Is this relevant re dysgraphia?

[CaitlinC]

Hi,

 

I'm new to the forums, but have learned a lot from them in general, and the LC board in particular, that I want to start by saying that I am very grateful to all who share their issues and their experience. There is something on my mind that I haven't seen mentioned here, so I thought I'd ask for you to chime in ...

 

Some background info. My ds, age 9 in grade 4, is diagnosed ADHD-PI and he has difficulty writing (the physical act of, and spelling, in particular). When he was tested in grade 2, the psychologist felt that it was premature to diagnose a disorder of written expression as he was able to use his learning strengths to compensate for his weaknesses, but that he should be monitored throughout elementary school to ensure that there is no disorder of written expression. This week, my dh and I are going to see his doctor to see if she thinks the time is right to get him re-assessed. He is doing a training programme at a learning center (kind of a combination of LiPs, Seeing Stars, and HWT) and his instructor at the center is suggesting meds as she is not seeing the progress she was expecting after 30+ hours of instruction.

 

My dh and I are reluctant to go that route (meds), but we won't rule it out. First though, we think we need a proper roadmap about what's going on so that we can choose the right remediation programmes. And, I am tempted to do some of the work myself where possible. When we go to see the pediatrician, we plan to go in with a list of symptoms (pencil grip, hates writing, difficulty learning math facts, fatigue, letter reversal b/d, freezes up when needs to write a composition, poor handwriting, funky spelling etc.) And now we are finally getting to my question, which may seem rather narrow, but I haven't really seen much mention of this here in connection with dysgraphia/ difficulties with handwriting, and that is difficulty flexing pectoral muscles. This evening, my ds commented on the fact that he still cannot figure out how to flex his arm muscles. I mentioned this in the past to his pediatrician in a casual way, and she did not think it significant, so I wasn't planning to raise it again. But I wonder if any of you have noticed this in a dc with dysgraphia? I am thinking logically, but with no medical background at all, that this might affect his ability to control the pencil in which case OT might be part of the puzzle, a layer of the onion so to speak? Then again, maybe it is not relevant?

[Tokyomarie]

The physical act of handwriting requires that a student have good core strength & postural control and, interestingly, good development of proximal muscles of the arm- ie good control of the muscles around the shoulder and the elbow, not just the wrist and fingers. I think it would be a wonderful idea to have an assessment with an OT who will look not just at the hand and fine motor tasks but also development through the trunk and shoulder.

 

It might be a little early to re-assess areas that were already tested in Grade 2. Usually, psycho-educational re-assessments are done about every 3 years in the schools. What is the learning center seeing in the way of behaviors that makes the instructor suggest meds? One what basis was your son diagnosed ADHD inattentive? If it was just based on parent and teacher questionnaires you might talk with your primary care physician about having some other measures that could substantiate the ADHD diagnosis before trying meds, such as might be done in a full neuropsychological assessment.

[CaitlinC]

I've never heard the mechanics of handwriting explained that way, thank you! I think we will pursue this angle then.

 

We actually got an assessment from a psychologist outside the school system (although she is a former school psychologist). I thought her assessment was quite thorough as she used a variety of tests (Wechsler IQ and achievement test, Nepsy, California verbal learning test, Ray complex figure test of everyday attention for children etc.). HIs processing speed was in the 34th percentile, while working memory was in the 50th. The teacher at the time rated him as extremely inattentive, but we now know that she is inclined to see things in a very dire light when they aren't necessarily quite so bad. I'm not saying that she was wrong, but it would have been advisable to get input from another source as well. My answers were showing a much milder rating for inattention (but I imagine that is fairly typical!). His current teachers don't tend to refer to attention problems, although one has mentioned that he sometimes looks sleepy. They are working on building up his confidence in writing. He gets lots of positive reinforcement at school.

 

The behaviours that are being noted at the center are mainly fidgeting and lack of progress in spelling (for example, he had "graduated" on the word "thought" (spelled it 5x correctly), but when tested today he spelled it as thowt. Also, when the instructor gives him an exercise to do, she is not satisfied with the number of words that he produces. So, he might produce a list of 10 words, but she would have expected 30 words. Also, he did IM at the center, and did not progress as expected. I don't remember the results, but in some of the tests related to attention, he did not budge at all. We did not really see any improvements coming out of the training, although he worked hard and improved in his ability to do the IM exercises.

 

My ds tells me that he has difficulty concentrating, and he himself has no doubts that he has adhd. But I have observed that when he is working at home, that he becomes spacey mainly when he is writing, or required to work with math facts. Otherwise, he tends to get through his homework quickly. Were it not for the problems with writing, we would not even be looking at meds at this time, because the symptoms are otherwise fairly mild. He is so curious, that by listening and asking questions, he is, in the main, able to pay attention when the teachers are teaching the material.

[PeterPan]

Sometimes they need OT before the IM can stick.

[geodob]

The Pectoral muscles are the muscles on the chest that connect to the shoulders.

Which has 2 muscles, the major and minor. Where basically one swings the arm side to side. Then the other swings it forward and back, and up down.

In combination, they can swing the arm in a circle.

The one that mainly impacts writing, is the one that swings the arm from side to side. Where as we write across the page, it moves the arm and hand across the page.

When their is difficulty with this muscle? When writing, people will instead turn their trunk from side to side, as a way to cope.

Though this isn't very effective, as it doesn't provide a fine control of the movement.

You could try writing a line of text and observe how precise the movement of your arm is across the page?

 

But you also said that he 'cannot figure out how to flex his arm muscles'? Which is probably referring to his biceps?

Where this could be very relevant?

An important thing to note, is that the fingers don't have any muscles.

Rather it uses muscles in the fore arms, that are attached by tendons to fingers on end, and around the elbow at the other end.

 

Though if his 'can't figure out how to flex his arm muscles', does refer to his biceps?

Then this could disrupt the stabilization of his elbow?

Which given that the finger muscles are attached to elbow, could have a disrupting effect on their control?

 

To flex a muscle, we actually have 'receptors' at both ends of every muscle.

So that when we flex or extend a muscle? It is these receptors that recieve the message, and then cause the muscle to contract or extend.

At birth these receptors just work as on/off switches, which are called the primitive reflexes.

Which then develop from on/off switches, to something more like volume controls? So that the rate of contraction/ extension can be controlled and held in any state in between.

 

So that when you said that he can't figure out how flex his arm muscles?

It is the receptors that aren't recieving the message to cause them to flex.

[CaitlinC]

Oops, I am sorry! My cheeks are red! I meant biceps not pectorals. (maybe it's me who needs to be tested :001_rolleyes: ) The truth is I am in a bit of a fog, but trying hard to be pragmatic.

I just got off the phone with the instructor to cancel the lessons short term, and she says the handwriting is 100% attention issues. She says his brain is basically not sending the signals to do the work (well not consistently) and that is a deep attention problem.

But what you are saying about the receptors not receiving the message doesn't necessarily contradict what she is saying?

[GoVanGogh]

To flex a muscle, we actually have 'receptors' at both ends of every muscle.

So that when we flex or extend a muscle? It is these receptors that recieve the message, and then cause the muscle to contract or extend.

At birth these receptors just work as on/off switches, which are called the primitive reflexes.

Which then develop from on/off switches, to something more like volume controls? So that the rate of contraction/ extension can be controlled and held in any state in between.

 

So that when you said that he can't figure out how flex his arm muscles?

It is the receptors that aren't recieving the message to cause them to flex.

Quoting the above in relation to my child's experience.

My child has a neuromuscular disorder. His brain does not send/receive those messages as would a brain in a neurotypical individual.

He comes across as twitchy, scattered and lacking focus when he needs to pull everything together to write.

It has been interesting, since getting the diagnosis, to watch him and realize how all this ties together with his struggles over the years. But it is also amazing how adaptive the brain is so that he doesn't have more problems than he does. He has little awareness of one side of his body, which - of course - is the side that he uses for writing. No wonder he struggles to write and why he tends to tilt to one side or drift off when walking. But you would never guess it, watching him run and play, bike, play a musical instrument. But - he struggles to swim because he doesn't know where that one arm is and he swim off to one side.

I won't even start on the spelling issue, but it has been very humbling trying to teach my child how to spell.

 

I would certainly bring it up with your doctor and therapist again and again what your child says about not being able to flex a muscle group. You might try to get a PT eval to see if there is an issue with muscle tone. That, for us, was more eye-opening/informative than getting the diagnosis from the neurologist.

[Tiramisu]

She says his brain is basically not sending the signals to do the work (well not consistently) and that is a deep attention problem.

 

 

Different specialists will each put their own spin on things, but I really have serious doubts about this comment.

 

Not sending signals consistently seems like it could be a processing issue rather than simply an attention issue. And if that's the case medication won't fix it.

 

If I were you, I'd read about dyspraxia, of which dysgraphia is a part. Very many of your comments make me think of dyspraxia. I'd go ahead with an OT evaluation and try therapy. But I would also consider a neuropsychological evaluation so you can determine what the exact issues are, what you can do to help, and what role inattention is playing before you decide to medicate.

 

You might also consider an auditory processing evaluation with a pediatric audiologist familiar with CAPD since he's 9 and should be ready for one. The spelling, language, and writing issues often show up with CAPD.

[PeterPan]

What the psych can't take the responsibility for is whether the signal isn't going through well due to attention or motor control (praxis, dyspraxia) or neurological damage or what. Definitely mention it again. You've got more than enough reason to warrant an OT eval. When IM is done by OTs, they usually do several months of regular OT first or integrate short spurts of the IM into regular sessions. There's a neurological foundation necessary for IM to make good progress. When I checked into it for dd, I talked with a LOT of practitioners who had given up because they were just doing it and not getting results. The people who seem to stick with it are OTs who are integrating it into their practice and doing vestibular and other neurological work first, getting better results.

[Lecka]

My son really struggles with math facts while otherwise being a strong math student (so far -- he is in 2nd grade now).

 

At this point I am working on facts with him through games, and at school he can do their things orally. He does written also but does not do the usual things his class does (he is just not able and was having noticeable anxiety -- it is his teacher's suggestion after I spoke to her about his anxiety and crying about it at home).

 

So just to say -- maybe look for another route for math facts, and also, maybe they are not worth a lot of angst. They are worth attention, but I don't think they are worth problems.

 

Edit: like doing them orally, untimed, with a game, etc. written is not helpful for my son, it is not a way he learns, and looking at flashcards is not easy for him either.

 

He is doing okay so far, but I am prepared to advocate moving to a chart or possibly (possibly) using a calculator in the future.

[GoVanGogh]

Re: math facts

My 11-year-old just retained his math facts over Christmas, when his dad was off work for nearly two weeks and drilled him twice a day, every day.

Some things that helped:

Repetition! Lots and lots of time with flash cards.

Having him, at first, memorize flash cards with the answer showing. (I have read - and believe - that for visual learners, they will remember "6 x 6 = BLANK" instead of remembering the answer. Let them visually see and memorize with the answer at first.)

Do not let this be a hurdle for advancing or a source of frustration. I sit next to child during math and, if he needs help with a math fact, I will say, "Let's repeat this math fact: Six times six equals thirty-six." I will have him repeat it several times so it sticks... somewhere... in his brain, I hope.

[CaitlinC]

I used your comments (with the exception of the comments re math facts, which are post-appointment) to organize my thoughts when we met with the doctor. Ds is going to get an evaluation with an OT and doctor would like a full neuro-psychological evaluation before prescribing meds. Interestingly, for the wrap-up of the tutoring, ds did a follow-up spelling test with the instructor, and he seems to have made remarkable progress for someone who was not paying attention as he tested at a grade 7 level using a standardized test (from grade 2 pre-instruction). These skills are still not applied in his writing from what I can see, but more when he is given the time to focus on spelling only. Spelling when writing a text isn't there yet, but time is certainly on his side. He feels good about his progress, so that's great. So we'll take the same approach to math facts and take our time. Thanks for the tips, I will try the oral repetitions when we work together and we'll do games too this summer.

[PeterPan]

You might try rewarding him for asking for help with his spelling when he writes. Keep a skittles bowl and give him a candy any time he asks how to spell a word. My dd really needed to make effort to THINK about whether she knew words or not.

 

And congrats on having a doc who wants fuller evals. That's what you want to hear! :)