got the report for dd's ot assesment, can anyone help me understand the scores?

[ditavonteesed]

the movement ABC-2

Maunal dexterity 5th percentile
Ball Skills 5th percentile
Static and dynamic balance 25th percentile
Total score 5th percentile

the development test of visual motor integration
VMI 16th percentil
visual perception 0.03rd percentile.

Obviousy there is also a lot of writing, we are going back on thursday for some excercises and school have some recommendations with regards handwriting.

From what it says I think this means she has dyspraxia, is that right? And if so what does that mean for her, will she remain under an ot? She is going to secondary school in a year and I worry as she recieves a lot of help at her current school, will this continue? Anything else you can tell me would be really useful. TIA

The only result there which would be classed as significantly below average would be the 0.3. The 5th percentiles would be classed as below average and I think the 16th and 25th percentiles a low average.

The OT will probably provide some suggestions for school and home and then discharge I expect.

Is her reading ok with the low visual perception score?

yes, her reading is the thing she gets on really well with.

Movement ABC scoring at the 5th percentile indicates that the child has a definite movement difficulty that requires intervention and appropriate accommodation in school.
Her static and dynamic balance are a definite strength; often these scores are also depressed and would be the first point for therapy.

VMI 16th percentile is OK...not great but OK.
It would indicate that further investigation is warranted i.e. is the difficulty with perception, with fine motor (cross ref with manual scores on M-ABC) or another issues.
The perception score on the VMI (0.3) is not a valid stand alone score but would indicate that she needs a visual perception assessment e.g.the DVPT.

Of itself, this is not enough to diagnose dyspraxia. This information should be combined with information on the child's Psychological assessment, their functional skills and clinical observations. But it would be a strong indicator.

All I would be happy to infer from just this information is that the child has movement difficulties...is it because of fine motor issues? is it because she has difficulty with visual perception? is it perhaps an issue with visual pursuits (i.e. fine oculo-motor skills...possibly no given reading strength)? Is there hypotonia and/or hyperflexibility?

If, IF, if this leads to a diagnosis of dyspraxia, then I would suggest that she has a package of therapy aimed at improving her fine motor skills, relieving her anxiety, giving her planning and organisational skills, and, importantly, starting the process of managing the transition to secondary now.
Hope that helps.

thanks, yes very helpful. The report says she has midly hypermobile wrist and elbow joints and a slight tremor in both hands which obviously contributes to her fine motor difficulties.

Hypermobillity in wrist/elbow and slight tremor.....
the major functional implication that comes to mind is that this will impact on handwriting.
Is she using typing to produce written work or is she trying to keep up with handwriting?

A handwriting speed assessment might be useful, to help with an argument for assistive technology in school e.g using a mini recorder for taking down homework, producing some written work.

she is still trying with handwriting and gets so fed up when she makes little progress. as she gets older would assistive technology be an option, the report did say that she manages very well but is very slow with fine motor tasks.

I would be asking what does that mean 'she manages very well'.

Is she producing her written work at an equivalent speed to her peers?
Is she producing it at the same speed but at a cost to her energy levels?

As a child progresses through school the focus in handwriting changes from letter acquisition and formation to speed, legibility and the content of written work i.e. it's use as a method of communication....primarily to demonstrate to teacher/examiner that the child has achieved the learning objective.

If a child is struggling with speed but they have acquired the language part, then there is (IMO) little to gain from insisting that they continue to produce all their written work by writing.

(Note: I am not saying that they shouldn't hand write- I do think there is still a value for hand function in continuing to practice it. But not for producing volumes of work if the cost is frustration, pain or tiredness in excess of peers )

The activity is not meaningful if its frustrating- and there is a risk that her frustration will interfere with her ability to learn first and then to demonstrate her learning.

Move to typing.

I dont know if this is relevant but at 10 years old she goes to bed at 7 and still often has to be woken at 7am, she has always had extreme tiredness could this be caused bby the extra effor she is having to put in?

Maybe.

If she is hypermobile/has low muscle tone, everything is going to require additional effort from her.

To counter this, therapy would focus on strengthening her core (over and above what is typical for her age group), giving her rest periods between activities, and compensating with equipment where possible.

Is she a bit over-sensitive to touch/emotion/pain?

very much so, the emotional side is why we started looking for help in the first place. She is forever screaming when she bumps into things. Doesnt really like hugs much but will siddle up for a quick cuddle on her terms sometimes.

Ah. I asked as I find that many children with low tone and hyperflexibility also have sensory processing difficulties: particularly with tactile.

Sensory and emotional processing are closely related (in that sensations can be emotionally coded e.g. associating a particular smell with home, or PTSD at the end of the scale, or a hug can be comforting).

As you can imagine, every day may be quite stressful for your DD and require a greater degree of energy and motivation to get her engine started.

Would you go back to the OT who assessed her and talk through all of this with them? She sounds as if she could benefit from some gym work using her whole body, planning movements and having to really exert herself to move through space. She would probably be exhausted after.

(On a side note, massage/brushing can be useful in reducing tactile sensitivity, and can help the child to self-regulate when stressed e.g. have a tube of 'special hand cream' to give her a hand massage. Introduce it at a time when everything is going well for her; e.g.already relaxed watching tv or in bed. When she is familiar with it, offer a 'special' hand massage when she seems stressed)

I am going back on thursday, she is giving us some core and shoulder excercises and to discuss all this. We tried doing the hand massage after we did theraplay with school but while dd says she likes it (people pleaser) she was obviously finding it physically distressing and trying to pull away.

She sounds quite tactile defensive.
Can she tolerate messy play? (like getting gloopy, hand painting)

yes she can tolerate messy stuff, we spent wuite a long time when she was a toddler encouraging it as she had eating problems. She loves blu tack and will sit with a ball of blue tack for hours, in fact one year my friend gave her a packet for her birthday and it was her favourite present. That doesnt really tie in does it.

Actually, I think it does. (And early eating problems confirms that she has tactile/sensory regulation/fine-motor difficulties)

She is tactile avoiding but seeks deep pressure using the blu-tack (if, as i imagine, she is pressing and pulling small pieces. Does she also like theraputty?)

Deep pressure is calming and is the 'short-cut' for dealing with sensory issues. That is why a deep pressure massage would help. But needs to be entirely on her terms.

As she's 10, I'd also introduce mindfulness as a cognitive strategy for her.

havent tried theraputty but willing to, where can I pick some of that up? I will ask her to let me know if she fancies a massage at all, we often play nails and things with dd2 so it would be easy to tie in to play. Can you explain what you mean by mindfulness? Thanks

polter that is really interesting I always assumed it would be all or nothing.

ds often has blutak or similar in his pocket as a "fiddle toy" . It helps take away the need to fidget and enable concentration.

we have a selection of squishy balls for anger diffusion. The ot said about her taking something in to fiddle with as she is very restless. Once we checked with the teacher she said it was fine, dd chose blue tack.

Theraputty
Doesnt have to be this...I've found lovely scented ones in a local pharmacy.

Science museum also do ones; or this one where they've hidden a pair of googly eyes inside and child finds them.

Firm massage; a little at a time; watch and follow her lead.

Mindfulness is a form of meditation that has been extensively researched. Lots of child friendly versions including ones that can be downloaded to a smartphone e.g. Smiling Minds or this one

Elastic bands also good for stretching, twanging.
Or the phone cord type bracelets.

Would teacher allow one strung around the legs of her chair so that she could bounce her calves on it?

probably not as the teacher said she could bring something to fiddle with but it had to be small and kept under the desk so she doesnt distract other children with it.