Questions Re 3y 9M girl with Apraxia and Drawing' writing skills

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Background : My daughter Niamh is almost 3y 9m. She was diagnosed with CAS just

under a year ago. She has always been very " klutzy " , but otherwise had advanced

motor skiils. She walked at 12m, was dressing herself at 18mth, scribbling with

a crayon a long time before her twin etc etc. her speech was delayed and she

went to an " infant toddler development program " and received individual ST both

through early Start from 18m - 3 years.

We had her assessed by a ped neurologist when she was 2 1/2 because I was

concerned about her falling over, poor balance etc and because of her speech.

They did not give her a diagnosis but referred her to a developmental

pediatrician - who diagnosed her with CAS . Her early start SLP had suspected

Apraxia, but didn't want to diagnose her, she was surprised that she was

diagnosed as CAS not global apraxia as she felt her incoordination/ clumsiness

was linked to her Apraxia (their program did also involve group time in the OT

gym, which the SLP was present during as well as on OT).

When she was assessed by the Dev ped they found her motor skills to be advanced

and put her clumsiness down to being " an active girl who isn't paying attention

to her surroundings " (She also has a really hard time sitting still and short

attention span).

The school district assessment when she turned 3 also found her motor skills to

be advanced, and she wasn't offered OT but does get 3x 30 min individual ST

through the school district each week.

She had a follow up appointment with Neurology 2 1/2 months ago - but was just

seen by a nurse practioner, who recommended continuing the same level of ST.

when I pointed out how strangely she runs (she swings her arms excessively from

side to side and looks really incoordinated), she said " she may have global

apraxia " .She didn't recommend OT but did recommend restarting a gym class (she

previously was in but had stopped).

I'm happy with her current speech therapy and she is much more conversational

than before but still has a lot of sounds she can't say (esp. in the initial

position), and still has a lot of inconsistencies.

MY CURRENT CONCERN is that her drawing / prewriting skills really don't seem to

be progressing at all. A year ago she was noticeably ahead of her twin brother,

but although he has made a lot of progress in the last year she hasn't and now

lags noticeably behind him.

She is not yet showing handedness- she will draw with both hands.

A year ago she could make a rough circle, now she will attempt to make a circle

but it is hardly recogniseable as one. If you ask her to draw a face the eyes

etc will be random dots/ marks not even in the circle. I was concerned about

this. so I asked her preschool teacher about this in November. Today was the

first chance I got to chat to her about it since the holidays and she said " she

is really just not connecting " with doing any of their art projects. She is very

enthusistic about doing art but just does a quick scribble and thats it.

I'm worried that her fine motor skills don't seem to be progressing at all, and

worrying that this may be a sign of future handwriting problems (she also seems

less able to recognise her letters than her twin and most of her classmates)

Am I worrying prematurely or is this something I should getting addressed now ?

Should I take her back to the developmental Pediatrician or get an OT assessment

? Should I get a school district OT assessment or private (my insurance doesn't

cover OT or ST).

I would appreciate any advice.

She is on ProEfa (2 capsules a day) and NV 1/2 scoop per day ( I have tried to

get more in but it just puts her off eating if I add to much, and there are very

few foods I can get away with putting it in, we have tried both flavors)

Thanks

Mum to Niamh 3y 9m (Apraxia), Aidan 3y9m (was globally delayed now pretty much

caught up) and 7y (NT)