Worried about possible dyspraxia... am i just opening a can of worms?

[alfiethetortoise]

I'll try keep this brief... I am a primary school teacher with one DD now age four just started full time in reception.

For a LONG time she has been what I would call excessively clumsy. As a baby, she walked steady at 10m but was always bumping into things and tripping over things on the floor. At the height of clumsiness she had permanent grazed knees, bumps, spilling drinks all the time, tripping over her own At 3 she was diagnosed with vision problems and now wears glasses. She slightly improved since.

Just got a form from school asking me 'are you worried your child may be excessively clumsy?'. As I paused to think she tipped her hot (warm!) chocolate all over herself and the sofa.

I mentioned her clumsiness to the private nursery last year. They agreed that she was very clumsy compared to the other children. I told them I wondered if she was possibly borderline dyspraxic but I wondered how she could be - she can ride a bike, no problems at ballet, can swim without floats. She hit all milestones early and is very bright for her age. However, i still have this niggle. I don't want her to be labeled as something she isn't. Am i just opening a can of worms? Would they even do anything about it?

HELP!

p.s. she has this awful thing about loud noise. She is very confident, not shy at all, and very sociable - i know it isn't autism or aspergers.

Dyspraxia (Developmental Co-ordination Disorder) is diagnosed in the absense of any other neurological issue, or learning difficulty.
Generally when the child is assessed by an EP or clinical Psychologist there is a profile of better verbal scores than performance scores. Which would usually lead on to an assessment by an OT who would look at the age appropriate gross and fine motor skills.

The bit about her needing glasses and being awful with loud noises is interesting. It might be that she has some proprioceptive issues (that is knowing innately where her body parts are in relation to each other and in relation to objects in the environment). It sounds like she needs to see someone in RL for a proper assessment.
Have a look at this. Does it ring bells for you?

Alfie - You are a teacher - so experienced in understanding peer development. You have a niggle - so your experience is telling you that there is something that you're not happy/quite sure about.
'Labelling' quite often takes a very long time, after having seen numerous professionals, who make sure that the child meets all the criteria for any kind of diagnosis. Talking to a GP and asking for a paediatric referral does not label a child.
If, and it is a big IF, there are elements of dyspraxia, it will not change your daughter and it will give you the knowledge to support her development.

Hi alfie

Funnily enough, I've just got back from an appointment with a paediatrician who said he was confident to diagnose DS with dyspraxia this morning. He doesn't have any LD and no evidence of neurological problems.

I went to the GP a few months ago with little more than you have written - although DS did struggle with bike riding, and swimming, but he also has some communication difficulties and also has a dislike of loud noises. And just a feeling I had that things weren't quite right.

The GP was great and said it sounded like he'd benefit from being seen by a Paed, and so referred him. We got a letter last week to say the referral had been accepted and to phone to make an appointment. We went this morning. I didn't have to tell him too much - just elaborate on the GP's referral and he got DS to do some tests - walking on different parts of his feet, testing his muscle tone and whatever.

He is referring us onto the Occupational Therapy Team.

My advice to you would be to go and see your GP asap. I can't help but think (although won't be dwelling on it!) that DS would have benefited from me taking him sooner. But hey, what can you do?

Even getting a label isn't really a label. It just means that we will able to better support him.

To take it away from him for a second, our daughter has just been diagnosed with mild/moderate deafness. She has been fitted for hearing aids and we will pick them up in a few weeks time. She's still the same girl she was, it's just that now she will be able to hear us better! And that's all it is. It just means you'll be able to access support that is available and have better knowledge and understanding of your daughter.

Good luck.

Oh and that link porridgelover posted is really useful. She posted it on my thread too. Thanks PL

I'm waiting for ds to be assessed for this, he's 13 (long story). He spills his drinks, he trips over things, he can't spot his shoes (even though they are by his feet), he falls over when he's walking (sometimes into the road), he's disorganised and incredibly messy. He can't swim, his handwriting is messy, he couldn't ride a bike without the stabilisers until he was 10. He's only just mastered a knife and fork. He also has problems with social skills, hates loud noises and every bump is so very painful. He doesn't have aspergers/ASD, he's already been assessed for this. The dyspraxia label isn't as important as your child receiving the support that they need.

Porridgelover, thank you I had a look at the list, there's a lot of bells ringing here.

alfie sorry for the side-track
folk and ladysybil I'm glad that you found that useful. It's good for organising your observations about all the things that are 'just the way that child is'.
Poor Sensory Processing is thought to be one of the big issues with Dyspraxia...the theory being that if one's brain is not getting or processing sensory information efficiently then it is simply not possible for smooth or efficient movement patterns to come out.

Bit like the old computer one that garbage in= garbage out

Thats why SI therapy is thought to be effective; it targets the sensory information going in and refines it or provides it in more acceptable form, for the child's brain to interpret.

thanks porridge lover for the link - i found it very useful. She does fit a lot of some of the criteria.

I mentioned it to her class teacher today. She is a bit old school and said she hadn't noticed any problems with dds 'clumsyness' but that she would 'keep an eye'. So is it worth taking her to the GP? Or do i sit back and wait? Parents evening in three weeks, possibly I could keep my own eye and bring it up again then?

Aunteveil - yes i know it wont change dd, but I worry about the overuse of labeling as a professional myself. If a child is told it is rubbish at something, it often becomes rubbish - i.e. one year i had a dyslexic boys in my class he was really on the fence. He could have aspired to more, but his parents seemed to think telling him 'its ok you can't do that, because you are dyslexic' was enough. He was being told he couldn't do it, and that was the main barrier, not some very mild problems with his reading and writing that could have been rectified much quicker if he didn't have a negative attitude towards his progress. So yes, there were things in place, but it was the negative attitude that had come from the label which was the real barrier in this case.

p.s. we live in a very rural area, I very much doubt there is much therapy around locally for DD if she needed it

Seriously, I would go to the GP.

I suspected things weren't right with DS when he was a toddler, but never having heard of things such as dyspraxia and the like, I assumed that what I was seeing was just him.

I also assumed that any difficulties would be picked up by the school.

Then I became a primary school teacher and, as you and I both know, being an expert in the national curriculum does not make one an expert in child health! There's a whole other professional field for that . So I wouldn't put too much stock in what her teacher said.

If you have a concern, go to the GP. The thing is, labels can be used in the way you suggest, but I prefer to think of them as just knowing which toolkit to use. So one of my son's big issues is his morning routine - washing, brushing his teeth etc. He spent years being sanctioned, marched back upstairs to do it again, coerced, cajoled... When we started to suspect dyspraxia, DH spent a week modelling his morning routine with him and setting up his things in the bathroom. With his tools and cues present, he can remember what to do (even if he still cant do it very well!) but at least he gets to be independent in that field and feel that it is something he can do rather than something he can't.

Tbh, I don't care about a label or not. It's only going to be known by people who have to know and people we/he choose/s to tell. But the strategies and tools we hope to get from it are what is important. In the example you cite, it was the way the parents used the label that was the problem, not the fact it was there.

Hmmm its a hard one isnt it. I hear what your saying about 'labels'. My DS has ASD with Dyslexia. I am constantly on to the school to say that while it explains, it doesnt excuse. For him, I tell him that this is something he has to work harder at. we all have something.

BUT your DD is 4. With visual issues. And nursery noticed her clumsiness. And you notice some of the sensory processing criteria fit.
TBH hitting motor milestones on-time, being able to ride a bike/swim isn't the profile I'd expect of a child with Dyspraxia. But I do think it's worth investigating.
If you had access to a good, sensory qualified OT anywhere locally I would go for a comprehensive assessment now....if there's anything there, then you have an early baseline. If you dont want to go the GP route would this help?

Alfie - would a label make you expect less of your DD? It doesn't make me expect less of DS, it also doesn't excuse any bad behaviour. It is sad to hear of a parent using a dx as an excuse for not trying.
There have been many threads on here about when to and if you tell a child about a dx. I did not tell my DS until he was 8. At that time he knew he was slightly different, and was relieved to be told that there was a reason for it. It made him more accepting, and in a way more likely to overcome difficulties. So you don't need to tell your DD, you don't need to tell anyone you think doesn't need to know.
I agree that educators are not medics, and cannot dx, but as a primary teacher you do know developmental skills and can make good judgements as to peer group abilities. So whilst I agree with folkgirl that school cannot dx, they can pass on concerns if they feel there is an area of development where they feel a DC is not developmentally reaching targets. It is their responsibility to highlight this and for you to make a decision as to what to do with the information.
I had the above scenario at the end of last year. DS1 has a dx, and I was burying my head somewhat in the sand assuming that DS3 was copying DS1. The teacher noticed throughout the year that his skills were not improving and at great odds with his academic ability. So I pulled my head out of the sand and am waiting for an OT referral. It may be something, it may be nothing, but I personally don't feel that for us not following it up is an option.
LadySybil LOL you gave me hope that by 13 my DS might have managed cutlery

So the GP will refer her to an Occupational Therapist for assessment? I thought that you would usually be referred through the school SENCO, but then the school are admitting they don't notice any problems where as the private nursery did agree with my concerns.

No I am even more confused! Will the OT see her on a regular basis? Will provision be made in school? I doubt she'd even qualify for funding, one of those 'not quite bad enough' kids I see so many of.

There is nothing available locally so it's GP then, or sit and wait. She's also due to have an operation soon. It seems like a lot to contend with all at once :o

alfie

Do not wait three weeks, get the ball rolling asap.

You are not opening a can of worms by having this further addressed via the GP; you are looking at why your DD is the way she is (I would also think dyspraxia here). A label to my mind should be used as a signpost for seeking more help.

You are truly her best - and only - advocate here.

re your most comment:-

So the GP will refer her to an Occupational Therapist for assessment?

I would hope so. The waiting lists can be very long, any chance of paying to see an OT privately?. I would also hope that your DD will see a developmental paediatrician as well.

"I thought that you would usually be referred through the school SENCO, but then the school are admitting they don't notice any problems where as the private nursery did agree with my concerns".

From what you have written about this school they seem pretty much clueless to be honest. Many schools do not notice children with special needs as the staff are simply not trained enough to do so. Not many teachers readily recognise dyspraxia or even the wide gamut of SN they see in their charges.

"No I am even more confused! Will the OT see her on a regular basis?"

You may receive a block of six sessions

"Will provision be made in school? I doubt she'd even qualify for funding, one of those 'not quite bad enough' kids I see so many of".

Do not even think for one second anything about funding. Any involvement with outside agencies (like the OT for instance) should automatically put your DD onto School Action Plus.

Thanks Atilla. I think I will phone the GP first thing in the morning and book an appointment for her to be seen. Yes, I'm fully aware of the way the schools place pupils.

So i take her to the GP, they refer her to an OT, we have six sessions maybe, they say she is dyspraxic. What exactly changes? How are things going to improve for her? I don't really see that it is causing her a great deal of trouble at the moment but I imagine if it doesn't improve then it will as she gets older and 'clumsiness' isn't acceptable for children her age (at four, you can get away with so much, 'its just the age'). She can hold a pen and write her name very clearly, more so than many other children in her class and she is very bright. Its concerning she is clumsy, but really i'd be a lot more concerned if she had problems reading and writing.

It won't change who she is, but it will give you strategies for helping her.

As she gets older you might find she has difficulties sequencing daily routines, remembering to take correct equipment to school on different days. That sort of thing.

They'll be able to give you tips and strategies (e.g. using visual prompts) to support her.

I don't know what difference it will make but even the school knowing will make a difference.

I didn't take DS to the GP for 'clumsiness' when he was 4 because I'd never heard of dyspraxia and felt similarly to you - well they can't stop him falling over, so what difference will it make? But as he's got older, the difficulties are more obvious and affect him more.

My DS is being referred to OT by the Paed. I don't know what will come of that. He's the same in that I doubt he'd qualify for any funding/financial support but it's not really about that. It's about making sure that he feels more confident about doing stuff that he finds difficult. So instead of seeing himself as someone who can't, he sees himself as someone who can, but with a bit of support/extra practice.

Alfie with the hitting motor milestones and the good writing ability are not typical of the profile for a child with Dyspraxia at 4.
But the clumsiness isn't typical either, if it's out of line for your typical 4 year old.
So what is going on? Well your GP is the first line of attack, to exclude any visual, metabolic, neurological or neuromuscular issues.

If thats all clear, then an OT or Clinical Psychologist is probably next.

A diagnosis is useful in terms of allowing the child to reach their own 'normal' which may be different (better or worse) than the NT child at the same age.

For example, my DS has HFA/ASD with associated Dyspraxia and Dyslexia.
He has an IQ well above average which nicely hides the fact that his expressive language is about 2 years ahead of his receptive language. So he gets totally confused by verbal instructions. School denied that he had any problems until I got a private psych ax.....but they have totally got on board once it was officially pointed out to them.
Thats the benefit of a 'label'.

My ds got dx of dyspraxia yr1 nearly 6 - school picked it up told me to tell gp they also wrote to gp, had ot assessment then 6 weeks work and now on 3 month review- what has made a difference is the little things at school such as he gets a bit longer for his spelling tests - so is more likely to finish them and get 8 or 10/10 than 3/10 as panics and stresses, they are starting to get him to learn to type ...he was allowed to do his SATS in a quiet place so didn't get distracted by others finishing etc they have helped work on his self esteem with work - is v social so that seems ok at the moment but may change as he gets older.....

however did have to push for Ed Psych report as am not sure its only dyspraxia - not received yet
I have to keep on top of them though and reminding them (nicely!) as he's on track according to the 'system' as got 2as for all except writing....

I'm glad we got the dx as they can't ignore it- all my friends who are teachers say I have to push as no-one else will and lovely as the teachers are at ds school they do need prompting and he does need support... hth