Written Expression Disability (Dysgraphia)

a. Auditory-Based

b. Motor-Based

c. Visual-Spatial Based

Diagnostic Features

A written expression disability or dysgraphia is diagnosed in children who have trouble learning to write and in adults who have difficulty in writing. Very poor handwriting is a symptom of a written expression disability. Problems with spelling, grammar, paragraph organization, and punctuation are also common in persons with this disability.  There are three types of written expression disability.

·          Auditory-based written disability (Dyslexic dysgraphia) is where the first draft of a paper is illegible but copied work is acceptable. This child will have difficulty with spelling as well. This type of dysgraphia does not necessarily mean that the child has dyslexia, a reading disability, although other learning disabilities may be present as well.

·          Motor-based written disability (Motor dysgraphia) is defined as having a deficit in fine motor skills, poor dexterity and poor muscle tone. This child will usually show illegible work, even when the work is copied. Letter formation in isolation is ok, but it takes a lot of time and effort. Spelling is generally ok for this child.

·          Visual-spatial-based written disability (Spatial dysgraphia) would be represented by a child who shows illegible work, even when the work is copied, but with normal spelling skills.

Diagnostic Criteria

A written expression disability is diagnosed when an individual displays “writing skills that are substantially below those expected given the person’s chronological age, measured intelligence, and age-appropriate education.” A key feature of a disorder of written expression is that oral language skills far exceed the ability to do the same via written language.

The diagnosis is made based on writing samples, and test scores. Tests that are helpful in diagnosing a disorder of written expression include: the Diagnostic Evaluation of Writing Skills (DEWS); the Test of Early Written Language (TEWL); and the Test of Adolescent Language.

Assessment using standardized tests is not enough to make a diagnosis of a disorder of written expression. It is important to distinguish between the cognitive processes underlying a written expression disability, and its end-results:  

The underlying cognitive processes involved in a written expression disability, which can be identified by means of tests such as the Beery or the TVPS-3 are:

·         Poor fine motor skills

·         Visual motor integration (which involves being able to coordinate the hand and eyes)

·          Perceptual discrimination and/or recognition of shapes, letters and/or numbers

·          General auditory or language processing

·          Sequencing and organizing of detailed information

The end results of the disability or common signs of it are:

• Bad or illegible handwriting

• Awkward or cramped pencil grip

• Writing that is markedly simple and brief

• Difficulty fleshing out ideas on paper (may write the minimum or less than the assignment requires) that is in contrast to their ability to discuss such ideas verbally

• Deficits in written production, including: spelling, grammar, and letter formation

• Inconsistency in the way letters and words look (may print a certain letter different ways within the same document)

• Difficulty writing within the margins or line spacing, and inconsistent spacing between words

Differential Diagnosis

Written expression disability is to be distinguished from Developmental Coordination Disorder or Apraxia. Also, most symptoms related to a written expression disability are often related to other disabilities, such as nonverbal learning disability , reading disability, mathematics disability , and attention deficit disorder.

Attention Deficit Hyperactivity Disorder (ADHD) - Students with an attention deficit disorder (especially with hyperactivity) often experience rather significant difficulty with writing in general and handwriting in particular.

Auditory Processing Weakness - Other students experience writing difficulty because of a general auditory or language processing weakness. A generalized auditory processing weakness is frequently referred to as a verbal or language-based learning disability and typically affects the areas of reading and writing.

Visual Processing Weakness - Although most writing disabled or "dysgraphic" students do not have visual or perceptual processing problems, some students with a visual processing weakness will experience difficulty with writing speed and clarity simply because they aren't able to fully process the visual information as they are placing it on the page. A visual processing weakness is sometimes referred to as a nonverbal learning disability and typically affects the areas of spelling and math much more than reading. (See also math disability or dyscalculia.) 

Prevalence and Etiology

Like other learning disabilities, written expression difficulty occurs more often in some families. It may also be tied to damage in certain parts of the brain.

Strategies and Accommodations

There is a multitude of strategies that can be applied at home or school to reinforce skills or teach a child with written expression disability. 

·          Use paper with clear lines printed for height and depth of letters (this means you know where the top middle and bottom of each letter should go).

·          Have the child write daily – and allow choice in what s/he writes. Encourage letter writing to family and friends.

·          Avoid making writing a punishment or negative activity.

The following are suggestions for the student:

Spelling and grammar

• Work on ‘non phonic’ ways of spelling such as visual or lexical methods which entail ‘seeing’ words.

• Use mnemonics or strategies based on a personal connection with the word.

• In learning rules, it helps to work on words and sentences from your own work, so you can work from example to principle rather than the other way around.

Writing

• The linear sequencing of ideas may be a problem. Try brainstorming your ideas in a mind map so that you are sure to capture them; you can then put them into a structure.

• When it comes to revision, deal with proof-reading difficulties by having someone read your work to you, or better still, revise it for you.

Assistive technology

• Word processing can help with writing through its redrafting and editing facilities, and does away with the need to write by hand.

• Planning or computer programs such as Inspiration help in taking notes and organizing ideas.

• Voice recognition can help you dictate your thoughts into a computer, and thereby avoid writing altogether.

References

Regina G. Richards (1999). The Source for Dyslexia and Dysgraphia. East Moline IL: LinguSystems, Inc.

Regina G. Richards. (2005). When Writing's a Problem: Understanding Dysgraphia and Helpful Hints for Reluctant Writers.

Diane Walton Cavey (2000). Dysgraphia: Why Johnny Can't Write : A Handbook for Teachers and Parents. Austin, TX: Pro-Ed.