Understanding Dysgraphia

What is dysgraphia? and hyperactive subtypes. Children with this kind of dysgraphia may respond to a combination of Dysgraphia is a specific learning disability that explicit handwriting instruction plus stimulant affects how easily children acquire written language and how well they use written language medication, but appropriate diagnosis of ADHD to express their thoughts. by a qualified professional and monitoring of response to both instruction and medication are Dysgraphia is a Greek word. The base word needed. graph refers both to the hand’s function in Dysgraphia may occur alone or with dyslexia writing and to the letters formed by the hand. (impaired reading disability) or with oral and The prefix dys indicates that there is impairment. written language learning disability (OWL LD, also Graph refers to producing letter forms by hand. referred to as selective language impairment, The suffix ia refers to having a condition. Thus, SLI). dysgraphia is the condition of impaired letter writing by hand, that is, disabled handwriting and Dyslexia is a disorder that includes poor word sometimes spelling. Impaired handwriting can reading, word decoding, oral reading fluency, and interfere with learning to spell words in writing. spelling. Children with dyslexia may have Occasionally, but not very often, children have impaired orthographic and phonological coding just spelling problems and not handwriting or and rapid automatic naming and switching. reading problems. Phonological coding refers to coding sounds in spoken words in working memory. Phonological What causes dysgraphia? coding is necessary for developing phonological awareness—analyzing the sounds in spoken Research to date has shown orthographic coding words that correspond to alphabet letters. If in working memory is related to handwriting. children have both dysgraphia and dyslexia, they Orthographic coding refers to the ability to store may also have difficulty in planning sequential unfamiliar written words in working memory finger movements. while the letters in the word are analyzed during word learning or the ability to create permanent OWL LD (SLI) are disorders of language memory of written words linked to their (morphology—word parts that mark meaning pronunciation and meaning. Children with and grammar; syntax—structures for ordering dysgraphia do not have primary developmental words and understanding word functions; finding motor disorder, another cause of poor words in memory, and/or making inferences that handwriting, but they may have difficulty go beyond what is stated in text). These disorders planning sequential finger movements such as affect spoken as well as written language. the touching of the thumb to successive fingers Children with these language disorders may also on the same hand. exhibit the same writing and reading and related disorders as children with dysgraphia or dyslexia. Does dysgraphia occur alone or with other specific learning disabilities? Why is diagnosis of dysgraphia and related Children with impaired handwriting may also learning disabilities important? have attention-deficit disorder (ADHD)— Without diagnosis, children may not receive early inattentive, hyperactive, or combined inattentive intervention or specialized instruction in all the

Page | 1 of 4 Understanding Dysgraphia relevant skills that are interfering with their • writing the letter from memory after learning of written language. Considering that interval that increases in duration over many schools do not have systematic the handwriting lessons; instructional programs in handwriting and • writing letters from dictation (spoken spelling, it is important to assess whether name to letter form); and children need explicit, systematic instruction in • writing letters during composing for 5 handwriting and spelling in addition to word minutes on a teacher-provided topic. reading and decoding. Many schools offer accommodations in testing and teaching to Students benefit from explicit instruction in students with dysgraphia, but these students also spelling throughout K–12: need ongoing, explicit instruction in handwriting, • initially in high frequency Anglo-Saxon spelling, and composition. It is also important to words; determine if a child with dysgraphia may also • subsequently in coordinating the have dyslexia and require special help with phonological, orthographic, and reading or OWL LD (SLI) and need special help morphological processes relevant for the with oral as well as written language. spelling of longer, more complex, less frequent words; and What kinds of instructional activities improve the • at all grade levels in the most common handwriting of children with dysgraphia? and important words used for the Initially, children with impaired handwriting different academic domains of the benefit from activities that support learning to curriculum. form letters: Throughout K-12, students benefit from strategies for composing: • playing with clay to strengthen hand • planning, generating, muscles; reviewing/evaluating, and revising • keeping lines within mazes to develop compositions of different genre including motor control; narrative, informational, compare and • connecting dots or dashes to create contrast, and persuasive; and complete letter forms; • self-regulation strategies for managing the • tracing letters with index finger or eraser complex executive functions involved in end of pencil; composing. • imitating the teacher modeling sequential strokes in letter formation; Do children with dysgraphia make reversals or and other letter production errors? • copying letters from models. Some children do make reversals (reversing Subsequently, once children learn to form legible direction letter faces along a vertical axis), letters, they benefit from instruction that helps inversions (flipping letters along a horizontal axis them develop automatic letter writing, using the so that the letter is upside down), or following steps to practice each of the 26 letters transpositions (sequence of letters in a word is of the alphabet in a different order daily: out of order). These errors are symptoms rather • studying numbered arrow cues that than causes of handwriting problems. The provide a consistent plan for letter automatic letter writing instruction described formation; earlier has been shown to reduce reversals, • covering the letter with a 3 x 5 card and which are less likely to occur when retrieval of imaging the letter in the mind’s eye; letters from memory and production of letters

Page | 2 of 4 Understanding Dysgraphia have become automatic. identification, prevention, and diagnosis for treatment planning and linking them to What kind of instructional strategies improve evidence-based handwriting and spelling spelling of children with dysgraphia? instruction (also see Troia, 2008). If children have both handwriting and spelling In summary, dysgraphia is a specific learning problems, the kinds of handwriting instruction disability that can be diagnosed and treated. described earlier should be included along with Children with dysgraphia usually have other the spelling instruction. problems such as difficulty with spelling and written expression, as well as dyslexia and, in Are educators in public schools identifying some cases, oral language problems. It is children with dysgraphia and providing important that a thorough assessment of appropriate instruction in public schools? handwriting and related skill areas be carried out In general, no. Although federal law specifies in order to plan specialized instruction in all written expression as one of the areas in which deficient skills that may be interfering with a students with learning disabilities may be student’s learning of written language. For affected, it does not clearly identify the example, a student may need instruction in both transcription problems that are the causal factors handwriting and oral language skills to improve in dysgraphia—impaired handwriting and/or written expression. Although early intervention spelling—for impaired written expression of is, of course, desirable, it is never too late to ideas. Some of the tests used to assess written intervene to improve a student’s deficient skills expression are not scored for handwriting or and provide appropriate accommodations. spelling problems and mask the nature of the disability in dysgraphia. Content or ideas may not References be impaired. All too often, the poor writing or Berninger, V. (2007a). Process Assessment of the failure to complete writing assignments in a Learner, 2nd Edition. Diagnostic for Reading timely fashion or at all is misattributed to lack of and Writing (PAL-II RW). San Antonio, TX: motivation, laziness, or other issues unrelated to The Psychological Corporation. the real culprit—dysgraphia. Children who are twice exceptional—gifted and dysgraphic—are Berninger, V. (2007b). Process Assessment of the especially under-diagnosed and underserved. Learner II User’s Guide. San Antonio, TX: Teachers mistakenly assume that if a student is Harcourt/PsyCorp. (CD format) ISBN bright and cannot write it is because the student 0158661818. Second Edition issued August, is not trying. 2008.

Are there research-supported assessment tools Berninger, V. (2007). Evidence-based written for diagnosing dysgraphia? language instruction during early and middle childhood. In R. Morris & N. Yes. See Berninger (2007a) and Milone (2007) Mather (Eds.), Evidence-based below for assessing handwriting problems interventions for students with learning associated with dysgraphia. Also, see Berninger and behavioral challenges. Philadelphia: (2007b) and Berninger, O’Donnell, and Holdnack Lawrence Erlbaum Associates. (2008) for using these tests and other evidence- Berninger, V., O’Donnell, L., & Holdnack, J. based assessment procedures in early (2008). Research-supported differential diagnosis of specific learning disabilities and implications for instruction and response to instruction (RTI). In A. Prifitera, D.

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Saklofske, & L. Weiss (Eds.), WISC-IV Henry, M. (2003). Unlocking literacy. Effective Clinical Assessment and Intervention, decoding and spelling instruction. Second Edition (pp. 69–108). San Diego, Baltimore: Paul H. Brookes Publishing. CA: Academic Press (Elsevier). Milone, M. (2007). Test of Handwriting Skills- Berninger, V., & Wolf, B. (in press-a). Teaching Revised. Novato, CA: Academic Therapy. students with dyslexia and dysgraphia: Distributed by ProEd, Austin, TX. Lessons from teaching and science. Moats, L. C. (Winter, 2005/2006). How spelling Baltimore: Paul H. Brookes. supports reading: And why it is more Berninger, V., & Wolf, B. (in press-b). Helping regular and predictable than you students with dyslexia and dysgraphia make think. American Educator, 12–22, 42– connections: Differentiated instruction 43. lesson plans in reading and writing. Troia, G. (Ed.). (2008). Instruction and Baltimore: Paul H. Brookes. [Spiral-bound assessment for struggling writers: book with teaching plans from University of Evidence-based practices. New York: Washington Research Program.] Guilford. Graham, S., Harris, K., & Loynachan, C. (1994). Yates, C., Berninger, V., & Abbott, R. (1994). The spelling for writing list. Journal of Writing problems in intellectually gifted Learning Disabilities, 27, 210–214. children. Journal for the Education of the Gifted, 18, 131–155.

The International Dyslexia Association (IDA) thanks Virginia W. Berninger, Ph.D., for her assistance in the preparation of this fact sheet.

The International Dyslexia Association (IDA). IDA encourages the reproduction and distribution of this fact sheet. If portions of the text are cited, appropriate reference must be made. Fact sheets may not be reprinted for the purpose of resale. © Copyright 2020. The International Dyslexia Association (IDA). For copyright information, please go to our website: https://dyslexiaida.org/policies/

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