Dysgraphia
Dysgraphia is a learning disability that results in impaired handwriting, impaired spelling, or both in someone of normal or above-average intelligence. It is not a mental health disorder, but rather a brain-based learning disability marked by difficulty forming letters, spelling words correctly, staying within lines, writing legibly, or organizing and expressing one’s ideas on paper.
Dysgraphia is frustrating for children or adults and can cause great emotional difficulty and distress. Someone with dysgraphia may have trouble spelling written words or writing at a normal speed, but will not necessarily have problems reading or speaking. Dysgraphia can occur in isolation or with other learning disabilities such as dyslexia, which is an impaired ability to read and comprehend written words. It can also co-occur with selective language impairments that cause additional problems with learning written and oral language skills.
Dysgraphia can manifest as problems with fine motor skills, spatial perception, and/or language processing. Possible signs may include:
- poorly formed individual letters
- lack of or incorrect punctuation and capitalization
- awkward or painful pencil grip and/or unusual positioning of wrist, arm, or body when writing
- frequent hand cramps while writing
- omitting words from sentences
- skipping letters when writing words
- poor sentence organization; sentences may be grammatically incorrect
- incorrect word usage
- difficulty writing and thinking at the same time
Because writing can be frustrating or even physically painful, some individuals with dysgraphia will attempt to avoid writing altogether or feel distressed at the idea of having to write. Children who have dysgraphia but no other learning disorder are sometimes mistakenly labeled as “lazy” or “unmotivated” when it comes to handwriting; these negative self-perceptions may persist until adulthood, especially if dysgraphia is not diagnosed or treated.
ADHD is not a cause of dysgraphia. However, children with ADHD are at a higher than average risk of developing dysgraphia; they may have additional learning disabilities as well. Some evidence suggests that girls with ADHD may be more likely than boys to have both dysgraphia and dyslexia.
Dysgraphia is most often identified in early elementary school, when children first learn to write. However, it is possible for the disorder to be identified later on, or even to remain undiagnosed until adulthood.
There is no single test for dysgraphia. The disorder is typically diagnosed using a battery of assessments, which may include tests of fine motor skills, spatial processing, and general writing ability, including word/letter formation and written expression. Past writing assignments, school records, and teacher/parent input may also be factored into the evaluation.
Dysgraphia, like other learning disabilities, cannot be outgrown or “cured.” However, many people with dysgraphia are able to find ways to cope with their biggest challenges and can even become successful writers, especially if treatment is initiated as early as possible.
Not necessarily. Many people have untidy handwriting but have no other difficulties with writing, and thus would not qualify for a diagnosis of dysgraphia. And in fact, individuals with dysgraphia may not have messy handwriting at all. However, writing is likely to be immensely difficult for them, and writing neatly may take intense effort and concentration.
Because dysgraphia is related to problems with fine motor skills, it may manifest, in some cases, as trouble with typing in addition to writing. However, because writing and typing involve different motor skills, many individuals with dysgraphia find typing significantly easier than writing by hand, and allowing the use of a keyboard is a common accommodation for children and adults with dysgraphia.
Handwriting is a complicated process that involves controlled motor skills, working memory, word organization, thinking about words and their meanings, and generating ideas. Children with dysgraphia may have a problem with orthographic coding, which is the ability to store written words in working memory or to form permanent memories of written words. They may also have trouble planning sequential finger movements. Adults may develop acquired dysgraphia, or agraphia, following a brain injury or stroke.
Dysgraphia and dyslexia are sometimes confused for one another—a problem compounded by the fact that they often co-occur. But dysgraphia and dyslexia are distinct conditions. Dysgraphia is specifically a problem with the physical act of writing, most often the motor skills and spatial processing involved in the process. Dyslexia, by contrast, is characterized by difficulties in reading—not recognizing words by sight, for example, or having immense difficulty retaining or explaining information one has just read.
Like other learning disabilities, dysgraphia tends to run in families and is thought to have a strong genetic component. However, the exact cause of the disorder is not fully understood.
Agraphia, or the sudden loss of writing ability, shares many symptoms with dysgraphia, such as the inability to properly form letters or correctly space out words. Agraphia is usually caused by a serious brain injury, stroke, or degenerative brain disease like dementia. Rehabilitation strategies may allow affected individuals to regain some of their lost writing ability. Agraphia often appears with other related disorders such as alexia (acquired dyslexia).
Graphomotor processing is the ability to transfer components of writing from the brain to the page; a disorder in graphomotor processing therefore precludes a person from recording information on the page, even if they conceptually understand what they are trying to record. Orthographic processing is the ability to identify the correct components of writing, such as spelling and punctuation, prior to executing them on the page. Children with dysgraphia may struggle with one or both types of processing.
Children with impaired handwriting ability require early intervention and specialized coaching in all skills related to written language. After an initial assessment of handwriting and other skills related to transcription and written expression, the child’s school most often handles the academic accommodations necessary for improvement. These interventions may involve physical exercises to strengthen hand muscles; reduced writing workload or extended time to complete written assignments; and writing activities that help the child develop motor control and learn to write complete letters, write letters from memory or dictation, increase handwriting speed, and spell the most common and important words they will need to use.
The team of helpers may include an occupational therapist, a speech and language therapist, a special education teacher, and, in some cases, a social worker or psychologist to help the child deal with anxiety and frustration. Treatment therapies vary with the type and degree of dysgraphia and may be different for adults with an acquired disorder due to underlying issues that may require very specific types of training.
Parents who suspect their school-age child may have dysgraphia or a graphomotor problem should first contact their teacher and decide whether an evaluation by a school-based learning specialist or occupational therapist is in order. This may be provided automatically with a teacher's recommendation.
Occupational therapy (OT) can be beneficial for dysgraphia, especially for individuals who struggle with the fine motor aspects of writing. OT can help children learn proper hand and body positioning, develop hand strength, and build motor skills that can make writing less laborious or painful. Teachers or other education professionals may also work one-on-one with students to help them learn how to better organize their thoughts and express themselves more clearly, which can also lessen the impact of dysgraphia.
Using pencil grips, allowing typing whenever possible, and providing written copies of notes—rather than asking a child to take notes themselves during class—can all be helpful accommodations for students with dysgraphia. Assistive technology, such as speech-to-text software, can be useful as well. Allowing extra time on tests or reducing the amount of homework given can help students show what they know without excessive stress and frustration.
Adults with dysgraphia may also benefit from occupational therapy, though it may be more difficult to find a practitioner who specializes in treating dysgraphia in adults. In many cases, modifying one’s environment through formal or informal accommodations can help adults compensate for their challenges and become more successful at work and at home. Possible accommodations for dysgraphia include the use of speech-to-text software, converting paper forms into fillable PDFs, taking notes on a laptop rather than by hand, or the use of graph paper to make it easier to write neatly and stay inside the lines. Traditional psychotherapy may also be immensely beneficial, as many adults with dysgraphia struggle with low self-esteem as a result of their condition, especially if they spent their childhood undiagnosed or being told they were "lazy." Recognizing that the disorder is brain-based, unrelated to intelligence, and has nothing to do with one’s worth can help adults rebuild confidence and figure out how to best cope with their challenges.