By: Catherine Joachin
What is dysgraphia?
Dysgraphia is a neurological disorder characterized by impaired written expression in the form of spelling, punctuation, and word spacing (NINDS). Dysgraphia involves a lack of coordination between several components including spatial perception, fine motor skills, and language processing (Cleveland Clinic). This disorder exists in many different forms including:
- Developmental dysgraphia (difficulties in the acquisition of writing skills)
- Acquired dysgraphia or agraphia (loss of writing ability following stroke or brain damage)
- Spatial dysgraphia (difficulties in spatial perception leading to poor drawing and letter spacing)
- Linguistic dysgraphia (difficulties in language processing skills necessary for spontaneous writing
(Chung et. al., 2020)
Symptoms vary widely, but individuals with dysgraphia tend to produce illegible handwriting, struggle with the use of correct grammar and have difficulty planning and executing written work (Cleveland Clinic).
Dysgraphia and Epilepsy
Dysgraphia is a common expression of neurological disorders. Children with absence epilepsy are 3.4 times more likely to develop dysgraphia than their neurotypical peers, suggesting the existence of dysfunctional networks underlying a co-occurrence between absence seizures and impaired writing ability (Guerrini et. al., 2015).
In case studies of epileptic dysgraphia, progressive handwriting difficulties were associated with an increase in epileptic activity (Hirashima et. al., 2007); (Mayor et. al., 2003). Pharmacological intervention for epilepsy was indirectly linked to a decrease in poor written expression. Further investigation is needed to better understand this phenomenon. However, researchers speculate that epileptiform activity in the left hemisphere could lead to dysgraphia (Hirashima et. al., 2007).
Diagnosis and Prognosis
The term dysgraphia is not used in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). Individuals with chronic writing disorders are instead diagnosed with “specific learning disorder” (SLD). This classification implies that dysgraphia does not have a specific criteria for diagnosis. Consequently, the condition is often undiagnosed, and the causes of the disorder remain largely unknown. However, dysgraphia is sometimes developed as a result of brain trauma in adult populations (NINDS).
Assessment for dysgraphia takes several factors into consideration, including intelligence, exposure to adequate learning opportunities and extent of writing difficulties (Cleveland Clinic). Diagnosis is usually performed by a healthcare professional or other specialist (e.g. neuropsychologist, special education teachers) tasked to administer a battery of tests meant to evaluate spelling, motor skills, and writing expression among other skills (NINDS).
In children, dysgraphia is sometimes comorbid with dyslexia, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, and other learning disabilities (Cleveland Clinic). Dysgraphia can impact learning and academic performance on top of disrupting children’s social and personal development (Germanò et. al., 2020). Persistent difficulties with written expression can lead to negative attitudes towards school and low self-esteem that can linger into adulthood (Chung et. al., 2020).
Treatment
Dysgraphia stems a failure to develop handwriting automaticity (Asselborn et. al., 2018). Therefore, handwriting practice alone is fairly ineffective considering that the ability to read or to identify letters and words in intact. There is no cure or designated medication to alleviate dysgraphic symptoms. Moreover, some dysgraphic individuals do improve, while the condition endures in others (NINDS).
Early identification of the disorder in childhood is key to the implementation of effective treatment. Treatment for dysgraphia can target motor function, memory or neurological problems (NINDS). Strategies such as the use of cursive handwriting can minimize the challenges associated with dysgraphia. Access to supportive resources can yield possible outcomes as well. In academic settings, accommodations many include the use of assistive technology (e.g. computers, voice-to-text software) to relieve handwriting stress (NINDS). Occupational therapy and training programs may be required to address targeted difficulties such as poor motor skills.
Conclusion
Dysgraphia is a learning disorder marked by subpar writing ability that affects unspecified percentage of the population (Cleveland Clinic). Research suggests that individuals with epilepsy are at a higher risk of developing dysgraphia than controls. Difficulties with written expression can lead to poor academic performance and precipitate negative attitudes towards writing and intelligence. The condition can be lifelong, therefore persistent writing problems can affect occupational performance and ability to execute daily tasks later in life.
Resources:
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Asselborn, Gargot, T., Kidziński, Ł., Johal, W., Cohen, D., Jolly, C., & Dillenbourg, P. (2018). Automated human-level diagnosis of dysgraphia using a consumer tablet. NPJ Digital Medicine, 1(1), 42-42. https://doi.org/10.1038/s41746-018-0049-x
Chung, P.J., Patel, D.R., & Nizami, I. (2020). Disorder of written expression and dysgraphia: definition, diagnosis, and management. Translational Pediatrics, 9(Suppl 1), S46-S54. https://doi.org/10.21037/tp.2019.11.01
Cleveland Clinic. Dysgraphia. Retrieved from: https://my.clevelandclinic.org/health/diseases/23294-dysgraphia
Germanò, Gagliano, A., Arena, C., Cedro, C., Vetri, L., Operto, F.F., Pastorino, G.M.G., Marotta, R., & Roccella, M. (2020). Reading-writing disorder in children with idiopathic epilepsy. Epilepsy and Behavior, 111, 107118-107118. https://doi.org/10.1016/j.yebeh.2020.107118
Guerrini, Melani, F., Brancati, C., Ferrari, A.R., Brovedani, P., Biggeri, A., Grisotto, L., & Pellacani, S. (2015). Dysgraphia as a Mild Expression of Dystonia in Children with Absence Epilepsy. PloS One, 10(7), e0130883-e0130883. https://doi.org/10.1371/journal.pone.0130883
Hirashima, Morimoto, M., Nishimura, A., Osamura, T., & Sugimoto, T. (2007). Alternative psychosis and dysgraphia accompanied by forced normalization in a girl with occipital lobe epilepsy. Epilepsy & Behavior, 12(3), 481-485. https://doi.org/10.1016/j.yebeh.2007.11.002
Mayor, Zesiger, P., Roulet, E., Maeder, M., & Deonna, T. (2003). Acquired epileptic dysgraphia: a longitudinal study. Developmental Medicine and Child Neurology, 45(12), 807-812. https://doi.org/10.1111/j.1469-8749.2003.tb00895.x
National Institute of Neurological Disorders and Stroke. Dysgraphia. National Institutes of Health. Retrieved from: https://www.ninds.nih.gov/health-information/disorders/dysgraphia?search-term=dysgraphia
