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People with dysgraphia usually can write on some level, and often lack other fine motor skills, finding tasks such as tying shoes difficult. It often does not affect all fine motor skills. They can also lack basic 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.”
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 on dysgraphia.
Types of dysgraphia
Some children may have a combination of two or all three of these,
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 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.
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
The child generally takes much longer than their peers to complete a written assignment despite having normal or even above average intelligence, a reluctance or refusal to complete writing tasks, and a strong preference to write in print instead of cursive.
Other symptoms include an inappropriate mixture of upper/lower case letters or all upper case letters, irregular letter sizes and shapes, unfinished letters, inability to stay within the lines of a page, struggle to use writing as a communications tool, odd writing grip, many spelling mistakes, frequent reversal of letter sequences, 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.
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.
Another aspect of this, is that instead of a feeling of pain, the person may experience a sense of considerable effort and exhaustion as if they were lifting heavy weights repeatedly. This occurs even though arm and hand strength are normal.
Parents should be alert for children who have an unusual amount of difficulty learning how to hold a fork or spoon.
Common problems that are often associated with dysgraphia
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.
It should be noted that children do not generally outgrow this problem, it continues to affect them as adults.
ADHD and Autism
As noted above, people with ADHD and Autism also have a high probability of being affected by dsylexia and dysgraphia and other learning disabilities.
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.
Often small things can help students with dysgraphia, such as allowing them to use a preferred writing utensil or allowing them to submit typewritten work instead of requiring their work to be handwritten.
Suggestions for teachers and parents:
- Use of small pencils (a typical pencil cut in thirds) golf pencils, or triangular shaped pencils all promote a functional grip. Jumbo pencils are useful for individuals with tremors or some types of cerebral palsy.
- Ensure that solid handwriting instruction has taken place. The student should be able to tell how each letter is made using the same verbiage as the teacher.
- Before the student begins to compose a paper, have them engage in prewriting activities such as webbing, or verbalizing what they will write about.
- Use pre-lined paper that has yellow highlighting where the words are supposed to go
- Allow students extra time to complete in-class assignments; otherwise they won’t get the benefit of the instructional practice
- Get students keyboarding early on
- Allow students to use laptop or other computer for class work
- Allow children to dictate to an adult; they can then recopy if necessary
- Allow children to dictate into a tape recorder; they or an adult can transcribe later. This allows the creative output process to occur without being stopped by the execution problem.
- a computer equipped with a speech recognition system can be a huge asset, but it can be difficult to find a quiet space in which to use it.