Dysgraphia

Type of psychology: Biological bases of human behavior; Clinical; Counseling; Developmental; Neuropsychological; School

Dysgraphia is a neurodevelopmental learning disorder that is manifested by significant difficulty in many aspects of writing. Letter formation, spatial organization, and spelling may be negatively affected. Properly sequencing letters in words and words in sentences may be extremely difficult. Reversals, inversions, and transpositions of letters are common. The ability to generate letters from memory without a model may be impaired. Written work is often illegible.

Introduction

The term dysgraphia was derived from Greek with “dys” meaning impaired and “graphia” meaning written by hand. This disorder, generally considered one of many different types of learning disabilities, is usually initially diagnosed when children first begin writing, most often in kindergarten or first grade. Researchers report that the disorder is more common in boys than girls. If milder forms of the disorder are included, it can affect as many as 15 to 20% of children. Forms of dysgraphia can also occur because of neurological damage later in life, for instance, following a stroke or as a result of a brain lesion. Typically, any tasks requiring fine motor skills, such as cutting, tracing, copying, and, of course, writing, are extremely difficult and frustrating.

Fine motor skills, which is the ability to control movements of smaller muscles such as those needed for writing and speaking, normally develop slowly over time. However, in some children, these skills are delayed or develop so slowly that they impede the ability to meet normal school demands. Because this disorder specifically interferes in the child's ability to produce written work, it can be highly visible to the child, teachers, and classmates, often resulting in loss of self-esteem and sometimes leading to a sense of failure and giving up. Writing is often extremely laborious and sometimes painful and consequently avoided and disdained. Learning how to properly hold a writing implement and the paper at the same time is imperative for children with this issue.

Presentation

Dysgraphia is considered to involve three aspects: a motor component, a visual-spatial component, and a processing component. The most common motoric presentation of dysgraphia is very malformed letters so that writing is often illegible. The child is often simply unable to generate the precise finger movements required to produce legible letters; the hand hold or body position may be odd. Sharp angles and changes of direction are particularly challenging. Other fine motor tasks such as tying shoes, closing buttons or snaps, and zippering may also present challenges.

The visual-spatial difficulties common in children with dysgraphia are most typically manifested in letters that appear to float off the line or collide with other letters. Spacing between letters and words is very difficult. Reversals (where letters are written backward or as if seen through a mirror), inversions (where letters are written upside down), and transpositions (where letters or words are in the wrong order) are also frequent signs of visual-spatial problems. Letters may be of varying sizes, mixed case, or a mixture of printed and cursive. Often these problems are not limited to writing but may appear in many additional tasks that demand good visual-spatial skills such as keeping a desk neat and organized, keeping papers in a folder, or putting needed materials away so that they can be easily retrieved.

Processing problems may be manifested by poor grammar and syntax in writing, leaving words out altogether and incoherently organizing sentences and paragraphs. The child may also struggle to think and write at once or to put thoughts down on paper but have little difficulty with oral expression of ideas. These issues are often more closely related to language processing and expression than fine motor weakness.

It is worth noting that dysgraphia can occur alongside other learning disabilities, attention-deficit and hyperactivity disorder (ADHD), or even extremely high levels of intelligence, as measured by standardized intelligence tests. Thus, correctly identifying the individual's specific abilities and needs is of great importance in aiding him or her appropriately.

Interventions

Interventions to address the difficulties presented in dysgraphia fall into three categories: remediation, accommodation, and modification. Efforts to remediate often include exercises to improve fine motor strength and control. Clay play, finger exercises, stirring, mixing, threading, and beading can be helpful. Pencil mazes that slowly progress from very easy with extremely wide borders to difficult with much narrower borders can slowly improve pencil control. Connecting the dots, cutting, and tracing are also beneficial. Practicing writing letters in the air with very large movements and progressively reducing the size of the movements is often very productive. Initially, writing should be very large so as to reduce the demands for precise motor movements of the fingers. A great deal of repetition is often required to assist children to overlearn letter formation so that they can eventually concentrate on the content of their writing rather than on the mechanical aspects of forming letters. The specialized assistance of an occupational therapist is often necessary to offer some children a very individualized approach.

There are many accommodations available that can be of great assistance in helping individuals with dysgraphia. Special pencil grips and other writing implements can relieve discomfort and offer more control. Writing paper with extra large spacing and raised guide lines makes it easier to avoid floating and colliding letters and words. Teaching children to use their thumbs or other spacers between words can greatly improve intelligibility. An alphabet should always be available so that children can check, as often as necessary, to see how letters look so that they do not have to rely on memory. Computers offer a wonderful way for individuals with dysgraphia to produce work that looks great, is easy to edit, and can readily be checked for grammar and spelling. They should be taught typing skills as early as possible. Modern dictation programs may even remove the need for typing. Some students may require additional time to complete assignments and to take tests. Some may even need a scribe for longer test responses. Oral or visual assignments, rather than written ones, and the use of audio recording equipment for note-taking can also be of help to students with dysgraphia. Individuals with dysgraphia should be taught to break tasks down into manageable steps and to create outlines or use keywords when planning written responses.

With understanding, remediation, and appropriate accommodations, children with dysgraphia can be happy and successful. Most aspects of adult life, with a few exceptions, do not require well-developed fine motor control. Word-processing software and voice-recognition software have greatly reduced the limitations of those with dysgraphia, and often in adulthood, dysgraphia is being relegated to little more than a nuisance.

Bibliography

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