Anonymous wrote:Kennedy Krieger explained to us that research shows that the frontal lobe is the area of the brain that controls executive functioning. Researchers suspect an ADHD brain has problems in this frontal lobe area. Likewise, motor skills such as writing are also controlled in a location of the brain close to the frontal lobe. Not every ADHD child has writing difficulties, however an ADHD child is more likely to have writing difficulties as compared to the general population. That is why the Beery-Butanka VMI test is a good test to perform if a child demonstrates executive functioning difficulties.

My two children with ADHD both tested low on the Beery-Butanka VMI test. KKI calls the issue a graphomotor disorder but the school team calls it dysgraphia. Whatever the label, accommodations such as class notes and extended time have greatly helped our children's performance.

Really interesting. My ADHD child had a brain MRI (for reasons other than ADHD) and it showed some cortical displasia in the frontal lobe. The neurologist said it was hard to say what impact that had, if any, since so few people get brain MRIs.

Kennedy Krieger explained to us that research shows that the frontal lobe is the area of the brain that controls executive functioning. Researchers suspect an ADHD brain has problems in this frontal lobe area. Likewise, motor skills such as writing are also controlled in a location of the brain close to the frontal lobe. Not every ADHD child has writing difficulties, however an ADHD child is more likely to have writing difficulties as compared to the general population. That is why the Beery-Butanka VMI test is a good test to perform if a child demonstrates executive functioning difficulties.

My two children with ADHD both tested low on the Beery-Butanka VMI test. KKI calls the issue a graphomotor disorder but the school team calls it dysgraphia. Whatever the label, accommodations such as class notes and extended time have greatly helped our children's performance.

Thanks 13:31 - I really appreciate all the thought, detail, and information in your response. Our son definitely had ADHD. Really really really significant ADHD. On meds we can get him to a place where he's able to control that, but we're barely there, and people do tend to focus on the ADHD. He's able to write decently, and spell decently, for his grade, but he's also old for his grade (his birthday is a week before the cut off, and we held him back) so it's hard to say if he's writing as well as he's supposed to be. He draws decently, at least similarly in terms of not great not horrid, compared to what my older child was doing at the same age. It's just the unwillingness to actually begin writing. He fights the process so much, and hates just getting started, and hates adding any more information or detail than he has to. Once he does it, he's able to produce something in-line with his grade-level peers, so we've always looked at it as him just being really defiant about wanting to write, and being forced to write, but maybe there's something other than his natural defiant tendencies going on here. Who konws. He also suffers from being a second child to a first child with a really significant language based disorder. As parents we try not to compare our kids, but sometimes you just do, and what he's doing is so much better than what his big brother was doing at the same age, that it's hard to see it as a "problem", but maybe we just haven't been paying enough attention...

Anonymous wrote:I'm OP - didn't mean to start a thing re: ODD - when we last had DS evaluated, and got the "one criteria short of ODD" reference, it was stil DSM-IV.

11:03 - I'll come back with a breakdown when I have our exact scores with me.

11:03 here. I really wanted to echo what you and another PP said about the torture of writing. Our DS really hated to write from the very earliest age. He never was into "coloring" or "painting" in pre-school, to a degree which was really different than others. When he did engage in these activities, his "product" was really just immature scribbling compared to peers. But, of course, that isn't really considered a "problem" in pre-school. Fast forward to preK and K, and DS was very resistant to writing activities. Of course, that was dismissed as his being an active boy, and "boys don't like to do those things". By first grade and second grade, DS began to act out in order to avoid writing. The final straw was when he actually broke down crying in class when his second grade teacher asked him to share what he wrote. He could see by then that he could not write like other kids, and the idea of being forced to reveal that in front of the whole class was just too much.

Fortunately, he had one teacher in 2nd grade who didn't think he was dumb or a behavioral problem. She took my concerns seriously and advocated and adjusted for him at school. We have a family history of language-based learning disability, so after the school refused to give him an IEP, I took him to a private neurospsych and had him evaluated. Here are the tests that, altogether, resulted in the diagnosis of specific learning disability/dysgraphia --

low average and significantly discrepant WISC Processing Speed Index -- (approx. 3.5 standard deviations which is huge)

diagnosed Mixed Expressive Language Disorder

low average and significantly discrepant TOLC-1 Oral Expression score

low and/or significantly discrepant scores in the following:

WIAT--III Alphabet Writing score in 8 %ile (compared to GAI in 99.8 %ile)
WJ-III Writing Fluency Score in the 24 %ile
WIAT-- III Spelling and Sentence Comp in the 70 %ile
WIAT --III Math Fluency and (61 %ile) and Numerical Operations (77 %ile)

Poor VMI score -- already mentioned above
Tower of London -- 17 %ile (testing executive function)

IVA -- Attention Quotient -- 4 %ile

TEACH Score Subtest -- 2 %ile (auditory attention)

All of this added up to a diagnosis of ADD/Inattentive w/ executive dysfunction, developmental coordination disorder and dysgraphia. DS' separate complete language assessment also showed difficulty with word finding, syllable segmentation and sound/symbol correspondence which made spelling and reading more difficult. Although he was significantly discrepant, he did not fall below average at that age. Language assessment also showed age discrepant problems with mastery of grammar, syntax, semantics and pragmatic language, all of which can impact writing (and reading).

Writing is a very complex process. It takes coordination and practice to write by hand quickly and neatly enough o be functional at school. It takes a certain amount of mastery of the sound/symbol correspondence to learn to spell quickly, and a certain amount of memory. Then there is mastery of grammar, syntax and semantics, which are necessary to write fluidly and to generate ideas based on the writing prompt and think in terms of categories and organization, as well as for editing. All of these different tests explained, together, how my child's "dysgraphia" was more than a simple problem of that could be cured by using the "Handwriting without Tears" program.

Here are the types of remediation that have been helpful to DS, most of it outside the public school system:

-explicit instruction in handwriting, with extensive practice and support, include gross motor activities
-Brain Gym activities to reinforce left/right
-explicit instruction in spelling patterns
-explicit instruction in sound/symbol correspondence
-explicit instruction in the organization of writing
-explicit instruction in editing -- including grammar, punctuation, and capitalization
-speech/language therapy, particularly in semantics and word-finding strategies
-accommodations including -- extra time, use of computer, use of spell check, use of graphic organizers (paper or on computer), use of text to speech programs for editing, Franklin Speller (not very useful) and AlphaSmart (also not very useful).
-a lot of "talk therapy" from us as parents about his LD and his high ability and reinforcement of success and effort. This has really helped mitigate low self-esteem and real anxiety about writing at school.

Not all kids with dysgraphia have ADD or executive dysfunction. Some kids with dysgraphia have coordination issues, some don't. Some have language disorders, some don't. Every student's individual testing profile will be quite different than our DS' even though the overall diagnosis of dysgraphia might be the same.

Watch your child carefully, both at home and at school when it comes to writing and drawing. Also look at math work (because writing affects the ability to write calculations, draw representative math pictures, and write math explanations). Observe in school if possible (our parental observation and that of our advocate and a central county staff person revealed quite obviously the ADD/Inattentive and the social masking of the writing problem).

Compare neuropsych testing results with observation and you will have a pretty good guide to your child's unique dysgraphia profile.

I'm OP - didn't mean to start a thing re: ODD - when we last had DS evaluated, and got the "one criteria short of ODD" reference, it was stil DSM-IV.

11:03 - I'll come back with a breakdown when I have our exact scores with me.

ODD is an impulse control disorder along with conduct disorder and intermittent explosive disorder. http://www.brainphysics.com/lifestyle/diagnosis/new-in-dsm-5-a-chapter-on-disorders-of-self-control

I believe ODD is still in DSM 5. However, I believe it rarely stands alone. There is a reason is acting ODD.

Can PPs with kids who took the VMI test share score breakdowns -- for example, my DS got a 97th percentile on visual perception and a 12th percentile on motor coordination, thus giving him an overall VMI score in the 39th percentile.

The school system said that he "didn't have a problem" since, at the 39th percentile, the overall "integrated" score was in the "average" range. The school refused to provide any assistance in handwriting on this basis. But, obviously, a kid has a very difficult time functioning, particularly in writing tasks, with a motor coordination score at the 12th percentile.

The ultimate diagnosis from a private neuropsychologist based on the VMI and a full battery of other tests was language disorder, dysgraphia, developmental coordination disorder, and ADD/Inattentive (the latter of which wasn't based on the VMI score but other testing).

"one diagnostic criteria short of an ODD diagnosis"

Is this still an actually diagnosis in the DSM-5? I know some providers are adamantly opposed to giving it ever.

A low visual-motor integration score suggests dysgraphia to me, not resistance to testing. Anxiety is often associated with dysgraphia, IME, and dysgraphia is often associated with ADHD.

OP here - thanks PPs for your insights, I really appreciate it. Our mornings at home are so hectic I keep forgetting to bring the report to work so I can scan it and, therefore, I haven't been able to send it on to his team at school. I really wonder if there's anything to this particular instance of this test, or if he was just being a turd during the testing.

Our fifth grade DD also has a high IQ, high scoring on Woodcock Johnson, and very high auditory processing, but below the first percentile on the Beery. This translates to very poor memory for spelling any word that does not have a purely phonetic spelling. She also will spell the same word multiple ways when writing, drop and juxtapose letters and forget punctuation. She sometimes even spells her own name incorrectly. She also makes many basic computation errors and errors organizing math calculations, even though she understands (and is in) advanced math. DD is willing to write, but resists any form of tutoring, suggestions for editing her work, etc. She does reasonably well in school, but these small errors impact her grades and detract from the quality of her work.

PP again. I'll note that DS, while not ODD (yet anyway) also has exhibited resistance to formal testing and, yes, it can really skew results and make it hard to figure out how to proceed.

DS has had it and also scored low on it. He also hates writing and has a DX of Disorder of Written Expression, as well as ADHD and some other specific LDs. OT can help improve certain visual perception issues and can help with handwriting. In DS's case, he actually is very talented in art so his writing issues are not physical ones. The other option is to get assistive technology to help him with writing -- which we have done.

Good luck.

Background first - my 7yo first grader son had ADHD and is one diagnostic criteria short of an ODD diagnosis. He's had an IEP since kindergarten, predicated on the ADHD, but giving services mostly related to his absolute unwillingness to write, and the panic attacks that come when he's made to write.

His ADHD was diagnosed as part of the NIH young-child ADHD study, and he had the full round of testing at school when he had the IEP first done about 18 months ago. He refused to participate in most of the testing done by the school and NIH the first time, (that ODD behavior coming through) and both the school psychologist and the NIH person told us that the IQ tests and basically every test other than things that diagnose ADHD were suspect, because of his refusal to really participate.

Fast forward to last month, we were at NIH for our annual visit, and mentioned how much better he's doing now that he's on meds, and wasn't it funny how he refused to participate in all the tests the first time? And they offered to do the tests again - caveated that they are given by grad students trained in administering these, but not psychologists, and that these are shortened forms of the tests.

We got the results on Saturday. His IQ scores came back very high - 99.9th percentile; his scores on Woodcock-Johnson stuff were all 98-99th percentile except for spelling, which was 64th; but on the Beery Visual Motor Integration test he came back with a 10th percentile.

What does that mean? A few things I saw suggested low muscle tone in his hands, I dn't think that's it. Last year a classroom parent who happened to be an OT evaluated all the kids whose parents gave permission for things like pencil grip etc and he showed no issues.

One thing I saw mentioned dysgraphia. Which, maybe? My other child has pretty severe dyslexia, so if they are related and travel in families, maybe? And maybe that also would explain the spelling, which is average, but theoretically should be better than average given his other test scores. More than anything, I'm wondering if somehow there's something here that explains why he hates to write so much. It's sheer torture to get him to write even the smallest thing. We attributed it to his perfectionism, but maybe there's something more here?

And maybe he just didn't feel like doing the test at NIH, or an inexperienced tester didn't know what they were seeing. I don't know, and we're going to send the report to school and see if they have any thoughts. But has anyone BTDT or have any suggestions or ideas for us?