Getting clumsier

[ohsewcrafty]

What is the difference between clumsy and "we should probably look into this?"

My 6 1/2 year old has always been clumsy, but the past few weeks have been absolutely ridiculous. He is covered in bruises from straight up walking or running into things as if they weren't there or falling off of things. Today alone, he walked into a store display, walked into a door jam so hard it left a bruise on his shoulder, then later opened a car door and somehow bumped his head on it.

He's always had ear problems, but not any vestibular problems. He currently has semi-permenant tubes (after 2 sets of regular ones) for chronic ear infections. His hearing is otherwise fine and was tested within the last 6 months.

He's only really gotten his vision checked at the pediatrician because he passes their "what's this letter" vision test. 

His OT has remarked on some body awareness issues and he had gross motor delays in the past (was in PT from about 8 months - 24 months). His fine motor has always been excellent - he could use a fork at 12 months and write legibly by 2, but at 6 1/2 still cannot peddle a bicycle or alternate feet going down stairs.

Any thoughts? Should I look into this more?

[brachysira]

My child is only 4, and last year at this time I got her some OT partly because she was walking into tons of things and partly because she wasn't pedaling a trike or getting dressed herself. I wondered if she had bilateral coordination issues, but OT thought she had visual attention problems. The pedi and her preschool teacher thought it was "spring." I think they were probably right as I'm seeing the same thing this year and last year it improved throughout the summer. Not sure where you live, but we play a lot more wildly once the snow melts and I think their coordination just takes a hit in the winter when they can't be outside all day, and then it improves once they've had a few weeks of good weather. My child is definitely behind so it's not all spring--she's in gymnastics with kids more than a year younger and they improve every week, whereas DD just stays the same, but I guess it's not really a delay as much as lack of gymnastics prowess. Since I'm worried about this too, I'm quite familiar with the milestones, and the stair thing is quite an early one. Peddling is an early skill too, but not balancing, so if he can do a trike but a bike is too hard, that's probably okay. If not pedaling anything, I would look up bilateral coordination and see if there are any other things listed there that your son can't do. They have some exercises to work on this on some sites too, that might help. I would say yes, get an assessment if no pedaling combined with the stairs.

Also, DD had a weird eye bump so now goes to a university optometry place who says she needs glasses but can wait until K, although she always passes the school test. So yes, perhaps a better vision test may be needed, but no one thought my DD's problems were due to her vision issues.

[theycallmemommy]

I would immediately get his eyes checked. The fact that it is getting worse would be a red flag for me. At least it's easy to rule out.

Vision is more than seeing obviously. We didn't suspect it was vision when my ASD son was doing the same stuff-- running into wall edges, bumping his head all the time, scared to climb -- because he was reading before age 3 from books and far away signs without squinting. Vision is very complicated though. It's not just can you see but what are the eyes telling the brain. My son got glasses the month he turned 3 and it was really dramatic. He also did vision therapy a year later for twice a week (4-5 years old) These results are not guaranteed for every child though. His eye doctor said if there wasn't improvement in 6 weeks, they would discontinue the therapy. It was helpful though and we did it for a year.


He is super coordinated with gross motor. Fine motor is still a huge struggle but I blame it on ASD and just keep hope that OT and school will continue to help as well as stuff we practice at home.

Tldr.... get the eyes checked!!

[luvboston]

Eye doctor first
Ear doc next
Then neurologist

[mrsbuttinski]

Given the ASD dx, this is one of those glitches like hypotonia that are characteristic but not part of the diagnostic criteria.

It sounds as if you are seeing 3 classic glitches-

1. The first is related to an issue with crossing the midline of the brain which is impacting his ability to coordinate movements on both sides of his body working together- hence the inability to pedal and descend stairs in a developmentally appropriate manner.

DS was late to be able to do such tasks- pre-dx he didn't learn to pedal until he was about 5- 5 1/2; stairs may have been a little later. He also tended to write/draw on the left side of the paper with his left hand and the right with his right. We never did therapy around this and DS did outgrow (learn to compensate, brain maturity, who knows?) I know other kids who had the benefit of an earlier dx who did PT and OT around this.

Bike riding is a zero-order skill by age 7-8, so that is something into which you may want to look. You want him caught up around this for social reasons.

icanshine.org/

2. The other issue sounds more like a classic case of spatial reasoning, motor planning and perhaps proprioception (knowing where his body is in space) issues.

nspt4kids.com/parenting/what-is-proprioception-and-why-is-it-important/

Normally OTs work on the sensory pieces, sometimes PTs do this as well.

3. Attentional issues are likely in play as well. Often kids with his particular alphabet soup are not as focused as a typical child that age would be with the consequence that he would really stand out. It's probably not that he's clumsier, but that his peers have outgrown the toddler-like bull-in-a-china-shop behavior.

Sometimes treating the impulsivity/inattention/poor executive function of ADHD and/or the anxiety associated with ASD can get them more focused in the moment and improve this situation. It wasn't our intention when we started meds, but things did improve.

In any case, this is something you will want to focus on as he gets older; those who don't improve around these kinds of skills are poor candidates for driving. You may want to hold off on licensing or have him evaluated by a specialist OT when the time comes. I know a couple of teens/young adults on spectrum who don't drive because of this- kids who are very bright otherwise.

I'll be the outlier. Unless he is truly clumsier and not just running into more things than his peers or seemingly so because he's taller and has a greater reach than he did a year ago- I would start with either his dev pedi or even the OT. You may have to find a different OT if this one is not up to standards around sensory processing and motor planning.

I would avoid a neuro at this point unless he already has one on his team who is familiar with the dx.

[akafred]

IDK about a neuro necessarily but I would definitely suggest an eye exam. The pedi office basic test isn't a substitute for a good annual eye exam. The ENT isn't a bad suggestion either; again, easy to rule out, though any physician can probably do the basic checks for fluid etc. Whoever is your ASD primary (dev pedi, probably) would be consulted if it isn't eyes or ears.

[Deleted]

I would also get eyes checked by an eye doctor. My youngest has the pedi's eye chart memorized, so they can't screen her that way anymore.

[ohsewcrafty]

Thank you for all the information!! I'm going to make an appointment to get his eyes checked first - it's an easy thing that should be done anyway. Our entire family on both sides wears glasses for nearsightedness, so I will never be surprised if my kids end up needing glasses regardless.

[ohsewcrafty]

May 1, 2017 5:22:02 GMT -5 mrsbuttinski said:

Given the ASD dx, this is one of those glitches like hypotonia that are characteristic but not part of the diagnostic criteria.

It sounds as if you are seeing 3 classic glitches-

1. The first is related to an issue with crossing the midline of the brain which is impacting his ability to coordinate movements on both sides of his body working together- hence the inability to pedal and descend stairs in a developmentally appropriate manner.

DS was late to be able to do such tasks- pre-dx he didn't learn to pedal until he was about 5- 5 1/2; stairs may have been a little later. He also tended to write/draw on the left side of the paper with his left hand and the right with his right. We never did therapy around this and DS did outgrow (learn to compensate, brain maturity, who knows?) I know other kids who had the benefit of an earlier dx who did PT and OT around this.

Bike riding is a zero-order skill by age 7-8, so that is something into which you may want to look. You want him caught up around this for social reasons.

icanshine.org/


OT has been addressing midline issues with him - it doesn't seem to be a significant problem, but pops up in certain tasks. He's a very cautious kid to begin with, so it's hard to tell what is coordination and what is anxiety. 


2. The other issue sounds more like a classic case of spatial reasoning, motor planning and perhaps proprioception (knowing where his body is in space) issues.

nspt4kids.com/parenting/what-is-proprioception-and-why-is-it-important/

Normally OTs work on the sensory pieces, sometimes PTs do this as well.


I definitely think he has some issues in this area. Often, it's like he doesn't know his own strength (walks heavy, grabs things too hard, play wrestles too rough, etc.), how to get down from things (like getting out of the car), and is, in general, awkward in his movements. We have a list of heavy work activities and he's got a trampoline in his room that he uses regularly.

The funny part in all of this... he can play the drums! Talk about coordination - he can play both hands and feet, following sheet music in a rhythm. I'll never understand. LOL 


3. Attentional issues are likely in play as well. Often kids with his particular alphabet soup are not as focused as a typical child that age would be with the consequence that he would really stand out. It's probably not that he's clumsier, but that his peers have outgrown the toddler-like bull-in-a-china-shop behavior.

Sometimes treating the impulsivity/inattention/poor executive function of ADHD and/or the anxiety associated with ASD can get them more focused in the moment and improve this situation. It wasn't our intention when we started meds, but things did improve.

In any case, this is something you will want to focus on as he gets older; those who don't improve around these kinds of skills are poor candidates for driving. You may want to hold off on licensing or have him evaluated by a specialist OT when the time comes. I know a couple of teens/young adults on spectrum who don't drive because of this- kids who are very bright otherwise.

I'll be the outlier. Unless he is truly clumsier and not just running into more things than his peers or seemingly so because he's taller and has a greater reach than he did a year ago- I would start with either his dev pedi or even the OT. You may have to find a different OT if this one is not up to standards around sensory processing and motor planning.

I would avoid a neuro at this point unless he already has one on his team who is familiar with the dx.


He does not have a neuro currently and I do believe a degree of this is him not paying attention. He also has an ADHD (inattentive type) diagnosis, so it's very well that he's distracted or isn't processing the current situation as well as he could be. He has a psychiatrist who saw him last year when he was in preK and told us to come back if the inattention and/or anxiety began to seriously impact his academics or life in general. 

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