Dysgraphia is a specific learning disability (SLD) as well as a transcription disability, meaning that it is a writing disorder associated with impaired handwriting, orthographic coding and finger sequencing (the movement of muscles required to write disorder.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dysgraphia is characterized as a learning disability in the category of written expression when one’s writing skills are below those expected given a person’s age measured through intelligence and age-appropriate education. The DSM is not clear on whether or not writing refers only to the motor skills involved in writing, or if it also includes orthographic skills and spelling.

There are at least two stages in the act of writing: the linguistic stage and the motor-expressive-praxic stage. The linguistic stage involves the encoding of auditory and visual information into symbols for letters and written words. This is mediated through the angular gyrus, which provides the linguistic rules which guide writing. The motor stage is where the expression of written words or graphemes is articulated. This stage is mediated by Exner’s writing area of the frontal lobe. The condition can cause individuals to struggle with feedback & anticipating and exercising control over rhythm & timing throughout the writing process.

The underlying causes of the disorder are not fully understood, but dysgraphia is known to be a biologically based disorder with genetic and brain bases. Specifically, it is a working memory problem caused by specific neurodevelopmental dysfunction. In dysgraphia, individuals fail to develop normal connections among different brain regions needed for writing. People with dysgraphia have difficulty automatically remembering and mastering the sequence of motor movements required to write letters or numbers. Dysgraphia is also partly due to underlying problems in orthographic coding, the orthographic loop, and graphomotor output (the movements that result in writing) by one’s hands, fingers, and executive functions involved in letter writing. The orthographic loop is when written words are stored in the mind’s eye, connected through sequential finger movement for motor output through the hand with feedback from the eye.

Family history of specific learning disabilities may play a role. It’s been observed that children with developmental dysplasia, developmental dysgraphia, and developmental dyslexia may be more likely to have family members with one of these conditions. Genetic studies suggest that verbal executive function tasks, orthographic skills, and spelling ability may have a genetic basis. Genes on chromosomes 6 and 15 may play some role in SLDs as they have been linked to poorer reading, poorer spelling, and lower phonemic awareness.

Dysgraphia is nearly always accompanied by other learning disabilities and/or neurodevelopmental disorders such as dyslexia, attention deficit disorder, or oral and written language learning disability (OWL LD). This can impact the type of dysgraphia a person has. Tourette’s syndrome, ASD, and dyspraxia are also common diagnoses among people with dysgraphia. Developmental dysgraphia was originally described as being a disorder that occurs solely in dyslexic individuals. Dysgraphia was not studied as a separate entity until the mid-20th century when researchers discovered different types that occur without dyslexia. People with dyslexia and dysgraphia experience similar synchronization difficulties and issues with spelling. However, dyslexia does not seem to impair physical writing ability or dramatically impact fine motor skills, and dysgraphia does not impact reading comprehension. Methods for evaluating, managing, and remedying dysgraphia are still evolving.

(Wikipedia, n.d./Dysgraphia)

Characteristics

People with dysgraphia can often write on some level and may experience difficulty with other activities requiring reciprocal movement of their fingers and other fine motor skills, such as tying shoes, fastening buttons, or playing certain musical instruments. However, dysgraphia does not affect all fine motor skills. People with dysgraphia often have unusual difficulty with handwriting and spelling, which can cause writing fatigue. Unlike people without transcription disabilities, they tend to fail to preserve the size and shape of the letters they produce if they can’t look at what they are writing. They may lack basic grammar and spelling skills (for example, having difficulties with the letters p, q, b, and d), and often will write the wrong word when formulating their thoughts on paper. The disorder generally emerges when the child is first introduced to writing. There is accumulating evidence that individuals with SLDs and DCD do not outgrow their disorders. Accordingly, it’s been found that adults, teenagers, and children alike are all subject to dysgraphia. Studies have shown that higher education students with developmental dysgraphia still experience significant difficulty with handwriting, fine motor skills, and motor-related daily functions when compared to their peers without neurodevelopmental disorders.

The symptoms of dysgraphia are often overlooked or attributed to the student being lazy, unmotivated, careless, or anxious. The condition may also be dismissed as simply an expression of attention deficiency or delayed visual-motor processing. To be diagnosed with dysgraphia, one must have a cluster, but not necessarily all, of the following symptoms:

• Poor legibility
• Excessive erasures
• Misuse of lines and margins
• Poor spatial planning on paper
• Relies heavily on vision to write
• Irregular letter sizes and shapes
• Frequent reliance on verbal cues
• Inattentiveness over details when writing
• Mixed upper-case and lower-case letters
• Switching between cursive and print letters
• Difficulty visualizing letter formation beforehand
• Slow writing speed or inefficient speed of copying
• Inconsistent form and size of letters or unfinished letters
• Difficulty understanding homophones and what spelling to use
• Handwriting abilities that interfere with spelling and written composition
• Struggles with translating ideas to writing, sometimes using the wrong words altogether
• Issues following rules of sentence structure or grammar when writing but not when speaking
• Tight, awkward or painful grip of writing utensil or feeling pain while writing (eg; cramps in fingers, wrist and palms)
• Odd wrist, arm, body, or paper orientations (eg, bending arm into an L shape, holding the paper down with non-dominant hand)
• Synchronization difficulties like writing and thinking at the same time (eg, creative writing, taking notes, tapping, and judging line orientation concurrently)

The symptoms of dysgraphia can change as one ages. Dysgraphia may cause students emotional trauma often due to the fact that no one can read their writing, and they are aware that they are not performing to the same level as their peers. Emotional problems that may occur alongside dysgraphia include impaired self-esteem, lowered self-efficacy, reduced motivation, poorer social functioning, heightened anxiety, and depression. They may put in extra effort to have the same achievements as their peers but often get frustrated because they feel their hard work does not pay off.  Dysgraphia is hard to detect as it does not affect specific ages, gender, or intelligence.  The main concern in trying to detect dysgraphia is that people hide their disability behind their verbal fluency/comprehension and strong syntax coding because they are ashamed that they cannot achieve the same goals as their peers.

It’s not uncommon for individuals with dysgraphia to be intellectually gifted, possess a rich vocabulary, and have a strong comprehension of language when speaking or reading, though their disorder is often not detected or treated. This may also be in part due to developmental dyslexia receiving far more academic and medical attention than developmental dysgraphia. In addition, gifted children with transcription disabilities seldom receive programming for their intellectual talents due to their difficulties completing written assignments.

(Wikipedia, n.d./Dsygraphia)

[The National Center for Learning Disabilities], (2021, Apr. 6). What is Dysgraphia? [Video File]. from https://youtu.be/jmBg_BvDL-c

Interventions and Strategies

Treatment for dysgraphia varies and may include treatment for motor disorders to help control writing movements. Helping students with dysgraphia overcome writing avoidance and accept the purpose and necessity of writing may be needed. Occupational therapy can be effective in the school setting, and teachers should be well-informed about dysgraphia to aid in the carry-over of the occupational therapist’s interventions. Treatments may address impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid handwriting problems. Dysgraphia can sometimes be partially overcome with appropriate and conscious effort and training. The International Dyslexia Association suggests the use of kinesthetic memory through early training by having the child overlearn how to write letters and later practice writing with their eyes closed or averted to reinforce the feel of the letters being written. They also suggest teaching the students cursive writing as it has fewer reversible letters and can help lessen spacing problems, at least within words, because cursive letters are generally attached within a word.

The National Center for Learning Disabilities suggests that children with dysgraphia be handled in a case-by-case manner with an Individualized Education Program or provided individual accommodation to provide alternative ways of submitting work and modifying tasks to avoid the area of weakness. Students with dysgraphia often cannot complete legible written assignments appropriate in length and content or within a given time. It is suggested that students with dysgraphia receive specialized instructions that are appropriate for them. Children will mostly benefit from explicit and comprehensive instructions, help translating across multiple language levels, and review and revision of assignments or writing methods. Direct, explicit instruction in letter formation and guided practice will help students achieve automatic handwriting performance before they use letters to write words, phrases, and sentences. Some older children may benefit from using a personal computer or a laptop in class so that they do not have to deal with the frustration of falling behind their peers.

It is also suggested by Berninger that teachers must decide if their focus will be on manuscript writing (printing) or keyboarding. In either case, it is beneficial that students are taught how to read cursive writing, as it is used daily in classrooms by some teachers. It may also benefit the teacher to develop other methods of assessing a child’s knowledge other than written tests; an example would be oral testing. This causes less frustration for the child as they are able to get their knowledge across to the teacher without worrying about how to write their thoughts. Students with dysgraphia may benefit from special accommodations by their teachers when required to write. Accommodations that may be helpful include but are not limited to offering larger pencils or pencils with special grips, supplying paper with raised lines to provide tactile feedback, allowing extra time for classwork assignments, scaling down large written assignments, and breaking down long written assignments into multiple shorter assignments.

(Wikipedia, n.d./Dysgraphia)

Assistive Technology

Kelly, K. (n.d.). 8 tools for kids with dysgraphia. Understood for All, Inc. https://www.understood.org/articles/en/8-tools-for-kids-with-dysgraphia

References

[The National Center for Learning Disabilities], (2021, Apr. 6). What is Dysgraphia? [Video File]. from https://youtu.be/jmBg_BvDL-c

Wikipedia, (n.d.) Dysgraphia from https://en.wikipedia.org/wiki/Dysgraphia

Updated 5/29/2024