Dysgraphia – The learning disability that affects writing skills.
Dysgraphia is a term that was previously used to describe and categorise a learning disability that affects writing skills, but its use is less common these days.
Trust the worlds of science, government, education, business, and many other organisations to aim to improve naming conventions but sometimes further confuse them. In my opinion, the replacement of ‘Dysgraphia’ with (…wait for it…) “A Specific Learning Disorder with Impairment in Written Expression” is one of those things.
Okay, I’m being slightly dramatic – I just really liked the term “Dysgraphia.” Dysgraphia was simple and easy to use in a report and sounded awesome! However, in truth, the wisdom that is delivered through the DSM – V, which among other things is the diagnostic bible when it comes to mental health conditions and includes developmental and learning conditions, accurately sub-categorises the term dysgraphia alongside the artists formerly known as;
Symptoms of dysgraphia: Difficulty with handwriting, spelling, and grammar.
SLD-WE is considered a learning difficulty that impacts on a person’s ability to write. It can manifest itself as difficulties with spelling, poor handwriting, and trouble expressing thoughts on paper. Since writing requires a complex set of motor and information-processing skills, saying a student has SLD-WE is not as simple as judging his/her handwriting.
Handwriting is one of the most complex skills that is learnt and taught. It requires motor, sensory, perceptual, praxis (motor planning) and cognitive functions, and the integration of these functions (Chu, 1997). When the complexity of this skill is considered, it is not surprising that many children experience difficulty in mastering handwriting.
When handwriting difficulties affect a student’s academic performance, confidence and willingness to engage in learning opportunities, intervention is warranted. A referral to an Occupational Therapist (OT) may be recommended and OTs usually adopt a diagnostic approach when assessing handwriting difficulties.
However, I did read a post recently written by an OT stating, “OTs cannot diagnose dysgraphia (SLD-WE), it is not in our scope.” Initially, I was quite confused and even dismissive of the claim – I have been doing handwriting assessments for years! In fact, an experienced clinical psychologist I have known for many years has sent several children to me over the years asking me to assess and confirm or diagnose SLD – WE, given that handwriting is an OT’s area of expertise. She feels that we are better equipped to complete the assessment and diagnosis. Then I started thinking about how this could be similar to OT’s involvement (or non-involvement) in the diagnostic process of Autism Spectrum Disorder (ASD). OT’s do not assess for the presentation of ASD, but we certainly work with people on the Autism Spectrum.
Perhaps OTs should only work with children with handwriting difficulties, but not diagnose the problem. I am sure this is a good one to debate, and if I was a younger version of myself with a desire to make sure OT was ‘involved’ and ‘present,’ I would be more proactive in staking a claim for our involvement in diagnosing and assessing. However, I am older, somewhat wiser, and I am driven by providing therapy rather than claiming rights.
Causes of dysgraphia: Brain differences or difficulties with fine motor skills.
Evaluation of handwriting difficulties can include and may not be limited to:
- Assessing Neuromuscular mechanisms – including postural control, upper limb stability and muscle tone.
- Sensory integrative functioning – poor perception and discrimination of touch can influence pencil grip, visual perceptual deficits, and poor motor planning skills can influence the quality and speed of writing.
- Motor control – poor fine motor control and dexterity. Lack of exposure and refinement of skills during preschool can exacerbate handwriting difficulties.
- Cognitive and psychosocial behaviours – attention span, memory, behaviour, motivation and self-concept are all important factors incorporated in the evaluation of handwriting skills.
Following a handwriting assessment, it is important to establish what approach is most appropriate for the student. In some cases, remediation is not possible without significant effort and financial burden. In this current technologically advanced climate, alternative options provide a range of choices that can be both cost-effective and preferred by the student. In all cases, consultation and collaboration with parents and teachers is recommended.
How to help your child with dysgraphia:
Treatment approaches include:
- Remedial – aims to address underlying inefficiencies in sensory processing, motor coordination and perceptual skills that will result in improved handwriting performance. Therapy can be clinic-based (sensory motor approaches) or school/home based.
- Functional – emphasises mastering the skills through practice and repetition. Like other acquisitional skills (learning to tie laces) handwriting may be improved through sequencing, tracing, templates, practice, and modelling.
- Compensatory – pencil grips, slant boards, Dictaphones, use of word processors/PCs, a scribe, voice-activated software. Due to technological advancement, these options are becoming more commonplace, appropriate, and affordable.
From all perspectives, handwriting is a complex “end product.” Identifying and seeking assistance at the earliest stages supports students in achieving their potential. However, improving handwriting should never override a student’s enjoyment of learning, nor should it determine their success at school.
My personal opinion about handwriting is that whilst it is a skill with many benefits in terms of communication, learning, and overall brain function, it is slowly becoming obsolete. It can be viewed as a ‘traditional’ form of written expression and not a contemporary one. Sitting here “writing” this on a notebook is proof that my time would have been better spent learning to touch type rather than persist with handwriting. I would welcome any discussion regarding the contrary.
I always confess to parents who bring their child in for “handwriting problems” that if you ever had to pick a struggle or difficulty to allocate your child in life let it always be “dysgraphia” (see, it sounds so much better than a Specific Learning Difficulty in Written Expression). And no, I don’t have some morbid sense of humour but sometimes the need to reiterate the point and put things into context is delivered more honestly and directly using this obscure analogy.
We have the technology, the cost of notebooks continues to decrease, and the need to be computer literate in the education and the working world has by far exceeded the need to have ‘nice penmanship.’ The best thing you can do for your child who has a SLD- WE, is to avoid making it a reason that they don’t want to engage in learning or school. The way you do that is to quite simply tell them that being good at handwriting doesn’t really matter – what you write not how you write is what really matters!
Author: Dino Mennillo – OTFC GROUP Director
BAppSc Occupational Therapy