Questions about Fine Motor Skill Delays After Language is Now Age-appropriate

Dear Laura,

You were nice enough to answer some questions a while back and I have a few follow up ones. My daughter was delayed in her expressive language and not combining words at age 2. With ST through the regional center she is now within “normal” range at almost 3 years of age and will probably not qualify for services through the school district. You mentioned to me before that catching up in expressive language by age 3 can mean the delay was just a case of late talking. We are hoping that is the case with our daughter (I was also a late talker) but now I have come to discover that she has some fine motor delays. She cannot cut with scissors or hold a pen properly (still grips it with a fist). Given that she had a speech delay & now a fine motor delay should I be concerned about an underlying cause? Would there be other symptoms or signs of some thing like mental retardation?

The SLP did both the preschool assessment scale & Rosetti and said she was within normal guidelines. Her receptive language has always been age appropriate & even ahead. Her strengths have always been her social skills. She is very engaging, empathetic (always concerned about others feelings),and affectionate. She loves playing with other children and adults. As far as the fine motor delays, I am wondering if lack of opportunity can contribute to this? I have to admit that she is not interested in doing these things and I never force her to practice. We do a mommy & me preschool two days a week and I noticed that many of her peers can write, cut, etc and I can hardly ever get her to cooperate with me. All she wants to do is play. Any suggestions?

We canceled the evaluation with the school district because her SLP was very confident that she would not qualify for speech services but I never discussed the fine motor concern with her. Also, my daughter has largnomalacia and I still feel that this caused early feeding issues and played a role in the speech delay. Any chance it can be related to fine motor as well? Why are fine motor & speech delay connected?

You gave some great details about what a 3 year old should be doing and I think my daughter is there. She can string 5-7 words together (but not every sentence has that many), she asks a ton of questions (repetitively), and can follow 4 step commands. I can understand 80-90% of what she says but strangers can not (maybe closer to 65-75%). I hope this is enough background for you to comment.I have to say you are such a great source of info and I really value the service you provide to the public. Sincerely, Kathy

Kathy – Although I can’t say for sure exactly what’s going on with her since I can’t see her, I’ll be glad to give it my best shot.

First of all, it’s great that she’s now within the normal range with language – Hooray for you!!! Pat yourself on the back since all your hard work as paid off!

Secondly, fine motor delays do sometimes accompany late talking, BUT this does NOT equate with mental retardation. She would not have language skills within the normal range and have huge cognitive issues – that doesn’t happen and really doesn’t make sense clinically since cognition is the underlying foundation for language. If cognition is hugely impacted, language is too. Now if they were telling you that her language is commiserate with her cogntition, that’s a whole different story, but you didn’t say that’s the case, and certainly from how you’ve described her, she’s functioning in the normal range. Again – good for you!!!

Has she been assessed by an OT? Occupational therapists are the professionals that can help you address the fine motor skills. However, your SLP may be able to give you some ideas BEFORE she’s discharged from speedh before she turns 3. If the fine motor delays are mild and related to not enough opportunities to practice, these should come along pretty well with increased focus from you. This could really be the case since her language has responded so beautifully to treatment. The initial diagnosis she received, the laryngeal dx – can’t remember how to spell it – is likely NOT the cause of the fine motor delay.

My advice for the fine motor skills are to start to practice these skills in a “no pressure” kind of way. Sit on the floor or at the table and cut, then ask her to join in. To entice her, you should cut fun stuff like hearts and snowmen and circles, but help her to cut straight lines at first. Some children (and adults!) do become very frustrated with activities when they’re not good at it, so it may take some time to encourage her to want to do it. Praise, praise, praise her efforts if this seems to help her want to try more.

For writing utensil grip, I always use the cue, “Hold it like a big girl,” then help her do it with her fingers on the crayon or pencil. Another trick is to break a crayon so it’s in a pretty small piece so that she can’t grab it with her fist. Then she’s forced to hold it with the 3-point grasp using her thumb and 2 fingers. Model this for her too so that she sees you having a ball coloring. Coloring on giant pieces of paper, or even on some big surface like a paper grocery bag or a cardboard box, also makes toddlers more likely to want to color. When her grip is better, switch to markers – usually a guaranteed hit! Again, get your SLP’s advice for more ideas since she may be able to pinpoint a cue or piece of advice that will really help you based on what she can SEE your daughter doing.

Have you read the book The Late Talker? I believe that it talks about fine motor delays or other subtle motor planning issues that can accompany late talking when it’s due to apraxia. Since your SLP has not mentioned this to you, this is likely not the case diagnostically, BUT if I remember correctly, the book has some good ideas for fine motor stuff too. I have loaned out my copy, so I cannot check this for you – sorry!!

Think those were all of your questions and concerns, but if I missed any, let me know! Laura

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Laura

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