OTS 114: Dysgraphia: How You Can Support Teachers & Students
- Jayson Davies M.A. OTR/L
- Dec 10, 2022
- 37 min read
Updated: Oct 28, 2024
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Welcome to the show notes for Episode 114 of the OT Schoolhouse Podcast.
Did you know that Einstein and Thomas Edison may have had dysgraphia?
In our chat with Cheri Dotterer today, she discusses the truth about dysgraphia. A lot of us have had specific beliefs about what dysgraphia consists of, but the true definition may surprise you. She also explores the different types of dysgraphia and bilateral integration, which include interlaced, symmetrical, and asymmetrical.
Tune in to learn even more about dysgraphia, and the results of a 6-week handwriting club focused on visual perception, visual motor, and memory with limited pencil use.
Tune in to learn the following objectives:
Learners will identify the different tiers and types of dysgraphia
Learners will identify the different types of bilateral integration
Learners will identify two-minute interventions that address the core components of writing
Guest Bio
Cheri Dotterer, OTR/L
Cheri is an international speaker, author, and consultant who trains adults to shift their mindsets about struggling writers to strengthen the social-emotional well-being of people with dysgraphia so they can fully engage in life activities and unleash their potential to change their future and other generations through the written word. She has been an occupational therapist for 25 years.
Her book, Handwriting Brain-Body DisConnect, has remained in the Top 100 on Amazon since publication in Handwriting Reference and Learning Disabilities. It was also a Top 10 Finalist in the Author Academy Awards in 2019. In addition, she was nominated for the USA 2022 Dysgraphia Expert of the Year by Global Health and Pharma Magazine.
Quotes
“Kids don't understand those symbols. And that's part of what we can do and help, as occupational therapists, is we can help them with understanding the overall concept, and how it applies to life” Cheri Dotterer, MS, OTR/L
“Dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity, and spelling” Cheri Dotterer, MS, OTR/L
“Did they effectively get enough background in their education to understand the language…reading is truly a sensory process with a little bit of ocular motor going on”
Cheri Dotterer, MS, OTR/L
“We can help instruct the teacher or the aides on how to provide the student with the just right challenge and let them problem solve during their assignments, as opposed to giving them the answer or writing it down so that they're copying” Jayson Davies, MA, OTR/L
“Visual perception, visual motor, and memory, because those are the big three core components of writing that are the foundation; if we don't have those foundations, language and cognition aren't really going to effectively integrate” Cheri Dotterer, MS, OTR/L
Resources:
Math Dys-Connected - available soon
Episode Transcript
Expand to view the full episode transcript.
Cheri Dotterer
But according to the DSM five, dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity and spelling.
Jayson Davies
So no motor component.
Cheri Dotterer
There is absolutely no motor component in the definition,
Jayson Davies
hey there, and welcome to the otschoolhouse com podcast. If you have listened to a good number of the otschoolhouse com podcast episodes, you may have recognized that voice that you just heard. That is Sherry, daughter, occupational therapist and author of the book, handwriting, brain, body, disconnect, Sherry has actually been on the otschoolhouse podcast before she was on episode 31 where she really introduced us to dysgraphia. Now she's returning to the podcast to provide some updates on dysgraphia, including that definition from the DSM five on dysgraphia, in addition to talking a little bit about dysgraphia, yeah, I know I can't say that word enough times in this introduction, we're also going to talk a little bit about bilateral integration, and she's also going to share with us some two minute activities that you can either do yourself with students or provide to teachers to support students who might have difficulties with handwriting. So let's go ahead, let's Cue the intro music, and when we come back, we are going to welcome back to the otschoolhouse com podcast, Cheri Dotterer.
Amazing Narrator
hello and welcome to the otschoolhouse Comcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Cheri, welcome back to the otschoolhouse com podcast. How are you doing today?
Cheri Dotterer
Oh my gosh, Jayson, it's so good to be here. I cannot believe it's been so long since we've actually gotten to talk in person.
Jayson Davies
Yeah. I mean, well, I still don't think we've actually met in person. Now we've met on zoom so many times, but, like, it's crazy, right? We used to say, Oh, I met you in person, and that actually meant, like, at a conference or something, and now it's like, I met you in person on Zoom. It's funny.
Cheri Dotterer
Correct, I don't think that we've ever physically shaken hands.
Jayson Davies
Yeah, one day, one day it'll happen. But yeah, it's been three years since our last podcast conversation. Of course, we've talked since then, but three years, yeah.
Cheri Dotterer
That's really hard to believe.
Jayson Davies
Yeah. In fact, you had a big thing three years ago. You launched your book, and that's kind of part of what we talked about on that podcast. So how's that going?
Cheri Dotterer
It's still going. It has remained in the top 100 on learning disabilities and handwriting reference with the Kindle version ever since it was published, which still blows my mind to this day, that it's still it. I mean, yes, it has fluctuated up and down a little bit, but it is still out there and selling all over the world.
Jayson Davies
That's awesome. And for anyone listening out there, that book is titled handwriting, brain, body, disconnect, adaptive teaching techniques to unlock a child's dysgraphia for the classroom and at home. You know what we're talking about, dysgraphia. In a way, we're kind of doing an update from three years ago with this podcast. So really quickly, why don't you just give us a quick synopsis of what your intention or what your goal was with that book?
Cheri Dotterer
Well, when I was publishing or and looking and doing my research, I was like, there's nothing out here. There's nothing. Nobody knows anything about dysgraphia. A lot of people thought ADHD symptoms and dysgraphia were the same thing. A lot of people thought that dyslexia and dysgraphia were the same thing. And really they're they're not. Here I am switching slides so that I have the the one in front of me that I want to have, but, yeah, it's been very interesting over the years. So that was like the very beginning, basically creating a textbook for anybody who wanted to learn anything about dysgraphia. And since then, I've actually submitted manuscripts for three books this year. Oh, wow. It has been a very, very busy writing year. The Chinese University of Hong Kong is putting out a handwriting book for spelling practice. Okay, I'm messing up the name totally, but they're putting out a book on on handwriting, and I know it has to go to the publisher by the first of December, so it's getting close to that next stage of completion. I asked them recently if they had a an image for the book cover, and. And they are working on that till the end of the month, so they couldn't give it to me yet, but next year 2023 it should be out. Also that was one, is that the full book, or a chapter in the book, or I contributed to a chapter in a book? Oh, awesome. Yeah. And the textbook with for the universities, I was totally blown away when that one came through. Yeah. Number two is, I am co writing a book with Jon Elise zupanzik. Jonna Lee zapanzik is a spunky little and I say spunky and I say little spunky little a math teacher who thinks in math bigger than the procedures that you do in school math. So she really is found several what she calls a reference tasks that help kids from kindergarten through 12th grade, and you can see the progression of math along the way when you're looking at what she's doing. But she came to me and asked me if I could put in help her understand the neurology. And next thing we know, we're co writing a book, and it's gonna be really amazing, because we didn't just write a book that like a textbook, like I did the first time. We are writing a story, and we are taking scenarios from different kids that we now and we're incorporating them into this story that we have designed about a seventh grade classroom and why these kids are struggling in seventh grade, and what we could have done in kindergarten and first grade and second grade to help them along. And it's not just the math that's the issue. It's the writing part. They don't know what symbols are, so one of their biggest things is pattern recognition. And that brings me to one of the things that about the future is in january 2023 so if anybody's listening to this, like right when it comes out, look for a five day challenge that she and I are going to do in January, that really we're going to focus on pattern recognition and then how it relates to number sense. Have you ever heard of number sense before Jayson?
Jayson Davies
I've heard of number sentences, but not number sense. No.
Cheri Dotterer
number sense is just really understanding how one number relates to another. Is four greater or less than five, is negative four greater or less than negative five.
Jayson Davies
So now we're talking about those Pac Man symbols, what I always call the greater than and less than Pac Man symbols. That's how I remember them.
Cheri Dotterer
There you go. There you go. But one of the things that that I realized by having conversations with her, is kids don't understand those symbols, and that's part of what we can do and help As occupational therapists, is we can help them with understanding the overall concept and how it applies to life. So the lot of the what I've contributed to this book has been, what is the neuroscience like? What's happening in the brain and how does it apply to everyday tasks, beyond just being able to do math problems, and we have designed a whole bunch of what she calls quick dots. She created the idea I've just, I'm just have been applying it to what I'm teaching. And quick dots are really one of those things that's going to make or break a kid's understanding of the concepts, concepts of math. So yeah, look for math disconnected next year, and look for the five day challenge on math disconnected coming in January.
Jayson Davies
That sounds great. I'm definitely we're gonna have to get a link from you so that we can add those to the show notes. That would be when it's available. Awesome. And then I think that was book number two. You said you had one more, or was that it?
Cheri Dotterer
Oh, okay, yes, you're right. I did forget book number three. So book number three is called Becoming you, how to dream, achieve. I'm missing one, okay, basically becoming you and basically so what I did was I I wrote my backstory from back in 2015 before I ever published handwriting. Brain, body disconnect when I was contemplating suicide, which you may not have even known, that I was contemplating suicide, and the thing that stopped me was, Oh, my What if my kids find me and there and from there, finding, trying to find a purpose in life, and that purpose has become being an. Kit for all of the students, no matter what their connections are in the classroom, what are they with special ed? Do they have a label? Do they not have a label? How can I help all students in the classroom as an occupational therapist and help them become leaders, that they unleash that leadership potential inside them so that they can belong no matter where they are in life.
Jayson Davies
Wow. Well, I two things that I want to say that is a I'm glad that you are here and we are having this conversation today. And secondly, I don't want to get into it, but I have had similar experiences and similar family connections. I guess you could call it that. That was my processing as well. You know, What would other people think? And that has definitely guided my career, my life, the way that I act, the way that I see people, view people, treat people, interact with every single person and so, yeah, thank you for sharing that. I appreciate it.
Cheri Dotterer
Hey, you're welcome. So anybody who out there that is an occupational therapist and you're feeling defeated, you're feeling like you're alone, you're not you're not alone. There is more to my story. There is more to Jason's story. Obviously, we both have some kind of mental health, emotional connection that we didn't even know about until this very moment.
Jayson Davies
Seriously, we can't plan that. That is not something we planned at all. It's yeah, yeah, so, but that is great that you have have taken your life experience now and have figured out a way to to support others through a book, and to just just use a difficult time in your life now to turn that around and to help not only yourself, but to help others. So that's fantastic, cool. So we'll have to, we'll have to keep a lookout for those, all three of those books, and yeah, we'll figure out how to link or all that in the show notes. So if you're listening and you want to learn more about those, check out the show notes.
Cheri Dotterer
I may not have the information by the time this episode releases. You may have to back up add more information at a later date when I find out more information about them, but as soon as that information becomes available, I will pass it on.
Jayson Davies
Stay tuned for Episode 100 and we'll call it 35 of the otschoolhouse podcast. Be back on to talk about more. Anyways, so I want to take a step back to that second book, because what I heard a lot that was the one where you're talking about how you're working with Jan. I think it was on math, then that's going to be interesting. And that kind of leads into what I want to talk about more in this podcast episode, the different types of dysgraphia. I think you and your book mentioned three different types of dysgraphia, and then also I couldn't help but think to myself, you didn't say the term, but just calcula, and how it kind of is working into that way. So before we dive into dyscalcula, why don't we just do a quick review of your working definition of dysgraphia? For those who you interact with.
Cheri Dotterer
Yes, when I was writing the book, I had a difficult time finding a concrete definition of what dysgraphia was. I finally found it when I looked at the DSM five. DSM five, I don't think it. I think it was being published around the same time I published so I did not have access to it. So this definition is not in the book directly, but I talk about it every time I talk to anybody about what dysgraphia is, and when I read this definition to you about what it is and then what it is not, you're going to say, Wait a minute. I thought it was something else, believe me. Okay, so according to the DSM five, dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity and spelling.
Jayson Davies
So no motor component.
Cheri Dotterer
There is absolutely no motor component in the definition. Now they do qualify all of the specific learning disabilities, which is the dyslexia, dyscalculia and dysgraphia, as part of it is when the activity demands exceed the student's capacity and there's an interference with activities of daily living. Still, does it say directly that there's a motor
Jayson Davies
problem? No, not at all. I mean, it does allude to that maybe a motor problem could be what is preventing the person from doing those concepts. But, yes, not a motor problem.
Cheri Dotterer
So this is what it says, that it is not okay, intellectual disability, right? A visual or auditory disability, mental health disorder, neurological disorder or psychological disorder. Interesting, okay, it also qualifies that at this. And it kind of like goes through that with and this is kind of like that combination of all three as well, a lack of proficiency in language skills and inadequate instruction. Now, I know you've told me that your wife is a principal, so we have had this last two years of chaos with education. So all of these kids that may be getting referred to occupational therapy for handwriting issues that lack of proficiency and motor skills and inadequate instruction are part of this definition. So we've got to really watch right now what we are classifying our writing errors in.
Jayson Davies
Expand on that.
Cheri Dotterer
So because we have had this these last two years where we basically been doing education by fire, we have this true understanding that maybe over the last two years, kids do not get educated the way that they would have liked to have been educated, correct? Not the kids themselves, but us as adults. So we really do need to keep that in mind as we are looking at these kids. Did they effectively get enough background in education, in their education to understand the language?
Jayson Davies
Okay, So, so we are saying, potentially, that kids are having difficulty with handwriting due to the lack of the lack of experience, the lack of exposure to written language. And I know some people will also argue that, and it probably is true that written oral language has a direct effect on written language. And so the lack of oral language, also within the pandemic time, could also potentially be impacting written language.
Cheri Dotterer
That is correct. And one of the things that I share with people is when I really look at the definition of reading in the DSM five, I look at the definition of written expression, and I look at the definition of math, one of the things that that I had this aha moment over the last couple years, and I believe it was, since the book was written, is reading is truly a sensory process with a little bit of ocular motor going on, but it really is when you're taking in the information in it is really that's the part of the process when we are actually doing that mental interpretation, and We need to feed something back out with reading fluency or reading comprehension that's actually either written expression or oral expression, and each one of those is a different neurological process. And my theory was confirmed by a research project done by Karen James back in 2017 and she shares in one of her articles this picture of the rain that has circles on it, and by different colors, one of them being reading, one of them being letter recognition and word recognition, and the third One is written expression. And although they are close, none of those dots overlap totally. It's more like a Venn diagram in every section of the brain. So every reading, each oral process, each written process, and every type of written process, whether it's an iPhone, Android, a tablet, a laptop, a computer, whatever it is, everything is a different neurological process. Your brain needs to create a new pathway every time you learn something new, like that. And the brain likes to learn things new, but it also likes to problem solve that's its main job. So keeping that idea of being able to problem solve things and not answer the questions for the kids is really one thing that'll help them with that proficiency in language skills and getting over the inadequate instruction pieces giving them creativity time.
Jayson Davies
Yeah, yeah. And I think that that piece, what you just talked about, is something that OTS can can do on behalf of a child. Oftentimes, we don't know what to do for students who are on consults, who have who have handwriting difficulties, um. That's something that we can do. We can help instruct the teacher or the aides on how to provide the student with the just right challenge and let them problem solve during their assignments, as opposed to giving them the answer or writing it down so that they're copying, which is obviously very different from coming up with your own words and whatnot. So, yeah, great, great strategy and idea there, awesome. Love it.
Cheri Dotterer
So one of the things that I've been working on is, like, I said, How to impact all the kids in the classroom. And one of the things that I tried, and this was, like, right before covid hit, it was after the book was written a while. I was out for a while, and I was working with a teacher in a public school building first grade, and it was amazing we even got this in. It blows my mind to this day that we even got this in before covid hit. But we were working with like we tried, we tried a handwriting club, but my goal was to teach her how to do handwriting club. So I was there more like the consultant, but one of the things that I did about handwriting club that may not be available for all OTs, but I encourage you to work on trying to get the education. And the collaboration with your teaching staff is we did a five day a week handwriting club in the morning before school started, and we only touched a pencil on day one and day 30, and we did it for six weeks. Oh, wow. So we were doing all kinds of activities that would support it. The big kickback I was getting was, well, we don't have 20 minutes every day. How can we do this? So I've been working on how to pare that down to an amount of time that's effective for the students that the teachers will like and then that they can manage. And I've actually gotten it down to two minute interventions. So I've been working on a process that cycles visual perception, visual motor and memory, because those are the big three core components of writing that are the foundation. If we don't have those Foundation, language and cognition aren't really going to effectively integrate, if that makes sense. So working on cycling, visual perception, visual motor and memory strategies over a 15 day period, and then recycle again, recycle again and recycle again. It's improving kids ability to engage in learning no matter what the topic is. They're getting better at math. They're getting better at writing. They're getting better at reading. I I had, don't have it published, because I don't have that capability right at this very moment. But it's out there and it's working. And what my focus is for 2023 is to educate as many teachers as I can on these two minute interventions. So I'm doing my own five day challenges in 2023 to help promote these two minute interventions that we are also going to incorporate a little bit into the math book as well.
Jayson Davies
Gotcha, that's great, yeah. And you're right, teachers. I always say, you know, we can't give teachers more work. We need to give them less work. And so if you can, anytime, you can turn a 20 minute lesson into a two minute lesson, they are going to love you, and especially because if it's two minutes, right, you can effectively train them. I mean, you said it's 15 lessons, right? So.
Cheri Dotterer
15 sessions, the kind of 15 sessions and encompassing all the components that impact handwriting and writing skills. So it's not all aspects of visual perception, it's not all aspects of motor function. It's those ones that really are going to target the writing skills and using worksheets and and that kind of activity in general, and school activities, learning, academic, academic in nature. And you can use these activities before social studies, before art, before music, before science, before math, before English, language arts and whatever else that I'm missing.
Jayson Davies
they can be used as transitions. And that's the simple thing.
Cheri Dotterer
Yep. I call them para moments. You have paraprofessionals. Well, those transition times between when. Transition time was really happening, and that moment before academic really begins, that para moment that right there, okay, I call these para moment interventions.
Jayson Davies
I like it. I like it. That works so, but it's, I mean, it's advanced, right? It's something that you have created, but at the same time you are making it very simple for the teachers. And if it's only you know, 15 or so two minute activities, it shouldn't take you too long to train the teachers in this or the paraprofessionals in this. Yeah, it might take you a little bit longer to train the science behind it, a little bit. But if the activities themselves isn't something that's daunting for for a teacher, love it.
Cheri Dotterer
and I've created several courses, trying not to put it all in one course, but I've created several courses that concentrate, one on the neuroscience, one on the interventions, one on the outcome, because I've also been looking at progress monitoring for these interventions and how to make it simple and easy for them. So I've been also working on evaluation, intervention and outcome, and trying to really delineate them as I am moving forward. So all of my course work is in my podcast community called the writing glitch.
Jayson Davies
Yep, and I'm a part of that, one of the one, one part of that. So yeah, that's we'll be sure to link to that as well. I want to ask you, though you have about 15 of these different activities, would you mind sharing just one or two?
Cheri Dotterer
I will do that. So one of the things that I have really been looking at is bilateral integration activities. And one of my first clients as an OT teaching OTS about handwriting and I were talking one day, and she was saying they were trying to do some different things with bilateral integration. And we started really getting into this. And then I started using the activities myself and sharing with other OTs, and we I had this oh my gosh moment one day, and I realized there's three types of bilateral integration. Are you interested in learning what they are?
Jayson Davies
Absolutely always more information the better.
Cheri Dotterer
Okay, so first one is asymmetrical bilateral integration. Okay, but let's break it down. Let's see if you can figure out what I mean by asymmetrical bilateral integration.
Jayson Davies
I'm assuming that it's more impacting one side of the body. That's what I'm thinking.
Cheri Dotterer
Good guess it's more like the pencils in one hand. The Helper hand is helping that. So you're not doing the same activity, yeah. Okay, so you're not doing the exact same activity, but both hands are necessary to get the task done.
Jayson Davies
Gotcha? Okay? So the hands are both at work, but doing different things.
Cheri Dotterer
Correct. Okay, then we have symmetrical so they're doing the same thing, but they're not doing it together. They're doing it together, but they're not doing it together, so it's kind of like a parallel activity. So the one that I like to use to demonstrate it is a lazy eight. Do you know how in the brain gym, they have you doing the lazy eight, where you have both hands out. I hope I don't hit the mic while I'm demonstrating this, we are doing a video so he can see me. Okay, so we're going like this with the lazy eight, where you're crossing midline, but you're crossing at that center point.
Jayson Davies
Your hands are moving together.
Cheri Dotterer
They're parallel. They're doing the same activity, but they're still separate. Okay, okay, then we have interlaced bilateral integration, so we can't just interlace our hands any old way, because we want to really enforce the writing down the road. So when we're interlacing our hands, we have our palms away from us. We're putting one hand behind the other, and then that you're both of your palms are facing away from you. Okay, and then the activity is they're doing the exact same thing at the exact same time. What's that doing? It's forcing both hemispheres and the corpus callosum to all interact together. So we are reinforcing the creativity pieces of the right brain, where encouraging the logic pieces of the left brain, and we are forcing multiple interconnections over the corpus callosum, and we're interacting with all parts of the brain at the same time. And kids are. Remembering it better. So what we're doing with the interlaced, bilateral negation integration is we're airwriting. So I don't know if I'm going to be able to do this and not hit the microphone, but with the interlaced I will have kids do full arm movements, the arms are going up over the head, and then I have them do vertical figure eight, because the figure eight being the hardest of all the numbers to write. And actually number eight, from a number sense perspective, is actually the hardest number to understand. So developmentally, because it's got two diagonals in it, you know, it like hits all of these hardest parts. So the number eight is the one that I like to target when I'm instructing people on this. Yeah, and if you can just sit back for a moment from your microphone and do a vertical eight with your interlaced hands, and then give me some feedback as to what you feel about happen, what's happening to your body.
Jayson Davies
I will say, I guess I have to get back closer to the microphone. I will say that it was a little actually tricky to get started. Once I got started, it was okay, but like, you know, you're used to writing an eight with a pencil. I'm not used to writing an eight air writing. I haven't done it in a long time. And so just like getting started was a little tricky, but once I did get going, it was, it was pretty smooth. You do feel both of your arms, right are? You're moving your arms together. My hands are inner lace, like I'm holding my own hands, as you mentioned earlier. So you do feel your entire both shoulders, both elbows, both arms completely engaged.
Cheri Dotterer
And it's forcing your pelvis to oblique as well, because you're having to force one side of the body to the other. So you're forcing your entire verti, your entire vertebrae, to shift so your hips are actually doing a left right oblique, yeah, yeah, as you're as you're going through it. So it really is also helping core strength. There you go. It's how it's helping visual perception, it's helping visual motor, it's helping memory.
Jayson Davies
All right, And you're hitting those three key areas that you were talking about,
Cheri Dotterer
and you just did that in less than two minutes.
Jayson Davies
Absolutely and and got the science behind it in about five minutes. All right, awesome.
Cheri Dotterer
So we're So thinking back to that handwriting program that I did that was one of the activities that we were doing as we were airwriting with the kids with the interlaced bilateral integration. And one of the kids in the classroom happens to be like my love at this point, because he just transformed so much. He was on the OT evaluation list. And like you, you've got to get this kid done like, ASAP, and we let's put him in handwriting club and see how he does. He was removed because his handwriting ended up better than all the kids in the class. Oh, wow, in six weeks.
Jayson Davies
Wow. And that's without using a pencil really like.
Cheri Dotterer
And that's only doing a pencil the first day to do a handwriting screening and went on the last day to compare them. Wow, that's amazing. So we were doing so the bilateral integration was one of the things that we were doing. Yes, we were there for 20 minutes. We were doing some other activities that were improving core strength, visual visual perception, visual motor and memory and but the thing that really made the difference for him, he said it, he's like this, doing with my hands together made a difference.
Jayson Davies
Wow. So when can we expect this professional development course to be ready?
Cheri Dotterer
It's already it's already there. It is the premier level of my handwriting community. So the writing glitch community, the amethyst plan is where you can get everything.
Jayson Davies
Oh, wow. Okay, very cool. And again, we'll link to.
Cheri Dotterer
We are. We are only going to as of 2023, we're only going to have one plan, one tier inside the community. So everything, there's some things that are separated. Right now we're going to move everything together. And by 2023 everything's going to be in one place. So if you want to learn just a little bit, you can take that particular program. If it if you want to learn more, you'll have a different things. If you want to get certified in my my program after a year, we have mastermind meetings once a month. You can get certified as a K to five dysgraphia specialist.
Jayson Davies
Oh, wow. Okay, very cool. So the three types of bilateral integration. Let me re make sure I have them all right, and so everyone else has a little recap. We have the integrated, right or interlaced, interlaced, interlaced. And then we have, gosh, my mom, my mind wants to use asynchronous and synchronous. And I know that's not the it's the where your hands are doing.
Cheri Dotterer
Think about the symmetric.
Jayson Davies
There we go. Tonic neck reflex. It was one of those ones that has an A in front of the word and then it's the rest of the word together. All right. So asymmetrical, symmetrical and interlaced. Integration, bilateral integration. Awesome. Thanks for sharing that, and I'm looking forward to it to more and more work on that from you in the future. All right, so those are the bilateral integration. They directly. They're different from dysgraphia, correct me, if I'm wrong, but they have an impact on a student who may display dysgraphia, correct. Okay, correct. So let's take a step back, because you mentioned earlier the DSM five definition, what it is and what is not. And we got distracted, but we are moving toward the three different types of dysgraphia, at least a little overview of them, because I think you mentioned them. We went over those pretty heavily in Episode 31 of the podcast. But how has what you've learned from the DSM five. Has it strengthened your three different types of dysgraphia, or has it blown it out of the water? Has it, what has that done for you in better understanding dysgraphia?
Cheri Dotterer
Just to recap the types of dysgraphia, or according to the International Dyslexia Association, are visual, spatial, motor and dyslexic, dyslexic dysgraphia is a difficulty with spelling. Okay, so if you look at the definition from Ida, and you look at the definition from DSM five, DSM five gets a little bit more detailed. I mean, it talking. It includes all types of language, not just spelling. Okay, so we have that sort of a disconnect between one versus the other. In my book, I talk about the types of dysgraphia, what I really needed to do with is clarify that these are intervention types of dysgraphia. These are not types of dysgraphia, really, as far as what Ida is is looking at and distinguishing these are really to help drive intervention. There's three tiers and six types. The bottom tier is the tier that I've been talking about this whole time, visual, spatial, motor and memory. The second tier is language based, and that's spelling and sentences. So syntax and all the the things that you need to create a sentence, the grammar, the punctuation, the capitalization, the top tier is cognitive, and that's paragraph.
Jayson Davies
okay, So it's kind of, it's a higher hierarchy of things, in a way, right? You have your your bottom level is the the skills that you need. The second part is the sentences and spelling a little bit higher. And then you get to the highest realm of what you want to call it, paragraphs and putting things together.
Cheri Dotterer
So if we don't have those foundations, we are not going to be able to be creative, to create narratives, expository writings, technical writing, or anything of those kind of natures, or we will, or we might learn one and not be able to engage in all of them. So as an adult, you might have these Splinter skills in writing, where you can write in your lane, but you get outside your lane and it's nothing happening.
Jayson Davies
Yeah. All right, cool. Thank you for that.
Cheri Dotterer
Sure. And can I just say that there are two people that I know of that were like that, that are very famous. One of them was Einstein. If you got Einstein outside of his wheel horse of knowledge, he had trouble with writing. He had and so did Thomas Edison. They both had scribes. And would you like to know the name of Thomas Edison? Scribe?
Jayson Davies
Uh, yes, but I wanted to try. What did they have the last name daughter?
Cheri Dotterer
No.
Jayson Davies
Oh, darn.
Cheri Dotterer
Good try, good try. No. It was Henry Ford before he broke away and created his own company.
Jayson Davies
Interesting,all right, from electricity, right? You said, Edison, right?
Cheri Dotterer
Thomas Edison, the light bulb.
Jayson Davies
Uh huh. And then two. Creating cars. Yeah, electricity is kind of important in cars, so I guess it makes sense. He had the knowledge from scribing for Edison and use some of that knowledge to develop a car. Cool. So, all right, so we've talked about bilateral integration, those types. We've talked about just graphy a little bit. Now, you know, I do want to everyone listening. Everyone wants to hear some practical stuff. And so just a little bit as far as when it comes to evaluations, you know, you get a student, and the first thing you see on that referral or something, as you're looking at their background, you see the term dysgraphia pop up, or maybe you just see the term difficulty with handwriting. Do you recommend any specific tools that a therapist should use during that evaluation? Any any recommendations for an evaluation?
Cheri Dotterer
Can I recommend the one that Nia should never use when you evaluate, that you should use, never use when you're evaluating handwriting, and that is the berry BMI. Okay, the berry BMI was not designed to be a handwriting assessment. It was designed for other reasons, and they have proven in a research study in 2015 that the berry is not correlating to handwriting improvement.
Jayson Davies
Okay. And the VMI, it looks at visual motor. There's three different areas. A lot of times, people only do two of them, right? You have the motor coordination, the visual perception, and then I'm blanking on what the actual name of the third one is where you're actually drawing within the lines. It's it's integration, visual integration, visual motor integration. I think that's actually the VMI part anyways. So those three parts. Now I do want to kind of push back just a little bit, because I understand that you mentioned just a moment ago, though, that visual perception, memory and was the third component, motor, motor. So how does that differ from the VMI, which looks at coordination, integration and perception, those it looks at similar things. So why doesn't it add up to handwriting?
Cheri Dotterer
When you compare the research study that I read when they compared the VMI from beginning to end of of 40 sessions of of handwriting instruction, they also did the test of handwriting skills, and they did the Minnesota assessment of writing okay, I might have that Minnesota writing assessment might be the right way to say that when they did a comparison and they looked at the results, the VMI did not reflect the handwriting improvement. And in their literature, there was three other articles that indicated that the correlation between writing and the VMI were not related. So there was four articles that total that are relating that so I've had a difficult time with the VMI. I never actually found it beneficial to help me with using it, so I use the dvpt, the developmental test of visual perception instead.
Jayson Davies
Yeah. And so I think what that research also kind of showed us is that, not necessarily that trying to get all three of them right again, motor visual perception and visual motor integration, not that those don't impact handwriting, but you don't necessarily see an improvement on The VMI if you work on improving handwriting. So, yeah, so visual perceptual skills, visual motor skills and motor skills, all those combined would have an impact on handwriting, but it doesn't necessarily mean that if you focus on handwriting, VMI scores are going to go up. So in that sense, we should not use a VMI from three years ago. Use it in our try and say, hey, look, they didn't make progress on the VMI. That doesn't mean that their handwriting didn't improve. So we should still do something like the ths, another handwriting assessment to compare handwriting to handwriting, as opposed to compare VMI to VMI.
Cheri Dotterer
Correct, The only handwriting assessment that I know of that's out there that has norms to it is the ths. The other ones are percentages of correctness, yep. And to my knowledge, they aren't finished with their research to have norms.
Jayson Davies
Yeah, that's that's what I have found as well. So that lines up with what I know to. So the ths. And to be honest, it's actually called the thsr. I know we all call the ths, but it's the ths revised. And, yeah, we'll link to that in the showness as well, so that if anyone's interested in learning more about the ths, to be honest, it's, it's so simple. I mean, you're just asking the student to to write letters, write the alphabet, copy a few words, or copy a few sentences and words, but yeah, it is, as far as I know, the only one that's standardized. So thank you for mentioning that.
Cheri Dotterer
that. Sure. And one thing about the thsr is that they're doing it without lines on the page. So it's very interesting when then you go back and you compare with them using lines on the page, and how they that compares to their understanding of the letter.
Jayson Davies
Yeah, yeah. And No, the one thing that I was always frustrated by the thsr was that it didn't have the lines. And so you're getting the standardized aspect of it, because, again, you're right. You're getting the standardized they're comparing whatever the results of your student compared to the numbers of other students. But at the same time, when we look at most work in the classroom, they have lines. So I will sit there in an IEP, and I'll say, look, standardized. The kids scored here on the ths, but there are no lines. So let's look at a piece of work from the student's classroom where they actually had lines. And then, of course, you have to talk about, okay, well, what about, you know, the worksheets that give you writing bubbles that don't have lines? Well, let's talk about that. You know, we can either put in accommodations potentially, there are other ways to go about that. It's hard. And I bring this up because when you do an evaluation like we want to just do one thing right? We want to just do the ths and and give our all of our results from the ths, but we need to be doing those observations to see what's actually happening in the classroom. And for those of you who don't have the pleasure of seeing us, Sherry just gave me a very, very exaggerated shaking of her head, no, so I'm going to let her add some clarity.
Cheri Dotterer
So one of the other things that I have done in my education process is got certified as an educational advocate. One of the things when I learned about in my educational advocacy school was that you need to do two assessments to really have a solid foundation. So in theory, that means that you should really do the sensory profile and the sensory processing measure and compare the two to get an idea of what their sensory processing is really like.
Jayson Davies
Yeah, and you say that you need to do at least two and to add on to that, that's why it's so important to know what the concern is, because you specifically mentioned two related to handwriting. Now, if there's a concern in another area, the ths doesn't look at the concern in other areas, it only looks at handwriting. So maybe you do need to do one or two more assessments if there's another area of difficulty. And I'm not trying to give everyone more work, I'm just trying to call it like what it really is. You know, we need to, we need to make sure that we are assessing the the difficulties or the need, and we can't just do the bot and say that we assessed handwriting, because there is no handwriting component to the bot. So yeah.
Cheri Dotterer
Yeah. So one of the things that you mentioned in that you do the ths and it doesn't hit all the concerns. There are some things that we can do that aren't formally assessed, but there are some norms out there for things. One of the things that really impacts handwriting, that people don't always think about are those primitive reflexes, okay, doing supine flexion and prone extension, like Superman and in turtle, doing an atnr assessment, doing an stnr assessment, doing a spinal gallon and a spinal pareese assessment are so crucial to understanding why a kid is having struggle sitting in their chair. If they can't sit in their chair, they're not going to be able to write. So even getting a little bit more granular with what I've learned about the writing is the primitive reflexes are a huge need that not everybody gets to assess. But you have also mentioned, I don't about spending more time. I want to flip that and say, if you don't do a comprehensive evaluation, you could get yourself into a situation where you've got an independent educational evaluator coming in and superseding your evaluation avoid that long term headache of having to go back and redo and redo and redo because. If you do it right, the first time, you won't have to. You'll save the kid, the parent, the teachers and the whole team a whole lot of headache
Jayson Davies
Yeah, and sometimes we have to explain that to our bosses, because they don't understand that. And it's hard, because our bosses do see they think in large numbers, right? And they think that if we do 1000 evaluations this year, and one student comes back with an IEE because of what an OT did, they see that as actually cost effective, because the other 999 students didn't necessarily need an IEE. So even though the evaluations that you didn't do maybe didn't warrant an IEE. You still need to at the end of the day, you need to best. You need to know that you did a good evaluation. And so I would if you have any evaluation, or, sorry, not an evaluator, if you have a boss at a whatever their position might be director, coordinator, who's telling you you need to speed up your evaluations. You know I would, I would just recommend that you push back a little bit and then, of course, a nice way, a polite way, and over time. It may not happen overnight, but I would definitely argue that we need to get the time that we need to complete a solid evaluation. We don't want IEE is we want to be effective. We want to be time efficient, but all that needs to be weighed out on making sure we have a good evaluation.
Cheri Dotterer
I have a list of a comprehensive ot evaluation on my website, in my Frequently Asked Questions page, that if anybody wants to really get an idea of where my brain is going with what a complete evaluation is, you can check out that page on my website.
Jayson Davies
Cool. We'll be sure to link to that as well. Awesome. Thanks for all the resources. All right, so let's move on here. We passed the evaluation. Now, you know, we could talk a lot about different interventions. I just want to ask you a few I few concepts ideas, and one that often comes up, and I get asked this question a lot, and I have my own response, and I think our responses might kind of align here a little bit, but at what time do we stop working on handwriting? Or how do we know when it's time to move on to typing? Same type of question that I often get, what are your thoughts?
Cheri Dotterer
Never stop working on handwriting. Yes, you can pull in assistive technology, but always find a way to incorporate some kind of handwriting into your work. So what that looks like sometimes is they copy or, okay, let me step back so they type what they need to, or they speak speech to text what they need to using whatever system technologies that they need to use. And then they take something that they've already completed that looks neat, that's has the capitalization, the punctuation, all the correct spellings and stuff like that, and that is what you practice typing on. So it's not something that they have to get done because they have to get it done for school. But if this teacher may not really want it in the typewritten form for the class, maybe it needs to be handwritten onto whatever it is. So utilizing the assistive technologies to do the first draft, fix it up, and then doing maybe final copy as a copy to whatever it is that they need to put it on. That's my way of of addressing that, that issue. Now it may be that it still takes a long time to do the copy. So you only might. You might only be copying one or two sentences, because it taking them 10 or 15 minutes to do that much work, but still do both.
Jayson Davies
Okay, yeah. And, I mean, I think, similar to you, I don't think that we should ever expect our students to not make progress on handwriting. You know, a lot of times people will ask, you know, at what age will kids stop learning to hand write? And when someone asks me that, like, I kind of, you know, not being devil's advocate, but kind of just thinking about other ways, it's like, okay, well, at what age will I stop being able to learn how to drive? At what age will I stop being able to learn how to use a computer? I'm a terrible typer. I know that I could learn how to be a better typer if I put effort into it, but I haven't taken that initiative to be a better typer. I don't go on typing.com every day in practice. So I hate, I very just very much dislike that question about like, at what age should we not. Expect a child to learn handwriting anymore. I don't think there is an age. I think that there are different ways to address handwriting, and that might change over time. You know, at a certain time, maybe we need to move from a therapeutic role of providing that handwriting, therapy for handwriting, into more of a consultative role, where we are teaching the teacher or the parent how to potentially work on handwriting, because they can do it for 10 minutes every day, where I can only do it for 30 minutes once a week, but we can still work on it. Does that make sense?
Cheri Dotterer
Oh, yes, absolutely. I'm totally with you.
Jayson Davies
Okay. And then a follow up question to this, a little bit, I think, is, and maybe I just answered that question on accident, but how do you tackle working with an older student as opposed to a younger student when it comes to handwriting and dysgraphia, or is it the same?
Cheri Dotterer
I like the phone. The phone has voice to text that is pretty well integrated into society these days. It's not like it was 20 years ago. So I use the phone a lot when I'm working with anybody who's in third grade or above. We will have discussions, and I will use some of the interventions, strategies that I'm teaching in my courses. I use images for writing prompts. I get their perspective. I'm recording the entire conversation so it might be a picture of bubbles in the foreground and something in the background. One of the images that I do have is bubbles in the front and trees in the back. And it's a campground, okay? And I asked the kids four questions in a statement. The four questions are, what do you see? What do you notice? How does it make you feel? What questions can you come up with to talk about this picture? And then I always ask them to tell me more. So that way, while we're recording it, I'm asking them the questions we can use a playback that playback can be copied by you, and then they copy it. That could be, they play and stop, play and stop. So it's a dictated style of regurgitation, up to from text to speech or text to written material. Or it could be they listen to the entire playback and then try to self generate their own new sentence. So there's, I utilize that a lot, depending no matter what the age of the student, I don't usually, well, okay, I really started around third grade, but I really tried to get them to engage in the conversation, and I am finding that images are a really good way to get an idea of what a child's perspective is.
Jayson Davies
Okay, and so that could work, like you said, you know, it could be a younger kid, or it could be maybe change the image, but it could work for a younger student or a potentially older student, similar treatment, similar activity, but it can be slightly modified, of course. Cool. All right. Well, you know what? I think we are going to kind of get toward the end here of wrapping up, you've given us a little bit of info about evaluations, a little bit information about a treatment, working, working with students, young, old, whether or not we're moving toward typing or not. And we also, very graciously, got a lot into your three different types of bilateral integration, as well as dysgraphia. So Sherry, I want to say before we get into this last piece, thank you so much for being here and for joining us and just dropping a lot of information today. And then I also want to give you the chance to share exactly where people can go to learn more about you. You've mentioned a few different things, but if people just to go to one spot, where should they go?
Cheri Dotterer
Cheri dotterer.com. all right, C, H, E R, I, D, O, T, T, E R, E R .com, yes, that's Cheri with a C.
Jayson Davies
Yes. And I have, over the last three years, I have made mistakes on your last name, enough that I no longer make mistakes on your last name. I've got it down. So yes, Sherry, you have made it into you have been ingrained into my brain with your last name and the CH so we are good. Thank you so much for being here. Thank you so much for all the information that you shared. Very valuable. And I can only imagine what, what else we might learn when we head over to the writing glitch community, it's going to be great.
Cheri Dotterer
Thank you. Thank you so much. And there is a link. Get one. cheridotterer.com on how to get to the writing glitch.
Jayson Davies
Awesome, great. Well, we will see you there. Take care. Have a great rest of your day.
Cheri Dotterer
Thanks. You too.
Jayson Davies
All right, that is going to wrap up Episode 114 thank you so much for sticking around with us. Thank you so much to Sherry daughter for coming on and sharing such valuable information. I'm excited for all the books you have coming out. I'm excited for all the all the programming you have coming up in your community. Cannot wait to learn more from you. If you're listening to the podcast right now, I would love for you to hit that subscribe or follow button so you don't miss a future episode and be sure to leave us a review. One star, five stars, anything in between. I would be so tremendously grateful if you leave a quick review. Thank you so much, and we will see you in episode 115, Until then, have a great day.
Amazing Narrator
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