Dysgraphia

Dysgraphia is a deficiency in the ability to write, primarily handwriting, but also coherence. Dysgraphia is a transcription disability, meaning that it is a writing disorder associated with impaired handwriting, orthographic coding, and finger sequencing (the movement of muscles required to write). It often overlaps with other learning disabilities such as speech impairment, attention deficit disorder, or developmental coordination disorder. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dysgraphia is characterized as a learning disability in the category of written expression when one's writing skills are below those expected given a person's age measured through intelligence and age-appropriate education. The DSM is not clear in whether or not writing refers only to the motor skills involved in writing, or if it also includes orthographic skills and spelling. Dysgraphia is a deficiency in the ability to write, primarily handwriting, but also coherence. Dysgraphia is a transcription disability, meaning that it is a writing disorder associated with impaired handwriting, orthographic coding, and finger sequencing (the movement of muscles required to write). It often overlaps with other learning disabilities such as speech impairment, attention deficit disorder, or developmental coordination disorder. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dysgraphia is characterized as a learning disability in the category of written expression when one's writing skills are below those expected given a person's age measured through intelligence and age-appropriate education. The DSM is not clear in whether or not writing refers only to the motor skills involved in writing, or if it also includes orthographic skills and spelling. The word dysgraphia comes from the Greek words dys meaning 'impaired' and γραφία graphía meaning 'writing by hand'. There are at least two stages in the act of writing: the linguistic stage and the motor-expressive-praxic stage. The linguistic stage involves the encoding of auditory and visual information into symbols for letters and written words. This is mediated through the angular gyrus, which provides the linguistic rules which guide writing. The motor stage is where the expression of written words or graphemes is articulated. This stage is mediated by Exner's writing area of the frontal lobe. People with dysgraphia can often write on some level and may experience difficulty with other fine motor skills, such as tying shoes. However, dysgraphia does not affect all fine motor skills. People with dysgraphia often have unusual difficulty with handwriting and spelling which in turn can cause writing fatigue. They may lack basic grammar and spelling skills (for example, having difficulties with the letters p, q, b, and d), and often will write the wrong word when trying to formulate their thoughts on paper. The disorder generally emerges when the child is first introduced to writing. Adults, teenagers, and children alike are all subject to dysgraphia. Dysgraphia should be distinguished from agraphia, which is an acquired loss of the ability to write resulting from brain injury, stroke, or progressive illness. Dysgraphia is nearly always accompanied by other learning disabilities such as dyslexia or attention deficit disorder, and this can impact the type of dysgraphia a person might have. There are three principal subtypes of dysgraphia that are recognized. There is little information available about different types of dysgraphia and there are likely more subtypes than the ones listed below. Some children may have a combination of two or more of these, and individual symptoms may vary in presentation from what is described here. Most common presentation is a motor dysgraphia/agraphia resulting from damage to some part of the motor cortex in the parietal lobes. People with dyslexic dysgraphia have illegible spontaneously written work. Their copied work is fairly good, but their spelling is usually poor. Their finger tapping speed (a method for identifying fine motor problems) is normal, indicating that the deficit does not likely stem from cerebellar damage. Motor dysgraphia is due to deficient fine motor skills, poor dexterity, poor muscle tone, or unspecified motor clumsiness. Letter formation may be acceptable in very short samples of writing, but this requires extreme effort and an unreasonable amount of time to accomplish, and it cannot be sustained for a significant length of time, as it can cause arthritis-like tensing of the hand. Overall, their written work is poor to illegible even if copied by sight from another document, and drawing is difficult. Oral spelling for these individuals is normal, and their finger tapping speed is below normal. This shows that there are problems within the fine motor skills of these individuals. People with developmental coordination disorder may be dysgraphic. Writing is often slanted due to holding a pen or pencil incorrectly. A person with spatial dysgraphia has a defect in the understanding of space. They will have illegible spontaneously written work, illegible copied work, and problems with drawing abilities. They have normal spelling and normal finger tapping speed, suggesting that this subtype is not fine motor based.