 

When he was in pre-school the pre-school teacher told me "he needs more practice with scissors, he is not doing well with scissors." I gave him more practice with scissors (I don't think we even had any at home b/c we did mostly play-doh for "arts and crafts," he loved play-doh). A few months later the pre-school teacher said he was doing fine with scissors.

 

So, dysgraphia can mean several things and have several profiles.

 

I guess officially all these things are called "Disorder of Written Expression" now. I don't know -- locally we are all saying "dysgraphia" wrt my son. But it can mean problems with physically handwriting, which can be for a list of reasons. Or it can mean problems with "getting things down on paper."

 

For my son, he is one where it is the act of writing, and where he has a much easier time typing, now that he can finally type. He is one where (and this is so frustrating) typing is held up as the thing that will really help him, but it is very hard for him to learn to type so that he is learning to type later than other children (or so it seems, lolololol).

 

He has come a long way and he is doing well. He is still improving, too.

 

Anyway, my comment is mainly to say, my son does dysgraphia but he does not have the profile you are describing at all.

 

But, the link I gave is only about the physical act of handwriting.

 

But there is other information that is about the "getting thoughts on paper." That is also what is meant, depending on the focus.

 

But difficulty with the physical act, and getting thoughts on paper, are two things that may or may not go together.

 

My son is average at that, when he is typing or dictating (to a "scribe," me or someone at school).

Edited July 30, 2016 by Lecka

[Lecka]

http://www.aacandautism.com/

 

I am sharing this link b/c I used to follow a Facebook page where the mother thought this was the best thing ever for AAC that is good for motor planning.

 

But I have never seen it locally, locally I think it is proloquo2go that people are using (or were using a couple of years ago when I was around pre-school kids).

 

I do not as much now, but I used to follow a lot of "emergent communicator" or "early communicator" types of Facebook pages, and a lot of them would include AAC.

 

My son does not use AAC but he has been with kids who do, and I have just got such a good impression.

 

I think from pre-school, I did see kids who had this kind of motor difficulty using AAC and doing well with it.

 

But it is like an impression from seeing other kids.

 

I also am not sure if you were around for a conversation here where some people were saying how sign language is so much better than PECS and AAC, and I was saying "some kids have trouble forming the signs!" This is the kind of thing where I think -- sometimes kids are having the same issues with forming signs as with producing speech.

 

Anyway -- I guess I have seen kids who seem this way (as another parent with a child in the same pre-school program) and who seem like they do awesome with AAC (again, as another parent).

 

But it is not my younger son's profile. I was told by an OT when he was in Kindergarten, that he has the best motor planning she has ever seen in a child with moderate-to-severe autism (since upgraded to mild-to-moderate).

 

So, he is almost 8 now, and he is starting basketball with tutors (he likes it and can work on a lot of skills). The first day he was able to dribble 3 times and make a decent pass. The tutor commented that she has worked with kids where it would have taken them longer to get to this point (they still get there). That is common for me, to hear comments like that, even though my son is still needing some help.

 

So, this son has always been fine for gross motor in general, like playing at a playground, climbing a ladder, kicking a stationary ball, etc.

 

Then some things are harder and he has worked on it.... hand motions to songs are harder for him, kicking a ball moving towards him was harder (you have to bring your foot back as it comes towards you), catching a ball... these are all things that will be harder for him. Learning to dribble more is going to be harder for him (but I think he likes basketball so I think it will be a good fit for him -- there are other options).

 

So I think of it like.... if he can climb a ladder to go down a slide at the playground, that shows some motor planning, b/c there are kids who are having motor planning work to climb a ladder. If he can pedal or push with his feet on age-appropriate tricycle (or the things you sit on and push with your feet) , then that is showing some motor planning. That is good. My son is good at those levels.

 

But then the things I mentioned are things where he does have to practice more, he needs to see simple steps, mostly he does not need any hand-over-hand but in the past we have done some hand-over-hand to help with motor patterning (maybe -- it is hard to know sometimes, b/c hand-over-hand can have multiple purposes, and if I do it I don't know if it is targeting motor planning or imitation, and we do know my son had extremely low imitation skills, but they are good now and were helped by hand-over-hand).

 

Then we have also done some hand-over-hand for more of a "hey, we said do this, now you have to do it" which is Very Controversial to a lot of people, but it is not the same kind of hand-over-hand that people do that is more like -- helping a child (in general) to hold and swing a golf club by standing behind them and helping them to swing it -- which is just helping a child learn to do that motion.

 

But that is something that took me a long time to figure out.

[Mom28GreatKids]

Uh no, apraxia is motor planning of speech.  My ds had no issues with scissors at that age and was actually just the opposite, unusually ADVANCED with a pencil!  So whoever is telling you the apraxia is the explanation of his overall motor planning delays is, well I have to stop because I'm just not polite enough this morning.  But I get so TIRED of stuff like this, kwim?

 

So tell us again why he's showing global delays, overall motor planning problems maybe, and the developmental ped is like oh, who cares??

 

I don't think they're going to diagnose dysgraphia in a 3 yo.  As you say, it's the disconnect with getting thoughts out.  It's not technically the fine motor itself.  

 

I'm concerned that doing the OT activities hurts.  This was old OT or a new OT?  Let me send you a name of someone who specializes in things.  Your SLP has the name, but they're not giving it to you apparently.

 

At some point you're going to need a better explanation for this, because apraxia of speech ain't it.  Call it DCD, ASD, CP, whatever you want, but I'm just saying it's not correct to say oh apraxia of speech as a diagnosis explains everything.  It doesn't.  

 

Fwiw, what ACTUALLY happens with apraxia of speech (and ASD and...) is brain re-direction of energy.  That's not a technical term.  The brain has tons of energy zooming around it that the body wants to, in normal development, spend on lots of areas!  This is a time of super rapid growth!  So the brain has energy to send to social, energy to send to fine motor, energy to send to intellectual, energy to send to speech, etc. etc.  When something is GLITCHED and the brain energy isn't GOING THERE, then that brain energy RE-DIRECTS.  

 

Again, I don't have swanky terms.  That's how it was explained to me, and that's what I've seen in my ds.  So, what happens is if you ramp UP one area, you're redirecting energy FROM other areas.  You CANNOT do everything at once!  The kid only has so much energy to go around!  But the flipside is, that's why you get these wicked brilliant surges and strengths, because you have kids whose energy that should have been spread out to speech and gross motor and academics and...  gets funneled into less areas.  It's not rocket science.  

 

So my ds had the fine motor of a 5 yo when he was eval'd at newly 2.  I kid you not, and I'm NOT pulling your leg.  At 9 months he could sit on my lap and pull the pins from my sewing as I sewed up to them on the machine.  He would use his pincer grasp, pull them out, and place them in a styrofoam bowl.  Over and over and over.  

 

Extreme development in one area, because the energy was being diverted from another.

 

So that means that we're probably not going to get everything at once, not if we're working very intensely on everything.  I actually stopped our speech therapy to let him work on reading.  Other people have said the same thing.  We're getting social this summer, and we've done nothing with language or reading.  And you can say oh you're busy, but it's more than that.  There's no brain energy left to work therapeutically on everything at once!  

 

Now therapists will TRY.  I've got everybody and their brother wanting to work with him, but is it SANE?  Is it doable?  Or do we really have to stagger?

 

So to me, I'd ask why xyz is slowed down, what else is getting that energy, and whether you want to pull that into balance.  Yes, you could do some therapy and work on that.  You might make some progress.  You could do lots of things sort of evenly or pick 2 or 3 areas to really focus on.  It's just choices.

 

If they haven't worked on gross motor with him, they're out of order developmentally.  If he was getting OT and the OT was trying (the same one who was flipping him out for behavior, right?), then maybe she was missing the clue phone on this.  Maybe back up, focus on overall strength and gross motor.  Wheel barrows, strength, motor planning, obstacle courses.  Or put him in gymnastics.   :D  You know my answer, put him in gymnastics.  Our Y has rat pack.  If your Y has it, it would be worth a LOT to you for him to be in there.  

 

Gross motor before fine motor.  So painting, wheelbarrows, overall.  How old is he?  He should probably still be writing in a sand tray if he's writing at all.  Or trace sandpaper letters and then rearrange those to build words and then trace those again with his fingers.  And meanwhile, get on a list for some comprehensive evals, because you've got so many global things going on here that it's mindboggling that somebody can't get you a diagnosis.  

 

 

Ok, let me explain a little better.  I know Apraxia of Speech isn't what is causing it.  I do know that kids with CAS can have other areas of motor planning problems and fine motor delays are often detected in kiddos with other motor planning issues.  DS is hyper advanced in gross motor.  He rode a bike without training wheels at 3.75 (which I know is wicked early because I have had a couple not able til close to 6.5).  He is very athletic.  He can hit a baseball pitched to him, dribbles a soccer ball and basketball, etc.  He has a little low core strength in that it affects his sitting posture and he "w" sits.  He is not overall low tone.  Quite the opposite.  He is a bit of a physical beast, lol.  

 

The fine motor is the really concerning thing because it seems to cause him pain when we work on it.  Like I said, scissors make him say "owie" when held correctly, same with a correct pencil grip.  He also has trouble with tongs, tweezers, droppers, squirt guns, spray bottles, etc. Also things like the climbing wall and monkey bars.  Like I said, his old OT worked a ton (who by the way was awesome, it was the SLP that brought him to hystarics on a weekly basis).  We just aren't going back because there are too many bad memories for both of us.  In any case, this seems to be the one physical thing affecting him.  I don't know if it is poor hand strength, lack of coordination, motor planning difficulty, or all of the above.  The only other overall motor planning issue he seems to have is getting dressed, though it is getting better.  He cannot get a shirt on for his life, though.  But shorts are coming along.  He has always had trouble pulling up his pants. mabe that is hand strength again????

 

I am not looking for a dysgraphia dx at 4.  I am looking to understand it as he starts school so I know what to look for and help him.  Hope that clears things up a bit.  :-)

Edited July 30, 2016 by Mom28GreatKids

[prairiewindmomma]

Have they checked him for too much tone in his hand and forearm? My kid had uncomfortableness with some of those actions at that age. If OT can't figure it out, maybe a physiatrist?

[Mom28GreatKids]

Have they checked him for too much tone in his hand and forearm? My kid had uncomfortableness with some of those actions at that age. If OT can't figure it out, maybe a physiatrist?

 

Ok, I wondered about this.  I wondered if it could actually be his anatomy here, and not brain hand disconnect.  So this would be more PT?

[geodob]

Mom28,  Dysgraphia isn't an officially recognized term, so that it doesn't actually have an accepted definition.

The term Dysgraphia, came about as a combination of the Greek roots: Dys for 'difficulty, impairment', and Grapho for 'writing'.

 

So that any 'difficulty/ impairment with writing', can use Dysgraphia as a term to describe it.

Without being specific.

Though you wrote that he says that his hand hurts, when trying to use scissors the correct way?

But the way that the muscles in the hands and fingers work?

Is in 'teams'.

For example, if you simply bend a finger, in and out?

While one muscle contracts to bend it in, and it's opposite muscle contracts to bend it out?

 

This doesn't simply involve one muscle for each of these movements?

Rather what happens, is that as a muscle contracts? It's opposing muscle needs to 'extend' in precise unison.

But when muscles aren't working in unison?

Then when a muscle contracts, and it's opposite isn't extending?

It will try and stretch its opposite.

Which will of course cause some pain, as it is stretched.

So that it is notable that his 'hand hurts'.

 

Though one cause of this difficulty, can be what is called a 'Retained Palmar Reflex'.

Which is the 'Grasp Reflex' that babies are born with.

Where touching the palm of a babies hand, will cause them to form a 'fist', as a reflex.

A baby then develops the ability to inhibit this reflex.

So that they can then develop the ability to control the contraction and extension of muscles in unison.

 

But a basic way to test for this, which can also be used for remediation?

Perhaps you could try it yourself, and then ask your son to do it?

It just involves, on each hand.  Touching your 'thumb-tip, to each 'finger-tip'.

Observing the fluid movement, as you do this.

 

Though when your son tries to do this, very likely, his fingers will rather 'spring apart'?

As he can't control the 'contraction and extension' of muscles used for this?

 

But if practices doing this for around 30 seconds, every hour or two?

You will likely find that his finger/thumb control, will become increasingly smoother.

As this simple exercise, helps the muscles to develop the ability to contract and extend in unison.

 

One other thing of note, is that a 'retained palmar reflex', will also effect the 'oro-facial muscles' around the mouth.

So that if he has difficulties with these muscles?  Then this might also improve.

[PeterPan]

nt 

 

Edited July 30, 2016 by OhElizabeth

[Mom28GreatKids]

http://www.aacandautism.com/

 

I am sharing this link b/c I used to follow a Facebook page where the mother thought this was the best thing ever for AAC that is good for motor planning.

 

But I have never seen it locally, locally I think it is proloquo2go that people are using (or were using a couple of years ago when I was around pre-school kids).

 

I do not as much now, but I used to follow a lot of "emergent communicator" or "early communicator" types of Facebook pages, and a lot of them would include AAC.

 

My son does not use AAC but he has been with kids who do, and I have just got such a good impression.

 

I think from pre-school, I did see kids who had this kind of motor difficulty using AAC and doing well with it.

 

But it is like an impression from seeing other kids.

 

I also am not sure if you were around for a conversation here where some people were saying how sign language is so much better than PECS and AAC, and I was saying "some kids have trouble forming the signs!" This is the kind of thing where I think -- sometimes kids are having the same issues with forming signs as with producing speech.

 

Anyway -- I guess I have seen kids who seem this way (as another parent with a child in the same pre-school program) and who seem like they do awesome with AAC (again, as another parent).

 

But it is not my younger son's profile. I was told by an OT when he was in Kindergarten, that he has the best motor planning she has ever seen in a child with moderate-to-severe autism (since upgraded to mild-to-moderate).

 

So, he is almost 8 now, and he is starting basketball with tutors (he likes it and can work on a lot of skills). The first day he was able to dribble 3 times and make a decent pass. The tutor commented that she has worked with kids where it would have taken them longer to get to this point (they still get there). That is common for me, to hear comments like that, even though my son is still needing some help.

 

So, this son has always been fine for gross motor in general, like playing at a playground, climbing a ladder, kicking a stationary ball, etc.

 

Then some things are harder and he has worked on it.... hand motions to songs are harder for him, kicking a ball moving towards him was harder (you have to bring your foot back as it comes towards you), catching a ball... these are all things that will be harder for him. Learning to dribble more is going to be harder for him (but I think he likes basketball so I think it will be a good fit for him -- there are other options).

 

So I think of it like.... if he can climb a ladder to go down a slide at the playground, that shows some motor planning, b/c there are kids who are having motor planning work to climb a ladder. If he can pedal or push with his feet on age-appropriate tricycle (or the things you sit on and push with your feet) , then that is showing some motor planning. That is good. My son is good at those levels.

 

But then the things I mentioned are things where he does have to practice more, he needs to see simple steps, mostly he does not need any hand-over-hand but in the past we have done some hand-over-hand to help with motor patterning (maybe -- it is hard to know sometimes, b/c hand-over-hand can have multiple purposes, and if I do it I don't know if it is targeting motor planning or imitation, and we do know my son had extremely low imitation skills, but they are good now and were helped by hand-over-hand).

 

Then we have also done some hand-over-hand for more of a "hey, we said do this, now you have to do it" which is Very Controversial to a lot of people, but it is not the same kind of hand-over-hand that people do that is more like -- helping a child (in general) to hold and swing a golf club by standing behind them and helping them to swing it -- which is just helping a child learn to do that motion.

 

But that is something that took me a long time to figure out.

 

This is all good food for thought, Lecka. In my other response I addressed some of the things he is good at and some of the things he struggles with.  He is not globally dyspraxic by any stretch. He recently learned to throw and catch a frisbie, which I think is pretty impressive for his age.  He is pretty awesome at it and is very proud that he can play frisbie with his older brothers and dad.  But there are some glitches- getting dressed, hand motions for songs. . . those are both hard for him.  Well, we are trying to find a new OT, so these are all things to think about.  Interesting thoughts about AAC and motor planning.  I have asked his SLP about AAC and she does not think he is a good candidate. . .

[Mom28GreatKids]

 

Mom28,  Dysgraphia isn't an officially recognized term, so that it doesn't actually have an accepted definition.

The term Dysgraphia, came about as a combination of the Greek roots: Dys for 'difficulty, impairment', and Grapho for 'writing'.

 

So that any 'difficulty/ impairment with writing', can use Dysgraphia as a term to describe it.

Without being specific.

Though you wrote that he says that his hand hurts, when trying to use scissors the correct way?

But the way that the muscles in the hands and fingers work?

Is in 'teams'.

For example, if you simply bend a finger, in and out?

While one muscle contracts to bend it in, and it's opposite muscle contracts to bend it out?

 

This doesn't simply involve one muscle for each of these movements?

Rather what happens, is that as a muscle contracts? It's opposing muscle needs to 'extend' in precise unison.

But when muscles aren't working in unison?

Then when a muscle contracts, and it's opposite isn't extending?

It will try and stretch its opposite.

Which will of course cause some pain, as it is stretched.

So that it is notable that his 'hand hurts'.

 

Though one cause of this difficulty, can be what is called a 'Retained Palmar Reflex'.

Which is the 'Grasp Reflex' that babies are born with.

Where touching the palm of a babies hand, will cause them to form a 'fist', as a reflex.

A baby then develops the ability to inhibit this reflex.

So that they can then develop the ability to control the contraction and extension of muscles in unison.

 

But a basic way to test for this, which can also be used for remediation?

Perhaps you could try it yourself, and then ask your son to do it?

It just involves, on each hand.  Touching your 'thumb-tip, to each 'finger-tip'.

Observing the fluid movement, as you do this.

 

Though when your son tries to do this, very likely, his fingers will rather 'spring apart'?

As he can't control the 'contraction and extension' of muscles used for this?

 

But if practices doing this for around 30 seconds, every hour or two?

You will likely find that his finger/thumb control, will become increasingly smoother.

As this simple exercise, helps the muscles to develop the ability to contract and extend in unison.

 

One other thing of note, is that a 'retained palmar reflex', will also effect the 'oro-facial muscles' around the mouth.

So that if he has difficulties with these muscles?  Then this might also improve.

 

 

Interesting . . .  OT does think he has retained Palmer and Rooting reflexes.  I did not know these were connected.  More food for thought.  Thanks for this. . .

[Lecka]

Okay, I am just throwing this out there, but there is a thing where kids do great when they can see what they are doing, but they don't do well when they can't see what they are doing.

 

This is mentioned and an example is always "why is it so hard to put on a shirt?"

 

And when other things are not an issue and it is, then it is "b/c the child can't see what they are doing."

 

I think it is mentioned with sensory and there is some sensory thing where the child doesn't have a good ability to know what their body is doing when their eyes are closed or they can't see what they are doing.

[Storygirl]

DS12 has been diagnosed with both dyspraxia (Developmental Coordination Disorder) and dysgraphia (among other things). He has always had good gross motor skills and was a competitive gymnast until this spring. But his fine motor skills are weak. He has trouble cutting food, for example. Interestingly, even though he is extremely physical and athletic, his OT said he has low tone. She explained that low tone is not really about how muscular or athletic you are but about how the muscles send their messages to the brain (I have not researched this, because I've spent time learning about my kids' other issues instead, but it is what she told me).

 

His handwriting is not completely automatic. It's messy, but not out of line with the messiness of the other boys in his grade. It took him longer to learn how to write, and he was never able to make perfect letters, even when he took his time (which he was not wont to do, anyway). He has gone through various handwriting phases over this last year. He had a phase where he liked to draw his letters in a scrolly way to make them look fancier. And he had a phase where he wanted to write super fast, which I tried to discourage, because it makes it harder to read. But I understood that, because he also noticed that he writes much slower than the other kids in the classroom. He would ask why. He has trouble staying on lines but can get things in approximately the correct place. It makes it harder for him to line up his math problems correctly.

 

The OT at school evaluated him this year and noted his difficulties, but they were not bad enough to get him any OT therapy at school. They did get him a huge list of accommodations in his IEP, however. They did not give him SLD written expression, but because he has writing goals and accommodations in his IEP anyway, I didn't push for that to be added to his list of SLDs.

 

He also has the kind of dysgraphia that makes it hard for him to get his thoughts on paper. So he has both kinds of dysgraphia.

 

When he was four, he was poor at all fine motor tasks. He has improved but still really lags behind his same age peers. He will still leave his shoes untied or his pants unbuttoned, because he doesn't want to take the time to fumble with those things. We got him some stretchy shoe laces that don't have to be untied before he went to a three-day camp this spring, and they have been helpful for him.

 

To me, it sounds like in addition to apraxia, your son might have dyspraxia or developmental coordination disorder, which affects the body, not just speech. Someone can be very athletic but still have DCD. This surprised me as well!

 

DS12 had speech delay, by the way, but was never diagnosed with apraxia. He started to speak just before age three and quickly caught up.

Edited July 30, 2016 by Storygirl

[PeterPan]

I'd probably work on those.  The reflexes they were talking about waiting on were STNR, ATNR.  Some of the things you do for the reflexes are sort of life activities you might just "happen" to do anyway.  

 

Praxis is a continuum, so you can have *some* praxis but not enough to get a dyspraxia/dcd label.  

 

I'm *guessing* the AAC is helping by improving sequencing.  So work on sequencing, kwim?  I don't know what they're doing with the AAC.  I agree with your SLP that when PROMPT is working as well as it is for your ds that there's no need to divert attention from it by bringing in AAC.  If anything, work on your PROMPT targets while doing your OT goals.  You're going to find out, over the next few years, that PROMPT is this super powerful tool you can bring into lots of things.  Bring it into your reading time and your speech time and your OT and all day long.  The work YOU do with him applying the skills is PIVOTAL to his progress.

[PeterPan]

Fwiw, to me the frisbee thing shows his convergence is ok right now.  That would be what I would take from it.  I wouldn't assume a lot about his motor planning from it.  

[Storygirl]

I find this interesting:

 

DS12 was found to be dysgraphic by the NP evaluations at age nine. At age 11, the school agreed with his delays but didn't give him the written expression SLD.

 

DD11 was NOT found to be dysgraphic by her NP at age 10. She is dyslexic. However, the same school psych that didn't give SLD written expression to DS DID assign it to DD. Because her dyslexia affects her spelling to such an extent that it affects whether someone can read what she wrote and know what words she meant.

 

So the school sees her as having SLD written expression (what they call dysgraphia) but not DS. However, they both get writing help in their IEPs and actually worked together on the same writing tasks with the intervention specialist at school in a small group.

 

So there is not really a consistency with the way our school labels this.

[Lecka]

For hand motions to songs, there is a lot going on. It is fast to do all the motions. There may be something like crossing the midline (this is common with autism, my older son had it, improved a lot in OT and at an older age, more like 2nd-3rd grades for him).

 

For hand motions, my younger son needs: a chance to slow down a lot and go over it one-on-one with somebody, so it is slow enough for him. He may need hand-over-hand to make a motion at first (not now that he is older, but he did when he was younger). (Sometimes they will think it is better to sit/stand behind kids if they are helping them make a motion.) With practice he can get it a lot better.

 

Then there is singing and making the motions at the same time. This is considered very hard. My son has only started this within the past year, and then only for very, very familiar songs and hand motions.

 

Hand motions for songs are considered very complex, though, so I don't know if there is something where there is a pattern it fits into, or if it is just a harder skill than some other things. I don't know.

Edited July 30, 2016 by Lecka

[Mom28GreatKids]

DS12 has been diagnosed with both dyspraxia (Developmental Coordination Disorder) and dysgraphia (among other things). He has always had good gross motor skills and was a competitive gymnast until this spring. But his fine motor skills are weak. He has trouble cutting food, for example. Interestingly, even though he is extremely physical and athletic, his OT said he has low tone. She explained that low tone is not really about how muscular or athletic you are but about how the muscles send their messages to the brain (I have not researched this, because I've spent time learning about my kids' other issues instead, but it is what she told me).

 

His handwriting is not completely automatic. It's messy, but not out of line with the messiness of the other boys in his grade. It took him longer to learn how to write, and he was never able to make perfect letters, even when he took his time (which he was not wont to do, anyway). He has gone through various handwriting phases over this last year. He had a phase where he liked to draw his letters in a scrolly way to make them look fancier. And he had a phase where he wanted to write super fast, which I tried to discourage, because it makes it harder to read. But I understood that, because he also noticed that he writes much slower than the other kids in the classroom. He would ask why. He has trouble staying on lines but can get things in approximately the correct place. It makes it harder for him to line up his math problems correctly.

 

The OT at school evaluated him this year and noted his difficulties, but they were not bad enough to get him any OT therapy at school. They did get him a huge list of accommodations in his IEP, however. They did not give him SLD written expression, but because he has writing goals and accommodations in his IEP anyway, I didn't push for that to be added to his list of SLDs.

 

He also has the kind of dysgraphia that makes it hard for him to get his thoughts on paper. So he has both kinds of dysgraphia.

 

When he was four, he was poor at all fine motor tasks. He has improved but still really lags behind his same age peers. He will still leave his shoes untied or his pants unbuttoned, because he doesn't want to take the time to fumble with those things. We got him some stretchy shoe laces that don't have to be untied before he went to a three-day camp this spring, and they have been helpful for him.

 

To me, it sounds like in addition to apraxia, your son might have dyspraxia or developmental coordination disorder, which affects the body, not just speech. Someone can be very athletic but still have DCD. This surprised me as well!

 

DS12 had speech delay, by the way, but was never diagnosed with apraxia. He started to speak just before age three and quickly caught up.

 

Thanks for this Storygirl.  Yes, I think this is what I was trying to say is that he does have more than just Apraxia of Speech and for him it seems like maybe it is coming out in fine motor tasks.  SLP is not shocked that he has trouble here.  She almost expected it.  It does not seem, though, that fine motor delay = disgraphia.  That is good.  Though in your case, for your ds, it seems as if it is the case.  I guess I just like to be prepared for the challenges that lay ahead.  I think for now, we will just focus on sorting out if there is a physical element to it.  The fact he says it hurts to perform the tasks is weird, because he doesn't ever tell us that anything hurts- not tummy, not throat, not head when he is sick.  But ask the kids to hold scissors correctly and jeesh.  

[Lecka]

I googled and I think what I heard of when they mentioned difficulty putting on a shirt, it was "proprioception" or "the proprioceptive sense."

 

This is OT stuff when they are talking about sensory stuff.

 

Anyway, that is what I was thinking of, but it doesn't really seem like what you are saying to be honest.

 

But that is where I have heard it I think.

 

Edit: for sensory I hear about the 5 senses plus vestibular and proprioceptive. They are OT/sensory things. I have been to speakers about it when they have parent information things.

Edited July 30, 2016 by Lecka

[Mom28GreatKids]

Onestep- we are not doing OT right now.  We left the clinic where he had a wonderful OT but terrible Speech therapists that were causing him to have unnecessary anxiety because they were putting demands on him that he was unable to fulfill.  It wasn't until I took him to a PROMPT therapist that I saw that his behavior at the old clinic was clinician induced.  Now, he did flip out yesterday with his PROMPT therapist because it was time to go and he didn't want to leave  because they were having so much fun, but until then he had a beautiful session.  I will take that over hiding, screaming and biting because the therapist was hounding him to say things he had no ability to do.  In anycase, at his behavior therapist's rec, we have ceased to get care at the clinic even though we really liked his OT.  SO now I am looking for a new OT and I want to be picky, kwim?  So I want to assess what he needs before I choose a new place.  So, I am trying to sort this all out.  Old OT did not work on gross motor since there just did not seem to be a need at all.  So, she worked sensory and fine motor for the most part.  

[Mom28GreatKids]

I googled and I think what I heard of when they mentioned difficulty putting on a shirt, it was "proprioception" or "the proprioceptive sense."

 

This is OT stuff when they are talking about sensory stuff.

 

Anyway, that is what I was thinking of, but it doesn't really seem like what you are saying to be honest.

 

But that is where I have heard it I think.

 

Edit: for sensory I hear about the 5 senses plus vestibular and proprioceptive. They are OT/sensory things. I have been to speakers about it when they have parent information things.

 

Yes, Lecka, he definitely has problems with proprioception, so that has been part of his sensory diet.  Vestibular too.  But he is weird- like  he doesn't get dizzy, and he can't swing high enough.  So he seeks activities that stimulates these.  It is under developed sense, I think??? It all gets so confusing.  But yes, he doesn't have good sense of where his body is when his eyes are closed.  So maybe that is the put on the shit problem.  

[OneStepAtATime]

Onestep- we are not doing OT right now.  We left the clinic where he had a wonderful OT but terrible Speech therapists that were causing him to have unnecessary anxiety because they were putting demands on him that he was unable to fulfill.  It wasn't until I took him to a PROMPT therapist that I saw that his behavior at the old clinic was clinician induced.  Now, he did flip out yesterday with his PROMPT therapist because it was time to go and he didn't want to leave  because they were having so much fun, but until then he had a beautiful session.  I will take that over hiding, screaming and biting because the therapist was hounding him to say things he had no ability to do.  In anycase, at his behavior therapist's rec, we have ceased to get care at the clinic even though we really liked his OT.  SO now I am looking for a new OT and I want to be picky, kwim?  So I want to assess what he needs before I choose a new place.  So, I am trying to sort this all out.  Old OT did not work on gross motor since there just did not seem to be a need at all.  So, she worked sensory and fine motor for the most part.  

Makes perfect sense.  And yeah, I would walk away from that, too.  Poor kid.  Don't they realize this can cause permanent emotional damage?  Goodness.   :grouphug:

 

I hope you find someone as good as your previous OT and if you need additional Speech therapy I REALLY hope they do a lot better.  And I agree, after your subsequent post it doesn't sound like his gross motor is the issue.  

[OneStepAtATime]

By the way, with regard to vestibular input, I have no clue if that is something you should consider but I though I would mention that vestibular issues are apparently kind of complicated (as is everything else along these lines, right :) ? ).  

 

DD can't swing high enough, either (in fact she prefers to swing very high), climbed early, swam early (saved her brother from drowning when she was 4 1/2), slid down huge slides at 2 with no issues, rode a bike well the first time she tried, got on in-line skates and only fell once her first day of skate lessons, was moved to the expert level within 2 days of starting her first skating lessons (after only being on skates one time for maybe an hour before starting skate lessons), and never complained of dizziness.  However, during long car trips she would get motion sick.  As a teenager, because we don't drive much anymore, she gets motion sick even more than she used to if she has to drive for any length of time.  Severely so if we are on a plane.  In fact, debilitatingly so.  She still swings ALL.THE.TIME.  She never gets dizzy or motion sick while swinging or swimming or climbing or skating, etc.  Although we are still in the process of getting evaluations, I have been told that she may have vestibular input issues.

[Lecka]

Grrrrr, so frustrating about the previous slp. So glad you are with your new one!

 

For the shirt and shorts, you might have him face a mirror and see if that helps.

 

You also might narrate and say the same thing every time.

 

See if you can get him to have his hands grip the shirt and do the motions even if you are helping him.

 

I also like to go with shirts with big neck holes, which does not look the best, but it is much easier for a child who is learning to get their head in the neck hole. Tee shirts are easier than a shirt with 3 buttons, because of the way the rest of the hole is sewn, it is overall smaller and harder to position.

 

But whatever works, he is still young and he has got so many things he is doing well :)

 

Edit: and I would think he was shockingly cooperative and well-behaved if he went along with all of this, lol. If you can get him to take part in one step, that is great!

 

If you have heard of back-chaining or front-chaining, it is when you get kids to do one step and then you do the rest, or two steps and then you do the rest. It is for when things are too frustrating or have too many confusing steps.

 

With front chaining the child starts with the first step.

 

With back chaining the child starts with the last step, and unless it is a harder step, it is considered better bc the child can feel more like "I did it."

Edited July 30, 2016 by Lecka

[Mom28GreatKids]

By the way, with regard to vestibular input, I have no clue if that is something you should consider but I though I would mention that vestibular issues are apparently kind of complicated (as is everything else along these lines, right :) ? ).  

 

DD can't swing high enough, either (in fact she prefers to swing very high), climbed early, swam early (saved her brother from drowning when she was 4 1/2), slid down huge slides at 2 with no issues, rode a bike well the first time she tried, got on in-line skates and only fell once her first day of skate lessons, was moved to the expert level within 2 days of starting her first skating lessons (after only being on skates one time for maybe an hour before starting skate lessons), and never complained of dizziness.  However, during long car trips she would get motion sick.  As a teenager, because we don't drive much anymore, she gets motion sick even more than she used to if she has to drive for any length of time.  Severely so if we are on a plane.  In fact, debilitatingly so.  She still swings ALL.THE.TIME.  She never gets dizzy or motion sick while swinging or swimming or climbing or skating, etc.  Although we are still in the process of getting evaluations, I have been told that she may have vestibular input issues.

 

Ok, you just described my ds. He hates the car, and I think it is because of motion sickness, but he cannot tell me- not enough words yet.  But he cannot swing or climb high enough.  Always more, more, more.  He is also is really good swimmer as well.  He can be on the merry go round at the park and spin, spin, spin, and then walks off like nothing ever happened.  The OT did say he has a vestibular issue, like it isn't sensitive enough?  And yes, she said it was very complicated.  Ugh.  

 

Thanks for the above words as well.  We had a rough go of getting help this last year.  Now that he is getting PROMPT and he loves her to boot, we are all doing much better.  Like, I was wreck dealing with it all too.  I almost went to my physician for meds I was so bad.  But things are better.  I love his Play Project therapist and she has been working with ASD and SPD kiddos for 35 years. She is a godsend.  Speech is good too.  So now OT is the last piece.  I need someone good with SPD, someone up on Primitive Reflexes and someone trained in Therapeutic Listening.  Long list, I know.  Anyway, keep me posted on what they say about your dd. 

[OneStepAtATime]

Ok, you just described my ds. He hates the car, and I think it is because of motion sickness, but he cannot tell me- not enough words yet.  But he cannot swing or climb high enough.  Always more, more, more.  He is also is really good swimmer as well.  He can be on the merry go round at the park and spin, spin, spin, and then walks off like nothing ever happened.  The OT did say he has a vestibular issue, like it isn't sensitive enough?  And yes, she said it was very complicated.  Ugh.  

 

Thanks for the above words as well.  We had a rough go of getting help this last year.  Now that he is getting PROMPT and he loves her to boot, we are all doing much better.  Like, I was wreck dealing with it all too.  I almost went to my physician for meds I was so bad.  But things are better.  I love his Play Project therapist and she has been working with ASD and SPD kiddos for 35 years. She is a godsend.  Speech is good too.  So now OT is the last piece.  I need someone good with SPD, someone up on Primitive Reflexes and someone trained in Therapeutic Listening.  Long list, I know.  Anyway, keep me posted on what they say about your dd. 

Soooo glad things are better.  And yeah, if I get anything useful I will share.  :)

 

And I forgot about the merry go round at our park!  DD used to love getting on those.  She never had an issue.  Me? Oh.my.goodness.  Yuck.  NO way.   :lol:

[PeterPan]

I find this interesting:

 

DS12 was found to be dysgraphic by the NP evaluations at age nine. At age 11, the school agreed with his delays but didn't give him the written expression SLD.

 

DD11 was NOT found to be dysgraphic by her NP at age 10. She is dyslexic. However, the same school psych that didn't give SLD written expression to DS DID assign it to DD. Because her dyslexia affects her spelling to such an extent that it affects whether someone can read what she wrote and know what words she meant.

 

So the school sees her as having SLD written expression (what they call dysgraphia) but not DS. However, they both get writing help in their IEPs and actually worked together on the same writing tasks with the intervention specialist at school in a small group.

 

So there is not really a consistency with the way our school labels this.

 

The school is only asking what affects their ability to access their education.  So someone could have dyslexia but not get labeled SLD by the school, yes.  I think they also use SLD Reading more broadly than the way we typically define dyslexia.  They'll take a dc with language problems that are enough to affect comprehension but not enough to qualify him under speech at put it as SLD Reading.  It's all a little nuts.  

 

So a denial by the school means nothing, and an inclusion by the school means something.  But yes, you could go to three psychs and get three different combinations of explanations.  

Edited July 30, 2016 by OhElizabeth

[Lecka]

Undersensitive can go with sensory seeking.

 

They take more to feel it and seek it out to reach "equilibrium."

 

There is a left to right line, and on the left is understimulated, the middle is equilibrium, and on the right is overstimulated. Kids can be on either side of equilibrium, and overshoot trying to get there. This can be the weird back-and-forth.

 

My son is one who has just improved with age (and he has had OT and I try to do sensory strategies). But it can get easier to start recognizing the signs and what they mean with an OT. I have not always gotten magic answers from OT, but it helps.

 

I am really not a super-OT person, I feel like I have to say that. I am an ABA person, lol. Locally it is a big thing like a lot of people are one or the other, and I am on the ABA side.

 

Edit: this is my son's thing, it is not everybody, but when he is understimulated he will seek stimulation (sensory seeking). But when he is overstimulated, he doesn't necessarily know what to do about it, AND (this was very eye-opening) he can LOOK understimulated when he is overstimulated, but it is actually really hard on him.

 

He has a look that I used to think only meant "understimulated" but now I know it can also mean "overstimulated."

 

But for him he is much better at getting/staying in equilibrium now, and I was told they see improvement like that a lot when kids are 6-7.

 

I don't know the name off the top of my head of what they use at school, but it is where they have the understimulated, equilibrium, overstimulated thing, and it was very helpful for me to have it explained that way.

Edited July 30, 2016 by Lecka

[PeterPan]

Op, transitions from therapy or any time they're really have a good time are HARD!  And sometimes it's just that they're really engaged and got stuck.  And sometimes it's that they used up all their self-regulation during the session and there's just not an ounce left to give.

 

What I had to do that for that was REQUIRE them to take breaks.  Like I don't CARE that he WANTS to go on!  They MUST, MUST, MUST take breaks with my ds.  Now we do double slots.  Are you doing single or double?  The SLP is motivated to push through, because they get a nice chunk of 15-20 minutes off then before their next person.  But me, I'm like NO WAY.  I paid for 50 min of therapy and 10 min transition where you talk TIMES TWO, so that's what we're gonna do!  

 

If he's having it in a one hour session, you can talk with your behaviorist.  She's your point person on this.  They can have a leaving routine.  Our previous SLP had a timer that would go off 5 minutes before, so when they alarm went off they would begin cleaning up.  They could have a little routine.  Our previous SLP gave prizes when ds was that age.  He would put on his shoes then pick out his prize. It was just a good little routine for him.  

 

So you'll want to talk with your behaviorist and nip this pronto.  You want some strategies.  Strategies on YOUR end can be having something to look forward to (oh, we're not doing that, next we're going to McDonald's for lunch! boys who have appropriate behaviors go to McDonald's for a treat! whatever).  You could go even higher power (at least for my ds, lol) and plan on going to the park afterward for appropriate behavior.  That would be huge with him!  But really, my ds needs to sleep and rest afterward.  Going lower key is better.  Getting that calmed down is better.  He goes right away into the car with his kindle set to audiobooks.  

 

So yeah, talk with the behaviorist.  They could make some changes on the SLP end and you might have some on yours.

[PeterPan]

PS.  Wendys has keytags once a year that are a $1 donation.  We go through the drivethru after speech and he gets a baked potato (healthy!) and a free junior frosty.  It's cheap, reasonably healthy, and something he looks forward to.  It's part of how we transition, because he knows he gets a frosty afterward.  For him it was just SO easy to get stuck.  So taking the breaks is about practicing taking breaks.  You can do it there and you can do it other places too.  Like when my ds plays wii, I set the timer and say hey you play and when the timer goes off we're going to X, then you came come back and play some more.  Because transitions are a super hard issue with ASD.  They just are.  And it ain't pretty and it won't get better without work.  And while normally I'm in the speech is speech camp, to me that's one that has to be worked on.  And it will just be a while and then he'll get used to it.  But I DO have to hawk them!  They're just so motivated not to take breaks!  It's really convoluted.

Edited July 30, 2016 by OhElizabeth

[PeterPan]

Which is, being interpreted, don't let people decide things out of their field.  The behaviorist decides how to handle behavior, not the SLP.  SLP might have suggestions or ideas, but once you've jumped to the level where you're using a behaviorist you REALLY have to pull the behaviorist card and say no the behaviorist says to do X.  

[PeterPan]

I'm sorta missing the flow on the sensory discussion, but mixed is common too.  So you can be underresponsive to pain but unusually responsive to certain sounds, etc.  

 

Neurofeedback toned down some of that on ds.  Things like the hand dryers, that kind of thing, the over-sensitivity.  Now he's mainly under.  Well I say that and he still squigs over stuff on his hands, prefers soft foods, etc.  LOL  And the gymnastics helps a LOT with the need for deep input.  The amount we keep him in for that is stupid high.  It's always something we're compensating for too.  Like he'd get out of the pool and have horrific behavior (going from deep pressure to nothing, BAM), so I made him this super heavy, double thickness gnome hooded towel.  He's super cute in it.   :D

Edited July 30, 2016 by OhElizabeth

[Mom28GreatKids]

Op, transitions from therapy or any time they're really have a good time are HARD!  And sometimes it's just that they're really engaged and got stuck.  And sometimes it's that they used up all their self-regulation during the session and there's just not an ounce left to give.

 

What I had to do that for that was REQUIRE them to take breaks.  Like I don't CARE that he WANTS to go on!  They MUST, MUST, MUST take breaks with my ds.  Now we do double slots.  Are you doing single or double?  The SLP is motivated to push through, because they get a nice chunk of 15-20 minutes off then before their next person.  But me, I'm like NO WAY.  I paid for 50 min of therapy and 10 min transition where you talk TIMES TWO, so that's what we're gonna do!  

 

If he's having it in a one hour session, you can talk with your behaviorist.  She's your point person on this.  They can have a leaving routine.  Our previous SLP had a timer that would go off 5 minutes before, so when they alarm went off they would begin cleaning up.  They could have a little routine.  Our previous SLP gave prizes when ds was that age.  He would put on his shoes then pick out his prize. It was just a good little routine for him.  

 

So you'll want to talk with your behaviorist and nip this pronto.  You want some strategies.  Strategies on YOUR end can be having something to look forward to (oh, we're not doing that, next we're going to McDonald's for lunch! boys who have appropriate behaviors go to McDonald's for a treat! whatever).  You could go even higher power (at least for my ds, lol) and plan on going to the park afterward for appropriate behavior.  That would be huge with him!  But really, my ds needs to sleep and rest afterward.  Going lower key is better.  Getting that calmed down is better.  He goes right away into the car with his kindle set to audiobooks.  

 

So yeah, talk with the behaviorist.  They could make some changes on the SLP end and you might have some on yours.

 

This is great advice.  Had not thought of it.  I will email her today.  I am leaving for a week (w/o kids) so he is missing ST this week, so I have time to get something worked out.   He is doing singles.  We did one double and it was too much.  He can't hold it together that long.  She wants to try 1.5 sessions when we get more funding.  Is there a park near the clinic?

[kbutton]

Undersensitive can go with sensory seeking.

 

They take more to feel it and seek it out to reach "equilibrium."

 

There is a left to right line, and on the left is understimulated, the middle is equilibrium, and on the right is overstimulated. Kids can be on either side of equilibrium, and overshoot trying to get there. This can be the weird back-and-forth.

 

My son is one who has just improved with age (and he has had OT and I try to do sensory strategies). But it can get easier to start recognizing the signs and what they mean with an OT. I have not always gotten magic answers from OT, but it helps.

 

I am really not a super-OT person, I feel like I have to say that. I am an ABA person, lol. Locally it is a big thing like a lot of people are one or the other, and I am on the ABA side.

 

Edit: this is my son's thing, it is not everybody, but when he is understimulated he will seek stimulation (sensory seeking). But when he is overstimulated, he doesn't necessarily know what to do about it, AND (this was very eye-opening) he can LOOK understimulated when he is overstimulated, but it is actually really hard on him.

 

He has a look that I used to think only meant "understimulated" but now I know it can also mean "overstimulated."

 

But for him he is much better at getting/staying in equilibrium now, and I was told they see improvement like that a lot when kids are 6-7.

 

I don't know the name off the top of my head of what they use at school, but it is where they have the understimulated, equilibrium, overstimulated thing, and it was very helpful for me to have it explained that way.

 

We had this with my ASD kiddo a lot.

 

With my apraxia kid, the stimulation level seems to be more about arousing his body and brain to work together, but not in a sensory way--it's more like if his body doesn't have some input, his brain is sluggish too. For my ASD kiddo, it was really all sensory, all the time--his brain might be disconnected as well, but it was more like it was distracted because of sensory, not that the two were tied together. For my apraxia kid, it's probably sensory in nature, but it doesn't look the same, and it's just different in a way I don't have words for. They use the word arousal for him vs. stimulated or understimulated. He did have some bodily distraction that took away from his mental energy, but that improved with VT and reflex work, and it wasn't always present to the same degree. The sensory stuff with my ASD kiddo was always there. Always.

 

Just in case you need more comparisons/contrast to get the right words. If not, ignore!!!

[PeterPan]

This is great advice.  Had not thought of it.  I will email her today.  I am leaving for a week (w/o kids) so he is missing ST this week, so I have time to get something worked out.   He is doing singles.  We did one double and it was too much.  He can't hold it together that long.  She wants to try 1.5 sessions when we get more funding.  Is there a park near the clinic?

 

Ok, I'm a very irritable person.  She's thinking of his good or hers?  What is 1.5 sessions?  No break?  Don't let the SLP decide that.

 

You could go two different days.  Or do the 1.5 but DO A BREAK.  Like go down the road to Wendy's and the park for an hour, take that break, and go back.  Yes, it will take longer, but he'll stay more regulated.  When my ds was younger and doing double sessions intensively, that's what we were doing.  I can't remember if we always did that, but I was a lot dumber then.  ;)

[PeterPan]

Kbutton, the low arousal level is a discussion they're having in the context of ADHD.  You can use some of your Zones techniques on him to perk him up, because he's essentially in blue and needs to get his motor going a bit.  I think there's even some research or discussion of a separate low whatever label.  We've had some threads on it.

[Mom28GreatKids]

Ok, I'm a very irritable person.  She's thinking of his good or hers?  What is 1.5 sessions?  No break?  Don't let the SLP decide that.

 

You could go two different days.  Or do the 1.5 but DO A BREAK.  Like go down the road to Wendy's and the park for an hour, take that break, and go back.  Yes, it will take longer, but he'll stay more regulated.  When my ds was younger and doing double sessions intensively, that's what we were doing.  I can't remember if we always did that, but I was a lot dumber then.   ;)

 

Ha ha, she says they do them all the time to build toward tolerance for a double.  So he would do 30 min, 10 min break, 30 min, 5 to transition out.  The only time I could do two days is summer.  No way I can do that during the school year.  

Edited July 30, 2016 by Mom28GreatKids

[PeterPan]

Ha ha, she says they do them all the time to build toward tolerance for a double.  So he would do 30 min, 10 min break, 30 min, 5 to transition out.  The only time I could do two days is summer.  No way I can do that during the school year.  

 

90 minutes -15 min break is 75 min, yields 40 min and 35 with breaks and 10 and 5, as you say.

 

Ds went directly to doubles, but we did singles a lot longer.

 

I'm just getting grouchy here, because after we got the scholarship our first name became MOO, as in cash cow.  Everybody kept offering everything, trying to help us spend the money, sigh.

[Lecka]

Okay, this was really helpful for me! I saw it at a parent program from an OT at school.

 

Okay, it is not mixed where one sense is under responsive, and another sense is over responsive. That is what I used to think mixed means (and it would mean this for some kids who do have this profile, it is different for different kids).

 

My son is both under and over responsive for the same sense.

 

So he can be going back and forth between over and understimulated for the same sense, trying to reach equilibrium in the middle.

 

I don't know how this fits into theory, but in practice it fits my son and is helpful. I may be wording it wrong but it is the idea.

 

So anyway -- if my son gets overstimulated he can look like he is still just sensory seeking, seeking equilibrium.

 

But he can really be overstimulated and on his way to crashing.

 

Crashing is just not good. It is not like it is outwardly bad or difficult, but it just just like -- my son will be so off and it is just not good for him. But it is "off," it is not "look at this wild kid."

 

So -- if he is looking "calm" that can be good or it can be "overstimulated on its way to crashing." Or it can just be disregulated and he is going to stop stimming a lot -- but a certain kind of stimming that is trying to block things out.

 

It is not the kind of stimming be usually has, he usually has stimming that as seen as helping him to regulate and focus.

 

This blocking-things-out stimming is just not good.

 

But to tie it in with what E says about breaks, sometimes my son needs to have breaks bc he is "overstimulated heading for crashing." And he needs to have a change or break. And it is not only sensory, it is like a total package of "what is going on, are things getting too hard, is that starting to make his sensory system get stressful."

 

Bc on the stressful part, if he is other wise getting stressed, that means he has adrenaline and that is going to trigger his sensory stuff.

 

So in practice now (with his improvement, this was not how it was in pre-school) usually stress from something else (too many demands, too long doing something, whatever) will be stressful and then that is what triggers the sensory part and then boom, here comes the sensory part.

 

But it can all be regulated (hopefully) before it even gets to the sensory part starting to get going.

 

When he was younger this was not so tied together, but now it is much more.

 

In ABA we say "we are losing him" and it is the same deal in a lot of ways, try to reduce the stress so he can regulate, try to have breaks and do activities that help him to regulate (with sensory as part of the whole package of regulation.... With this, they can say regulation includes a lot of factors and one is sensory, but there is also emotional regulation and things like being tired or having to do things that are too hard or that are disliked).

Edited July 30, 2016 by Lecka

[Kat w]

There's another dys...and is associated with dysgraphia. It may have been in the links Lecka provided.

 

I cannot for the life of me, pull out if my brain right now, the other dys and ia associated with dyscalcula.

 

I could pull out my paperwork and probably find it.

(I'm avoiding those like the plaque these days) ..ladies here helped me come to grips with global and balh blah.

Brain is still processing it.

 

But somebody help me here please. We have it...crud.

So many dys and IAS.

 

Anyone? Hopefully it was in laeckas links.

I'm gonna look in my bookmarks.

( tough day here today)

 

There is tho, another one associated with it.

[Lecka]

Responding to other posts... We use arousal also but I think it is different people talking about the same thing for him. Arousal is his heart rate going up and that can be the same feeling as having your heart rate go up because you are excited or nervous or anxious. It is like -- the arousal level is the same, and then the feelings get confused.

 

That is what we are talking about when we talk about adjusting to different levels of arousal, and we don't think he has ADHD, just ASD.

 

Yeah, I don't think it is so much sensory for him.

 

People who say it is so much sensory, are just saying different things.

 

We have an overall regulation with a lot of factors that all are playing a part and that all can be the cause of disregulation, and they all need to be going well to be regulated, in equilibrium, "ready to learn," (etc whatever we are calling it lol).

 

But the strategies go together and work together.

 

From what E says, I do think speech therapy can need to fit into the day and fit in with the things in the day needed to stay in equilibrium.

 

But if it is just hard work and the hard work is needing to happen, and it is not going into "crash" territory, then I think it can be okay to push him a bit, too. Just not pushing to the point it is counter-productive.

 

As someone who has gotten speech and OT services during school for a while, I know they do look at it this way, bc they are there and they see if the child is having too much of a reaction after the therapy. I think that is seen more at school than when parents are picking kids up.

 

It is actually something that is a huge weight off of me, bc I don't wonder "is it me" or "is this just what it is going to be like."

 

I would say when this change happened (compared to me taking him to an office) I got feedback like "it is really hard on him, and it needs to be a bit easier on him so he does not have such an effect on him," and that is not something I knew when I was picking him up and then trying to manage the rest of the day.

 

But I think we had a different situation. I think it sounds like this speech is going very well and is very worthwhile. It sounds like maybe some little changes could help, but maybe overall it is worth it to have some little drawbacks bc the progress is so helpful.

 

The place I was going was more like your first slp.

[Lecka]

Kat -- maybe dyslexia. It can go with dysgraphia a lot of the time, too.

 

My older son is just diagnosed with dysgraphia, but he did a lot of reading remediation to learn to read, and I suspected dyslexia when he was younger.

[Lecka]

I am just going to mention, my younger son I am talking about, he did have a lot of difficulty with regulation when he was younger.

 

But in June he went to church camp for 2 overnights! And I got him Reading Eggs last month and he is on Lesson 60 now! (It is not new material but very good review.).

 

A lot of things are going extremely well and he has made a ton of progress. I feel like I am saying a lot of negatives, but his regulation is much better now.

 

He did very well at day camp, too, but it was a special program, I didn't think he could do a general day camp. His church camp was just regular church camp and he had a great time and did very well.

 

When we got there to pick him up at pick-up/cook-out, he was standing by the fire holding his hot dog stick with all the other kids, and he went with all the other kids to have help putting it on a bun and then getting ketchup, etc.

 

Stuff I never thought he would be able to do when he was in pre-school.

[Kat w]

OhE makes a good point on energies and where they go. We stop and start other and different things too and I am always shocked....

 

When we go back to the thing we stopped to do something else?

He will be like...bam! And suddenly have remembered what he learned in the thing we stopped. And goes..... Boom. He's off to the races. Of course that doesn't continue forever .

 

But always shocks me stopping and restarting...what he will do with the area we had taken a break from.

 

Ironically, that's when I get the beat memory retention from him. Weird.

[Kat w]

Ok, you just described my ds. He hates the car, and I think it is because of motion sickness, but he cannot tell me- not enough words yet. But he cannot swing or climb high enough. Always more, more, more. He is also is really good swimmer as well. He can be on the merry go round at the park and spin, spin, spin, and then walks off like nothing ever happened. The OT did say he has a vestibular issue, like it isn't sensitive enough? And yes, she said it was very complicated. Ugh.

 

Thanks for the above words as well. We had a rough go of getting help this last year. Now that he is getting PROMPT and he loves her to boot, we are all doing much better. Like, I was wreck dealing with it all too. I almost went to my physician for meds I was so bad. But things are better. I love his Play Project therapist and she has been working with ASD and SPD kiddos for 35 years. She is a godsend. Speech is good too. So now OT is the last piece. I need someone good with SPD, someone up on Primitive Reflexes and someone trained in Therapeutic Listening. Long list, I know. Anyway, keep me posted on what they say about your dd.

I did go to my doc and gets a med for me. I had to.

 

I think we moms put varying amounts of internal pressure on ourselves . I do.

 

I also think, we need to give ourselves permission to do what we need to, to function the best overall for....*ourselves*.

 

We become so focused ( me) on the children and very easy to forget..we are in the trenches with them. And say, hey, it's OK to have situational issues. (Depression, anxiety, or just plane ole ...I'm stuck and overwhelmed myself).

 

We forget about ourselves sometimes.

Don't be shy about getting something if you and the doc deem necessary . doesn't have to be forever , but we go through seasons in life.

 

It's OK to tend to us sometimes too. I myself am so guilty of this.

[Kat w]

Kat -- maybe dyslexia. It can go with dysgraphia a lot of the time, too.

 

My older son is just diagnosed with dysgraphia, but he did a lot of reading remediation to learn to read, and I suspected dyslexia when he was younger.

No, that wasn't the one I was looking for....we have that too though.

 

Im going to go through my bookmarks when I get a bit.

 

Wish it wasn't escaping my memory right now.

[kbutton]

Kbutton, the low arousal level is a discussion they're having in the context of ADHD.  You can use some of your Zones techniques on him to perk him up, because he's essentially in blue and needs to get his motor going a bit.  I think there's even some research or discussion of a separate low whatever label.  We've had some threads on it.

 

I realize that discussion has been brought up. It's not that cut and dry for him. He has other physical, can't put our finger on it, stuff going on that I do not believe is ADHD, but I do believe is related. We are hoping that some of the referrals we have shed light on that, but the fact that reflex work showed such amazing differences leads us to believe there is more going on. Talked to the ped at his well visit, the ped, on his own, said, "So, you have some of the trees, but you need someone to tell you what the forest is." Exactly. And that wasn't even about stuff that was necessarily all related in my mind.

 

I do think he could still have ADHD.

 

Clear as mud? Yeah, we think so to, lol. ;-) 

 

I just know that sometimes stimulation and arousal are used together, and they can be different, and we might be talking about different things sometimes.

[kbutton]

Okay, this was really helpful for me! I saw it at a parent program from an OT at school.

 

Okay, it is not mixed where one sense is under responsive, and another sense is over responsive. That is what I used to think mixed means (and it would mean this for some kids who do have this profile, it is different for different kids).

 

My son is both under and over responsive for the same sense.

 

So he can be going back and forth between over and understimulated for the same sense, trying to reach equilibrium in the middle.

 

 

 

So anyway -- if my son gets overstimulated he can look like he is still just sensory seeking, seeking equilibrium.

 

But he can really be overstimulated and on his way to crashing.

 

Crashing is just not good. It is not like it is outwardly bad or difficult, but it just just like -- my son will be so off and it is just not good for him. But it is "off," it is not "look at this wild kid."

 

So -- if he is looking "calm" that can be good or it can be "overstimulated on its way to crashing." Or it can just be disregulated and he is going to stop stimming a lot -- but a certain kind of stimming that is trying to block things out.

 

It is not the kind of stimming be usually has, he usually has stimming that as seen as helping him to regulate and focus.

 

This blocking-things-out stimming is just not good.

 

But to tie it in with what E says about breaks, sometimes my son needs to have breaks bc he is "overstimulated heading for crashing." And he needs to have a change or break. And it is not only sensory, it is like a total package of "what is going on, are things getting too hard, is that starting to make his sensory system get stressful."

 

 

But it can all be regulated (hopefully) before it even gets to the sensory part starting to get going.

 

regulation includes a lot of factors and one is sensory, but there is also emotional regulation and things like being tired or having to do things that are too hard or that are disliked).

 

 

Responding to other posts... We use arousal also but I think it is different people talking about the same thing for him. Arousal is his heart rate going up and that can be the same feeling as having your heart rate go up because you are excited or nervous or anxious. It is like -- the arousal level is the same, and then the feelings get confused.  That is not the way in which I am using arousal, but it's good to know that people use that word that way.

 

That is what we are talking about when we talk about adjusting to different levels of arousal, and we don't think he has ADHD, just ASD.

 

 

 

We have an overall regulation with a lot of factors that all are playing a part and that all can be the cause of disregulation, and they all need to be going well to be regulated, in equilibrium, "ready to learn," (etc whatever we are calling it lol).

 

But the strategies go together and work together.

 

From what E says, I do think speech therapy can need to fit into the day and fit in with the things in the day needed to stay in equilibrium.

 

But if it is just hard work and the hard work is needing to happen, and it is not going into "crash" territory, then I think it can be okay to push him a bit, too. Just not pushing to the point it is counter-productive.

 

I like how you broke this down. It makes sense with my ASD kiddo, but replace speech with some other thing he is learning to do while also staying regulated.

[Pistachio mom]

I am skimming through these posts and many people have really contributed in a thorough way. My oldest student has some disgraphia issues, and the Brain Training program was a help to her.

 

Have you ever seen Dianne Craft"s website?  She has a Brain Training program for parents and teachers to use with children to help with coordination and learning issues. It might be worth investigating. Basically, you learn  to do large muscle exercises that make a difference in how the Brain transfers and stores information. The Family Hope Center website is another alternative option to investigate for complicated special needs.

 

 

http://www.diannecraft.org/

http://familyhopecenter.com/

 

I will pray that God gives you wisdom and that He directs you to the right helpful options as you research. Since you son is so young, the intervention you implement can really help him!