So... Impairment in Written Function

[mommymonster]

I wrote this back in June about DS(now)9’s challenges:

 

The two main things I'm concerned about: (i) General inability to put pencil to paper for any period of time without finger pain and frustration, letter reversals, and a general lack of figuring out spacing, ascenders, descenders, and punctuation. He can copy pretty well, if the thing to copy is on the line above where he's copying to (does that make sense? It has to be close so he can look at it while writing). If you ask him to write the sentence, "The cat ran," without a copy for him to look at, he will not be able to do it legibly.  We've done Handwriting Without Tears (with many tears), and done the OT evaluation. He’s never liked coloring, play dough, cutting, or anything using his hands. He has a hard time with a fork. His grip seems really weak. He has huge hands. (ii) Inability to spell whether on paper or orally. He has some excellent reading skills, specifically decoding and comprehension (allegedly at a seventh grade level). We did year-end testing and he scored in the kindergarten level for spelling (he can do CVCs pretty well, but that is all. He can't do words like "is," "was," or "of" -- they come out iz, wuz, and uv.

 

Fun additional challenges, but not sure if they're relevant: light and noise sensitive, highly food texture sensitive. Right brained. Did vision therapy for a number of issues, including figure ground, tracking, and making mental pictures (that is, he can't make mental pictures). We have a strong family history of dyslexia. Relatively poor core strength and he hates sitting at a desk for any period of time. He gets overwhelmed very easily. Has to think things through… Can’t memorize math facts to save his life. He loves to run and rides his bike well. He has tons of friends and is comfortable in social situations. (From this thread: http://forums.welltrainedmind.com/topic/519718-two-things-at-once-typing-and-spelling/)

 

Well, then. We received my son’s neuropsych eval results, and the results were a bit of a mixed bag. I wrote a list of strengths and weaknesses my son had prior to the neuropsych eval, and every concern I had tested out as an issue. The formal diagnoses were general anxiety disorder and Specific Learning Disorder with Impairment in Written Function (Spelling, Punctuation, Grammar, Clarity).  She said it isn't dyslexia and isn't dysgraphia, though.

 

Unfortunately, the neurophsych didn’t really have any ideas on a remediation game plan, which I didn’t really expect, but… I had this little dream that she would pull out a plan. Sigh. I’m at a point where I don’t know what to work on first. Or if any of this can actually be “fixed†or “improved.†An overall theme with DS9 is that he can learn stuff with a context, an overarching story, with work. He cannot memorize facts that aren’t part of a story or a narrative. So, no math facts or spelling rules stay in his brain.

Looking at the tests, he is at less than fifth percentile on the WISC5 in digit spans, coding, and processing speed. 

 

He is very low on Phonological Processing, as well as Pseudoword Decoding. She did not recommend a SLP or audiologist assessment. The odd part is that he reads at a mid-sixth grade level. I asked whether I should do another phonics program (we did OPGTR), and she said his reading is above average so we don’t need to remediate reading. I’m not sure if this was impacted by his anxiety/perfectionism issues, if that makes sense? Like, if he can’t make sense of the words, he’s not going to say nonsense out loud? Or if he really doesn’t know phonics and just memorized the words by sight? He shouldn’t be able to do that, though, given his vision problems. He has a robust vocabulary and seems to be able to intuit stories, so he can decode complex words.

 

For writing, he can compose reasonable sentences in his head. They aren’t great writing, but he can do it. If I scribe them, we are fine. If he has to write them, it all falls apart. He can’t spell words, doesn’t know what letters look like, and he forgets what to do next. It implodes pretty quickly, especially when his anxiety issues kick in.

 

 

 

Note: Edited the paragraph on phonological processing and pseudoword decoding. 

 

And for even more fun, we had an OT eval through our PPO, which was again a lesson in frustration. DS9 had the *exact same* raw scores as he did when tested about two years ago. All the work we’ve done on fine motor skills, and he has not improved one iota. Even better, since his raw scores haven’t improved, his percentiles have dropped off, as he hasn’t developed like other kids his age. Fabulous. The OT looked through the things we do to try to improve his fine motor skills, and she said she couldn’t offer anything better than what we already do. Awesome. She was shocked we hadn’t started assistive technologies. For some reason, as a just-turned-nine year old, I thought we still had time to remediate. Does this mean I give up on remediation?

 

It seems like we need to somehow work on spelling, math facts, digit spans (Maybe? Does practice actually help/translate into other skills?)? How do I teach rote facts to someone who just can’t memorize them?  He learns well with music, but most math fact songs are just someone chanting 2 + 4 = 6… not really a narrative or story to remember.

 

In thinking about assistive technologies, I know about Dragon Speaking Naturally… what else should I know? Should I even try to teach cursive?

 

If you’ve made it this far, thank you. Writing this has been oddly therapeutic, but not terribly self-enlightening. I hope you will be able to do some enlightening. 

[PeterPan]

I have only two bits of advice, since I haven't been exactly where you are.  1) Find some games and real life activities to stretch his working memory and cognitive skills.  For instance take up cards, play memory games, get A Fistful of Coins, Ticket to Ride, whatever. 2) Figure out what he does well and spend at least 1/2 of every day doing it. 

 

You've got enough that it would be easy to freak out and spend all day working only on what he's poor at.  If you spend 1/2 your day catering to his strengths (which hopefully that eval helped you identify!), it might balance him out.  And it gives you something to harness to work in your therapy goals.  I know that's a hard line to balance.  I'm in so freaked out mode, I spend most of my time sweating reading and no time sweating whether I'm giving him enough stimulation in other areas.  But by that age (9) I'd definitely be looking for that balance.  

 

Keep writing and talking.  Maybe as you write it will sort out for you.  Not that you have to say, but what was his IQ?  Was there a big discrepancy between IQ and CTOPP percentiles or were they pretty close?  I agree when the dc is doing well with his reading I wouldn't sweat it.  And yes, dd somehow began to read in spite of low working memory, her undiagnosed vision problems, and her total unwillingness to sound out.  I think it's a testament to their brightness.  That's why I say you need to spend at least 1/2 of every day catering to his strengths no matter what.

 

Some people do really well with the dictation that now comes with computers, ipads, etc.  With any of the apple computers you're going to be able to download voice to text for free.  The non-streaming version works well.  It's what dh uses to write his grad papers. I just taught another dyslexic adult to use it and we found it very successful.  I'm guessing Dragon is fine too.  It's just more that you have to figure out what device you're wanting to work from.  Dd's writing took off the year we: did metronome work at home, went crazy working on Dvorak (an alternate keyboard layout), and got her an ipad.  For her, it's about the device you have with you.  Get the device and put on it what can work for dictation, kwim?  

 

 

[Heathermomster]

In my view, getting a handle on the anxiety should be the priority.

 

From all the things that you have described, the weak core and the inability to sit still jump out at me. Motor issues will affect attention, math, and the ability to sequence. I almost think you should find a new OT/PT and have them look for retained prim reflexes and generalized coordination issues. Interactive Metronome might work for the digit span exercises.

 

OhE is currently using a program called S'cool Moves with her son. You want to look at exercises using both sides of the body, such as cross crawls to better integrate nerves between the halves of your son's brain (corpus callosum), and exercise ball type core exercises for core strength. Maybe take him swimming at an indoor pool.

 

Your DS is very young. My DS was mid-fifth grade when he learned to type. Scribe for your son and explore speech to text as OhE mentioned.

 

For materials that teach math facts using pictures and story, maybe check out the following:

http://www.amazon.com/Addition-Fun-Way-Picture-Learning/dp/1883841348/ref=sr_1_3?ie=UTF8&qid=1417870692&sr=8-3&keywords=Addition+facts

 

Lastly, check out the thread started by FP and watch the webinar.

http://forums.welltrainedmind.com/topic/534095-anyone-watch-the-webinar-on-teaching-writing-to-dyslexics/

 

The thread is mainly about dyslexia and writing; however, written expression issues are not simply about bad handwriting. Written expression issues affect all the subroutines and word retrieval necessary for coherent sentence output. You can teach your child strategies to help him cope using materials for dyslexics.

[mommymonster]

Thank you both for your thoughts!

 

Heather, I should have said that we are starting family and individual therapy to work on my son's anxiety, as well as PTSD for the rest of the family (due to DS5's medical issues). 

 

OhE, his IQ was listed as 100, but it was listed as very unreliable due to a lot of scatter. His core knowledge is strong, but he has a lot of issues getting the information out. due to slow processing speed and the writing issues. I think he's bright, just problems with output (on multiple fronts).

 

I will look into S'Cool Moves, as well as FP's thread. We are headed to an elk meadow today to feed elk (it's through our state), and a 1860s historical holiday celebration. I will be back on the board tonight. 

 

 

[geodob]

You wrote that 'he can't make mental pictures'.

Where this would be a major factor with all of his difficulties.

Which would be compounded, when combined with his fine motor difficulties.

 

Where given his reading ability?

His only difficulty with spelling, is that he can't visually recall what the letters and words look like?

Also with math, being able to form a mental picture of numbers is critical, as a shorthand method.

So that when doing math, numbers can be pictured as a single image: 159.

As opposed to holding it in the mind verbally: one hundred and fifty nine.

 

Where you might compare doing a math calculation verbally rather visually?

159 + 27= ?

One hundred and fifty nine plus twenty seven ?

 

Where if you try to do it as a purely verbally process?

You will no doubt get lost in the process?

 

But a really critical issue, is where you wrote in the other thread:

"He can copy pretty well, if the thing to copy is on the line above where he's copying to .... ."

 

What this demonstrates, is that he can hold a mental picture of the line above, as he copies it to the line below !

Where the importance of this needs to be highlighted.

As the image of the line, or word above?

Which is formed on the 'back of the eye'.

Only lasts for about 60 milli-seconds, or about a 20th of a second, before it disappears and is replaced by the next image.

 

So that the fact that he can hold an image of the line above long enough, to copy it to line below.

Demonstrates, that he can retain a mental picture, all be it briefly.

(But in this regard, I would also ask about the difference it makes to his physical formation of each letter, when copying from the line above? )

 

Though perhaps I might mention that I've been doing study and research into the developmental process of the ability to visualize, and work with mental pictures.  For about 10 years, and also conducting trials of methods to develop this ability.  

Which uses an incremental process.

Where it gradually increases the time between looking at the line above, and copying it to the line below.

Which requires holding it in Visual working memory.

But I also like to use 'non-verbal' symbols as well.

Such as: ^[#~

 

Where it can only be remembered as a visual image, to copy it.

But might begin with just: #~

 

Though the next step, is to practice retaining a mental image in short term memory?

Which could extend to looking at: ^~#.

 

Then trying to hold a mental image of it, as one gets up, walks across the room.

Then comes back and writes or types the symbols.

Where the process of retaining the image is practiced.

 

But a really critical factor with the ability to visualize and form mental images?

Is that it isn't an ability that we are born with?

Rather it is an acquired skill, that takes around 8 years to develop.

 

Where the acquisition of the skills to form and retrieve mental images, is vulnerable to disruption?

Where the different types of vision difficulties discussed here, can disrupt the skills develop in different ways.

But importantly, the potential is still there.

It just remains there, waiting to be developed !

Where he could learn how to save "was, is, of' as visual images in long term memory.

Linked to the sounds that they represent.

Then learn how retrieve them later.

[VinNY]

My dtr age 13 just received the same dx this fall. She didn't get anxiety disorder but instead has an anxious temperament. My dtr was also dxed with a language disorder and speech sound disorder (oral motor difficulties). She has APD and dyspraxia. 

 

She also learns better through stories. I recommend teaching math facts through stories like Addition the Fun Way and Multiplication the Fun Way. I used this http://www.multiplication.com/products/books/memorize-minutes-times-tables.

 

He is still young so you may see more writing output as he gets older. I was in the same boat as you where she could only copy. Bad enough, my dtr had severe language issues I couldn't understand her narrations :) At least that is getting better.

 

My dtr started writing two paragraphs at 12. The content is good but the grammar, spelling and punctuation isn't at grade level. I highly recommend starting with Apple and Pears Book A spelling, punctuation and grammar program. I broke the lessons up and my dtr didn't always pass so we went back to the beginning of the chapter like they tell you to. We are now on book C. 

 

As he gets older, try Writing Skills Series by Diana Hansbury King.

 

I did VT with my dtr and Perceptual Therapy.  My dtr is also light and noise sensitive. She did some Therepeutic Listening through an OT. It helped some. She had OT from K-6th. 

 

We are getting an Assistive Technology Eval through the school. My dtr has speech issues so a speech to text wasn't recommended but for your son it may help. I was recommended to teach my dtr to type and to get her to use a program that provides computer assistance for organizing papers (examples: SOLO Draft builder, Inspiration or FreeMind). I was also recommended a program called ReadNaturally.

 

HTH

 

 

[VinNY]

"The thread is mainly about dyslexia and writing; however, written expression issues are not simply about bad handwriting. Written expression issues affect all the subroutines and word retrieval necessary for coherent sentence output. You can teach your child strategies to help him cope using materials for dyslexics. "

 

I just read Heathermomster's reply and I heartily agree.

[mommymonster]

This board is just amazing. Thank you, all. 

 

Geodob: Yes. Yes. Yes. One hundred times, yes. This is exactly the issue. I spoke with our COVD guy when DS9 got his diagnosis, and he was very grim about DS9's prospect of ever making "pictures" in his head. That is why I'm always talking about learning through songs and making rhymes and whatnot, as he just can't seem to build and keep those pictures. Unfortunately, doing purely verbal math (two thousand nine hundred forty seven minus sixty eight) isn't sustainable. To be clear, though, DS9's copying of a line of text is a time-intensive, painstaking endeavor. He does do a good job, though -- very few reversals, etc. But it does give me hope that you're analysis is spot on. In your research, have you published any methodologies or processes for working on these skills? Books? Is there a place where I can go to learn more about the process? I'd just like to have some guidelines on this process to make sure we get on the right path. 

 

Heathermomster: FP's webinar is on my list for listening/viewing pleasure tonight. Also, I should update the original post to say that due to reading the forums, we've had DS9 in swimming lessons for the last five or six months. He's making good progress in swimming! I will pull out our yoga ball, as well. It might be interesting to see what he can do in terms of balancing for a bit during lessons, and then maybe some core strength exercises. 

 

VinNY: Thank you for your recommendations! I have been a bit disheartened by how little information is available online about remediating the diagnosis, so it is especially useful to "meet" other parents working through these challenges. I ordered the Addition the Fun Way for math, and I'm hoping it clicks. We're going to give it our best faith effort and hope for the best. We were doing Apples and Pears, but the program was so writing intensive that it really drained him. We might just go back to it, as we aren't making any real headway with AAS (not that it's AAS's fault, it's just not clicking).

[geodob]

With the fine motor exercises, have you been doing the main one?

Which just involves touching finger tip to thumb, going back and forth from finger to finger.

This term 'core motor strength', confuses the understanding?

 

The fundamental factor with all muscles?

Is that they all work in teams, where they all have an opposing muscle.

Where they maintain a balanced state of tension between each other.

So with any movement, as one muscle contracts, its opposite muscle extends.

 

To appreciate it, you might simply try opening your hand, Then try and bring a fingertip and thumb together.

But importantly, do it as 'slowly as you can'?

As you do it, might have a sense of the opposing muscles?

Where some muscles are contracting, to bring your thumb and fingertip together.

At the same time, their opposing muscles, are extending, To let the thumb and finger come together.

But with trying to do it slowly?

While some muscles are trying to bring them together.

It is the opposing muscles, that are really controlling this Slow movement, by a slow extension.

 

Then you could also again try to bring a fingertip and thumb together?

But this time, stop half way and keep them 'still'.

 

Which might seem simple, as no movement is happening.

But in fact, this involves the opposing muscles in the thumb and finger.

Maintaining a 'balanced state of tension', with its partner muscle.

 

But then, you might consider the situation, where opposing muscles haven't developed the ability to work in precise harmony with their partner muscle?

Where their can be a struggle against each other?

Which cause them to rock back and forth.

 

Though this relates to the value of a yoga/ balance ball?

Which requires constant readjustment to remain seated on.

Rocking back and forth.

Importantly, this allows one to practice the gradual refinement of the rocking back and forth of opposing muscles.

So that less and less movement is required, to keep seated on a balance ball.