Building Handwriting Speed?

[nature girl]

So Anna's neuropsych eval mentioned issues with fine motor dyscoordination. She's able to follow lines in mazes and such reasonably well, but her handwriting is very slow and labored. (She also has an issue with finger strength...We've always done a lot of Play-Doh play, but I'm going to switch over to clay and plasticine, maybe even theraputty to see if we can build that up.) 

 

I guess fine and gross motor developmental dyscoordination disorder are typical for ADHD, and the OT volunteered to work with her but I'd rather spend our limited OT time on things we can't do at home. What do kids actually do in OT for fine motor, to help handwriting? Is there any way I can work on handwriting speed and coordination at home, besides just practice (which she hates)?

[Tiramisu]

OhE once put a link up to the EZWrite website. (I think that's what it's called.) They had a alphabet speed drill that's supposed to improve speed.

 

From what I remember in a previous post, though I could be mistaken, your dd may lack automaticity in writing. If she can achieve automaticity, her speed will improve. The advice I got here to help build automaticity was to integrate gross motor into writing practice. One method was to use writing 8's, and do them on a chalk board or even the air with very large arm movements.

 

There are also apps that you can use on the ipad or a kindle fire to reinforce proper stroke order.

 

My dd's writing is showing great improvement this school year, and I credit VT. One funny thing she's doing is writing the longest words she can think of with her eyes closed. It's just a game that she came up with for fun, but to me, it's revealing about how much less effort-ful writing is for her. And interesting that I give credit to VT and she's not even using her eyes to write! I guess that must mean it's more automatic at some level. Right?

[Pegs]

I attribute my DS' handwriting improvement to the core and and upper body work I'd been doing with him. He has very hypermobile fingers - we have a genetic thing - so hand strengthening via putty and the like was always going to be of limited use (though he does play with lego a lot, also). He played on a low trapeze, climbed ropes, rode a scooter into town when we were running errands, and did lots of wheelbarrow races.

 

Just a few more ideas in case the finger strengthening isn't the answer for you. :)

[Heathermomster]

We were told that DD had weak core, weak pincer grasp, and mild motor planning issues.  Here is a website that contains directions for half of the exercises DD performed 5 times per week using a stability ball:  ball push-up with feet up, ball chest fly, and ball dumbbell press with soup cans.  DD worked her way up to 15 reps each exercise.  DD performed additional exercises; however, I am unable to find them on-line.  She also worked with the OT once per week.  These exercises take very little time.  For motor planning, we were advised to start kid yoga.  We have a video but have not used it.

 

I presently use Start Write software to print up handwriting sheets.  DD practices writing her name, day of the week, full date, and a sentence or verse from whatever subject or book that we are studying.  I am slowly increasing the amount of writing.  Sometimes, DD will dictate a sentence or names that she wants to write.  She will copy popular Star Wars phrases or the names of My Little Pony characters.  I just go with it if her own dictation keeps her motivated.  She sits at a table adjusted for her height.  We have experimented with short and regular sized pencils with grips.  DD prefers a shorter pencil and no grip.  IKEA sells awesome adjustable desks and chairs for grammar stage students.  DD has also started using KWT.  I'm not 100% sold on typing at this age, so KWT may not fly.

 

I forgot to mention this.  We use the LOE Student Whiteboard.  We love it and use it with phonics and spelling.

 

I wrote the above one year ago.  To follow up, I discovered a pediatric PT, who worked with DD for 8 sessions, and we discovered that DD is low tone.  DD developed automaticity about 4-5 months ago.  Looking back, the wheelbarrow walking and yoga ball exercises helped the most.  ETA:  KWT did work out for us because her hands were too small for the keyboard.

 

ETA:  Stability ball exercise link and LOE Student Whiteboard link.

[nature girl]

Thanks for the ideas! I'll try the large arm movements, she might even think it's fun. I know it was part of HWT, but we never did it because she knew her strokes reasonably well and I didn't understand the point at the time. I found "Alphabet Race" as part of EZWrite 1st grade, but there's no description of what it actually is. Does anybody know?

 

I know she has an issue with core strength and has low tone, I wonder if that's part of the problem. Hmmm...She hates wheelbarrow walking (we were doing it as part of her heavy work and she had a really hard time with it, even if I held at her waist) but I'll have her do more crab and bear walking, and frog jumps, which she likes.

 

Do you remember what the website is, Heather? I don't see it linked above. I've thought of starting kid yoga with her actually, I wondered if it might be calming. Have you tried it since your post?

[Heathermomster]

I just added the links to my post. Sorry about that.  The PT gave us several stability exercises to do at home, so we never bothered with the yoga videos. 

[Tiramisu]

Thanks for the ideas! I'll try the large arm movements, she might even think it's fun. I know it was part of HWT, but we never did it because she knew her strokes reasonably well and I didn't understand the point at the time. I found "Alphabet Race" as part of EZWrite 1st grade, but there's no description of what it actually is. Does anybody know?

 

I know she has an issue with core strength and has low tone, I wonder if that's part of the problem. Hmmm...She hates wheelbarrow walking (we were doing it as part of her heavy work and she had a really hard time with it, even if I held at her waist) but I'll have her do more crab and bear walking, and frog jumps, which she likes.

 

Do you remember what the website is, Heather? I don't see it linked above. I've thought of starting kid yoga with her actually, I wondered if it might be calming. Have you tried it since your post?

 

Like Peg's ds, my kids have hypermobile fingers. The ones it affected most are the ones who also seem to be low tone. I never thought of dd as being low tone but it came up in the OT report.

 

Monkey bars is something that has also come up here for improving hand and upper body strength. One of my girls was also given theraputty to work with.

 

One thing that came up with my youngest in the report is that she is very strong and has great motor skills but she is unable to sustain effort and she used to complain about pain when she wrote. So far, so good this year, but I haven't been overdoing what I ask of her. 

[Tiramisu]

Thanks for the ideas! I'll try the large arm movements, she might even think it's fun. I know it was part of HWT, but we never did it because she knew her strokes reasonably well and I didn't understand the point at the time. I found "Alphabet Race" as part of EZWrite 1st grade, but there's no description of what it actually is. Does anybody know?

 

I know she has an issue with core strength and has low tone, I wonder if that's part of the problem. Hmmm...She hates wheelbarrow walking (we were doing it as part of her heavy work and she had a really hard time with it, even if I held at her waist) but I'll have her do more crab and bear walking, and frog jumps, which she likes.

 

Do you remember what the website is, Heather? I don't see it linked above. I've thought of starting kid yoga with her actually, I wondered if it might be calming. Have you tried it since your post?

 

I know I read a description before but I can't seem to find it on their website now. From what I remember, a child should write the alphabet as quickly as they can. My memory was that it was very straightforward, and that it should be done twice a week. 

 

My only concern about it is that we've had some issues with incorrect stroke order and I worry about reinforcing that. 

 

My plan for this year was to work on stroke order with apps. And guess what? I haven't done it yet. I was going to hold off on cursive and have her do it with her dad, but my MIL got sick and passed away so everything requiring our intervention got pushed to the side. In the meanwhile, dd decided to start working with a HWT cursive workbook and it's going amazingly well. When things are going well, I try to ride the wave and not mess with it too much.

[geodob]

A simple exercise that you could have her do?

Involves touching finger-tip to thumb.

Doing it with the fingers in random order, back and forth.

 

This develops 'muscle tone'.

Where muscle tone isn't to do to with muscle strength?

But rather, it's the ability to control 'sensors' at both ends of every muscle.

That control and regulate muscle 'contraction and extension'.

 

 

[nature girl]

One thing that came up with my youngest in the report is that she is very strong and has great motor skills but she is unable to sustain effort and she used to complain about pain when she wrote. So far, so good this year, but I haven't been overdoing what I ask of her. 

 

Anna also is unable to sustain effort, she gets tired walking more than a half mile, and can't even bike a quarter mile, she just has no stamina. I guess it's partly because of tone, but I feel like there's more going on there. She's never complained of pain while writing, but she's not really writing long enough pieces now that it's really challenging her stamina, four or five sentences at the most.

 

Geodob, that's interesting, I'll have her try that! We do piano (only a couple of times a week, though) so that may help as well. I also found some finger exercises with a pencil last night in a hs blog I follow, which look like they might be great for increasing finger dexterity and possibly strength.

 

ETA: This is the blog post, in case anyone comes upon this in archives at some point and is interested. http://www.learnwithplayathome.com/2015/09/finger-exercises-for-kids-learning.html

[geodob]

Anna'sMom,

We don't actually have any muscles in our fingers?

The fingers use muscles in our fore-arms.

When we extend our fingers, this uses the muscles on the top of our forearm.

Then we contract our fingers, it uses the opposing muscles under are forearm.

 

A most important factor with this, is that all muscles work in unison with their opposite.

So that when a muscle contracts, its opposite needs to extend in precise unison.

But perhaps you could imagine the situation, where as a muscle contracts?

Its opposite doesn't extend in unison?

What this results in?  Is that when a muscle contracts?

It tries to 'stretch its opposite'?

Which of course can result in pain.

But it also means that any precise use of the muscles is lost, as they don't work in synchrony.

Which is basically what 'low muscle tone' is.

 

Though the finger to thumb exercise that I mentioned?

Will identify whether the muscles for the fingers, are contracting and extending in unison?

But they can also be used to develop this unison.

[nature girl]

That's interesting, geodob, thank you! So her inability to press piano keys firmly or draw dark lines with crayons is associated with a lack of strength in her forearms? That seems counterintuitive, but I'll take your word for it!

 

Do I need to specify (or have her specify) which fingers to touch to her thumb, or have her touch one at a time in order, or can I just have her do it randomly?

[Tiramisu]

That's interesting, geodob, thank you! So her inability to press piano keys firmly or draw dark lines with crayons is associated with a lack of strength in her forearms? That seems counterintuitive, but I'll take your word for it!

 

Do I need to specify (or have her specify) which fingers to touch to her thumb, or have her touch one at a time in order, or can I just have her do it randomly?

 

Maybe geodob will answer better than I can, but strength and tone are different things. I know that two of my kids seem to have tone issues but good strength. Tone has to do with the level of muscle contraction while at rest. 

[geodob]

No, it's not to do with 'strength'?

 

To explain it, simply bend one of your fingers, in and out?

When you bend your finger in, a muscle under your forearm, contracts and bends your finger in.

 

Then when you bend your finger back out?

A muscle on the top of your forearm, contracts and bends your finger back out.

 

So that basically each finger has these 2 muscles attached it.

But the main factor, is how these 2 muscles work together?

When a muscle contracts?

Its opposite muscle doesn't go loose and let the other one contract?

Rather, the opposite extends in precise unison with other one contracting.

Which needs to be at the same rate.

 

Though the problem that occurs?

Is when the muscles aren't working in unison?

So that as a muscle contracts?

It's opposite doesn't extend at the same rate?

Coming back to your finger.

Imagine when trying to bend your finger inwards?

That the muscle that bends it outwards, wont extend?

 

If its opposite wont extend, then what it does is to try and stretch it?

Which is what causes pain.

So that muscle strength isn't the problem.

It's just the struggle with its opposite.

 

Though with this 'finger to thumb' exercise?

Which is done in random order.

This just provides an opportunity to directly practice, getting opposing muscles to work in unison with each other.

As they contract and extend.

When their is a difficulty with this, typically the fingers will snap together, and then spring apart.

Where the aim is to gain control of the speed of the movement.

With a focus on being able to slowly and smoothly, bring the finger-thumb together and apart.

[Heathermomster]

Geoff, how does tone relate to this?

[kbutton]

Our OT also told us to do a lot of wheelbarrow/crab walking for hand strength, theraputty, etc. A lot goes into the writing process. I think I get what geodob is saying, though you also have hand muscles. Like he was saying, I don't think they control your fingers, but they support your fingers and hand--I am pretty sure that weak hand muscles (called the intrinsic hand muscles by our OT) influence how you hold your hand, which influences whether you hyperextend your fingers and such. At least that's what I've gotten from the descriptions our OT gave us (and shoulder girdle, core muscles also cascade into whether you hold your arms and hands in the right way). 

 

Some other ideas from our OT--playing games where the child has to wrap their hands around something thick with a bit of give, like a pool noodle--so, you can use the noodle for games, or you can put a section of noodle on a broom or rake handle for chores. You can put small objects in your hand, move them to your fingers one by one, and then place them on a surface one at a time (marbles, pennies, beans). You can also pick them up one by one, and hold the ones you've picked up in your hand as you go. Flipping playing cards over one at a time. Using clothes pins to hang things. Work with tongs and tweezers. For shoulder girdle (and eye tracking), tether ball activities are good. If regular tetherball is frustrating, or the child doesn't get enough chances to hit, you can just hang a tetherball straight down from an eye bolt, and you can hit it that way. You can get a pair of boxing gloves if it's too hard on the hands (they have some tetherballs with soft covers). You want to hang the tetherball at shoulder height (punching balloons and such work on those things too).

[kbutton]

Oh, BTW, automaticity and hand strength don't always go together. That's a brain sequencing thing. 

[PeterPan]

AM, I'm coming in here late, but you're getting an OT eval?  ADHD and DCD do not just naturally go together.  You can have the one without the other.  You've got an additional thing going on, and with the *multitude* of symptoms you've had (SPD, DCD, hypotonia, etc.), it will be really good to get that OT eval, get it sorted out, and get a complete approach.  

 

As you're finding, compliance is an issue.  Not only is your understanding piecemeal if you do it yourself, but some of these things are challenging or unfun.  The OT can break it into small bits, make it like games, and get the ball rolling so that then you just continue that momentum at home.  I don't remember all the details of your mix, but she's probably going to benefit from dramatically more OT than you expect.  I wouldn't think in terms of 8 weeks.  I'd think in terms of years.  I thought that was crazy going in with ds, but OT is actually helping us make serious headway on stuff.  When there are a *lot* of things going on, you need a *team* approach to get there.  Even if you could sit here and research every single thing, you can't hardly keep up with it.  That's some of the best advice I got when we started evals with ds, to build a good team.  

[geodob]

Heather, you asked how this relates to tone?

Where muscle tone, is actually 'muscle tension'.

 

When we aren't using a muscle, it doesn't 'switch off'?

Rather at any moment, every muscle in our body, limbs and head?

Is held in a state of tension.

Which is balanced with its 'opposing muscle'.

So that they are switched on, and ready to react instantly.

 

Though problems with muscle tone/ tension?

Can be either be with reduced muscle tone, where their is little tension constantly maintained in muscles.

The word 'floppy' describes this, and is termed as Hypotonia.

Then the opposite of this, is where muscles are maintained at a high level of tension.

Which is termed as Hypertonia, and at the extreme end, results in Spasticity.

 

Though behind this, is the way that muscles work?

Where every muscle has a nerve receptor at each end.

These nerve receptors create a chemical 'ATC', that causes a chemical reaction?

What this chemical reaction produces, is a 'micro-volt of electricity'.

 

Where increasing or reducing the production of this ACT chemical?

Causes an increase or decrease in the micro-voltage.

Which is what cause a muscle, to 'contract or extend'.

 

Where a way to think of this? Is like every muscle having its own 'volume control' ?

But a crucial factor here, relates to when a muscle isn't being used in movement?

It doesn't 'switch off'?

But rather returns to a default volume level, of muscle contraction.

Where this default contraction, is our Muscle Tone.

Which each muscles settles into, when not active.

 

So that low or high muscle tone, is nothing to do with the strength of a muscle?

But its ability to use its 'volume control', to contract or relax a muscle.

 

Which comes to back the often raised topic of 'Primitive Reflexes'?

Where a baby only has an On/Off control of muscles.

With no Volume Control of muscles?

So with the development of the ability to 'Inhibit a Reflex'?

The first stage involves discovering the 'Pause' button for muscles.

Having put a muscle on Pause?

A baby/infant, can then start to explore how to use the volume control knob for muscles?

So that instead of a muscle, instantly fully contracting?

It is able to gradually contract a muscle (or muscle group), and pause at any point.

 

But their is a further level of complexity?

Where all muscles work as a team of 2.

Muscles move bones. So that when a muscle contracts, it pulls a bone one way.

But that muscle can't push the bone back the other way?

It relies on its 'opposite muscle', to pull the bone back.

But it doesn't simply 'let go', and let the other muscle pull it back?

 

To understand this?

You have probably used a knob on a stereo system, which adjusts the volume between the left and right speakers?

So that as you turn the knob, it automatically reduces the volume on one side, and increases the other side.

Which can be done very precisely.

Though our opposing muscles work in just as precise synchrony.

Where they contract and extend in synchrony with each other.

 

So that with muscle tone?

The idea of making a muscle stronger to solve the problem?

Is rather like having a stereo system, and not knowing how to use the volume control?

With getting a stronger/ louder stereo system seen as the solution?

When the real solution, is to gain control of the volume!

As well as control the volume for both speakers/muscles.

[nature girl]

This is all so interesting, thank you! I'm reading all this information, and trying to figure out how it applies to DD. For most things her fine motor seems pretty good...She developed pincer grasp quite early, and was able to string beads on toothpicks at around 18mo, so I assumed she didn't have any fine motor issues. But it took her a LONG time to be able to scribble, in EI between 16 and 20 months they'd try to get her to move a paintbrush and she just refused. It wasn't till around 2.5 that she was able to scribble (she's never been even remotely interested in coloring books, still won't use them), and she didn't even try drawing a face till around 3 (and even then never picked up a crayon or marker unless I sat to encourage her.) Maybe related, she wasn't able to put toys through hoops until much later than other kids.

 

Now she's actually quite good at drawing, it's kind of interesting, it's like she sees the essence of a thing and creates an abstract image of it, kind of like a caricature, good enough that when she draws a picture of myself or my husband we can tell who it is. She draws these VERY quickly, but when she draws letters it's usually painfully slow. (She can actually write more quickly, but it's extremely messy and sometimes missing parts, like the line at the beginning of a lowercase n or m or r. So is that an automaticity issue? Or a coordination issue?) In doing geodob's exercise, she couldn't really move her fingers quickly, maybe two fingers per second, and when I tried to get her to speed up she just mashed all her fingers at once up and down against her thumb. I don't know if that's a sign of age or of a real issue, but we'll keep practicing. She was able to control the fingers pretty well, though, not like you're describing geodob where the fingers snap up and down, she could lower them carefully.

 

The pediatrician has always said her muscle tone is good, but we've known for a long time that she has an issue with strength (and stamina) which I always assumed carried through to her issues with pressing deeply enough to use a pencil/crayon and with pressing piano keys.

 

The exercises you've all suggested are great, thank you, especially since some of the core strengthening exercises we can also use as some of our heavy work. (And it's almost leaf raking time, this is an excuse to get her out there helping us.) She likes doing animal-walk races, so I'll do more of them with her too. She got a kick out of the figure 8 exercise, we've made it into a kind of dance. :)

[Tiramisu]

This is all so interesting, thank you! I'm reading all this information, and trying to figure out how it applies to DD. For most things her fine motor seems pretty good...She developed pincer grasp quite early, and was able to string beads on toothpicks at around 18mo, so I assumed she didn't have any fine motor issues. But it took her a LONG time to be able to scribble, in EI between 16 and 20 months they'd try to get her to move a paintbrush and she just refused. It wasn't till around 2.5 that she was able to scribble (she's never been even remotely interested in coloring books, still won't use them), and she didn't even try drawing a face till around 3 (and even then never picked up a crayon or marker unless I sat to encourage her.) Maybe related, she wasn't able to put toys through hoops until much later than other kids.

 

Now she's actually quite good at drawing, it's kind of interesting, it's like she sees the essence of a thing and creates an abstract image of it, kind of like a caricature, good enough that when she draws a picture of myself or my husband we can tell who it is. She draws these VERY quickly, but when she draws letters it's usually painfully slow. (She can actually write more quickly, but it's extremely messy and sometimes missing parts, like the line at the beginning of a lowercase n or m or r. So is that an automaticity issue? Or a coordination issue?) In doing geodob's exercise, she couldn't really move her fingers quickly, maybe two fingers per second, and when I tried to get her to speed up she just mashed all her fingers at once up and down against her thumb. I don't know if that's a sign of age or of a real issue, but we'll keep practicing. She was able to control the fingers pretty well, though, not like you're describing geodob where the fingers snap up and down, she could lower them carefully.

 

The pediatrician has always said her muscle tone is good, but we've known for a long time that she has an issue with strength (and stamina) which I always assumed carried through to her issues with pressing deeply enough to use a pencil/crayon and with pressing piano keys.

 

The exercises you've all suggested are great, thank you, especially since some of the core strengthening exercises we can also use as some of our heavy work. (And it's almost leaf raking time, this is an excuse to get her out there helping us.) She likes doing animal-walk races, so I'll do more of them with her too. She got a kick out of the figure 8 exercise, we've made it into a kind of dance. :)

 

Some things about your dd really remind me of my kids. Now my oldest who almost got a developmental coordination disorder dx used to leave parts off of letters, rather that write strokes in the wrong order like two of my other dd's. The only learning label she officially has is CAPD. I wonder if it could be a motor planning- attention thing. 

[nature girl]

AM, I'm coming in here late, but you're getting an OT eval?  ADHD and DCD do not just naturally go together.  You can have the one without the other.  You've got an additional thing going on, and with the *multitude* of symptoms you've had (SPD, DCD, hypotonia, etc.), it will be really good to get that OT eval, get it sorted out, and get a complete approach.  

 

As you're finding, compliance is an issue.  Not only is your understanding piecemeal if you do it yourself, but some of these things are challenging or unfun.  The OT can break it into small bits, make it like games, and get the ball rolling so that then you just continue that momentum at home.  I don't remember all the details of your mix, but she's probably going to benefit from dramatically more OT than you expect.  I wouldn't think in terms of 8 weeks.  I'd think in terms of years.  I thought that was crazy going in with ds, but OT is actually helping us make serious headway on stuff.  When there are a *lot* of things going on, you need a *team* approach to get there.  Even if you could sit here and research every single thing, you can't hardly keep up with it.  That's some of the best advice I got when we started evals with ds, to build a good team.  

 

We've been to 4 OT appointments, and the evaluation has been ongoing at each appointment, they haven't finished yet. I guess they do some testing, then do some heavy work with her, and then just let her play. I'm a little disappointed with this, all insurance will pay for is a half hour (and we have to pay $50 for that half hour.) I'm thinking of asking how much extra we'd have to pay for an hour-long appointment if we covered the rest ourselves, because at this rate I feel like it will take forever. She's also had 3 different therapists as they have differing availabilities, and the most recent one that they want us to stick with doesn't even let me in the room to watch what's going on. Last appointment she invited me in for the last 7 minutes while Anna was just coloring, to discuss...which means Anna only got 23 minutes of OT (and it takes us 35 minutes to get there...The only work they gave me for home was a list of sensory diet activities. So...I'm not very impressed so far, but I'll hold off judgment for at least a little while since this is the only OT in the area. /vent

 

The coordination disorder is apparently somewhat common for ADHD, although I realize they don't always go together. (A number of athletes have ADHD.) In the brief discussion we had, the therapist only said, "There's definitely something neurological going on." Which tells me exactly nothing. She did mention too that Anna had a hard time on one side when closing her eyes, touching her nose and then her opposite finger...The primal reflexes they've tested for so far have all been fine.

 

Maybe the dyscoordination has led to the core strength issue, since her muscle strength is okay? But she doesn't do many things like climbing monkey bars, etc. because it's harder for her? And the lack of stamina means she can't bike or run very far, so that feeds in as well. (She's also a very awkward runner.)

[Tiramisu]

We've been to 4 OT appointments, and the evaluation has been ongoing at each appointment, they haven't finished yet. I guess they do some testing, then do some heavy work with her, and then just let her play. I'm a little disappointed with this, all insurance will pay for is a half hour (and we have to pay $50 for that half hour.) I'm thinking of asking how much extra we'd have to pay for an hour-long appointment if we covered the rest ourselves, because at this rate I feel like it will take forever. She's also had 3 different therapists as they have differing availabilities, and the most recent one that they want us to stick with doesn't even let me in the room to watch what's going on. Last appointment she invited me in for the last 7 minutes while Anna was just coloring, to discuss...which means Anna only got 23 minutes of OT (and it takes us 35 minutes to get there...The only work they gave me for home was a list of sensory diet activities. So...I'm not very impressed so far, but I'll hold off judgment for at least a little while since this is the only OT in the area. /vent

 

The coordination disorder is apparently somewhat common for ADHD, although I realize they don't always go together. (A number of athletes have ADHD.) In the brief discussion we had, the therapist only said, "There's definitely something neurological going on." Which tells me exactly nothing. She did mention too that Anna had a hard time on one side when closing her eyes, touching her nose and then her opposite finger...The primal reflexes they've tested for so far have all been fine.

 

Maybe the dyscoordination has led to the core strength issue, since her muscle strength is okay? But she doesn't do many things like climbing monkey bars, etc. because it's harder for her? And the lack of stamina means she can't bike or run very far, so that feeds in as well. (She's also a very awkward runner.)

 

I'm curious if you ever taken her for an eval with a pediatric neurologist.

[nature girl]

I'm curious if you ever taken her for an eval with a pediatric neurologist.

 

Yes, we've been to a ped neurologist and a neuropsych. She had a full-day neuropsych eval last month, and it showed some issues with fine motor although she seemed to think they weren't major. The neurologist wasn't able to do complete neurological testing during her first eval (because of Anna's noncompliance and poor focusing on tasks). We're meeting with her again in a month, so maybe she'll try to complete the exam...She did say that her muscle tone and reflexes seemed normal. She had her try to stand on one foot and to hop, something she still can't do, but said it was because of poor effort/focus rather than a real issue. (I'm not sure I agree that's the reason, though.)

[kbutton]

I think we are all going back and forth between the big picture and the details of how ADHD/SPD/OT works, how does Anna fit that overall view, why doesn't this piece of information fit. I think your questions are good, we all have those sorts of question. I encourage you to let the OT know that you are trying to figure this out, and you'd like to know why she's taking a particular approach. If you can ask it casually but seriously, then the OT won't feel put on the spot. You can ask why you're not allowed to observe (it could be that it's very distracting for Anna, and not because of anything you are doing). I think if you are neutral and just tell them that you are trying to put what seems like disparate pieces of information in their proper place, you might get some insightful answers. Each OT is going to present a different personality and a different way of working, and that is okay as long as they are doing a good job. 

 

As you're finding, compliance is an issue.  Not only is your understanding piecemeal if you do it yourself, but some of these things are challenging or unfun.  The OT can break it into small bits, make it like games, and get the ball rolling so that then you just continue that momentum at home.  

:iagree: Yes, yes, yes. And it's GOOD for your child to establish a relationship with these sorts of providers. Very good. My kids loved the OTs, and each OT was very different and brought different strengths to the table. Our clinic assigned OTs to a child based on the intake form. They did an awesome job--both of my kids got OTs that were suited very well to their own needs. My younger son's OT came across as kind of scattered, but she was perfect for him. She had BTDT perspective of having a son a lot like him, and she also was playful and spontaneous in a way that drew him in and motivated him. The OT my older son had was steady like a rock, and she was warm, but she was also pretty no nonsense. It was just what he needed. If I just met them on the street, I would have had a definite preference based on my initial impression, and then one of my kids would've missed the experience he needed.

 

This is all so interesting, thank you! I'm reading all this information, and trying to figure out how it applies to DD. For most things her fine motor seems pretty good...She developed pincer grasp quite early, and was able to string beads on toothpicks at around 18mo, so I assumed she didn't have any fine motor issues. But it took her a LONG time to be able to scribble, in EI between 16 and 20 months they'd try to get her to move a paintbrush and she just refused. It wasn't till around 2.5 that she was able to scribble (she's never been even remotely interested in coloring books, still won't use them), and she didn't even try drawing a face till around 3 (and even then never picked up a crayon or marker unless I sat to encourage her.) Maybe related, she wasn't able to put toys through hoops until much later than other kids.

 

 

Anna's Mom, on 27 Sept 2015 - 10:09 AM, said:

 Oops, messed up the multiquote when I was backspacing...

 

It's fairly normal for kids to have big peaks and valleys like this in skill areas. My son asked me to teach him to knit at 4, and he could defeat child locks, string beads, etc. all very, very early. I thought the Montessori preschool was nuts when they mentioned both his fine and gross motor issues. Well, they were right. He has trouble with both. He also has amazing skills in both areas. 

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Last quote:

We've been to 4 OT appointments, and the evaluation has been ongoing at each appointment, they haven't finished yet. I guess they do some testing, then do some heavy work with her, and then just let her play. I'm a little disappointed with this, all insurance will pay for is a half hour (and we have to pay $50 for that half hour.) I'm thinking of asking how much extra we'd have to pay for an hour-long appointment if we covered the rest ourselves, because at this rate I feel like it will take forever. She's also had 3 different therapists as they have differing availabilities, and the most recent one that they want us to stick with doesn't even let me in the room to watch what's going on. Last appointment she invited me in for the last 7 minutes while Anna was just coloring, to discuss...which means Anna only got 23 minutes of OT (and it takes us 35 minutes to get there...The only work they gave me for home was a list of sensory diet activities. So...I'm not very impressed so far, but I'll hold off judgment for at least a little while since this is the only OT in the area. /vent

 

The coordination disorder is apparently somewhat common for ADHD, although I realize they don't always go together. (A number of athletes have ADHD.) In the brief discussion we had, the therapist only said, "There's definitely something neurological going on." Which tells me exactly nothing. She did mention too that Anna had a hard time on one side when closing her eyes, touching her nose and then her opposite finger...The primal reflexes they've tested for so far have all been fine.

 

Maybe the dyscoordination has led to the core strength issue, since her muscle strength is okay? But she doesn't do many things like climbing monkey bars, etc. because it's harder for her? And the lack of stamina means she can't bike or run very far, so that feeds in as well. (She's also a very awkward runner.)

______________________

 

The changing therapist thing might bother me, but it sounds like they were trying to accommodate you and get you in ASAP. They may also take this approach to see who makes the most headway with your daughter, to work together to formulate a game plan with more than one opinion on the matter, etc. They may also test this way to get more data over time vs. Anna having a really good or bad day when evaluated. Keep in mind that the initial evaluation is a hefty one with a big price tag--you are probably going to find that this approach doesn't change the price that much. They might be testing her a bit at a time because she's hard to keep on track and could not do one big testing session.

 

The part about something neurological going on--they probably meant that comment encouragingly in a "yes, she really does need to be here" kind of way. They may mean that they can't parse it all out, but they see pieces of what is going on.

 

I think you are getting good care. You should know that we've all hit that place where we aren't able to put all the pieces together at once, and we just have to try something, stick with it, and see it come together later.

 

:grouphug:

[PeterPan]

Wow, what is this place charging for an hour??  No wonder you're frustrated!!  Around here private OTs are $80-110 an hour and hospital-associated with be 2-3X that much.  So you're paying for a half hour *with insurance* the same amount I pay without.  

 

I would not tolerate not being in there.  I know some OTs pull that stunt, but you have no way to learn and carry things over if you can't be there to observe.  You also have no quality control.  I'm also not a very nice person to work for.  That's definitely something to sort out, that you really want to be in there to observe, learn, etc.  But as far as them shifting you around, is it just temporary till one gets consistent openings?  What if you just pay for a 2 hour block and do a full eval and be done with it?  And are any of them SIPT certified?  Do any of them specialize in ASD/SPD?

 

OT can be sort of a gestalt, voodoo-ish sort of field to those of us who are listmakers and precise.  My ds started OT this summer and had short sessions (free, during dd's neurofeedback) twice a week for a number of weeks.  Then we finally started his full, regular weekly, one hour (very generous, more like 1:15) sessions.  It's now almost October, and I only now feel like we're making some serious headway.  Before it was more like hmm, a little progress, couldn't put our fingers on it.  When you've got lots of issues (DCD, SPD, etc.), it's going to take some time to start unpacking that, problem solving, doing things, having those things kick in, etc.  This is not going to be fast.

 

If your label switched over to ASD, would your insurance kick in with better therapy funding? 

 

That OT *should* be helping you learn things to do at home, but really you need to be in the room to see stuff happening.  I'd be upset too if they were losing 7 minutes out of a 30 minute session to talking with parents, mercy.  That's just really short.  What would your local ps give you?  Some would be short (15 min) but some would be 30 min.  I don't know, just thinking.  At 30 minutes, there's hardly time for *you* to talk things through with the OT and problem solve.  I had two hours a week to sit and chat with the OT at the beginning.  It takes time to talk through things.  And some of the stuff she would just test, so do this, and send me home with things to do.  A lot of it you *can* do at home, but you need someone you feel like you have that kind of problem solving relationship with.  Maybe figure out which is the OT you can do that with at this practice and then say no, get me in with her consistently, kwim?  And maybe get this eval thing over with or pay to bump the sessions up to one hour for a while, kwim?  If the OT diagnoses DCD/SPD, does that change what your insurance will cover?

[kbutton]

Wow, what is this place charging for an hour??  No wonder you're frustrated!!  Around here private OTs are $80-110 an hour and hospital-associated with be 2-3X that much.  So you're paying for a half hour *with insurance* the same amount I pay without.  Our OT was $136 per hour, and the insurance didn't pay for anything (hadn't met deductible), but gave us a $56 write-off, so our total was considerably less. The two-hour evaluation was similar in price, but I don't think there was a write-off from the insurance for that. It might actually be cheaper to do the evaluation over a few weeks instead, but I would want to know when they think they will be done and to know if it's taking longer for them to discover all of Anna's issues, or if this is how long all the evaluations take. We had two hours, but if they had needed to do a SIPT exam, it would have been four hours.

 

I would not tolerate not being in there.  I know some OTs pull that stunt, but you have no way to learn and carry things over if you can't be there to observe.  You also have no quality control.  I'm also not a very nice person to work for.  That's definitely something to sort out, that you really want to be in there to observe, learn, etc.  But as far as them shifting you around, is it just temporary till one gets consistent openings?  What if you just pay for a 2 hour block and do a full eval and be done with it?  And are any of them SIPT certified?  Do any of them specialize in ASD/SPD? I would not be happy to not sit in the session, but I think it's worth asking why she excluded you before being upset about it. If Anna really can't work with you in there, that's important to know. A lot of kids behave differently with the parents in the room. 

 

 

[PeterPan]

We had to do that for a while for ST, because ds just would not buckle down and comply.  For a while I sat in a room adjacent, just to where I could hear through the doors what was going on without being seen.  After a while of that, he got back in the groove where he needed to be and I could sit quietly in the room.  But yeah it's an unpleasant stage to be at where they're using you, pulling away, trying to get out of therapy.

 

I just have a thing about practitioners, because I just do.  I like ones that facilitate, not ones that build themselves up as the ONLY people who can do anything.  And maybe dropping off works better for some people, but it doesn't *have* to be that way and all OTs aren't that way.  After I got burnt with one of ours, I had to get really honest about what kind of relationship I wanted with the OT.

[nature girl]

I think we are all going back and forth between the big picture and the details of how ADHD/SPD/OT works, how does Anna fit that overall view, why doesn't this piece of information fit. I think your questions are good, we all have those sorts of question. I encourage you to let the OT know that you are trying to figure this out, and you'd like to know why she's taking a particular approach. If you can ask it casually but seriously, then the OT won't feel put on the spot. You can ask why you're not allowed to observe (it could be that it's very distracting for Anna, and not because of anything you are doing). I think if you are neutral and just tell them that you are trying to put what seems like disparate pieces of information in their proper place, you might get some insightful answers. Each OT is going to present a different personality and a different way of working, and that is okay as long as they are doing a good job. 

 

 

Thank you, that's perfect, I may quote you exactly when I talk to the therapist at Anna's next appointment on Weds. I really wasn't comfortable not being in the room...And she didn't even explain what she'd done with Anna till I asked her about it once she was finished. I was there for Anna's first 2 appointments with a different therapist, and Anna didn't even acknowledge I was there, she was having so much fun. I just watched from a distance and didn't interact at all, so I don't understand why I've been kept outside. The first appointment with this therapist, she acted really abrupt when I started to follow them in, told me to wait outside and that she'd come and get me when they were done, and that really did turn me off. The whole "black box" nature of OT makes me uncomfortable in general, and this makes it even more black-boxy. 

[nature girl]

Wow, what is this place charging for an hour??  No wonder you're frustrated!!  Around here private OTs are $80-110 an hour and hospital-associated with be 2-3X that much.  So you're paying for a half hour *with insurance* the same amount I pay without.  

 

I'm not sure how much they'd charge without insurance, but our co-pay is always $50 for a specialist, so that's what we pay for OT. If I could pay an additional $30 and get another half hour, I'd definitely do that, maybe it's worth asking them how much they would charge.

 

I would not tolerate not being in there.  I know some OTs pull that stunt, but you have no way to learn and carry things over if you can't be there to observe.  You also have no quality control.  I'm also not a very nice person to work for.  That's definitely something to sort out, that you really want to be in there to observe, learn, etc.  But as far as them shifting you around, is it just temporary till one gets consistent openings?  What if you just pay for a 2 hour block and do a full eval and be done with it?  And are any of them SIPT certified?  Do any of them specialize in ASD/SPD?

 

I think the problem was finding a therapist with availability. It seems they only start work at 3:30, when kids get out of school, and driving around rush hour would make an already long drive much longer so I was trying to get an earlier appointment. They finally found someone to come in a half hour before her first appointment, and that's the therapist they're sticking us with long-term. She actually seems to be the only therapist there who isn't SiPT certified, but she does have 20 years or so of OT experience, so I'd assume she knows her stuff.

 

OT can be sort of a gestalt, voodoo-ish sort of field to those of us who are listmakers and precise.  My ds started OT this summer and had short sessions (free, during dd's neurofeedback) twice a week for a number of weeks.  Then we finally started his full, regular weekly, one hour (very generous, more like 1:15) sessions.  It's now almost October, and I only now feel like we're making some serious headway.  Before it was more like hmm, a little progress, couldn't put our fingers on it.  When you've got lots of issues (DCD, SPD, etc.), it's going to take some time to start unpacking that, problem solving, doing things, having those things kick in, etc.  This is not going to be fast.

 

If your label switched over to ASD, would your insurance kick in with better therapy funding? I don't think it would...There's always a $50 copay, and according to OT, for those with insurance, the insurance only agrees to fund a half hour. She said without insurance they typically give 45 minute appointments...Even though we're paying less, it does make me feel like Anna's being short-changed.

 

That OT *should* be helping you learn things to do at home, but really you need to be in the room to see stuff happening.  I'd be upset too if they were losing 7 minutes out of a 30 minute session to talking with parents, mercy.  That's just really short.  What would your local ps give you?  Some would be short (15 min) but some would be 30 min.  I don't know, just thinking.  At 30 minutes, there's hardly time for *you* to talk things through with the OT and problem solve.  I had two hours a week to sit and chat with the OT at the beginning.  It takes time to talk through things.  And some of the stuff she would just test, so do this, and send me home with things to do.  A lot of it you *can* do at home, but you need someone you feel like you have that kind of problem solving relationship with.  Maybe figure out which is the OT you can do that with at this practice and then say no, get me in with her consistently, kwim?  And maybe get this eval thing over with or pay to bump the sessions up to one hour for a while, kwim?  If the OT diagnoses DCD/SPD, does that change what your insurance will cover?

 

You really do have the Dom Perignon of OT groups, goodness! And I have the jug wine...I feel jealous every time you talk about it! I do wish she'd be willing to give me a call at some point after the appointment to discuss it all, especially because I really don't like talking about Anna's abilities and difficulties while Anna's in the room. Maybe I'll ask her that...I don't want to be annoying (and she seems like the type who really would get annoyed) but maybe I need to be.

 

[kbutton]

Your options in a rural area are going to be more limited. I am sorry about that. You might need to bite the bullet and come in later if you don't like the therapist who is coming in early. But you'll have to be delicate about changing if they've bent over backward to get someone there early for you.

 

It sounds like they are trying their best to help you though. It's a pretty big deal to have someone come in early.

[geodob]

Perhaps you could have try another exercise?

Which just involves rotating her index finger in a circle, from her knuckle?

Then doing the same, with both the index and next finger?

 

Where it would interesting to know if she can freely form circles?

This actually uses 4 muscles.

 

[kbutton]

Perhaps you could have try another exercise?

Which just involves rotating her index finger in a circle, from her knuckle?

Then doing the same, with both the index and next finger?

 

Where it would interesting to know if she can freely form circles?

This actually uses 4 muscles.

 

This sound similar to (but a bit different) from an exercise our kids have used. You hold a lid of some sort (like a jar lid, but something that's an easy size and thickness), and you have the child rotate it with fingertips (you hold it like you would hold a knob you want to turn, but you put all your fingers on it). The fingertips march along the lid one by one. When you get really good, you use smaller and thinner objects--like a quarter. It helps if you bend your fingers just a bit, like you would curve them to play the piano.

[nature girl]

Thank you for the ideas! Geode, we tried your exercise this afternoon, and honestly I don't know if I can do it myself, haha. Maybe I'm picturing the exercise wrong? But I can't get my fingers to circle from the knuckle without my whole finger moving in that same circle (and neither could Anna.) Am I misunderstanding?

 

We'll try your exercise tomorrow AM, kbutton! I have a vitamin bottle lid smaller than her palm that should work. This reminds me, it took her a long time to be able to unlock the bolt on our door, I don't know if it was a strength issue or a coordination issue but she was 4 before she could turn the latch (which is stiff but not THAT stiff.)

 

Today we were reading about hummingbirds, how they flap their wings 50 times a second, and we both tried to demonstrate fast flapping with our fingers. Her hands were very slow, I was surprised she wasn't able to move them faster. (I realize that's not a good test of finger coordination, but I wonder if it's a sign of something being off...) I'll have to ask her same-aged neighbor friend to see how fast she can flap, because I'm not sure what's developmentally appropriate.