Help me parse learning disorder....stuff?
March 1, 2019 9:28 AM   Subscribe

I am confused, looking at the results of my daughter's pycho-educational assessment. I am particularly confused about the results of what the tester has called "The Developmental Test of Visual Motor Integration." She scored very low. 8th percentile. This led to the tester diagnosing her with Severe Developmental Coordination Disorder. What do these things mean, and a few other questions inside.

I am going to number my questions because I'm very stressed and exhausted from failed googling. And I have a 10 month old and my husband is less than helpful. And I am neglecting both children as I spends hours trying to research this...

But, so you will not say I buried the lede - she was diagnosed by this psychologist as gifted (very high IQ), ADHD (I will confirm with an MD) and with dysgraphia (now called Specific Learning Disorder in Written Expression). Also, we are in Canada and our school system is different, however she will get an IPP presumably. This testing was done not via the school, but rather, privately. The school thinks there is nothing wrong here. She behaves well at school and gets Bs. Behavior at home - not so great to say the least. I am reading what I can, listening to the podcasts, doing my best.

Here goes:

1. What test did she perform (is it the Beery one)? Where can I see a copy of the questions?

2. Is Developmental Coordination Disorder the correct diagnosis to make from those test results? Another highly qualified professional with many years experience says - no. An OT whom I spoke with over the phone says she does not have the correct symptoms for that - my daughter never had issues with clumsiness, doing up buttons, riding a bike - plus she's taking competitive dance classes and does extremely well. She can draw reasonable-for-her-age pictures - although not from imagination. The kids show each other how to draw specific things in a specific style and she does that well. I think if I asked her to draw, say, a horse, she would get frustrated, refuse and then have a tantrum if I insisted. Anyhow, it seems that where she actually struggles is with reading speed, missing words or ends of words, missing lines. So - is there a dyslexia diagnosis here, possibly, that has been missed? I am confused about the fact that there is no specific test for dyslexia. ** And now I literally just spoke with another professional who says DCD is very complex and does not just mean 'clumsiness'. Now I am even more confused.

3. She is being tested again by this same tester, today, for Erlin's - which if you don't know is a controversial thing some people don't think exists - sensitivity to certain colours in the light spectrum - necessitating coloured paper, overlays, and if you go hardcore - tinted glasses. I *think* she said it's basically dyslexia - if you know about this stuff, do you think that's reasonable? To say Erlin's is basically dylsexia?

4. Yes I will pose some of these questions today, but I am asking around frantically because I no longer trust this lady - I trust her abilities, but not her conclusions. Based on several direct opinions of her from other professionals. Thank you for helping a worried parent who wants desperately to help get the best resources to help her child.

5. One more - if you can offer better search terms than what I am aware of (based on what I've written) that would be so great. I have people who can grab me articles from PubMed, etc,
posted by kitcat to Education (9 answers total) 1 user marked this as a favorite
Can you let us know how old your daughter who was evaluated is? You mention your 10 month old, but not your other daughter's age.

I am a speech therapist, but some of my students have had occupational therapist evaluations to look at visual coordination. From my understanding, it's a way to measure how a child is coordinating their vision with other motor aspects, or how they use their eyes to help guide motions of their body. For young kids (like preschool age), it may be seeing how/if they look at their jacket sleeve to put it on their arm (using both vision and the motor movements of moving their jacket/arms together). From my (very basic) understanding, it's how a child uses their vision to help complete other motor movements (like walking, turning a paper or object to make it match another object).

Was the evaluator an occupational therapist? I'm in the US, so things might be different where you are up north. I hope an OT can fill in with more info.

If the school doesn't see concerns that you and the private evaluator sees, you can still ask to have a meeting at her school to go over the private report and your concerns. In the USA, the specialists have to meet in what is called a "child study" meeting when a parent requests it, and it would help you share your concerns/her results with school staff who understand the testing. If your child is not currently receiving gifted services in the school, but she had a private gifted diagnosis, this could also be something to share to support that she has needs that are not being met.
posted by shortyJBot at 10:03 AM on March 1, 2019

Response by poster: Oh dear I'm sorry, she's 8 and in grade 3. The evaluator is a registered psychologist. I would like to see an OT and I've spoken on the phone with two so far, but it is not covered either by gov't or my insurance. Yes, I have a long report to give the school, but I know I will be met with opposition and so I am trying really, really hard to validate the report and have a strong idea of what's going on before I give them the report and meet with them. That's why I am asking here.

*Also she has a slight, occasional strabismus which was checked years back, before she could read I think, and deemed unproblematic, but now I've just made an appt with a pediatric optometrist who can do proper testing and a referral if needed. I never thought about it until today, when an OT mentioned ruling out eye problems.
posted by kitcat at 10:14 AM on March 1, 2019

Because the evaluation does not seem to match up entirely with your own observations, it seems worthwhile to get a second evaluation done by a second examiner. See what the school's position is on providing that evaluation or acknowledging the results of an external evaluation.
posted by trig at 10:44 AM on March 1, 2019 [1 favorite]

Based on our history of assessments, the visual motor integration test is not used to diagnose developmental coordination disorder. We were given rating scales for DCD that asked about various gross motor skills (running, kicking, throwing, etc). We were also asked about the speed of new motor skill acquisition.

The visual motor integration test involves copying various shapes on paper - starting with basic square/circle/etc, and then moving on to diagonal lines, 3D objects, etc. From the report: "The Beery VMI is designed to assess the extent to which individuals can integrate their visual
and motor abilities" When my son took it, he was given a visual motor integration test, a visual only test, and a motor only test. He scored quite high on the integration and the visual tests, and quite low on the motor test. Other tests showed significant gross motor delays at that time. So the answers you are getting now seem off to me.

I do recommend an exam by a pediatric optometrist, by the way, if something seems 'off' to you. My son ended up having vision problems that affected his depth perception, and that definitely was part of a complex interplay with the motor skills.
posted by telepanda at 12:05 PM on March 1, 2019

Best answer: The 57th page of this document shows examples of the three subtests (visual motor integration, visual, and motor). It's someone's thesis about the validity of the VMI test, so you might find some helpful information in the background sections about what the test is supposed to measure.
posted by telepanda at 12:08 PM on March 1, 2019 [1 favorite]

Best answer: It me. That is, I was diagnosed, at various times, with ADHD and dysgraphia, and my IQ is high but not stratospheric. For me, the dysgraphia manifests as clinically bad handwriting. And it's really quite frustrating -- I go to write 'd' and 'g' comes out. My parents got me a computer to do schoolwork on (in the 80s, this was unusual). I did do some schoolwork, but mostly I taught myself to program and now have a successful career as a software engineer.

I still can't draw even a little bit, but it turns out that I am OK at sculpting.

First line treatment for ADHD is often Ritalin (methylphenidate). But many ADHD people do better on other drugs, so don't rule out meds (or the diagnosis) just because Ritalin doesn't work well.

Hopefully this is at least somewhat reassuring.
posted by novalis_dt at 2:18 PM on March 1, 2019 [4 favorites]

OT here, but not YOUR OT, and not in Canada.

Looks like it's probably the Beery, yes.

That's an awfully expansive diagnosis from a single test, especially one that's so paper/pencil based. I'd be quite interested to know the motor vs. Perceptual subtest scores, which can be quite revealing as to where the system is failing (with the perception, with the control, etc). Also, remember that 8th percentile means that in a class of 25, you'd expect one other kid with skills at that level.

In the US, to get school services, you have to not only show low scores, but that those scores are affecting the kid's ability to do school. I've seen kids with scores like that with amazing coping skills (often they use words where visuals don't stick, so they talk themselves through the test, describing things to themselves) so the impact on their function is minimal.

As a school practitioner, we'll usually give decent credence to test scores, but take interpretation with a grain of salt. Especially with a bright, older kid, I'd definitely be talking to your daughter about her reality. What about writing is hard? Especially with attention issues in the mix, things get complicated and fuzzy real fast. And, as an OT, I'm more interested in figuring out how to help her make things work than how she is or isn't "typical"

So, i'd say, especially if the ADD/ADHD feels accurate, then stop spending a lot of time on wide-net research, and take some of that time talking to your kid about what specific problems she's having and how you can work together to help her learn how to address them. None of this stuff is "magic bullet" territory (unless the Erin's is a thing, then start with that to get those letters to sit their asses down on the page and stop dancing), so it's a long process of problem-solving, with whatever support team you can get going, but with your kid at the center.

I'm not sure at all if any of that answers any of your questions, but I hope at least a little of it helps.
posted by DebetEsse at 3:51 PM on March 1, 2019 [1 favorite]

I am a clinical psychologist at a major research university in the US, and I work with kids with neurodevelopmental disorders. I'm not going to try to answer your questions here, because honestly I think it would be unethical for me to try to address them in this context. So you may find this an unhelpful answer, but I feel compelled to tell you that you should strongly consider going to see a different psychologist. I've seen a few of your recent questions, and I'm concerned that the professional who is best positioned to give you this information is instead leaving you confused and searching the internet for answers. DCD is complex (like all neurodevelopmental diagnoses), and certainly should not be diagnoses based on the results of a single assessment. Likewise, I'm quite concerned that the psychologist is assessing for Irlen's. Calling it "controversial" is generous - the scientific community is quite united in concluding that it has no scientific basis, and the limited research on it has been inconclusive at best.
posted by scalar_implicature at 4:50 PM on March 1, 2019 [8 favorites]

Protocols are the test forms where the student's responses are recorded or where the student actually completes the test (e.g., their writing sample on a writing test). I would suggest requesting to see a copy of the protocol to see the questions/prompts as well as your daughter's responses.

Additionally, try looking into advocacy organizations to see if they could provide you with guidance/assistance working through this process.
posted by dearadeline at 7:38 PM on March 1, 2019

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