Fine/gross motor skill delays and how they can impact learning

[Seeker]

Original Subject line: SD won't give difficult child an IEP - only offers 504

We had our team meeting on October 9th, and the public school said my 4 year 10 month old difficult child (who is in a Kindergarten that accepts 4 year 9 month olds) is ineligible for Special Education or for an IEP -- that they would only give her a 504 plan. This is because they said she has a disability, but that it is not interfering with her performance in school. I need advice on whether to accept what they are offering, or ask for more services or for an IEP, which I understand has teeth in it, unlike 504 plans. The 504 plan means that she would get one half-hour per week of Occupational Therapist (OT). My guess is that that would be a group session. This is because the Occupational Therapist (OT) said that she has a poor pencil grip (overhand, fisted, pronated), which barely makes a mark on the paper, and makes her handwriting poor for her age. The neuropsychologist who tested her privately had also stated that she had fine motor problems. The Handwriting Without Tears program is in use in the regular classrooms in this school. The Occupational Therapist (OT) also said that she has problems with visual tracking, and loses eye contact with obects when they cross the midline. The Occupational Therapist (OT) said she shows poor motor planning. The Occupational Therapist (OT) also said that she has low muscle tone, joint hypermobility, and low strength in her upper body. The neuropsychologist had identified problems with motor planning, visuo-motor tasks, and visual tasks (e.g. doing puzzles, putting blocks into designs to match her designs). All of this is supposed to be addressed by the 1/2 hour per week group session with the Occupational Therapist (OT). The speech therapist, school psychologist, Special Education teacher, and classroom teacher all said that she is doing well in the classroom (singing, smiling, playing with other kids, following the rules, participating, speaking when the teacher speaks to her) and less well but OK on the playground. The Special Education teacher and SLT did some minimal testing that showed my difficult child to be age-appropriate in her academic skills (e.g. recognizing letters, counting) and social-pragmatic language skills(even though the neuropsychologist, in much more extensive testing, found her to be below age level in a number ways). Since the SD found my difficult child to be age or grade appropriate and adjsting well to school, they do not feel any other services are required. They say that she has not seemed withdrawn or aggressive in the classroom (she was withdrawn but not aggressive at preschool, and stopped being aggressive or oppositional or defiant at home a month or so ago and never behaved that way at preschool). Therefore, they do not feel that she needs any social skills training, besides which a daily social skills lesson is incorporated into the classroom for several other kids who are in there (including one with Asperger's/possible Autism). The neuropsychologist added up the fine motor, motor planning, visual-motor and social skills problems into NonVerbal Learning Disorder (NVLD) and right hemisphere problems and wrote a very negative report on my difficult child -- made it seem like she was quite impaired. The SD was painting a much rosier picture. THe SD dismissed this discrepancy by saying my difficult child did not perform at her best for the neuropsychologist because she did not want to be there (true enough, and indicated in the report). This SD has a reputation for doing right by kids with Special Education needs, and I know my daughter is indeed doing OK in the classroom, but she can barely make a few wispy marks on paper, whereas some of the other kids are writing words effectively. Should I just let my little 4 year 10 month old have an enjoyable Kindergarten experience and a little Occupational Therapist (OT), and see how she is doing in six months (anticipating that she might spend another year in Kindergarten), or should I push for more from the SD? If I should push for more, what should I ask for? A part-time aide to work with my daughter in the classroom when they do writing tasks, since this is a class of 19 kids with one teacher, and a half-time aide, and some of the other kids have special needs, so it seems unlikely that she will have a huge amount of time to correct my difficult child's pencil grip? What else should I ask for? Or would it be best for my difficult child just to have a normal school year without an IEP, and some time for her immature brain to develop, since she is young to be in school, and younger than many of the kids in the class (the oldest who does not have substantial special needs is probably five years eight months old). Please give me some advice. Thanks in advance...

 

[Sheila]

At your daughter's age, her skill level should be viewed with-making sure she gets what she needs to work toward the goal of reaching a "ready for Kindergarten level" by the end of the school year in my opinion. If she's not, you're still in a good position in that she can repeat Kindergarten.

the neuropsychologist, in much more extensive testing, found her to be below age level in a number ways

This appears to be a direct is a conflict with-the sd's opinion. A child's cooperation can certainly impact the results of testing, however, this factor should have been taken into consideration when the neuropsychologist made his/her final determination and recommendations. Sd personnel should know that.

Based on what you've written the sd's testing was "minimal" and may equate to "informal means" or "observation." Review the sd report -- the school district's "Initial Evaluation" should be done primarily via normed testing. Find out the name of the test instruments if they are not included in the report (and also get sd subtest scores if there is a report).

The school district is probably taking the standard "we'll wait and see" position which isn't necessarily a bad thing considering this is a 4 yr old. However, in that early intervention is so critical, I'd recommend that you push to get her the services she needs. They should be spelled out in the neuropsychologist's report.

Regarding Occupational Therapist (OT). It's very important. I was shocked to learn how delays in these areas adversely impact the learning process -- now and in the future. I wasn't aware of how appropriate fine and gross motor skill development facilitates learning. It was not at the top of my worry list. At the least, it should have had equal status.

It's a plus that the sd is willing to address the Occupational Therapist (OT) issues. I'd want the expertise of a private pediatric Occupational Therapist (OT) however. 30 minutes per week in group therapy may be inadequate. The sd Occupational Therapist (OT)'s report should outline recommendations and specific goals.

The "perceptual skills" thread in this forum touches on the visual impact (which can be treated by an Occupational Therapist (OT)).

Keep in mind that if you don't agree with-the sd's evaluations, you can get an IEE at no cost to the parent.

Also, if there is a disagreement about whether your child is eligible for an IEP and it's your opinion she needs the services afforded by an IEP, you can file for mediation.

 

[Seeker]

Thank you for your excellent advice as always, Alisha Leigh :laugh: . I am planning to have an evaluation by a pediatric opthalmologist (because of all this visual stuff being mentioned, and because difficult child had occasional strabismus as a baby). I am planning an evaluation by an ENT, because the SLT said difficult child seemed to have a "raspy" voice and asked if she might have abused her vocal cords by screaming (ROTFLMAO!! . I guess you are right that I should also have an evaluation and probably therapy by a private pediatric Occupational Therapist (OT) through medical insurance (SIGH). Does this never end? Poor difficult child was quite uncooperative with the neuropsychologist, because she is sick of doctors, and she was cooperative with the school staff because she likes and is comfortable at school (Glad of that! /importthreads/images/graemlins/smile.gif ) But you are right, the neuropsychologist says in her report that she did take that into account, and adjust the testing accordingly and that what she says is a true picture of difficult children functioning at that time. on the other hand, that was two months ago, and difficult child's ODD has really gotten much, much less pronounced in that time in apparent response to the poker chip system. THe SLT and Special Education teacher and Occupational Therapist (OT) did a little age-normed standardized testing, and gave me reports with subtest scores. The rest of the info was from informal observation. The psychologist did no testing because so much testing had been done so recently (by the neuropsychologist, who I paid for myself, since our health insurance plan offered only folks our treating behavior therapist psychologist warned me not to use -- he said insist on someone with real training in pediatric neuropsychology). One thing I could do (if I think it would be of value) would be to ask for the school psychologist to do testing now, or in a few months. I don't feel like I know whether I should try to get an IEP or just go with her having only a 504 plan - I'm looking for advice on that question. Suggestions anyone?

 

[Sheila]

Typically, a 504 contains "accommodations." If the sd won't provide the recommended remediation in the neuro's report, push for the IEP.

Keep in mind also that parents are not mandated by law to be part of the 504 team as with an IEP.

 

[Seeker]

Do you folks think that difficult child's Developmental Coordination Disorder (which I think is the DSM-IV-TR diagnosis that applies to someone with problems with handwriting, fine motor skills, gross motor strength and skills, crossing the midline, catching balls, motor planning and visual tracking, etc.) could be considered to cause impairment of her ability to do schoolwork if she CAN'T EVEN MAKE A LEGIBLE MARK ON PAPER WITH A PENCIL? She has such a poor pencil grip (fisted and pronated, the Occupational Therapist (OT) called it) that she makes a really light, barely visible mark on the paper when she tries to write. How can that be considered not to impact her ability to do schoolwork? And isn't that what determines whether a kid with a disability gets a 504 plan or an IEP? So aren't I within her rights if I press for an IEP? Or should I figure that it is within the normal range of typical development for a child aged 4 years almost 11 months now to be unable to use a pencil to write on paper? I don't think that is typical -- from what I've seen I bet fewer that 5% of kids her age are unable to just make a legible X on paper with a pencil. Given that she has that problem plus problems with visual tracking, any task that requires crossing the midline, catching a ball, motor planning, fine motor and gross motor problems, poor upper body strength, excessive joint mobility in her upper body, low muscle tone, etc. -- what accomodations or supports or remediation or goals should the IEP contain? Individual Occupational Therapist (OT) provided outside of school hours? Specialized Gym classes paid for by the school? Not being required to copy from the board? Scribing for all tasks? I am not thinking about scribing and copying from the board in Kindergarten but in 1sr grade. Should I not get an IEP but just plan on retaining her in Kindergarten so she can catch up? DO kids with these kinds of problems catch up, or will she still be behind her peers in her fine motor skills when she hits first grade, even if she does have two years of Kindergarten? Please help me figure it all out -- I'm confused. Should I get help from an advocate (I do have one lined up if needed, but she costs beaucoups bucks!).

 

[transformtriumph]

I had a comprehensive evaluation done by an outside occupational therapist and another by a physical therapist. The SD had to pay for both reports because they showed the deficits that my son had, and outlined the needed course of action. The SD had "conveniently" only given my son the tests in the areas that he was strongest.

 

[Seeker]

Thank you very much for that idea, Transform Triumph. Would I need to go through some sort of slow process of getting prior approval from the SD for the evaluations, or can I just quickly get them done and then get the SD to pay ex post facto? Can I get the SD to pay for the private neuropsychologist evaluation that I had done before the school did any testing? Also, why would I need to get SD funding? Can't one get Occupational Therapist (OT) and PT evaluations done through one's pediatrician, paid for by medical insurance? Also, what about having difficult child seen (again) by a neurologist if her upper body is said to be weak and her muscle tone is said to be low throughout her body? Or by some sort of opthalmologist if she supposedly can't follow a ball that is thrown to her with her eyes? The neurologist didn't find anything abnormal when he examined her and did an EEG, but doesn't our nervous system control our muscles, and our eye movements?

 

[SassyGirl]

Seeker, I am not an expert. However, I have gotten an IEP for my son based on behavioral issues and some learning issues.

If you can get your own professionals to evaluate your child via insurance, I would do that. If you are asking for an IEP, parents' input has to be considered. I think I would want these professional tests as a baseline for my child.

I would keep a complete journal of all the tests given to your daughter, her abilities now, how she is doing in school (daily/weekly), her attitude, etc. You will want to be able to show progress or lack thereof throughout the year.

If I were you, I would go with the 504 now and if you can arrange for additional services, do so. I have not dealt with physical issues, but it seems she may need more than 1/2 hour a week of Occupational Therapist (OT). She may have to repeat kindergarten if she does not progress, but that wouldn't be the worst thing in the world due to her age.

Here's where I am coming from. Others may not agree with me. You will be having a long-term relationship with this school and school district. Try not to get into full-blown warrior mode in kindergarten, especially if you can arrange outside services yourself in preparation for asking for them from the school. I have found that school personnel can hold grudges and judge early. You will want to appear as cooperative as you can while building your case and seeing how far your daughter progresses with the supports you and the school put in place. Now is not the time to panic.

If you want, I'd check with the advocate if you want to know your rights and just to get ammunition for the future. But don't bring an advocate in YET. You are just starting this process. You will want to build relationships with these people, not start on an offensive foot (versus defensive!).

I hope I made sense. I have been working with my son's school for the last 3 years and the school district, and we are headed for due process in December. I'm pretty sure the district thinks I"m their number one enemy now, and they have tried to settle twice. We have a good case.

Hope you can get what you want.
Many hugs,
SassyGirl

 

[TYLERFAN]

I didn't even get done reading your post and found myself thinkin'...THIS STUFF SURE DOES AFFECT difficult child'S LEARNING ABILITY. I don't know who or why they are telling you that it doesn't....(well, I think I know why). Throughout my search for "services" and help for my difficult child, during her school years I always insisted on the 504 Plan over and above the Special Education plan. This is a long story...and may cause more than some controversy...however, once my difficult child was diagnosed with a learning disability (Dyslexia) by a very competant and recognized pediatrician neurologist specialist etc...(I was lucky, he lived near my house) anyway, I digress.....This psychiatrist advised me to never put her in Special Education or in the hands of the SD. I didn't really question it at the time and it seemed that the only help I could receive was to have her labeled and classified. This was something I felt very strongly against. I fought an fought with the school, but all I kept hearing was there WAS nothing else. One of my mom's friends has a son who is sort of a rebel(willing to give more info than most in SD) psychiatric....he specializes in difficult child's. He was the one who told me about 504 and that the school must give it to me...as long as I could prove difficult child had a disability that interferred with her learning....She did, does and boy, they (SD) never mentioned 504 once!!!!! :mad: Yours as I stated, seems also to have a clear disability that IS interfering with ability to learn. Get a private psychiatrist to make this statement to the school. 504 (and I am not an expert) is supposed to be (by federal law, I think) just as flexible and even more beneficial than some Special Education programs(not meaning to offend anyone, just my experience). Why then was no one telling me about it and I had to research for a year to figure this thing out?? For one thing (and this is the biggest thing, I believe) the SD doesn't get financial aid from the state or federal government for a person with a 504 plan. This is because this person is 1) not classified as being under the Special Education umbrella, 2) will now be getting services that are offered in Special Education without a classification...read: they will have to spend money on your difficult child without any incentive financially (I can't believe I just wrote that), this still gets me so angry!! The 504 can and should exceed services offered in Special Education...we had extra time for tests, resource room, auditory learning,teachers who had to follow up daily with homework (did it get there, etc.). There were constant communications, alot of adjustments to her schedule, shortened school day, the list goes on. Once they knew that I knew I was legally entitled to these services for my difficult child, they had no leg to stand on. This was MY experience, I do not say this with intent to judge, harm or say Special Education is a bad thing.....That is NOT my purpose...Special Education has been great for some kids and is very progressive these days....It wasn't the right thing for MY child. I got myself educated about the system in my state...NY. I don't know if it is the same in yours, but I do believe this falls under the "Persons with Disabilities Act" (federal)...look it up on the web. I really wondered whether to post this because I do have issues with how our SD tried to decieve me (My Opinion). I don't want anyone getting angry or a fight to start because I said something about the Special Education process as I have found it here. I only posted because I know what a great opportunity 504 is for a difficult child and that the truth is, SD's nationwide fail to tell parents about how it is really supposed to work. Enough said...You can e-mail me if you like or want to discuss further, I would be happy to. I just don't feel comfortable doing this here as I know many work in Special Education professions and are highly gifted and dedicated to our kids....Please get yourself familiar with 504 fully, then make your decision. If I had to go back, I would have only wished I had learned of it sooner.
God Bless and I hope I didn't cause a war here...
Melissa

 

[Sheila]

Do you folks think that difficult child's Developmental Coordination Disorder (which I think is the DSM-IV-TR diagnosis that applies to someone with problems with handwriting, fine motor skills, gross motor strength and skills, crossing the midline, catching balls, motor planning and visual tracking, etc.) could be considered to cause impairment of her ability to do schoolwork if she CAN'T EVEN MAKE A LEGIBLE MARK ON PAPER WITH A PENCIL?

Absolutely.

She has such a poor pencil grip (fisted and pronated, the Occupational Therapist (OT) called it) that she makes a really light, barely visible mark on the paper when she tries to write. How can that be considered not to impact her ability to do schoolwork? And isn't that what determines whether a kid with a disability gets a 504 plan or an IEP?

Yes. To be eligible for an IEP, there has to be a "severe discrepancy." with-a 504 the disability has to meet ONE of the three requirements.

So aren't I within her rights if I press for an IEP? Or should I figure that it is within the normal range of typical development for a child aged 4 years almost 11 months now to be unable to use a pencil to write on paper?

Yes, you are within her rights and yours as the parent. Occupational therapy is a related service which should be provided with either an IEP or a 504. You need to factor in the neuropsychologist's recommendations however. Depending on what they are, she may need an IEP to receive those services.

I don't think that is typical -- from what I've seen I bet fewer that 5% of kids her age are unable to just make a legible X on paper with a pencil. Given that she has that problem plus problems with visual tracking, any task that requires crossing the midline, catching a ball, motor planning, fine motor and gross motor problems, poor upper body strength, excessive joint mobility in her upper body, low muscle tone, etc. -- what accomodations or supports or remediation or goals should the IEP contain? Individual Occupational Therapist (OT) provided outside of school hours? Specialized Gym classes paid for by the school? Not being required to copy from the board? Scribing for all tasks? I am not thinking about scribing and copying from the board in Kindergarten but in 1sr grade.

Typically, a school district provides Occupational Therapist (OT) that they feel impacts learning -- like developing fine motor skills because there is no question that this impacts learning. And remediating visual motor skill problems. It's usually done during school hours. However, there are cases where a sd would have to contract with an outside Occupational Therapist (OT).

Caution #1: Requiring your daughter not to copy from the board might be an accommodation you want to consider, but the goal you want to work toward in Occupational Therapist (OT) is for her to be able to copy from the board. Likewise with scribing -- you don't want this to be permanent. She needs the practice -- it helps develop her fine skills. Via Occupational Therapist (OT), the goal would be for her to be able to write on her own. She needs the "practice" that will come from participating in class also. These type issues can often be remediated or corrected with Occupational Therapist (OT).

DO kids with these kinds of problems catch up, or will she still be behind her peers in her fine motor skills when she hits first grade, even if she does have two years of Kindergarten?

Your daughter has developmental delays. She may catch up in some areas on her own over time, but still be "behind." You'd be wise to work on the premise of no intervention will likely equal no growth.

Should I get help from an advocate (I do have one lined up if needed, but she costs beaucoups bucks!).

I'd at least go for a consult. Also, if you continue your search, you may be able to find someone that is less expensive or free. You need to be aware that there are timelines on parents filing for the next step when there is a disagreement between parents and school on things like eligibility, placements, etc. Check your state regs for this information.

Caution #2: I would doubt that the school district would provide an overall Occupational Therapist (OT) treatment plan. They typically concern themselves only with things such as getting children to a level where they can write. I strongly recommend you go the private Pediatric Occupational Therapist (OT) route. The type delays that your daughter has impacts her ability to learn in a variety of ways. Fine and gross motor skill delays are much more serious than many people think, and it's one area that has treatment that can provide permanent improvements in all environments. Depending on the child and the expertise of the Occupational Therapist (OT), great gains can be made in a relatively short period of time. But again, early intervention is the key.

Bottom line is that your daughter will likely need private Occupational Therapist (OT) also, even if the sd provides some of it.

 

[Sheila]

Possible other advocate resource for you.

www.fetaweb.com

Also, you can do additional research on the Development Coordination Disorder by using keywords such as Coordination Disorder, Coordination Developmental Disorder, and Apraxia (motor).

 

[Sheila]

Links that help explain how fine/gross motor skill delays impact learning.

http://www.apraxia-kids.org/

http://www.conductdisorders.com/com...tual-skills-and-how-they-affect-learning.412/

 

[Seeker]

Alisha Leigh, you are a gift, a real gift . Thank you so much for your wise comments, your advice, for all of these resources (it will take me a week or so to look at all those web pages! ) and for the time you so kindly spent responding. I had not remembered that your son has some similar diagnoses. I had been wondering if "developmental coordination disorder" or fine motor delays were essentially equivalent to apraxia. I've also been noticing some things that make me think I should read the Out of Synch Child and perhaps take my daughter (oh, groan, not another evaluation!!! ) to a Sensory Integration Disorder clinic that I've heard about near here. I have to tell you, reading your statement, "Your daughter has developmental delays" nearly brought me to tears . I've been dealing with the fact that she has some significant difficulties for at least a year now, but denial dies hard. And let me say that the school nurse (who gives difficult child her noon-time Tenex) took me aside today to tell me at length how absolutely adorable she thinks difficult child is. And since her ODD is essentially almost gone, our relationship is tremendously improved, and I feel like she is absolutely adorable too . Anyway, thank you very much for your help.

 

[Christine]

This is my son! It took me a little while to get him an IEP. He has poor fine motor skills, he is 8 years old, almost 9 and can barely hold a pencil. Occupational Therapist (OT) gave him special grips that help. He also can not cut a cirlce or anything. The problem is Occupational Therapist (OT) can not stand alone. So we got his ODD diagnosis'd and they had to give us an IEP. Now he has writing recovery and Occupational Therapist (OT) and counceling/behavior services as needed. What is your difficult child's diagnosis? Use it, and if she does not have one, get one! Then the services will hopefully come pouring in. On the up side, Chris started Cursive this year and it is so much easier for him! THe teacher said it would be, the flow is different, and he can lean on the paper constantly with the pencil! E-mail if you have other questions!

 

[Sheila]

Sensory Integration Disorder (SID) falls under Occupational Therapist (OT). A Pediatric Occupational Therapist (OT) certified for SIPT could do the evaluations.

Great to hear difficult child has improved so much. As appropriate interventions come on-line, it's not unusual for "ODD" to dissapate or disappear. Good work, mom!

I understand about the denial phase. It usually takes me a day or two to come to grips with-a new "identified" problem, even when I have strong suspicions before a formal diagnosis comes into the picture.

Glad the info above was helpful.

 

[OpenWindow]

My difficult child had an IEP in kindergarten and it was taken away. We accepted a 504 and it has worked out great - because the teacher was willing to make the accommodations and really wanted to help. This year it's the same situation, the teacher is going out of her way to make accommodations.

The school counselor told me in our last meeting that a 504 is just as binding as an IEP - something I already knew but was very glad to hear her say it.

I think as long as your school is willing to try everything and work with you, I'd recommend accepting the 504 now, line up your private evaluations and push for a re-evaluation by the school if you think there are issues they can't address with the 504.

We're in that process right now.... trying to decide if he needs the intervention of special school district, which would mean a re-evaluation by them and a possible IEP.

My difficult child did make progress with fine motor skills from kindergarten to 2nd grade without the IEP or Occupational Therapist (OT)... but he had a great teacher who gave him lots of attention and helped him with his handwriting issues.

So your original question - accept the 504 now, then push for the IEP evaluation. Once you have the 504 they can't take it away simply because you are asking for an IEP evaluation. I know some kids have both a 504 plan and an IEP.

Linda

 

[Seeker]

Thanks, all, for your helpful comments. Alisha Leigh, some of those web sites were priceless :laugh: -- I feel much more educated now about what dyspraxia, motor planning problems, fine motor delays and hypotonia all are, and what needs to be done about them. Plus some understanding that difficult children problems with vocal quality (she sounds "raspy" or hoarse) and pitch/prosody may be a form of apraxia/dyspraxia. For one thing, I think I will ask our pediatrician for a test of whether difficult child has Fragile X syndrome, as well as asking her whether any evaluation needs to be done to detect any possible medical causes of the hypotonia. And I got some excellent ideas about fun stuff we can do at home to improve difficult children fine motor skills (squeeze foam balls, work with playdough, use different kinds of fun writing implements), and put two and two together about why she has had trouble stringing beads and performing other such tasks ( duuuh.....how dumb am I?). This fine and gross and oro-motor motor dyspraxia and hypotonia stuff is a whole other issue, quite distinct from (or possibly related to???) difficult children old problems of expressive language delay (resolved) and ODD (almost completely resolved) and separation anxiety disorder (reduced). It is non-psychiatric, and clearly important. I will have to learn, and act. /importthreads/images/graemlins/smile.gif

 

[Seeker]

Well, I've got evaluations (paid for by medical insurance) scheduled -- Occupational Therapist (OT), ENT, and opthalmology -- to follow up on the issues raised by the school evaluation. And I have involved an educational consultant who has an excellent reputation, though unfortunately it sounds like she won't be doing much for us till December. And difficult child does seem to be enjoying Kindergarten, learning things just fine, and even improving her pencil grip. Also, she has not resumed having multiple whopping tantrums every day, injuring family members, destroying property, even though her dose of Tenex is now only 0.5 mg per day. Her problems are certainly not all solved, but the progress she has made in the past year is amazing. Jumping for joy!

 

[Sheila]

It takes time to pull it all together. You're doing great.

Sounds like difficult child is coming right along.

 

[Calista]

Alisha Leigh, can you tell us or give us a link to a site that explains the diferences between a 504 and an IEP and any other thing that may apply to difficult children with needs based on behavioral and emotional issues? Thanks!