Dysgraphia

Overview

What is dysgraphia?

Dysgraphia is a neurological condition in which someone has difficulty turning their thoughts into written language for their age and ability to think, despite exposure to adequate instruction and education. Dysgraphia can present with many different symptoms at different ages. It’s considered a learning difference.

Writing is a complex process that involves many skills and brain functions, including:

  • Fine motor skills.
  • Spatial perception (ability to perceive the space around you).
  • Working memory (ability to hold and manipulate information in your mind).
  • Orthographic coding (ability to form, store and recall letters, numbers and symbols).
  • Language processing.
  • Conceptualization.
  • Organization.

Because of this, dysgraphia is somewhat of a catch-all term to diagnose issues with writing and can be difficult to diagnose.

Dysgraphia generally appears when children are first learning to write. This is called developmental dysgraphia. People can also develop dysgraphia suddenly after some type of head or brain trauma. This is called acquired dysgraphia.

Dysgraphia is considered a “specific learning disorder” — more specifically, a “specific learning disorder in written expression.”

Is dysgraphia a form of dyslexia?

Dyslexia and dysgraphia are two distinct neurological conditions, though they’re easy to confuse because they share symptoms and often occur together.

Dyslexia is a learning difference that makes it harder for people to learn to read. If you have dyslexia, you may read more slowly or have trouble recognizing words. Often, people with dyslexia read at a lower level than expected. People with dyslexia may struggle to break words into sounds or relate letters to sounds when reading.

Dysgraphia involves difficulty with the act of writing. Difficulties can range from issues with physically writing words to issues with organizing and expressing thoughts in written form.

Is dysgraphia a form of autism?

Dysgraphia isn’t a form of autism spectrum disorder (ASD). Though dysgraphia commonly occurs in people with autism, you can have dysgraphia without having autism.

Autism spectrum disorder is a neurodevelopmental condition characterized by:

  • Difficulties in social communication differences.
  • Deficits in social interactions.
  • Restricted, repetitive patterns of behavior, interests or activities.
  • Sensory problems.

Who does dysgraphia affect?

Dysgraphia can affect children and adults. As with many neurodevelopmental conditions, dysgraphia is more common in children assigned male at birth (AMAB) than in children assigned female at birth (AFAB).

You’re more likely to have dysgraphia if other family members also have it, and dysgraphia is common in children with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD).

How common is dysgraphia?

Dysgraphia is common. Researchers estimate that 5% to 20% of people have dysgraphia. The estimated range is large because dysgraphia often goes undiagnosed or misdiagnosed.

Symptoms and Causes

What are the signs of dysgraphia?

People with dysgraphia may have several different difficulties when it comes to writing and may speak more easily and fluently than they write. They may have issues with:

  • Letter formation and/or legibility.
  • Letter size and spacing.
  • Spelling.
  • Fine motor coordination.
  • Rate or speed of writing.
  • Grammar.
  • Composition.

Specific ways dysgraphia can present include:

  • Difficulties writing in a straight line.
  • Difficulties with holding and controlling a writing tool.
  • Writing letters in reverse.
  • Having trouble recalling how letters are formed.
  • Having trouble knowing when to use lower or upper case letters.
  • Struggling to form written sentences with correct grammar and punctuation.
  • Omitting words from sentences.
  • Incorrectly ordering words in sentences.
  • Using verbs and pronouns incorrectly.

Having one of these signs doesn’t mean that a person has dysgraphia, but if your child is having trouble learning the basic skills for writing that are appropriate for their age, they should be tested to see if they need specific help.

What causes dysgraphia?

Scientists and neurologists aren’t sure what causes developmental dysgraphia. Writing is a complex task, and several areas of your brain are involved in the process. There seems to be a genetic link, as dysgraphia often runs in families.

Diagnosis and Tests

How is dysgraphia diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) includes dysgraphia under the “specific learning disorder” category, but doesn’t define it as a separate disorder and doesn’t have specific criteria for diagnosis. This can make dysgraphia difficult — but not impossible — to diagnose.

Similar to the assessment process for dyslexia, an assessment for dysgraphia involves careful consideration of your child’s:

  • Learning strengths and weaknesses.
  • Educational history.
  • The extent of their writing difficulties.
  • The type of writing difficulties they’re having.
  • What impact targeted teaching therapy (remediation) and support has had on their current academic achievement levels.

The diagnosis of dysgraphia is typically made in an educational setting by a team assessment, which can include the following specialists:

  • Occupational therapists.
  • Physical therapists.
  • Special education teachers.
  • Educational psychologists.
  • Speech therapists.
  • Neuropsychologists.

When should my child be tested for dysgraphia?

Typically, early testing is best for learning differences. Your child can learn new writing strategies sooner when dysgraphia is diagnosed early. Depending on how your child is affected by dysgraphia, they may show signs of the condition as early as 5 years old or as late as young adulthood.

As writing demands in school increase with age, it’s important to diagnose dysgraphia as early as possible. It’s also important to remember that it’s never too late to get a diagnosis and help.

Your child’s school may recommend an evaluation for learning disabilities with a certified educational psychologist. Ask the school administration for help finding one available to you.

What tests will be done to diagnose dysgraphia?

There’s no medical testing required or available for diagnosing dysgraphia. Instead, healthcare providers and education specialists carefully assess your child’s writing difficulties to make a diagnosis.

Healthcare providers may use the following assessments and tests in the diagnostic process:

  • Formalized handwriting assessments: These tests can help measure the speed and legibility of your child’s writing.
  • Beery Developmental Test of Visuomotor Integration (VMI): This test helps assess the extent to which your child can integrate their visual and motor skills, which is necessary for writing.

These tests don’t assess all the possible aspects of dysgraphia, so your child’s education team will likely rely on additional methods to diagnose dysgraphia. Depending on your child and their learning differences, more thorough academic testing may be done.

Management and Treatment

How is dysgraphia managed?

As dysgraphia has a broad range of signs and each person is affected differently by it, management for dysgraphia is very individualized.

Currently, no medications treat dysgraphia. Instead, educational interventions can teach effective, new ways to write.

In general, educational interventions can be categorized by the following levels:

  • Accommodation: Your child has access to the mainstream education curriculum with supportive or assistive resources without changing the educational content.
  • Modification: Your child’s school adapts your child’s goals and objectives, as well as provides services to reduce the effect of dysgraphia. For example, your child may be able to orally give test answers instead of writing them.
  • Remediation: Your child’s school provides specific interventions to decrease the severity of dysgraphia.

It’s important to advocate for your child and work with their school to ensure your child receives the education they deserve.

Prevention

Can I prevent dysgraphia?

Unfortunately, you can’t prevent dysgraphia. But you can manage it by finding different strategies to write.

Early diagnosis is essential — talk with your child’s healthcare provider if you notice any early signs of dysgraphia. If your child is diagnosed, work with their school to develop an individualized education plan (IEP).

Outlook / Prognosis

What is the prognosis (outlook) for dysgraphia?

When dysgraphia remains undiagnosed, children struggle to succeed in school.

Writing is an important academic skill that’s been associated with overall academic achievement.

Children who have difficulty with writing are often mislabeled as sloppy or lazy rather than being recognized as having a learning disorder.

Because of this, a child with dysgraphia may have self-esteem issues or believe they’re not intelligent. Positive support from loved ones and teachers can help a child overcome these obstacles.

Living With

What does living with dysgraphia mean?

Having dysgraphia means writing is difficult for you, not that you’re incapable or lazy. Finding techniques to help manage dysgraphia is critical to successful learning and self-esteem. Understand that having dysgraphia doesn’t reflect poor intelligence.

How can I help my child with dysgraphia?

Be an advocate for your child. You and your child’s school can develop an individualized education plan (IEP). This document sets personalized expectations and lesson plans for your child at school.

You can also help your child build writing skills at home. Try out pencil grips and other tools that may make writing easier. Look for apps or software that can help with handwriting and graphic organizers that can help with writing assignments.

A note from Cleveland Clinic

If you or your child’s teacher suspects your child has a learning difference like dysgraphia, you can get help. Dysgraphia is a manageable neurological condition. Talk to your child’s healthcare provider, teacher or the school’s administration to discover ways to help your child with their writing skills.

Last reviewed by a Cleveland Clinic medical professional on 06/15/2022.

References

  • Chung PJ, Patel DR and Nizami I. Disorder of Written Expression and Dysgraphia: Definition, Diagnosis, and Management. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082241/) Transl Pediatr. 2020; 9(1): S46-S54. Accessed 6/15/2022.
  • Dyslexia – SPELD Foundation. What is Dysgraphia? (https://dsf.net.au/what-is-dysgraphia/#:~:text=also%20have%20Dyslexia.-,Dysgraphia%20can%20appear%20as%20difficulties%20with%20spelling%20and%2For%20trouble,help%20prevent%20or%20reduce%20problems.) Accessed 6/15/2022.
  • International Dyslexia Association. Understanding Dysgraphia. (https://dyslexiaida.org/understanding-dysgraphia/) Accessed 6/15/2022.
  • Rocha Cabrero F, De Jesus O. Dysgraphia. (https://www.ncbi.nlm.nih.gov/books/NBK559301/) [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Accessed 6/15/2022.

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