What is Dysgraphia?

Does your child have bad handwriting? It could be caused by a larger underlying problem: dysgraphia. Problems with developmental skills are often difficult to identify. A skill like handwriting is second-nature to most adults but new to a child first learning it; so it is not unusual for them to have some troubles when starting out. It is estimated that 10%-30% of school-aged children have handwriting difficulties (Karlsdottir & Stefansson, 2002). That being the case, how can a parent distinguish between bad handwriting and an underlying cause like dysgraphia?

Dysgraphia is a brain based condition that causes trouble with writing and spelling. Dysgraphia is often overlooked or attributed to laziness, lack of motivation, carelessness, or delayed visual and motor processing (Berninger and Wolf 2009). According to Berninger and Wolf (2009), a diagnosis of dysgraphia is made when the child exhibits “a cluster”, but not necessarily all, of the following symptoms:

• Cramping of fingers and/or pain while writing short entries
• Odd wrist, arm, body, or paper orientations such as bending an arm into an L shape
• Excessive erasures
• Mixed upper-case and lower-case letters
• Inconsistent form and size of letters, or unfinished letters
• Misuse of lines and margins
• Inefficient speed of copying
• Inattentiveness over details when writing
• Frequent need of verbal cues
• Referring heavily on vision to write (e.g., needing to copy rather than formulate)
• Poor legibility
• Handwriting patterns that interfere with spelling and written composition
• Difficulty translating ideas to writing, possibly including difficulty with word-finding

Handwriting is a complex task involving both central (e.g., cognitive, linguistic and psychosocial) and peripheral (e.g., motor and visual) abilities (Purcell, et al., 2011). Individual assessment should begin with a clear description of the individual’s difficulties, with as much descriptive data as possible and using a sample that, as closely as possible, replicates naturalistic (e.g., classroom) demands, such as a written composition task (i.e., a writing sample). The descriptive analysis should include accuracy (letter formation, spelling, word spacing, sentence formulation and punctuation, paragraph formulation, discourse formulation) and writing efficiency (i.e., accuracy plus speed).  This type of focused  description may lead to additional assessments, including standardized assessments (e.g., of spelling, copying speed, etc.).

While a number of standardized instruments exist (see Rosenblum, Weiss, & Parush, 2003, for a review), each tends to focus on only a single task, usually copying or sentence composition, so they are typically insufficient to capture the demands of naturalistic handwriting performance (Schneck & Amundson, 2010; Feder & Majnemer, 2003).  For example, pediatric occupational therapists tend to use standardized tests to evaluate underlying (mostly motor) components of handwriting as opposed to the cognitive and linguistic demands of handwriting such as spelling and sentence formulation (Crowe, 1989; Feder, Majnemer, & Synnes, 2000; Rodger, 1994). The Lexercise Writing Scale is designed to rate diverse aspects of a child’s writing, based on a 15 minute naturalistic writing sample elicited using a picture or situational prompt.

If you have observed your child displaying a cluster of dysgraphia symptoms you may want to seek clinical help and possibly an official diagnosis. Thankfully, structured literacy therapy is typically very successful in addressing dysgraphia symptoms and in improving overall written communication.

Credits to Marie Lunney for her consultation on this Blog Post.