Dysgraphia

Holden Milner is a disgraphic

Dysgraphia
Specialty	Neurology, psychomotor education

Dysgraphia (or agraphia) is a deficiency in the ability to write, regardless of the ability to read, not due to intellectual impairment.

People with dysgraphia usually can write on some level, and often lack other fine motor skills and may be cross dominant, finding tasks such as tying shoes difficult. It often does not affect all fine motor skills. They can also 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 trying to formulate thoughts (on paper). In childhood, the disorder generally emerges when the child is first introduced to writing. The child may make inappropriately sized and spaced letters, or write wrong or misspelled words despite thorough instruction. Children with the disorder may have other learning disabilities, but they usually have no social or other academic problems. Cases of dysgraphia in adults generally occur after some neurological trauma. Dysgraphia may also be diagnosed in a person with Tourette syndrome, ADHD or an autism spectrum disorder such as Asperger syndrome. The DSM IV identifies dysgraphia as a "Disorder of Written Expression" as "writing skills (that) ...are substantially below those expected given the person's ...age, measured intelligence, and age-appropriate education."

Etiology

The cause of dysgraphia is unknown but whenever it occurs in an adult, it is usually caused by head trauma, some types of diseases or brain damage. When it is found in children there is a tendency for there to be multiple dysgraphics in his or her family. A parent or close relative of the child tend to also show signs of dysgraphia.

There have been few studies in the field.

Types of dysgraphia

Three principal subtypes of dysgraphia are recognized. Some children may have a combination of two or all three of these, and individual symptoms may vary in presentation from what is described here.

Dyslexic dysgraphia

With dyslexic dysgraphia, spontaneously written work is illegible, copied work is fairly good, and spelling is bad. Finger tapping speed (a method for identifying fine motor problems) is normal, indicating the deficit does not likely stem from cerebellar damage. A dyslexic dysgraphic does not necessarily have dyslexia. (Dyslexia and dysgraphia appear to be unrelated but are often found together.)

Motor dysgraphia

Example of motor dysgraphia in a 30-year-old female.

Motor dysgraphia is due to deficient fine motor skills, poor dexterity, poor muscle tone, or unspecified motor clumsiness. Motor dysgraphia may be part of the larger problem of motor apraxia. Generally, written work is poor to illegible, even if copied by sight from another document. Letter formation may be acceptable in very short samples of writing, but this requires extreme effort and an unreasonable amount of time to accomplish, and cannot be sustained for a significant length of time. Writing long passages is extremely painful and cannot be sustained. Letter shape and size becomes increasingly inconsistent and illegible. Writing is often slanted due to holding a pen or pencil incorrectly. Spelling skills are not impaired. Finger tapping speed results are below normal.

Spatial dysgraphia

A person with dysgraphia due to a defect in the understanding of space has illegible spontaneously written work, illegible copied work, but normal spelling and normal tapping speed.

Symptoms of dysgraphia

A mixture of upper/lower case letters, irregular letter sizes and shapes, unfinished letters, struggle to use writing as a communications tool, odd writing grip, many spelling mistakes (sometimes), pain when writing, decreased or increased speed of writing and copying, talks to self while writing, muscle spasms in the arm and shoulder (sometimes in the rest of the body), inability to flex (sometimes move) the arm (creating an L-like shape), and general illegibility. Reluctance or refusal to complete writing tasks.

Many people who are dysgraphic experience pain while writing. The pain usually starts in the center of the forearm and then spreads along the nervous system to the entire body. This pain can get worse or even appear when a dysgraphic is stressed. Few people who do not have dysgraphia know about this, because many with dysgraphia will not mention it to anyone. There are a few reasons why pain while writing is rarely mentioned:

• Sufferers do not know that it is unusual to experience this type of pain with writing.
• If they know that it is different from how others experience writing, they feel that few will believe them.
• Those who do not believe that the pain while writing is real will often not understand it. It will usually be attributed to muscle ache or cramping, and it will often be considered only a minor inconvenience.
• For some people with dysgraphia, they no longer write, and just type everything, so they no longer feel this pain.

Common problems that are often associated with dysgraphia

Stress

There are some common problems not related to dysgraphia but often associated with dysgraphia, the most common of which is stress. Often children (and adults) with dysgraphia will become extremely frustrated with the task of writing (and spelling); younger children may cry or refuse to complete written assignments. This frustration can cause the child (or adult) a great deal of stress and can lead to stress-related illnesses. This can be a result of any symptom of dysgraphia.

Treatment

Treatment for dysgraphia varies and may include treatment for motor disorders to help control writing movements. Other treatments may address impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid the problems of handwriting.

Occupational therapy could be considered to strengthen muscle tone, improve dexterity, and evaluate eye–hand coordination. Dysgraphic children should also be evaluated for ambidexterity, which can delay fine motor skills in early childhood.

See also

• Alexia without agraphia
• Dyslexia
• Learning disability

References

General references

• International Dyslexia Association on http://www.interdys.org/.
• Just the facts... Dysgraphia: Fact Sheet #982. Retrieved Jan. 9, 2005.

External links

• John Ploskina – Dysgraphia Survivor
• NINDS Dysgraphia Information Page
• Information on dysgraphia and learning disabilities for ages ranging from early childhood through adulthood.
• LD Online
• Dysgraphia
• Free on-line resource for dyslexia, dysgraphia spelling assistance.