I’d like to get your thoughts on a boy I’ve been treating privately since October 2015. I wrote to you about him nearly 8 months ago because of his regulatory issues. He’s doing so much better with that, but he has significant motor planning, visual motor, fine motor, and postural issues. He is not on the spectrum but might have the weakest skills in the above areas of a child not on the spectrum that I’ve ever seen. He is at least average if not high average cognitive ability.
Basically, any activity we do that requires him to assume a position is difficult. So, if I have him in prone position in the net swing with a cushion in it, he cannot extend his arms forward with elbow extension. If I have him cross sitting opposite me and have him imitate me clapping my hands like a seal, he has a very hard time knowing how to position his hands. I made some fish and a hook out of pipe cleaners and showed him several times how to hold the hook to catch the fish, but he kept turning the hook the wrong way. If I work on drawing any kind of line or shape, I have to separate the actual fine motor from the motor planning skills.
So I might have him draw a line or a shape in frosting, chocolate pudding, or foam soap, and he can usually do it, but as soon as I give him a small crayon piece to draw on paper, he has difficulty holding the crayon and can’t control it enough to draw a shape. As you can see, he can’t integrate fine motor and motor planning skills at all. Again, he’s doing better at the tasks when I separate them out, though he still needs lots of demonstration and practice. Usually, when I’ve been working with children for this long, they really start to improve and put it together.
Do you have any suggestions at this point? Thanks for any ideas and help.
This child does seem to have severe dyspraxia. Here are some suggestions:
- Dyspraxia is typically rooted in poor body awareness. Lots of heavy-duty proprioceptive and calming vestibular input (linear, rhythmic) prior to motor planning tasks may help.
- The Spio products (http://www.spioworks.com/), compression garments, and weighted items (wrist and ankle weights) may be helpful as they give the body more input about where the body parts are in space. If he has low tone, opt for compression rather than weighted garments.
- Test for the presence of primitive reflexes. Some of the issues you describe may be improved through reflex integration exercises.
- Since development happens in a proximal to distal manner, focus your treatment on his core and gross motor planning to stay at the just-right level of intervention.
- While you are focusing on the development of proximal muscle control, he may need adaptations and modifications in place in his educational environment depending on his age/grade.
I hope this helps!