Adult DCD Dyspraxia Assessment for DSA

UK DCD descriptor (2018)

Developmental Coordination Disorder (DCD), also known as Dyspraxia in the UK, is a medical disorder affecting movement and coordination in children, young people and adults with serious symptoms present since childhood. DCD is distinct from other motor disorders such as cerebral palsy and stroke and occurs across the range of intellectual abilities. This lifelong condition is recognised by international organisations including the World Health Organisation. A person’s coordination difficulties affect their functioning of everyday skills and participation in education, work, and leisure activities. Difficulties may vary in their presentation and these may also change over time depending on environmental demands, life experience, and the support given. There may be difficulties learning new skills. The movement and coordination difficulties often persist in adulthood, although non-motor difficulties may become more prominent as expectations and demands change over time. A range of co-occurring difficulties can have a substantial adverse impact on life including mental and physical health, and difficulties with time management, planning, personal organisation, and social skills. With appropriate recognition, reasonable adjustments, support, and strategies in place people with DCD can be very successful in their lives.

The professional making the DSA assessment cannot make a diagnosis of DCD Dyspraxia but can review evidence and agree that referral to an occupational therapist may be useful. it is highly unlikely that professionals such as preschool staff, trained infant teachers and PE teachers will not have noted movement and coordination difficulties in the early and later years and this information will have been recorded in school and nursery reports. it is also highly unlikely that parents haven’t noted poor movement and coordination and discussed with the family GP. Consequently there will be a paper trail.

If a student has serious concerns about movement and coordination which have persisted since childhood then then prior to the assessment:

1. Read the description of DCD Dyspraxia above carefully and discuss with parents or other relatives.

2. Watch these videos:
   https://youtu.be/ncnVYonMA5Y
   https://youtu.be/DKY3EAiLi3g

3. Gather records from the GP and old school reports and any other hard copy evidence of a history of significant and serious difficulties with movement and coordination.

4. Print and complete The Adult DCD Checklist:

   https://www.patoss-dyslexia.org/write/MediaUploads/Resources/ADC_checklist.pdf

5. Bring your evidence to your assessment, the assessor will be able to score The Adult DCD Checklist and discuss.

Can a 7 year old be assessed for dyslexia

This is a question that we are often asked. For instance:

Dear Specialist Assessor,
We are interested in a dyslexia assessment with you for our daughter who is 7 years old. We suspect she may have dyslexia. We have been told by her SENCo to wait until she is 8 however she fits the description of dyslexia and we don’t want to wait.

My reply:

Dear Parents,

The reason dyslexia is generally identified from 8 years old, is that there is some evidence that some children are not ready to learn to read until they are 7 years old. If that is the case, then at 8 years old we can be confident that most children have been learning to read when they are certainly ready to do so, both in and out of school, for at least a year by the time they are 8 years old.

In some cases, a 7 year old child has had much specialist literacy intervention using multisensory methods (for example they have been seeing a specialist literacy tutor outside of school). Their difficulties taking on new literacy learning are clear, and the literacy tutor notes that the child’s literacy difficulties are resistant to intervention. If this is the case, and the child has had at least 6 months of weekly specialist intervention on top of schooling and support at home, then if their profile fits with a diagnosis of dyslexia on assessment, this can be diagnosed from 7 years old. However, it is more often the case that the child has not yet accessed specialist support; if this is the case, then at 7 years old the recommendation would be to do so for a period of time before assessment. Then, when the child is 8, they can come for assessment with good evidence that they have done extra work to try to improve their literacy skills, and despite this, they are still struggling.

A specialist tutor can be found on the PATOSS and BDA websites; they contain a directory and you can search based on your location.

Dysgraphia

The term dysgraphia is taken from the Greek word, (dys) meaning "bad" or "difficult" and (graphia) meaning "writing." Thus, "dygraphia" literally means "bad writing".

Dysgraphia does not appear in the DSM V, however the DSM V does include difficulties with written expression within the criteria for diagnosing specific learning disorder. For a student with no difficulties with written expression but with generally hard to read and illegible handwriting, there is no internationally recognised diagnostic criteria, such as ICD-10 or DSM V, that a clinician can refer to.

Searches of the internet reveal many definitions of dysgraphia which include difficulties with: fine motor co-ordination, organisation and presentation of written material, writing to be distorted or incorrect, letters and numbers may be backwards and out of order, expressing thoughts in writing, not understanding the spellings of words, having trouble with punctuation, more than simply “untidy” writing; it affects people’s ability to write effortlessly, a neurological condition that impairs writing and memory processing.

Using the latest DSM 5 definition of specific learning disorder most of the above would now fall within the diagnostic criteria for specific learning disorder, except for difficulties with the act of writing by hand. Because of this some practitioners now consider dysgraphia to be defunct as a diagnosis.

Dysgraphia is a very useful descriptor for handwriting that is so hard to read that it is generally illegible. Dyslexia South uses a very simple criteria: If a free writing sample is more than 25% illegible; that is more than one out of four words are illegible, or can only be read by reading around the target word to deduce what the word is, then the person’s handwriting is considered to be dysgraphic. We use a technique whereby the sample is read from the bottom in reverse, which helps to ensure that each word is read in isolation.

Dyslexia South Criteria for Dysgraphia

More than 25% of handwriting sample hard to read or illegible when the sample is read from the bottom backwards.
 

Two samples of dysgraphic handwriting:

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Dyspraxia Checklist

Dyspraxia Checklist.

Dyspraxia is caused by an immaturity of the brain resulting in messages not being properly transmitted from the brain to the body.  It may help if you think of it as a problem with the internal wiring of the brain.  The incidence of Dyspraxia is approximately 2 people in 100 (2% of the population).  Within the group of people with this difficulty there is a spread, with some affected much more than others.  There is a much greater chance of males being affected, the male female split being 70% and 30% respectively.   As with any diagnosed condition, as educators or parents we always have to view things, not from the position of what is wrong, but from the standpoint of what works.  What strengths does the child have?  How can we teach this child?  To achieve a level of knowledge sufficient to teach the child and thus assist in the child maximising their development and potential we must ask questions.  Questions such as, when did the child show evidence of really engaging in a task?  When was the child put off by a task?  What was different about the two tasks?  It is only by the use of reflective and analytical teaching approaches that we will discover the way to teach any child who has special needs and difficulties.

As with any parent or teacher applied checklist, you are not making a diagnosis.  The diagnosis of Dyspraxia is a highly skilled task.  Please use this checklist to see if it seems to “fit” the child.  Not all Dyspraxic children will meet all the indicators.  If there does seem to be a good “fit” then it would be useful to refer the child to a professional who is in a position to provide an accurate assessment and diagnosis.  In the UK this is often done by an occupational therapist and/or a speech and language therapist.

Dyspraxia checklist.

1. People describe the child as being clumsy, you suspect this is due to a weak sense of body awareness.

2. The child has poor posture

3. They may walk awkwardly.

4. Laterality confusion, check this by: Asking which hand s/he writes with, which foot s/he takes kicks a ball with, ask them to look through a cardboard tube, which eye do they hold it up to?  Hand them your watch, which eye do they hold it up to?  Does everything happen with the same side or are

5. some things done left sided and others right sided?

6. The child may have difficulties throwing and catching, even with quite a large soft ball.

7. You may notice that the child is much more sensitive to touch than other children.

8. There may be objections to wearing some clothes and other routine events such as the application of plasters, having their hair brushed or teeth brushed because the child finds this uncomfortable.

9. Parents and teachers may be frustrated or have noticed that the child forgets tasks learned the previous day or there is evidence to suggest that the child has a weak working memory (short term memory).

10. There will probably be reading and writing difficulties

11. There is a very strong chance that the child cannot hold a pen or pencil properly.

12. Does the child have a weak sense of direction?

13. The child has had real difficulties with or cannot hop, skip or ride a bike.

14. The child was much slower than most children to learn to dress or feed themselves.

15. Parents and teachers may have noticed there is a difficulty in answering simple questions even though they know the answers.

16. There may be evidence of speech problems perhaps with the child being slow to learn to speak or speech may be difficult to understand.

17. It is possible that the child has a difficulty with phobias and perhaps obsessive behaviour.

18. The child may be frustrated and impatient more than one would expect for a child of their age.

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Observation, Checking A Child Is Accessing The Curriculum

This technique is primarily aimed at children who are not accessing the curriculum due to language difficulties.  You should, however, also be aware and take note of the child's propensity/ability to make appropriate use of peers for support and assistance as this may contribute to the evidence gathering process shedding light upon areas such as approach to learning, social skills and self esteem.

Usually I prefer to observe a child before they know who I am. This technique is usually used after some assessment which has lead to a hypotheses of some difficulty. At the very least it may be that the child is not comprehending the verbal learning environment very well for a range of reasons such as specific or general language problems.  You could use this technique for a child that has difficulties concentrating by being very overt and telling them that you are going to be looking to see how many questions they can answer if they concentrate.   Similarly this may be used just before a review is due to gather information to compare with a base line specified prior to your intervention.

You will need the observed session to have a strong verbal component; carpet time is often suitable.  You will be keeping one eye on the child and noting their behaviour, but you will also be noting down questions that can be asked about what is being taught, the story that is being read out etc. 

You will then be left with a series of age appropriate questions that relate to the 15 to 20 minute session that they have just taken part in.  You will also have some notes on the presenting behaviour. Was it restless? Helpless? Actively involved?  Below is an example layout with example questions:

Question	Appropriate Answer	Child's Answer
Who was asked to come to the front and talk about an award they got?	Ben and Tom	Ben and Tom
What did thy get the award for?	Football	Reading?
Your teacher read you a story, what was it about?	Harry Potter	looks at me for a clue no answer
Your teacher asked you all to tell your parents some things about sports day.  Can you tell me something she asked you to tell your parents?	Next week on Wednesday, white shirt, will get letter later this week with details.	They can come?

Naturally you would have a few more questions but you should get some ideas about their behaviour.  The little boy in this example is confirming our hypothesis gained from assessment or professional judgement: he has real difficulties processing the spoken word into usable information or remembering it once he has processed it.  You are now able to illustrate in your report the scale of the child's difficulties by detailing the questions asked and the responses.  You may wish to ask other members of the class the same questions to develop a contrast between the target child and peers.

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Advanced Observational Techniques (use of a control pupil)

Once you have got the hang of observing using the methods suggested in the previous paper on basic observation techniques, you may wish to strengthen your reports or evidence gathering with a comparison to other members of the class.   This technique involves the observer making a primary observation on the target child using the same methodology advocated in basic observation.  However, after the target child has been observed, the observer will make a secondary and nearly simultaneous observation by quickly looking at the control child (a child selected at random from within the same class) and note what they are doing.  Thus an observation record would look something like this:

Time	Target Child	Control Child
10.00	Fiddle with pencil case 30 sec. LA 10 sec. Talk 20 sec.	OT
10.01	Talk 30 sec. W 30 sec, talk to blonde girl	OT, talk 10 sec.
10.02	W 40 sec talk to blonde girl T> sit down, to seat	OT >T for help
10.03	LA 10 sec, talk 30 sec T> stern look. OT 20 sec	With T, OT
10.04	W 40 sec girl red jumper T> warn, OT 10 sec	OT
10.05	OT 20 sec, talk40 sec	OT
10.06	T> final warn, argue 60 sec.	OT, Talk 15 sec, to pencil sharpener

OT =  on task
LA = look around
W = wander around classroom
T> = teacher instigates interaction with target pupil
>T = pupil instigates interaction with teacher

You are now able to report in a more professional way that the target child was, for instance, on task (OT) for 60 seconds (control 5 minutes plus) and engaged in the following restless and off task behaviours: talking 3 minutes 10 seconds (control 10 seconds), wandering 3 minutes 30 seconds (control 0 seconds), teacher needed to approach pupil 4 all disciplinary in nature escalating from non verbal to final warning (control  one approach to Teacher for help).

You will note that the control pupils behaviour is notably different from that of the target child.  The use of a control has made the behaviour of the target child more notable due to the contrast.  By using a control you have also made a point with regard to the behaviour of the rest of the class, it is very good if surmised from the above.  However, you may be asked to report on a child who is in a very noisy class, use of a control may highlight the need for a whole class approach due to the behaviour of the control which may be nearly as poor as the target child. 

You may wish to note in your report onhow the control was selected.  Did you choose them at random? Or did you ask the teacher to point out an average child.  Personally I have usually gone for a child with similar coloured and styled hair or a similar jumper.  There is no science in this and once or twice I have selected a child that also has difficulties, however this soon becomes apparent and you can switch control very easily.  I prefer to be able to report that I selected the control at random using hair colour in my reports rather than report that the control was selected by the teacher because I feel that it adds credibility.

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Observation In Playground And Classroom

Classroom and Playground Observation

There are books and chapters in books and no doubt countless pages on the internet describing various techniques for undertaking this part of a child’s assessment. Over the years I have practiced, I must have looked at hundreds of examples. For a parent or teacher seeking information on observation techniques it must seem very confusing. The following techniques are the methods I have settled on and used successfully for years; both are very simple. I always use both techniques sometimes in sequence but more often in tandem. If you are new to observation I would suggest doing them in sequence, you will naturally begin to use them in tandem as you gain experience. All you need is a note pad a pen and a watch.

Minute by minute observation:

I tend to do a 20-minute observation using this technique. You need to establish some codes for yourself. Some codes you will use for every observation, other codes you will need to generate as the child presents particular behaviors. For instance >T means child approaches teacher, whilst T> means teacher approaches child. I tend to embellish this with a note as to the reason for the approach, teach, help, reprimand for example. If the child makes animal noises, I might code this as AN – Dog. If the activity changes note this down and carry on with the observation

Here are some of my regular codes:

· >T help = Child approaches teacher you can note why if you wish.

· T> teach = Teacher approaches child to teach task individually

· W 20 sec sharpen pencil = The child wandered the classroom for 20 seconds and sharpened pencil

· OT 30 sec. = On task for 30 seconds

· Off T 60 sec. = Off task 60 seconds

· LA 20 sec = look around 20 sec.

These are just to give you some idea; it may be best if you figure out your own codes. You use codes to increase your head up observing time, the observation sheet does not have to be lovely and neat. Mine are only really decipherable by me, but I get a lot of head up observing time.

This observation technique will allow you to be very scientific. You will for instance be able to say that when a child is offered a pencil and paper task they will be off task for so many minutes in a 20 minute observation. You will be able to include in your report the noises the child made or the number and amount of time they spent wandering around the classroom. You will be able to baseline the most used off task behavior and use this as the data to measure any improvements against. When you look at the observation as a whole in a quiet moment you may see patterns.

Observation technique two

This technique is quite the opposite of the above technique. Here you simply clear your mind and watch the child in the learning context. I tend to note down what the set task is and if it changes note this, thus the set task note breaks up my notes. I tend to watch in five-minute blocks then write down anything I feel is relevant. I am looking for patterns of behaviour, friendships, alliances, evidence of relationships both individual and group. You are observing as a human not as a specialist, parent or teacher. No matter how odd your perception of what is happening note it down.

An example may look like this

A. Child Observation, Science. 2.2.99

Task: to watch teacher demonstrate an experiment to the whole class.

Seems keen and interested. Puts hand up to assist. No negative interaction between target child and peers or teacher. 15 min

Task: to copy notes about the experiment from the board.

Appears to look up at the board more frequently that the other children. Poor visual memory?

Gets on with task, no negative behaviors. 8 min.

Task: teacher does question and answer session to round off lesson.

Off task, pays little attention to teacher. Rarely makes eye contact with teacher, but seems to be trying to gain the attention of peers by engaging in various acts of silliness. He is not disruptive because the other children choose to ignore him. If they were bored or badly taught they may use him as a catalyst to disrupt the lesson. 5 min

Task, sit and listen to teacher rounding off the lesson. (Telling them what he has told them)

Much better but not looking at the teacher and not really on task but not seeking to be disruptive. 3 min

Footnote:
This is a real example. Subsequent assessment suggested this child did have a weak visual memory. However, this was not the problem. When I asked what the lesson was about, just as the teacher had done in the Q and A session the child shrugged shoulders and told me "don’t know". I had noted down some of the vocabulary used in various parts of the lesson and the child could offer good or fair definitions of the words related to the content of the lesson. The child therefore understood the lesson in its parts but not as a whole. We hypothesized that the child was not able to "chunk" information. We implemented a simple intervention using mind mapping and much improvement was made. At the time of my observation this child was at serious risk of being permanently excluded (expelled). This is no longer the case.

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Inconsequent Behavior

Inconsequent behaviour

Children who repeatedly get into trouble for the same or similar behaviours are a great strain on their teachers and parents. They leave the adults responsible for their care confused, possibly angry and most certainly with a feeling that they lack the skills to cope.  Some people may advocate comprehensive and instant punishment for these children.  You have tried it and still nothing much changed.  Two questions must surely come to mind.  Why? What can I do about it? 

Children will engage in repeated naughty behaviours for a whole variety of reasons.  Some may be seeking attention and if they find a naughty behaviour that gets attention, not surprisingly they use it over and over.  For other children there may be an unintended pay off.  For instance they are told the next time you do that your parents will have to come into school.  As parents are separated the child feels that getting the parents together is a good thing and sure enough the behaviour is repeated.  The purpose of this paper is to focus on children who have a social comprehension difficulty.  A social comprehension difficulty describes a specific difficulty that may be likened to any other specific difficulty.  It could be riding a bike, dancing (me), dyslexia and so on. 

A very convenient way of analyzing behaviour is to view it using ABC analysis. 

• A = Antecedent (that which come first, the trigger)

• B = Behaviour (what happens as a result of the antecedent)

• C = Consequence (much more than a sanction it also includes the effect on others)

An every day situation may be, Gill looks strangely at John when he can’t read a word.  John hits Gill.  The teacher keeps John in at playtime.  The other children get scared of John.  Gill really doesn’t like John and so on.  The consequences are huge. 

The first question to address is why does the adult impose a sanction, what are the assumptions behind it.  First assumption is that the adult does not really want this type of relationship with the child, they would rather be praising, but needs must, so a punishment is imposed.  The second assumption is that the next time John feels provoked he will think “The last time I hit someone I got kept in at break and I didn’t like that”.   This is where the adult could be wrong. 

Let’s assume that the child has a specific social comprehension difficulty.  In other words the process of learning via reward and punishment and the associated feed back via thought isn’t working too well.  Just as a child with dyslexia can’t process written text too well and the bad dancer can’t process music to movement efficiently.

If this were true what would happen.  Presumably the child would be getting into trouble over and over again for the same type of naughty behaviour.   One way to prove that this is the case would be to teach the child very actively about the behaviour consequence cycle.  Just as we provide dyslexics with multi-sensory teaching and the poor cyclist with extra support and time to learn these skills, we must give children who do not appear to have strong social comprehension skills a suitable intervention.   

What to do:  If you have picked up the reason for the child’s behaviour then an intervention called choice points is very effective.   It is probably best delivered as part of a general social skills development programme that is specifically tailored to the children in the group.  However, it can produce results if used as a one to one intervention.  I would suggest three sessions per week; each session only takes about ten minutes.   

The first step is to tell the child why you are doing this.  You are not doing it so that you can punish them but to help them because you think they are getting into trouble not because they are naughty but because they don’t understand.  The child will probably be rather lacking in trust so it may be best to use imaginary incidents at first.  As the child gains confidence in you s/he will be willing to be forthcoming about real incidents. 

Ask the child “What happened?”  You will probably get an answer that puts no blame on them, such as, “Jimmy hit me”.   Get a piece of paper and write this in the middle of the page and draw a circle around it.

Then ask, “What happened before that?”  Repeat what you did above, write it to the left of the previous comment and circle it.

Continue asking, “What happened before that?”  Until you are satisfied that you have a reasonable account of the beginning of the incident.

Read how the incident began to the child.  For instance, “Paul and Jimmy had an argument.  I walked into the classroom.   Paul told me that Jimmy had said rude things about my Mum.  I swore at Jimmy.  Jimmy hit me.”  Then ask, “What happened next?”  Continue as before but this time working your way to the right until you have a reasonable account of the whole incident.  Read back the whole incident to the child.  At this point they often want to add something.  If they do, add it and then read the whole incident back again.  If the child agrees with the map of the incident draw in some arrows so that the flow of the incident is clear and graphical.

Put the map in front of the child and ask if s/he can spot where they had a choice.  At first they find this difficult and you will probably have to help them.  After a while they get very adept at it.  Mark in the choices on the map.

Once the child has identified all the choice points ask, “What were the choices here?” Pointing to one of the choice points.  Write the choices they give you. As ever, at first the child will find this difficult, so the adult can take the lead and offer them some choices for their agreement.  For the first choice point some of the choices are:

• Ignore Paul.

• Tell Teacher

• Swear at Jimmy

• Hit Jimmy.

• Ask Jimmy if it is true.

The next step is to use gently probing questions to help the child to understand the consequences for each choice.  You write this up in front of them.  It may look something like this:

• Ignore Paul -- Nothing happens to me but I would be a bit cross for a while

• Tell Teacher -- She would probably ask Jimmy if it was true or do nothing.  Nothing would happen to me.

• Swear at Jimmy -- All sorts of trouble.  I ran out of school.  Mum is involved now.  

• Hit Jimmy -- Probably get suspended.

• Ask Jimmy if it is true --  If he did do it, I would probably hit him.  If he said he did not then nothing would happen.  I quite like Jimmy and we would still be friends.

The next step is to gently encourage the child to select the best choice for them.  

As time goes by you will be able to run through this procedure with the child or explore incidents in a group very efficiently with the child/children identifying choice points and the choices then selecting the best choice very rapidly.  They will transfer these skills to their life.  This can be a life changing experience for a child.

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How To Set A Reading Book At The Learning Level

Children read or look at books for a number of different reasons.  We ask children to read and look at books for a number of different reasons.  One of the reasons we ask children to read to us is to teach them to read.  If that is the activity we are engaged in with the child it is absolutely crucial that the book you are reading together is set at the learning level.  The following general rule is suggested by Marie Clay who became famous within the world of education due to her Reading Recovery system. 

Learning level = Child able to read 95 words in 100 (95%) 
Frustration level = Child able to read less than 95 words in 100 (<95%) 
Non learning level = Child able to read more than 95 words in 100 (>95%)

Obviously a few words either way is fine.  This is a general rule.  Ensuring a reading book is at the learning level is very easy.  All you need is a piece of paper, the back of an envelope will do.  A book, a child and you.  Ask the child to read the book to you.  As s/he reads, for each word correctly read do a / on the paper.  For each word the child is unable to read do an X.    You don’t actually need to let the child read 100 words, 50 will do and simply double the error count.  It is probably best if you do the scoring away from the child’s view.  Some people like to use an alternative to an X.  / and – for instance, then the child doesn’t see an X.  There is an example above done on the back of an envelope to give you a better idea.

If you feel that a child is not making progress please contact me for advice.

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Handwriting Assessment For Teachers And Parents

Educational analysis of handwriting

This paper is concerned with the analysis of handwriting from an educational perspective, with a view to understanding the difficulties that a student may be experiencing in connection with writing by hand at school, college or university.  It will address the assessment of hand writing using standardised tests which are readily available to teachers and other professionals as well as describing how a standardised test of handwriting can be enhanced and supplemented using dynamic assessment techniques and describe how handwriting can be assessed without use of standardised tests.

The first step is to gather hand writing samples.  This can be done using standardised tests or using dynamic assessment techniques.  The Detailed Assessment of Speed of Handwriting (DASH), and its sister test, the Detailed Assessment of Speed of Handwriting 17+ (DASH 17+) are the standardised tests that my organisation has settled on.

The DASH is used to measure the handwriting speed of students from nine years to 17 years of age.  The DASH 17+ is used to measure the speed of handwriting of students from 17 years of age up to a test ceiling of 24 years 11 months.  This does not mean that the test cannot be used on students who are older than the test ceiling, although a note should be included when reporting the results that the scores are not offered as a truly standardised and accurate score.

The DASH and DASH 17+ tests the handwriting speed of a student under four different stresses: copying best, alphabet writing, copying fast and free writing.

The sub-test scores for all four can be cumulated in order to derive a standard score with associated percentile.

After the administration of a standardised test of handwriting speed you may wish to explore the student’s handwriting further using dynamic assessment techniques.  Alternatively you may not have standardised tests available or have objections to standardised tests.  If so the use of dynamic assessment techniques is very powerful.  While this approach will not offer a standardised and statistically reliable score, it can allow students to produce a writing sample at a level more relevant to them than is required by the DASH.

To gather samples of a child or adults handwriting without use of standardised tests.  First type the standard sentence containing all letters of the English alphabet: The quick brown fox jumps over the lazy dog and print it out (Aerial 18).  Organise some sentences which will be presented visually at distance to emulate copying from the white board etc. during lessons/lectures.  Provide the student with pen and lined paper and ask them to:

• copy the standard sentence in their best handwriting repeatedly for one minute.

• copy the standard sentence in their fastest handwriting repeatedly for one minute.

• copy from distance for one minute.  

• free write about something simple, such as their day so far (low cognitive demand).  Allow five minutes for this with one minute for planning.

• free writing about something complex (high cognitive demand).  This task needs to be appropriately challenging and set in relation the student and their course of study.  The task would be the equivalent to an examination question. Explain that they will need to spend 10 minutes on this task. Allow two minutes for planning.

• Write to dictation (for secondary age students and above only).  Take your dictation sample from a text book they are currently using.

If a student has fast, average or generally slow handwriting it is likely that the words written per minute will be similar for each sample.  If using a standardised test very accurate tables will be available to you.  If using dynamic techniques the following writing speeds offer a rough rule of thumb:

Age                WPM

9                    10

10                  12

11                  14

12                 16

13                  18

14                  20

15                 22

16                 24

Adult          25

Analysing the Results and Intervention.

If you conclude that the writing speed is slow, then it may be useful to discuss making an alternative method of recording such as through typing or using dictation software as the main method of recording at school, college or university.  To facilitate the effectiveness of this intervention it may be necessary for the student to further develop their touch typing skills such as through typing club.  

Analysis of spelling error. You may wish to analysis the free writing sample for spelling errors under the following types.

• phonetic errors: This type of error may occur due to phonetic attempts to spell a word, for example, ‘right’ may be spelled as ‘riyt’. omitting suffixes: for example, I am go to the park.  Rather than  I am going to the park. 

• omitting plurals: for example, The Doctor had many patient waiting.  Rather than The Doctor had many patients waiting.

• vowel substitutions: for example brothor, for brother

• insertions, for example, whinning, for whining.

• omissions, for example, beining for beginning.

• transpositions, for example,  pharacuetical for pharmaceutical.

• Substitutions, for example, subsidice for subsidise. 

During the hand writing sampling students may balk, become distressed or present behaviours that indicate they are under stress.  If so stop testing.  If this happens during the copying samples, an exploration of alternative ways of recording would be an appropriate intervention, this could include dictation using a scribe or voice recognition software, use of a personal computing device: lap top, net book, tablet.  If it occurs during the free writing samples then further training in academic planning skills with some additional time in examinations (if possible) would be a useful intervention. 

It is useful to report the student’s pen grip.  There is a progression in pencil grasp from early childhood onwards Schneck and Henderson (1990).  In general pen holds are broken down into functional and inefficient grasp.   

Functional Grasp Patterns 
Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle. 

Quadripod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle. 

Adaptive tripod or D'Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end. 

Immature Grasp Patterns 
Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children. 

Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3. 

Inefficient Grasp Patterns 
Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand. 

Thumb tuck grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb tucked under the index finger. 

Thumb wrap grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb wrapped over the index finger. 

Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space. 

Finger wrap or inter digital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed. 

Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers. 

On occasion difficulties may be identified that will necessitate onward referral to an educational psychologist or occupational therapist.  For instance, if the percentage of illegible words exceeds 25% then there is a strong likelihood that an educational psychologist or occupational therapist may consider a diagnosis of dysgraphia supported by the results of test instruments such as the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) this would enable an assessment of the underlying skills associated with the development of hand writing to be explored.

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References:

https://www.typingclub.com/

Beery, K.E. & Beery, N.A. (2010) The Beery-Buktencia Developmental Test of Visual Perception and Motor Coordination. Bloomington: Pearson (6th ed.).

Frith, U., 1982. Cognitive Processes in Spelling and their Relevance to Spelling Reform. Spelling Progress Bulletin, 6-9.

Handwriting Identification: Facts and Fundamentals   Roy A. Huber, Alfred M. Headrick 1999 crc press LLC

JCQ/AA/LD Form 8.  Application for access arrangements – Profile of learning difficulties

Min, K., Wilson, W.H., Moon, Y., 2000. Typographical and Orthographical Spelling Error Correction. LREC Conference.

Spelling Progress Bulletin, Summer 1983, pp14-16] Spelling and Handwriting: Is there a Relationship?,by Michael N. Milone, Jr, Ph.D. James A. Wilhide, and Thomas M, Wasylyk** Zaner-Bloser, Inc., Honesdale, PA.

SpLD Working Group 2005/DfES Guidelines.

Varnhagen, C.K., Varnhagen, S., Das, J.P. 1992. Analysis of Cognitive Processing and Spelling Errors of Average Ability and Reading Disabled Children. Reading Psychology, 17(3): 217-239.

Exam Access Arrangements Form 8

The examination boards in the UK offer a variety of access arrangements for candidates who demonstrate a need for these, generally through adaptations being required in the classroom along with a set of standardised scores which fit JCQ requirements.   

The type of access arrangement will very much depend upon the results of testing, history, interview with the young person and their normal method of working.  Assessments for access arrangements should occur in or after year 9. Generally schools have their own access arrangement assessors, however parents may feel their child is not being considered for special arrangements and in this case, they can seek their own assessment through either a Level 7 specialist assessor or an educational psychologist. The assessor and school must agree and communicate in advance if a private assessor is going to complete a Form 8 for Access Arrangements for the school. Often, a private report is used to inform an internal school access arrangements assessor of the difficulties they should look out for, and they then conduct their assessment accordingly.

A full SpLD assessment will give much more information than an access arrangement assessment, and may pick up more subtle difficulties or identify ways of working which could be missed in a quick access arrangement assessment. The assessor can recommend a variety of adjustments such as, extra time, the use of a scribe,  the transcription of the candidates script, use of a computer if this is the candidates main method of recording at school/college etc.  The aim is to allow, as far as is possible, a fair and level playing field for the candidate to operate on, without giving them unfair advantage.

Pressure of work often leads to only the most severely impacted children being assessed and offered access arrangements.  If you feel your child needs additional support in exam, and no moves are being made to request access arrangements, then you need to liaise with the school and ask them to either complete their own access arrangements assessment, or ask that they liaise with an assessor who you as a parent are going to employ.

Dana at Dyslexia South works alongside schools in this way to complete assessments for schools and will complete a Form 8 for schools as long as this has been agreed in advance, and as long as school have completed and provided Dana with the relevant paperwork PRIOR to any assessment being undertaken.

Please contact us to discuss further or book an appointment.

Dyslexia Checklist

If your child fits many of the below indicators, an assessment to formally diagnose dyslexia could prove very useful. It would also be helpful to see what effect changes to the way the child is expected to engage with learning materials has.  Experiment by adjusting approaches, finding what works and what doesn’t.  Reflective teaching in essence, is what will really matter to the child.  A diagnostic assessment will ask perceptive questions and the outcome will guide the process of learning about the child's learning.

Seek advice from an assessor.

1. Dyslexia checklist

2. Did you worrythat s/he spoke later than other children of his age?

3. Is there a family history of literacy difficulties?

4. Is the child good at things that have a strong visual element?  But inexplicitly poor in other set tasks?

5. Is there evidence of laterality confusion?  Check this by: Asking which hand s/he writes with, which foot s/he takes penalties with, ask them to look through a cardboard tube, which eye do they hold it up to?  Hand them your watch, which eye do they hold it up to?  Does everything happen with the same side or are some things done left sided and others right sided?

6. Can the child follow a number of instructions in sequence?  For instance, “go to the living room and get my slippers, then bring them to me.”

7. Is there evidence of reversals when writing? 

8. Does s/he have particular difficulty with literacy or one area of literacy, such as spelling or reading?

9. Is the child noticeably inconsistent when reading, recognising words then being unable to read the same wordlater in the day/book/page ?

10. Can the child spot when a word is spelt correctly when offered a range of spellings for the same word? 

11. Does the child spell the same word in different ways on the same page?  If asked the difference between the various spellings can they identify them?

12. If you observe the child when engaged in literacy tasks is there a noticeable difference between on task time than when they are engaged in other tasks, such as drawing, practical activities?

13. Is the child able to talk out an answer or story but produces little when asked to write it?

14. Do people describe the child as clumsy?

15. Can the child add a rhyming or alliteration word to a sequence of rhyming or alliterating words?

16. Is the child on a much easier reading book than most of his/her close friends?

17. Is the child in a much lower spelling group than their close friends?

18. If you observe the class during a note taking or copying activity is there a marked difference between the child and the rest of the class?

19. Is there a noticeable difference in work output if the child is given help with planning their work?

20. If the child is taught strategies to develop sequencing skills, does this have an effect on their work output and general happiness at school?

21. Has the child begun to resist writing because they are bad at it?

22. If you observe the child during a copying from the board activity, do they appear to be looking up at the board much more often that the children around them?  Suggesting a weak short term visual memory.

23. Has the child responded to a handwriting development programme?

24. Have you noticed that the child has lost confidence over time in an educational setting.

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Dyscalculia Treatment And Intervention

If a child or adult has been diagnosed with dyscalculia or if they are experiencing difficulties with basic number processing then intervention is needed. Whilst there are well known, well used and recognised intervention plans and resources for dyslexic students the position with dyscalculia is less clear. If you are seeking to help a student with number processing difficulties access to an expert teacher with specialised training in the teaching of students with specific learning difficulties would be a good first step. Before appointing a specialist teacher it would be essential to discuss the approaches that they have found useful in the past and ask for an account of their depth and length of experience in dealing with dyscalculia. 

Some well tested and trailed resources are available such as the Oxford Publications Kinaesthetic Multiplication Table

The Davis Dyslexia approach to treatment of dyscalculia uses an array of approaches and makes much use of multi-sensory teaching methods, which some of our clients have found very effective.

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Dyscalculia Assessment And Diagnosis

A child or adult who presents significant difficulties with basic number processing and calculation, that is to say adding, dividing, subtracting and multiplying may be dyscalculic.

In the Dyslexia Centre, we take as a definition for dyscalculia that which was provided from the department for educational skills 2001 and the definition provided in DSM-5.

Dyscalculia is a condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts, lack an intuitive grasp of numbers, and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence (DfES 2001).

Definition provided in DSM-5: specific learning disorder (F81.2) impediment in mathematics, problems with:

•    Number sense;
•    Memorisation of arithmetic facts;
•    Accurate and fluent calculation
•    Accurate math reasoning. 

In order to make an evaluation and diagnostic assessment for dyscalculia in the Dyslexia Centre, we work to the guidance provided by the specific learning difficulties working group 2005/DfES. In order to conform to all these guidelines, the following process must take place; 

•    an in depth interview focused on mathematical history and experience
•    the administration of a dyscalculia screen
•    the administration of a standardised test of core mathematical processing and calculation skills.

In-depth interview
This interview can be undertaken with an adult client, an older child, a parent or teacher. It will focus on areas of difficulty which are then presented in the final diagnostic report.

The history section will include identified areas of difficulty such as; feeling anxious or nervous when asked to do maths or algebra, there will also be a section in the report where a mathematical support history is presented for instance; the level and intensity of support and intervention focused on the development of mathematical and calculation processing skills.

The report will also reflect any difficulty with everyday number experience for instance; difficulties with managing money or time management.

The report should also encompass a section where observations are made of the student when undertaking mathematical processing tasks.

Dyscalculia Screen:
There are many dyscalculia screens available, both commercially and free of charge. For students of 14 years + dyscalc 2013 is available free of charge on this website.

Standardised Test of Basic Numeracy Skills.:
The administration of a standardised test; number processing should take place using a reputable well known and well standardised test instrument such as: the WIAT-II numerical operations subtest.

The professional undertaking the diagnostic assessment, will need to take all information into account and furnish the reader with a diagnostic conclusion based on the evidence presented in the report.

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Children Who Find Writing Difficult

Alternative Methods of Recording

Writing is important up to a point as an adult.  The average specialist assessor or doctor writes reports all the time.  Or do they?  Sure enough some professionals do actually handwrite their reports, prior to having them typed, but many use alternative methods, such as word processing or dictating for a typist to type.  Is this any different to the occupational experience of many in the working population?  However, for a child at school writing is a very important skill.  Why?  The answer is simplicity; it requires little teacher thought or preparation; the materials are cheap and readily available and the finished product is easily portable. Writing leaves a trace, which shows the child, has processed the information, yet handwriting is only one method of leaving a trace and demonstrating that information has been processed.  For a child who is experiencing difficulty with hand writing, persisting with that as the sole medium is not a particularly productive nor thoughtful approach to educating that child.  Similarly if the child is physically capable of writing, then it is important to develop that skill but in a way that will not leave the child with low self esteem.  

When investigating an alternative method of recording, it is crucial that the child is offered a range of choices and is then allowed to experiment with each approach.  Recording, for instance, is something that requires a clear mind, and the skills of prior reflection and planning.  Typing on a computer or portable word processor has the advantage of leaving a visible trace, which is available for instant review, however it can be vastly slower.  Speech to text software has the speed of speech, and the advantage of leaving an instant trace for review.  It does, however, require the use of a reasonably up to date PC.  The use of a scribe is a very expensive method, but has advantages with respect to chivvying the child along, and offering help at crucial moments.  

It may be that the child needs to use a mix off approaches.  For example, if the child is ok at writing factual information, then the use of a laptop may be the right approach for this type of lesson.  For creative writing they may need a scribe because they lack confidence, or they find concentrating on the creative process takes all the cognitive resources they have, thus makeing handwriting much more of a problem for them.  For note taking, they may hand write, but use mind mapping rather than writing things in long hand.  Copying from the board is not wise, but if the child were to process the information and reduce it to a mind map, then they would probably get more out of the lesson than the children who simply copied off the board.  Come to think of it why don’t all the children use mind mapping?  They would then all be actively processing and learning.

A particularly cost efficient and learning efficient method is to use discussion groups with a scribe.  The children discuss the information they are required to process and learn and come to some joint conclusions which are written by a scribe; often a child who is good at writing. 

Of course we need the child to develop their handwriting skills as far as is comfortable for them.  A useful approach is to present the child with an acknowledgement that they have found handwriting very difficult and offer them alternatives.  Explain that they are free to find the best recording and processing method for them, then explain that it is still very important that they practice their handwriting.  Ask if they will commit to 10 minutes practice per day; this doesn’t have to be in one lump, they can do it in a number of small sessions whenever they have a free moment, or they can request some time out to do it.  They will be in control.  A teacher or parent should of course monitor this and reward with much praise.  What tends to happen is that the child will respond and will quickly work up to the limit of their endurance.  If the child does not practice of their own volition, reduce the daily commitment to something they will do and then build up to 10 minutes via a reward and praise system.  

If you encounter difficulty in persuading your childs' school to adopt this approach, it may be useful to seek advice from an specialist SpLD/Dyslexia assessor. 

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Autism Checklist

The diagnosis of Autism is a very skilled task, generally undertaken by a multidisciplinary team (MDT) containing a clinical psychologist or psychiatrist and often a speech and language therapist or other autism specialist. Please remember it is very easy to go down the wrong path with home-based diagnosis. As with the other checklists provided on this site, the aim of this is to identify if further assessment is necessary. If you would like to further explore a diagnosis of autism, then you can discuss this with your GP or seek a private assessment. Ensure that any privately obtained assessment is provided by a qualified MDT (for example, Compass Psychology).

The behaviours listed would normally be expected to be present across social contexts, and thus be present in contexts where they are not appropriate, taking into account the age of the child.  

Autism check-list

• Has little interest in mixing or playing with other children.

• Leaves you confused because they laugh at inappropriate times, sometimes when people are hurt.

• Makes very little eye contact and when they do it is fleeting, often out of the corner of their eye.

• Likes predictability and routine and can become distressed if this does not occur.

• Would be described as having no fear of danger.

• Games may appear odd, choosing to play with unusual items such as vacuum cleaners.

• Does not seek attention when obviously in pain and may therefore be described as insensitive to pain.

• Repeats phrases that they have heard, often in a completely wrong and inappropriate context.  They may repeat rude phrases.

• Would be described as liking their own company.

• Cuddles are not sought or wanted.

• May engage in the spinning of objects or be fascinated by patterns of moving light.

• Appears not to listen and respond to the verbal world.

• May attach to very unusual objects, or be over attached to items such as cars or Thomas the Tank Engine.

• Has great difficulty in expressing their wants and needs.  Will probably be highly reliant upon gesture and pulling adults to what they want.

• Physical activity may be much more pronounced than other children of the same age, or much less active.

• The child may enter into a tantrum without there being a discernable cue or trigger; the tantrums seem to come out of the blue.

• Will respond to teaching that is highly adjusted to suit children with Autistic Spectrum Disorders.

• There may be an uneven development of large and fine motor skill development.  For instance, the child may be able to thread beads with great skill, but find riding a tricycle or bike very difficult.

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Adult Assessment For Dyslexia

Many adults come to this site in a very unsure fashion.  They may have realised that one of their children has specific difficulties, and have begun to see their own difficulties in a new light. Or when beginning a higher level of study, the methods that they managed to use are no longer cutting it and they begin to struggle at A-Level or university.  

Adult assessment includes anyone over 16-years old. There are many routes by which they can be assessed.  Colleges and Universities should have a list of assessors, and there is likely to be a system whereby the student can have the fee paid, or receive a subsidised diagnostic assessment. This is particularly true in Higher Education.

Often a person will have been highly successful, but just feels that their learning is impeded.  An assessment will often shed light as to why the person feels that way, and offer ways around the subtleties of their specific learning difficulty (SpLD). This allows the person to go on and achieve to their fullest potential. Planning difficulties often surface, as do complex language processing difficulties, along with a whole host of other subtle SpLd's that interfere with seamless learning and cause underachievement.  With the extensive array of teaching and technological solutions available today, an assessor familiar with adult assessment can usually put together a complex solution that leads to the client going forward and learning in an unimpeded way, perhaps for the first time in their life.  Underachievement and the consequent emotional effects on self esteem will be slowly left behind.

If you would like to arrange for an assessment of an adult contact Dyslexia South.

See also: DSA assessment for those in adult education

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ADHD Diagnosis and Checklist

Who Can Diagnose ADHD?

ADHD is generally diagnosed by a clinician trained in differential diagnosis (so that they can determine if symptoms relate to one condition, such as ADHD, or if they fit with something else such as autism). Generally this is a clinical psychologist or a psychiatrist.

In adults over 16 years old, specialist assessors (APC) and educational psychologists are able to identify if ADHD is highly likely and this level of identification can be used to gain support at university and work, DSA funding and Access to Work funding. Please contact Dyslexia South to organise an adult ADHD assessment (educational diagnosis).

The medical route (which requires diagnosis by a psychiatrist) would have the potential to provide specific medications for ADHD that can help to control impairing levels of inattention, hyperactivity, impulsivity and associated emotional lability. Several medications are safe and effective for treating ADHD and for preventing many adverse outcomes (Faraone et al, 2021). These are recommended by NICE (2008, 2018) as first line treatments for the reduction of impairing levels of ADHD symptoms and may have a considerable impact on improving educational performance and other aspects of ADHD. The NICE guidance recommends a holistic approach when planning treatment and highlights the importance of discussing strengths and weaknesses of both pharmacological and alternative interventions with people with ADHD. It should be noted that NHS services are limited in this area.

ADHD Checklist

If your child fits many of the criteria below, you may wish to seek further professional advice around ADHD.

• The child is much less likely than the other children in class to pay attention to school work, and makes seemingly inexplicable mistakes.

• The young person appears to have substantially more difficulty sustaining concentration when engaged in practical or play activities.

• The child is described as failing to listen, even when spoken to directly.

• When the child is given a task which they are motivated to engage with, they do not complete it.

• The child does not seem able to get hold of themselves and the set task sufficiently to be able to organize their thoughts and plan a reasonable plan of action, yet they do understand what is expected of them when questioned about the task.

• The young person will actively avoid, and clearly dislikes, tasks and activities that demand sustained concentration and thought.

• Teachers and parents complain that the child always manages to lose things. This becomes particularly apparent with respect to school essentials like pens, pencils etc. but they will also be mislaying items precious to them such as toys.

• The child is easily distracted; when observed, they appear to turn toward movement and noise.  The child appears to be over alert.

• Routine tasks are often forgotten, leading to frustration in those who have to manage the child, who may complain of the child deliberately avoiding routine tasks.

• When observed, the child appears much more restless than peers.  For instance, when on the carpet they may squirm from one side of the carpet to the other, seemingly oblivious to what they are doing.

• There is a very clear pattern of wandering around the classroom when the task demands the children are seated. They appear to be on the look out for any reason to leave their seat.

• The child will take any opportunity to engage in running around or climbing; this is particularly noticeable when it is an inappropriate activity and other children in the class are not engaging in these activities.

• Quiet play is not something you would associate with the child.

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