Dysgraphia

• A neurological condition that can affect  an estimated 5-20% (up to 30%) of the population

• Defined as an impairment in age-appropriate written letter and number formation

• It  can include difficulty with written expression (translating ideas into text) for some

• Classified as a specific learning disorder  under DSM-V

• Can affect speed and automatic ability to physically write, copy, draw, organize, and translate thoughts into written words (different mechanics from written expression disorder)

• Does not affect intelligence

• Mentally effortful

• Diagnosed in children and all ages (developmental and acquired)

• Severity varies and differs for each individual.  

• It is often under-diagnosed (missed) or misdiagnosed (attributed to another condition), and can lead to confusion and mislabeling of an individual as “unmotivated”,” messy”, “unorganized”, or “lazy”.

• Graphomotor skills can be tied up – leading to difficulty with controlling and using writing tools

• Possible orthographic coding impairment  –  meaning issues with storing, recognizing,  remembering and recalling sequence order, patterns of letters, symbols and words

• Possible dysfunction in phoneme-to-grapheme translation -  impacting sound to symbol/text

• Possible dysfunction in lexicon-to-grapheme translation - impairment with mental (visual) spelling to written word

• Fine motor (muscles), working memory, and executive functioning skills (planning and focus) can often be impacted

Dyspraxia can result in the difficulty or inability to:

• Physically write and draw

• Form letters, numbers, shapes, and symbols completely

• Automatically recall letters, numbers, shapes, symbols and word patterns

• Re-visualize  letters, numbers, shapes, and symbols,

• Retrieve the sequence of steps to form the letters, shapes and symbols correctly (order, orientation)

• Remember the motor patterns of letter forms, numbers, shapes and symbols.

• Write automatically and rapidly

• Hold, position, and use writing and drawing tools properly

• Make use of proper grammar rules

• Spell (in written form)

• Properly space letters and words

• Sizing and scaling failures

• Fluidly compose written text - affects overall  composition and ability to communicate, fully, thoughts in writing

The examples below outline some of the developmental and real-world context and problems that can arise from living with this condition.

Dysgraphia can create impairment or challenges with:

writing ● printing ● typing ● drawing ● spelling ● writing rapidly ● writing legibly (readability) ● writing clearly (thoughts) ● forming letters ● numbers ● shapes ● symbols ● using correct stroke sequences ● copying text ● transcribing words (sound to text) ● transposing letters and words (swapping positions) ● incorrect word order ● skipping letters when writing or copying ● omitting words in sentences ● spacing issues ● squeezing letters too close together ● crowding words and sentences ● mirror writing (writing from right to left) ● letter reversals (b, d, p, q) ● inversions (m, w) ● inconsistent writing ● disproportionate sizing (text too large, text too small) ● mixed letter sizes ● mixed use of upper and lower cases ● mixed use of cursive and print ● inconsistent punctuation and grammar rules ● alignment issues ● lopsided letters ● distorted shapes ● uneven lines ● difficulty crossing letters (‘Ts’, ‘Es, ‘Fs’,‘Hs’ and ‘Xs’) ● forgetting to cross letters ● general alignment issues on a page ● writing straight (without lines) ● staying in the margins ● writing coordination (brain to motor to text/paper) ● ability to hold writing tools ● finger positioning on a pencil ● arm posture to hold a pen ● no automatic writing ● discrepancy between spelling and speaking ability - high verbal intelligence (some) ● impaired spontaneous writing ● effortful writing ● no fluid writing ● impaired writing flow and composition ● inability to express oneself in written form ● impacted memory and retrieval systems ● low classroom productivity ● incomplete school work ● writing problems dismissed (by educators and professionals) ● students overlooked (at school, at home) ● students underserved (no help) ● unfairly mislabeled (messy, unmotivated)

Early intervention, along with explicit and systematic instruction implemented for writing, spelling, and composition - with specialized OT help - will go a long way to manage and ease the struggles with dysgraphia.

• Dysgraphia can often be a catch-all diagnosis for writing problems.

• Distinct from Dyslexia.  The two often co-occur

• Distinct from DCD | Developmental Coordination Disorder, though the two can co-occur

• Has high co-morbiditys with many other neurodivergent conditions – Autism and ADHD, written expression disorder, and expressive language disorder for example.

• Can be a standalone diagnosis (but not always recognized by all organizations) e.g. American Psychological Association or IDEA

• Rooted in difficulty storing and automatically retrieving letters, numbers, shapes and symbols

• There may be a genetic component

• Showing one sign of dysgraphia is not an indicator that you have dysgraphia

• Some people can speak more easily and fluently than they write

• Oral spelling can be preserved, despite struggle with written spelling

• Progression of complexity of work increases will make dysgraphia more detectable, discernable.

• Early intervention helps

• Management strategies needed

• Specialized instructions and OT assistance are great resources

• No medication to treat