Understanding Dysgraphia

by Peter J. Chung, MD

Dr. Peter Chung is a board-certified developmental-behavioral pediatrician and the medical director of the Center for Autism & Neurodevelopmental Disorders at the University of California--Irvine. He and his colleagues recently published a scientific review article on dysgraphia in Translational Pediatrics and he was kind enough to summarize the article for the Dysgraphia Life community.

The Process of Writing

The task of writing requires coordination between many different parts of the body and the brain. It is actually a very complicated task. Try writing down a word on a piece of paper and think about all the steps you had take. First, your brain has to first come up with the word that is going to be written. This requires communication between parts of the brain that remember the concept or idea, the sounds associated with that concept, and then the letters associated with those sounds. Signals then travel from your brain down to the nerves and muscles of your arms, hands, and fingers. These signals have to control the coordinated movements, amount of pressure, and grip strength to transform brain’s thought into a written product. This process can get more complex as you write bigger and longer products (sentences, paragraphs, and essays).

When you think about it, writing is not a “natural” skill, it is a human invention.

Typically developing children will organically learn to speak, play, interact with their environment, make emotional connections, and learn basic things about the world around them without needing any specific instruction. They will learn these skills from natural experience. However, learning to read and write requires someone to teach children these skills.

Students spend a lot of time in school learning how to read and write. They start in preschool and kindergarten learning how to copy different symbols and shapes to practice coordinating the muscles needed to hold and use a pencil. In early elementary school, they learn to recognize the different letters and the sounds they make and start to put them together into words. Meanwhile, they are supposed to be getting better and better at writing letters and numbers. By third grade, children are usually expected to be able to write letters automatically (without thinking about each movement that they need to make). As they progress through their education, writing assignments become longer and more complicated. By the time students are in high school, they are expected to write essays that require the ability to plan, organize, and revise in addition to coordinating the brain and body to produce words and sentences.

What is Dysgraphia and What Causes It?

“Dysgraphia” and “disorder of written expression” are official terms that have been used to describe individuals who have trouble with learning how to write. The difficulty with the writing task can happen at one or more of the steps in the process. For example, one child may have trouble making the connection between a word and the letters that make up the word. Another student may struggle with coordinating the muscles needed to write a word. Other students may have trouble organizing their thoughts in essay form. All of these difficulties can affect an individual’s writing ability differently. If a student has difficulty with an early part of the process (like making the letter-sound connection or drawing basic shapes ), difficulty with writing is likely to be picked up at a young age. However, more abstract difficulties like problems in organizing and revising an essay may not become noticeable until middle or high school. Whatever the kind of writing difficulty, any level of problems in this area can result in decreased grades, lower self-esteem, and more behavioral problems in school.

We don’t know exactly what causes dysgraphia, but there are a number of theories. Different areas of the brain are responsible for different things, like short term memory, long term memory, visual memory, auditory memory, motor control, attention span, etc.

People with writing challenges may have differences in how one or more of these brain areas operate, including how their brain areas communicate with one another.

The cerebellum, a part of the brain that is responsible for coordination and balance, seems to play an important part in the act of writing; for example, adults who previously had no problems with writing can demonstrate writing challenges after their cerebellum has been injured in some way. Genetic differences may also play a role. Research has shown that certain “codes” of information on genes can be linked to reading and writing problems. Whatever the cause of dysgraphia, there are different techniques and therapies that have been shown to help.

What Can I Do To Help My Child?

If you are concerned about your child’s writing skills, you can consult with your general pediatrician. You can help your doctor by sharing as many details as you can, including the kinds of problems you have noticed with your child’s writing ability, how long you have been concerned, and any associated other symptoms (e.g. clumsiness when running, trouble holding utensils, etc). Your pediatrician can do a neurologic exam looking at how well your child's brains, muscles, and nerves work together. Some children with dysgraphia can have mild differences on the exam that are noticeable by a trained health professional. Your pediatrician may have some experience and knowledge about typical writing development and be able to administer screening tests to evaluate writing ability. Depending on your insurance coverage, he or she may also be able to refer you to specific testing to evaluate your child's coordination, balance, strength, learning styles, and other measures of brain abilities.

However, not all pediatricians are familiar with disorders of written expression. Don’t be too discouraged if your child’s doctor seems to downplay your concerns or isn’t able to provide sufficient help. You can always request additional testing and help through your child’s public school district though an evaluation for an “Individualized Education Program”, or IEP. An IEP does not require any prescription or doctor’s note. Actually, the request for an IEP has to come from either the child’s teacher or parent/guardian. Websites like Dysgraphia Life can provide a lot of additional information and resources that talk about how dysgraphia is diagnosed and treated. Other helpful sources include understood.org, the Learning Disabilities Association of America, and the International Dyslexia Association, among others. Just remember that you are not alone, and don’t be afraid to ask for help!