What Is Dysgraphia?
Dysgraphia is a neurological disorder characterized by writing disabilities. Specifically, the disorder causes a person’s writing to be distorted or incorrect. In children, the disorder generally emerges when they are first introduced to writing. They make inappropriately sized and spaced letters, or write wrong or misspelled words, despite thorough instruction.
A learning disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social and practical adaptive skills. This disability typically originates before age 18.
Over the past decade, important changes have been made in disability terminology, resulting in the renaming of mental retardation to intellectual disability. Though this disability, which has a major impact on a patient’s life, is sometimes hard to diagnose, medical science has developed a better understanding of its causes.
Learning disabilities are disorders that affect the ability to:
- Understand or use spoken or written language
- Do mathematical calculations
- Coordinate movements
- Direct attention
Learning disabilities occur in very young children, yet they are usually not noticed until the child reaches school age. Learning disabilities can be lifelong conditions with a range of impacts and accommodation requirements.
In some people, several overlapping learning disabilities may occur, with frequent overlap of attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD) diagnoses. Other people may have a single, isolated learning problem that has little impact on their lives.
There is some incidence of learning disabilities in adults, such as adult-onset dyslexia. This usually occurs as a result of brain injury or dementia. However, some adults with dyslexia were never diagnosed with dyslexia as children or adolescents. Dyslexia can be inherited; recent studies have identified a number of genes that may predispose a person to developing dyslexia.
Types of Dysgraphia
There are five types of dysgraphia with various symptoms:
- Dyslexic dysgraphia: Poor handwriting, particularly with spontaneous written work
- Motor dysgraphia: Challenges with fine motor skills, poor handwriting
- Spatial dysgraphia: Trouble with visual-spatial ability, resulting in poor spontaneous and copied handwriting
- Phonological dysgraphia: Problems with spelling unfamiliar words or phonetically sounding out irregular words
- Lexical dysgraphia: Commonly misspells irregular words, reliant upon sound-to-letter patterns
Causes of Dysgraphia
Most developmental disabilities are thought to be caused by a complex mix of factors. These factors include genetics, parental health and behaviors (such as smoking and drinking) during pregnancy, complications during birth, infections the mother might have during pregnancy or the baby might have very early in life, and exposure of the mother or child to high levels of environmental toxins, such as lead. For some developmental disabilities, such as fetal alcohol syndrome, which is caused by drinking alcohol during pregnancy, we know the cause. But for most, we don’t.
Cases of dysgraphia in adults generally occur after some trauma. The cause of the disorder is unknown, but in adults, it is usually associated with damage to the parietal lobe of the brain.
Risk Factors for Dysgraphia
Most developmental disabilities are thought to be caused by a complex mix of factors. These factors include genetics, parental health and behaviors (such as smoking and drinking) during pregnancy, complications during birth, infections the mother might have during pregnancy or the baby might have very early in life, and exposure of the mother or child to high levels of environmental toxins, such as lead.
Developmental disabilities begin any time during the developmental period and usually last throughout a person’s lifetime. Most developmental disabilities begin before a baby is born, but some can happen after birth because of injury, infection or other factors.
Screening for & Preventing Dysgraphia
Healthcare providers can play an important part in collaborating with schools to help a child with learning disorders or other disabilities get the special services they need. The American Academy of Pediatrics (AAP) has created a report that describes the roles that healthcare providers can have in helping children with disabilities, including learning disorders:
- Identifying children in need of early intervention or special education services.
- Sharing relevant information with early intervention or school personnel.
- Meeting with early intervention or school personnel and parents or guardians.
- Using early intervention or school information in medical diagnostic or treatment plans.
- Working within an early intervention, school or school-based health clinic.
- Working at an administrative level to improve school functioning around children with special needs.
Evaluators may test for dysgraphia by assessing the mechanics, thematics and fine motor skills involved in writing. Additionally, they may evaluate the child's handwriting skills by analyzing samples they've completed as part of the assessment.
Signs & Symptoms of Dysgraphia
Children diagnosed with dysgraphia make inappropriately sized and spaced letters, or write wrong or misspelled words, despite thorough instruction. For example, writing "boy" for "child."
Dysgraphia disorder is commonly co-occurring with learning disabilities; however, children with dysgraphia usually have no social or other academic problems. Cases of dysgraphia in adults generally occur after some trauma.
There are five types of dysgraphia with various symptoms:
- Dyslexic dysgraphia: Poor handwriting, particularly with spontaneous written work
- Motor dysgraphia: Challenges with fine motor skills, poor handwriting
- Spatial dysgraphia: Trouble with visual-spatial ability, resulting in poor spontaneous and copied handwriting
- Phonological dysgraphia: Problems with spelling unfamiliar words or phonetically sounding out irregular words
- Lexical dysgraphia: Commonly misspells irregular words, reliant upon sound-to-letter patterns
Diagnosing Dysgraphia
Similar to dyslexia, early testing for dysgraphia is helpful to keep your child on track in school. Working with your school resources or specialists, your child can learn strategies and tools following a formal handwriting assessment that tracks both speed and legibility, and the Beery Developmental Test of Visuomotor Integrations (VMI), which evaluates your child’s ability to integrate the visual and motor skills required to write.
Children with learning disorders may feel frustrated that they cannot master a subject despite trying hard, and they may act out, act helpless or withdraw. Learning disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD), or anxiety. The combination of problems can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is crucial so that the child can get the right kind of help for each.
Many children may struggle in school with some topics or skills from time to time. When children try hard and still struggle with a specific set of skills over time, it could be a sign of a learning disorder. Having a learning disorder means that a child has difficulty in one or more areas of learning, even when overall intelligence or motivation is not affected.
Children with a displayed lack of achievement may be diagnosed just as commonly as those of average or above-average intelligence. Discrepancies may exist from one type of diagnosis to another, with variations depending on the individual. Learning disabilities and deficiencies in information processing can make learning and communication challenging or impossible.
Treating Dysgraphia
Treatment varies and may focus on controlling writing movements and addressing impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid the problems of handwriting. Some individuals with the disorder improve their writing ability, but for others, the disorder persists.
Children with learning disorders often need extra help and instruction that are specialized for them. Having a learning disorder can qualify a child for special education services in school. Schools usually do their own testing for learning disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s behavior or emotions. Parents, healthcare providers and the school can work together to find the right referrals and treatment.
The most common treatment for learning disabilities is special education. Specially trained teachers may perform a formal assessment to understand the child's academic and intellectual potential. They will also look at the level of academic performance. Once the evaluation is complete, the basic approach is to teach learning skills by building on the child's abilities and strengths while correcting disabilities and weaknesses. Other professionals such as speech and language therapists also may help. Some medications may help the child learn by enhancing attention and concentration. Psychological therapies may also be used.
Living with Dysgraphia
Children with specific learning disabilities are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA).
The U.S. Department of Education issued a “Dear Colleague” letter providing clarification to both parents and practitioners about ensuring a high-quality education for children with specific learning disabilities, including children with dyslexia, dyscalculia and dysgraphia.
To develop a better understanding of your diagnosis, consider participating in a clinical trial so clinicians and scientists can learn more about learning disabilities and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat or prevent disease.
All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.
For information about participating in clinical research, visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for participants at Clinicaltrials.gov.