Thursday, April 25, 2013

Fine Motor Skills testing done

The boys had their evaluations at the hospital with a couple of Occupational Therapists. The boys loved it because they thought they were doing a lot of games rather than testing.
Brady tested pretty good. He's on the low end of average for a few things, but overall he did just fine, even though he isn't great at writing or drawing. Apparently there aren't high expectations for boys at this age yet, whew. It was more about grasp and the ability to copy some shapes, trace, drawing lines between places. I guess if a child can do some of these activities, it means they're on pace to correct writing and drawing, which isn't expected at almost 5 yrs old yet, I guess. I was given some tips and ideas on how to help him with his grasp and some other things.
I asked why they thought he wasn't able to peddle a bike yet, even though that's a gross motor skill for physical therapists, and she said she thinks it's because he's not super strong and he most likely needs to build up some strength. She noticed something about his shoulder blades sticking out a bit, which I guess is a sign of upper body strength weakness, but she said it's not bad and he'll get stronger this summer when playing outside. Climbing and side walk chalk were some suggestions.

He needs to keep using a big boy bike and not a Big Wheel since the Big Wheel requires different muscles and is actually harder. So we'll keep working on the big bikes! Going down an incline will help, so I'm excited to try that with them.
She said that if it weren't for his speech, she'd have no idea that he had any 'apraxic' issues (referring to his motor skills) at all. She said that people will treat him younger than what he is because of his size and speech, but to know that any motor problems will work out over time with practice and more strength. She of course asked if he was getting intensive speech therapy, yeah, it's definitely our focus.
Jason is convinced Brady will be a baseball player so he doesn't have to communicate with speech much and can just hit baseballs and run (which is his new favorite past time... non-stop laps around the house.. .for no reason) and to look cute in a uniform since he's obsessed with costumes. Ahhh, I love that kid.

Then there's Jax.
This poor kid. I actually sat in his room (the boys were in separate rooms) because the therapist wanted me to fill out a form talking about 'sensory issues' to make sure we weren't missing anything (we're not everything is fine there).
I peeked over at the tasks being asked of him, and I was so proud of some of them like replicating some block formations, but then for some others, I actually cringed when she asked Jax to do them. I sat quietly almost fighting back a tear when she handed Jax a shirt and asked him to button it, or when she gave him scissors and asked him to cut the circle out (he can barely cut a piece of paper in half let alone cut out a shape!).
This therapist gave me a lot of scores, some that were decent, but one of them was '36 months' which I believe was hand-eye coordination and depth perception (I'll get the formal reports soon I'm sure). She said he needs weekly OT therapy at the hospital once school is out, and that the school should absolutely not be 'graduating' him from OT for 4k.
I'm officially not looking forward to his IEP meeting next month in case they say they didn't plan to give him OT next year. At least Jason will be with me when I lay the paperwork down stating he's scoring so low, and let's be serious... the kiddo can't button, zip, trace, write, draw or cut paper. So, maybe the school will already be on pace knowing he needs fine motor skill help.

She said he still needs work on core strength and his low muscle tone (which is PT) so we'll see what the school says about that too. He's doing well with his hand-eye coordination in gross motor skills, just watch him hit a baseball :) There's just not a lot of force behind it.
 Jax currently gets OT, PT, Speech and a specialized phy ed class at school, and I know they told me he'd be graduating from some of these therapies next year, but now it seems like maaaaybe that's not quite right yet.
I have some paperwork to fill out for the teacher/therapists to review before they write up the IEP that asks my opinion on strengths and weaknesses, so I'll definitely put all this down for them to consider in advance. I'll even send along the new OT report in advance too.
They said Jax's feeding issues are most likely motor planning hurdles too, so to see all these fine motor delays aren't surprising to them. They do want Jax to be evaluated at the hospital for gross motor skills to stay on top of his need for the braces. We'll see what the PT at school says next month. They said his Apraxia is a lot more global compared to Brady, which maybe is why Brady has the speech part so bad? Like... did it spread everywhere for Jax? How odd to even ponder, like I'll ever know?
Jason thinks this kid will be a baseball player too, just to be featured on ESPN as overcoming his physical obstacles. Ha, well, this is definitely the toughest little elf I've ever met. He is a growly little motor-driven nut.

Of course I smelled that Jax had pooped in his pants while we were there, so I excused myself to change him. When I got back they asked me about toileting and I told them that what they witnesses is pretty much it. After all the fine motor skill testing, they told me to try and not worry too much about the potty training yet. The boys are still at an age that they often see struggling when delays, prematurity or neurological issues are at play (she was referring to the speech apraxia). Both the therapists said they believe it will just click soon enough, and to not punish or push them. Pretty much the exact same speech we get from everyone!

As for the boys being impulsive and jumping from one activity to the next and running into things and people... well Jax did this last night and gave himself a bloody shiner over excitement of a book at bedtime. I brought it up and the therapists agreed that they didn't think ADHD was an issue at all, but as for the impulsiveness that they display, they think it's because they've always had each other as constant stimulus and they're used to trying to get to things first. Part of it is personality, part of it is being a 4 yr old boy and part of it is being a twin. We need to work through it and remind them to sloooow down and hopefully school can help with that too.

Whew, that was an afternoon. Tomorrow we go back to check out Jax's hearing with the new tube. And then next week should be much quieter, I can't wait!


Christina said...

We meet with OT (the new one) today and found out the break down from the results from the last OT, the attention issues are normal for kids with complex issues like both our sets of twins, not a sign of ADHD but more the twins coping skill as they show more signs of it when the are trying to do a tast more complicated for them (which makes sense since I have 2 older ones with ADHD and there is a difference) as for the toilet training my other kiddos trained at 2 K just trained and it clicked but J seems like we are going to be looking into that down the road as in mabye grade 1(she is developmentaly just 2)
Be forwarnd the senosry scores will come in high for Jax but make sure they take into account the feeding issue's as without that setback the sensory scores would not be as bad. And J's scored 80 on every sensory score, 80 is the highest.

tesyaa said...

My son who is 8 1/2 (and mostly nonverbal with apraxia and ADHD) just started buttoning shirts recently. I don't have the patience to work with him much on it (he's the youngest of 6), but I think his OT spent some time on it. Overall, I don't think it's a big deal that he's so delayed in shirt buttoning (there are bigger issues). It sounds like your kids are doing really well.

Michele said...

I just had my 9-yo evaluated by a pediatric optometrist and it turns out she has almost no peripheral vision or depth perception, despite having 20/20 vision. Totally explains SO MUCH that nobody else had an explanation for, like her slowness to pick up reading despite being very bright, or her inability to ride a bike without training wheels until age 8. Keep on keeping on! I must seem overwhelming now but you're hunting down all their issues at such a young age - can you imagine what they would have gone through just a generation ago, before we knew how much physical and occupational therapy helps? (My 9-yo will have near-perfect vision by age 10, thanks to weekly vision therapy sessions! And her 5-yo sister was also just diagnosed with mild depth perception problems and a "lazy" eye, which will be solved by age 6.) There is no shame whatsoever in being diagnosed with a developmental issue, and you can only address what has been diagnosed. And I really think there needs to be a National Hug Your PT/OT day!