2. Dysgraphia
Origins of the word:
According to Berninger & Wolf (2009), the word ‘dysgraphia’
comes from the Greek dys (δυσ-), meaning ‘impaired’
(or ‘bad’) and graphia (γραφία), meaning ‘written’.
Definition:
“Impairment of the ability to write, usually
caused by brain dysfunction or disease.”
FROM STEDMAN’S MEDICAL DICTIONARY
3. Dysgraphia
Signs and symptoms
According to a variety of sources, a person with dysgraphia:
• Has difficulty thinking and writing at the same time (taking notes / creative writing)
• May have illegible printing and cursive writing
• May show inconsistencies, e.g. mixtures of print and cursive, upper and lower case, or
irregular sizes, shapes or slant of letters
• Has unfinished words and / or letters, or omits words and / or letters
• Has inconsistent spacing between words and letters
• Exhibits strange wrist, body or paper position
• Has difficulty pre-visualizing letter formation
• Shows poor spatial planning on paper
• Copies or writes in a slow and labored way, and /or;
• Has a cramped or unusual grip (and may complain of a sore hand).
4. Dysgraphia
Symptoms of dysgraphia by age group
Messy handwriting, often illegible even by the author, is a symptom in all age groups.
Children (0-6):
• May have an awkward pencil grip, and / or an overly tight grip
• May show signs of slow and labored writing
• The child’s writing may feature inconsistent letter shape and size
• Writing may feature an inconsistent sequence of strokes to draw the same letter / number
• The child’s writing may feature inconsistent spacing (between letters, words and sentences [the
child cannot stay on / between the lines])
• The child has a poor understanding of upper and lower case letters.
Children (7-15):
• The child has a weak comprehension of writing (concentration is on letter formation)
• The child omits or does not finish words in sentences or the sentence itself.
Adults:
• The adult has a dislike for writing, including short notes or cards
• The adult encounters difficulty with sentence structure and grammar
• There is a gap between understanding and the ability to convey that
understanding in print.
Gen George S. Patten Jnr.
5. Dysgraphia
Types of dysgraphia
Dyslexic dysgraphia
• Spontaneously written work is illegible, copied work quite good, while spelling is bad. Finger
tapping speed - used to identify fine motor problems - is normal, which indicates that the deficit,
“does not likely stem from cerebellar damage”. A dyslexic dysgraphic does not necessarily have
dyslexia, while dyslexia and dysgraphia, “appear to be unrelated”.
Motor dysgraphia
• Due to a deficiency in “fine motor skills, poor dexterity, poor muscle tone, and / or unspecified
motor clumsiness”. In general, written work is “poor to illegible”, even if copied by sight from
another document. While letter formation may be acceptable in very short writing samples, it
requires “extreme effort and an unreasonable amount of time to accomplish, and cannot be
sustained for a significant length of time”. Finger tapping speed results are “below normal”, but
spelling skills are not impaired.
Spatial dysgraphia
• Refers to a defect in relation to a person’s understanding of space. Spontaneous written work is
illegible, as is copied work. But finger tapping speed / spelling is normal.
Combinations (of the above)
• It is possible that some children may have a combination of any two or all three of these forms.
6. Dysgraphia
How dysgraphia impacts a child’s learning skills
• Although not as widely discussed as dyslexia, dysgraphia is surprisingly common, according to
Devine (2016), who describes it as a “brain-based issue”. In children, it generally emerges
when a child is first introduced to writing. Children with dysgraphia may have other learning
disabilities, however, they usually have no social or other academic problems. Cases in adults
usually occur after some neurological trauma or it could be diagnosed in a person with
autism, Asperger’s Syndrome, Tourette’s Syndrome or ADHD.
• Children diagnosed with dysgraphia often exhibit difficulties with handwriting, spelling and
composing written work. The main problem seems to be perceptual; children have difficulty
sequencing, so they may write backwards or out of order, according to the Arizona Office for
Americans with Disabilities.
• Devine notes that a child with dysgraphia may have the ability to think up the most incredibly
creative story, but when to trying to write it down, it would take the child hours. Devine also
highlights a case study, which suggests that dysgraphia causes the child to be held back in all
subjects.
7. Dysgraphia
Impact of dysgraphia on a child’s social skills
According to Understood.org, as well as impacting upon a child’s overall learning skills, dysgraphia
can negatively affect a child’s social skills. For example, it can lead to:
• Frustration: For kids with dysgraphia, writing can be a difficult and slow process. Being
pressured to write can add to the anxiety.
• A lack of expression: The child speaks vaguely or ‘talks around’ things. Kids with dysgraphia
can find it difficult to express ideas and speak about specifics.
• ‘Missing the point’ (humor): It can be tough for kids with dysgraphia to understand humor
or language nuances, such as sarcasm.
• Lack of self-confidence: Children with dysgraphia may feel ‘different’ from other kids and
worry about whether or not they are intelligent. This can lead to low self-esteem.
8. Dysgraphia
Testing and Diagnosis
The following includes key points relating to testing and diagnostic procedures for Dysgraphia:
• Dysgraphia is not usually diagnosed until a child is school-aged.
• A psychologist or neuropsychologist can diagnose dysgraphia. The evaluation process includes
gathering information about family history, the individual’s developmental milestones, as well as
academic history (including samples of written work), including intelligence tests, academic
achievement, and activities that would help to assess the individual’s fine motor functioning (such
as examples of drawing or tracing).
• Letter formation and other types of motoric dysgraphia can be diagnosed at 5-6 years old.
• Some diagnostic tools, including the Test of Written Language (TOWL-4) are only suitable for
students 9 years old and older, since by this age they will have had sufficient experience with
writing instruction and the complexities of written language.
• A dynamic assessment may be able to provide insights, within which an evaluator may ask for
questionnaires from parents and teachers. This may include insights into which kinds of support
are most likely to help the child.
• The evaluator may also ask the parents to fill out some questionnaires
9. Dysgraphia
Strategies for addressing dysgraphia
Richards (1999) identifies two approaches to addressing dysgraphia. The first form uses
systematic techniques that improve functioning; this is referred to as a remedial treatment.
Remedial treatments seek to correct handwriting, either through direct instruction of
handwriting or a fine motor program. Best Practice example 1 is a remedial treatment.
The second strategy uses what are termed as bypass strategies, such as the use of technology, to
find a way around the difficulties. Compensatory techniques or ways to alleviate the problem
would be bypass strategies. Best Practice examples 2 and 3 are bypass strategies.
10. Dysgraphia: Best Practices (1)
Best practice: Use of a non-intensive ‘spell-study-spell‘ intervention
Definition: Primary Progressive Aphasia (PPA)
PPA is a cognitive impairment that includes a progressive loss of language function. While aphasia is a
general term used to refer to deficits in language functions, PPA emerges due to degeneration in the parts
of the brain that are responsible for speech and language. It is caused by neurodegenerative diseases,
such as Alzheimer’s or Frontotemporal Lobar Degeneration.
Introduction
PPA begins gradually and is initially experienced as difficulty thinking of common words while speaking or
writing. It gets progressively worse until verbal communication by any means is difficult. The ability to
understand what others are saying or reading also declines in someone affected by PPA. Memory,
reasoning and visual perception are not affected by the disease during early stages, so people with PPA
can still function normally in relation to most routine daily living activities. But as the illness progresses,
other mental abilities also decline.
Adults can develop PPA at any age, although it is more common among those aged under 65. People with
PPA may have a variety of different language symptoms.
11. Dysgraphia: Best Practices (1)
Best practice: Use of a non-intensive ‘spell-study-spell‘ intervention (continued)
Methods and results
Rapp & Glucroft (2009) carried out a case study that let them examine the effectiveness of a non-
intensive spell-study-spell intervention procedure. They compared the performance on four sets of
words: Trained, Repeated, Homework, and Control words at five evaluations – baseline, during
intervention, after the intervention and at six- and 12-month follow up.
The study found that:
• At the end of the intervention, Trained words showed a small but statistically significant improvement
relative to the baseline and an advantage in accuracy over Control, Homework, and Repeated word
sets.
• All word sets exhibited a decline in accuracy from the end of the treatment to the six-month follow-
up evaluation. The researchers said this was consistent with, “the degenerative nature of the illness”.
Accuracy on Trained words continued to be superior to that of Control words and not statistically
different from pre-intervention baseline levels
• Repeated testing and practice at home yielded modest numerical advantages relative to Control
words, but these differences were, for many comparisons, not statistically significant, according to the
researchers.
• At 12 months post-intervention, all word sets had significantly declined relative to pre-intervention
baselines and performance on the four sets was comparable.
Conclusion : The researchers suggest the results from this study showed, for the first time, that behavioral
intervention can provide both immediate and short-term benefits for dysgraphia in the context of PPA.
12. Dysgraphia: Best Practices (2)
Best practice: Assistive Technology
Bypass strategies involve the utilization of computers and other assistive devices to help students
with dysgraphia.
Definition: In the U.K., assistive technology is defined as, “any item, piece of equipment, or product
system, whether acquired commercially off the shelf, modified, or customized, that is used to
increase, maintain, or improve functional capabilities of individuals with disabilities,” according to the
U.K.’s Technology-Related Assistance for Individuals with Disabilities Act (1988).
According to an article posted on Public School Review (U.S.) in 2009, “some schools may permit
dysgraphic students to use computers for some [or all] of their assignments.” The same article notes
that some students may be … “permitted to use a laptop in the classroom,” noting that many leaders,
“believe that the support of a computer helps students with written expression struggles overcome
some of their most frustrating challenges.”
Usage among dysgraphic students is likely to be much more widespread now, although I have not
been able to locate specific figures in terms of usage rates at the time of compiling this resource.
13. Dysgraphia: Best Practices (3)
Best practice: Assignments: Structuring suitable alternatives
In an article published by the (non-profit) Davidson Institute, Jones suggests some practical
steps that teachers can utilize when issuing assignments to students with dysgraphia.
Jones suggests that dysgraphic students should be able to substitute a written assignment with
an oral or visual assignment. This option would require the teacher to produce a rubric to define
exactly what the assignment should include.
Another practical suggestion is the use of cooperative writing projects, in which students play different
roles, such as, ‘the brainstormer’, ‘the organizer of information’, ‘the writer’, ‘the proofreader’ and
‘the illustrator’.
When referring to ‘modifications’, Jones suggests reducing the length requirement of assignments,
stressing, “quality over quantity”.
ADDitude, a leading media network aimed at parents and adults living with attention-deficit disorders,
suggests the removal of neatness as a grading criterion and allowing students to replace full sentences
with key words.
*Dysgraphia Accommodations and Modifications (1999)
