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Dysgraphia: Symptoms, Types, Causes, Treatment

Table of contents:

Introduction

Dysgraphia
Man is unique in his ability to communicate ideas in symbolic language, and writing has been an essential method of communication for centuries. Spelling checkers have certainly made life easier for modern-day writers. However, regardless of your chosen career, you have to know how to write if you want to be successful.

The concept of “writing” encompasses a broad spectrum of tasks, ranging from transcribing a single letter to the intricate process of conceptualizing, drafting, revising, and editing a doctoral dissertation. Writing is the usual medium through which students convey to teachers what they have learned. Adults also find writing a necessity they cannot avoid.

Most people never consider the complexity and difficulty of the writing process. Yet, relative to all other academic activities, writing requires more basic skills than any other. Even during their earliest handwriting exercises, children must combine complex physical and cognitive processes to render letters precisely and fluidly.

As writing tasks become more complex, students must call on an increasingly wide range of skills to not only write legibly, logically, and in an organized way but also invoke rules of grammar and syntax. This combination of requirements makes writing the most complex and challenging use of language. For individuals with dysgraphia, writing can therefore be an uphill battle.

What is dysgraphia?

The term dysgraphia is often used when discussing writing disabilities. The word was coined from the Greek words dys meaning ill or difficult, and graphein, meaning to write. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) includes dysgraphia under the specific learning disorder category but does not define it as a separate disorder.

At its broadest definition, dysgraphia is a disorder of writing ability at any stage, including problems with letter formation/legibility, letter spacing, spelling, fine motor coordination, writing rate, grammar, and composition. Dysgraphia can also refer to severe handwriting difficulties only. We will use the first definition and look at its subcategories of spelling, handwriting, and written composition. Children with a writing disability may experience difficulties in one or more of these areas. 

Writing is an essential academic skill and has been linked to overall academic achievement (Cahill, 2009). On average, writing tasks occupy up to half of the school day (Amundson & Weil, 1996).

Dysgraphia, like all learning disabilities, can be devastating to a child’s education and dramatically limit what that child can achieve later in life. A child with a writing disability will find it increasingly difficult to express their knowledge on many subjects. Deficient writing may also lead to lower self-perception, lower self-esteem, and poorer social functioning (Chung et al., 2020).

How common is dysgraphia?

Due to a lack of a clear-cut definition for dysgraphia and the dearth of research explicitly focused on it, there are few statistics regarding prevalence. However, writing disabilities are prevalent in students with learning disabilities, including in children with Attention Deficit Hyperactivity Disorder (ADHD) (Adi-Japha et al., 2007), and they tend to be persistent.

According to Kushki et al. (2011), 10 to 30% of children experience difficulty writing, although the exact prevalence depends on the definition of dysgraphia.

There is an overlap between the signs and symptoms of dysgraphia and dyslexia. From the first studies of dyslexia, there has been continuing evidence that mild clumsiness — a possible symptom of dysgraphia — is associated with dyslexia. In a review of Orton’s research, Geschwind (1982) noted: “He pointed out the frequency of clumsiness in dyslexics. Although others have commented on this, it still remains a mysterious and not adequately studied problem.”

Data from the British Births cohort examined the skills of 12,905 children. They identified two motor skills tasks at age ten significantly associated with dyslexia: failure to throw a ball up, clap several times and catch the ball, and failure to walk backward in a straight line for six steps (Haslum, 1989). Deficits in fine motor skills have also been identified in terms of characteristically poor handwriting and copying in young children, coupled with difficulty tying shoelaces (Chung et al., 2020). Deficits in motor skills are also symptomatic of dysgraphia.

What are the symptoms of dysgraphia?

Below are possible symptoms of dysgraphia:

Dysgraphia symptoms

Handwriting:

  • Generally illegible writing, despite appropriate time and attention given to the task.
  • Inconsistencies: mixtures of print and cursive, upper and lower case, or irregular sizes, shapes, or slants of letters.
  • Inconsistent position on a page concerning lines and margins; uneven spaces between words and letters.
  • Motor feedback difficulty: trouble tracking the location of the pencil; face too close to the paper; cramped or unusual grip, especially holding the writing instrument very close to the paper or holding the thumb over two fingers and writing from the wrists.
  • Inability to remember motor patterns associated with letters.
  • Inability to revisualize letters.
  • Talking to self while writing or carefully watching the hand that is writing.
  • Slow or labored copying or writing, even if it is neat and legible.
    .

Spelling:

  • Spelling errors; sometimes, the same word is spelled differently in the same sentence or paragraph.
  • Reversals; phonic approximations; syllable omissions; errors in common suffixes.
  • Difficulty comprehending spelling rules, patterns, and structures (in older children); lack of phonemic awareness (in younger children).
  • Random or non-existent punctuation.
    .

Written composition:

  • Individuals with dysgraphia may exhibit strong verbal but inferior writing skills.
  • Production problems: overly simplistic; too many common words; or complex with errors in syntax, morphology, or semantics.
  • Unsophisticated ideation: difficulty selecting a topic, brainstorming, researching, thinking critically, coming up with ideas, et cetera.
  • Organizational problems: do not know where to begin, confusion with steps.
    .

What does dysgraphia look like?

What are the warning signs of dysgraphia?

In early writers:

  • Tight, awkward pencil grip and body position
  • Avoiding writing or drawing tasks
  • Trouble forming letter shapes
  • Inconsistent spacing between letters or words
  • Poor understanding of uppercase and lowercase letters
  • Inability to write or draw in a line or within margins
  • Quickly tiring while writing
    .

In young students:

  • Illegible handwriting
  • A mixture of cursive and print writing
  • Saying words out loud while writing
  • Concentrating so hard on writing that comprehension of what was written is missed
  • Trouble thinking of words to write
  • Omitting or not finishing words in sentences
    .

In teenagers and adults:

  • Trouble organizing thoughts on paper
  • Trouble keeping track of thoughts already written down
  • Difficulty with syntax structure and grammar
  • A large gap between written ideas and understanding demonstrated through speech
    .

What are the types of dysgraphia?

Dysgraphia is commonly thought of in the following two ways:

Acquired dysgraphia is associated with brain injury, disease, or degenerative conditions that cause the individual (typically an adult) to lose previously acquired skills in writing.

Developmental dysgraphia refers to difficulties in acquiring writing skills. This type of dysgraphia is typically considered in childhood. Researchers have identified several subtypes of developmental dysgraphia:

  • Motor dysgraphia is due to poor fine motor skills, dexterity and muscle tone, and/or unspecified motor clumsiness. Generally, written work is inferior 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, an unreasonable amount of time to accomplish, and cannot be sustained for a significant length of time. Writing is often slanted due to holding a pen or pencil incorrectly. Spelling skills are not impaired. Finger-tapping speed (a method for identifying fine motor problems) results are below normal.

Example of spatial dysgraphia
The writing of an eight-year-old German boy with spatial dysgraphia, before and after three months of Edublox training. Copyright: Edublox Online Tutor.
  • Spatial dysgraphia is due to a defect in the understanding of space. This person has illegible spontaneously written work, illegible copied work, but normal spelling and normal finger-tapping speed. Students with spatial dysgraphia often have trouble keeping their writing on the lines and difficulty with spacing between words.

  • However, others have placed much more focus on the language processing deficits related to written expression, with less emphasis on motor issues. Qualifying terms for this type of dysgraphia include “dysorthography,” “linguistic dysgraphia,” or “dyslexic dysgraphia.” With dyslexic dysgraphia, a person’s spontaneously written work is illegible and their spelling poor, while copied work is pretty neat. Finger-tapping speed is normal. A dyslexic dysgraphic does not necessarily have dyslexia, but they often occur together.

What causes dysgraphia?

Most problems can be solved if one knows what causes them. For example, a disease such as scurvy claimed the lives of thousands of seamen during long sea voyages. However, the disease was cured fairly quickly once the cause was discovered: a vitamin C deficiency. Therefore, a feasible point of departure would be to ask, What causes dysgraphia?

As early as 1896, Baldwin noted that human learning is a stratified process, which implies that specific skills must be mastered before it becomes possible to master subsequent skills. For example, one has to learn to count before it becomes possible to learn to add and subtract. In the same way, there are skills that a student must have mastered before they will be proficient in writing. The child’s writing will not improve until these underlying shortcomings have been addressed.

Letter awareness typically begins in kindergarten and progresses through second grade. During this time, the child becomes familiarized with the relationship between sounds and phonemes while continuing to develop motor skills (Berninger et al., 2008). Automaticity, in which individual letter writing has become a rote response, is usually developed by third grade (Feder & Majnemer, 2007).

Dysgraphia causes

Research has confirmed that language, cognitive, and motor skills underlie the act of writing.

Language:

Language is an essential ingredient of writing. The ability to recognize letter sounds, comprehend words and their meanings, understand word order and grammar to construct sentences, and describe or explain ideas all affect a person’s effectiveness as a writer.

Attention:

Writing often requires considerable mental energy and focus over long periods. Writers must preview what they want to convey and continually monitor what they have already written to stay on track.

Adi-Japha et al. (2007) revealed that children with ADHD and normal reading skills made significantly more spelling errors than their non-ADHD counterparts. Furthermore, their spelling errors showed a unique pattern, such as letter insertions, substitutions, transpositions, and omissions. This error type, also known as graphemic buffer errors, can be explained by impaired attention aspects needed for motor planning.

The results suggest that the spelling errors and writing deficits seen in children with ADHD stem primarily from non-linguistic deficits, while linguistic factors play a secondary role.

Ordering:

Many students with learning disorders have problems with ordering — either ordering things in time (temporal ordering), sequence (sequential ordering), or ordering things in physical space (spatial ordering).

Children with dysgraphia may struggle with spatial ordering, i.e., they have decreased awareness regarding the spatial arrangement of letters, words, or sentences on a page. They may also struggle with sequential ordering, i.e., difficulty placing in order or maintaining the order of letters, words, processes, or ideas.

Memory:

Rapp and colleagues (2016) studied 15 years’ worth of cases in which 33 people were left with spelling impairments after suffering strokes. Some of the people had long-term memory difficulties; others had working-memory issues.

With long-term memory difficulties, people cannot remember how to spell words they once knew and tend to make educated guesses. They can, probably, correctly guess a predictably spelled word like “camp,” but with a more unpredictable spelling like “sauce,” they might try “soss.” In severe cases, people trying to spell “lion” might offer things like “lonp,” “lint” and even “tiger.” With working memory issues, people know how to spell words, but they have trouble choosing the correct letters or assembling the letters in the correct order — “lion” might be “liot,” “lin,” “lino,” or “liont.”

On the other hand, a study by Vlachos and Karapetsas (2003) confirmed the claims of previous studies that at least some types of dysgraphia are associated with visual memory problems. Furthermore, their results suggest that children with dysgraphia suffer from poor visual memory even more than visuomotor skills. Visuomotor skills refer to vision and movement working together to produce actions.

Graphomotor:

Graphomotor function is the use of the neuromuscular system to effectively maneuver a pen or pencil and put letters and words on paper. Children with graphomotor problems struggle with this, especially as assignment length increases. In addition, this function affects a student’s ability to keep pace with the flow of ideas.

Graphomotor skills include gross and fine motor skills. These two motor skills work together to provide coordination. 

  • Gross motor skills involve the movement and coordination of the arms, legs, and other large body parts. They participate in actions such as running, crawling, and swimming. Many think that excellent gross motor skills will enable a child to excel at sports, but this is only part of the benefit!

    Developing a child’s gross motor skills can do so much more than that – they can influence their writing ability. Efficient control of the larger muscle groups in the neck, shoulder, and trunk is necessary to maintain stability for the fingers and hands to move to complete the handwriting task.

  • Fine motor skills are involved in smaller movements in the wrists, hands, and fingers, as well as in the feet and toes. They participate in actions such as picking up objects between the thumb and finger, writing carefully, and even blinking.

    Children with poor fine motor skills will typically

    • have an awkward or immature pencil grasp for their age
    • have poor handwriting; their writing may be messy, slow, or laborious
    • fatigue quickly when typing or using a mouse on a computer
    • have difficulty when using scissors
    • have difficulty performing precise manipulation tasks, for example, using a spoon or fork, buttoning their clothes, or tying shoelaces
    • have difficulty performing age-appropriate self-care tasks independently
    • quickly tire when engaging in fine motor tasks.

How does treatment for dysgraphia work?

Dysgraphia may be caused by language problems, weak underlying cognitive skills (e.g., poor visual memory), and deficient graphomotor skills (e.g., poor fine motor skills), which may affect handwriting, spelling, and writing composition. For this reason, each child’s Edublox program is tailor-made. 

Since dysgraphia may co-occur with other learning disorders and problems, a customized approach is even more needed. Depending on the variables studied and the definitions utilized, between 30-47% of children with writing problems also have reading problems (Chung & Patel, 2015).

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Key takeaways


Authored by Susan du Plessis (B.A. Hons Psychology; B.D.), an educational specialist with 30+ years of experience in learning disabilities.
Medically reviewed by Dr. Zelda Strydom (MBChB).