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Dysgraphia - info for staff

Dysgraphia is a difficulty writing coherently, if at all, regardless of ability to read. People with dysgraphia often can write, and may have a higher than average IQ, but lack co-ordination, and may find other fine motor tasks such as tying shoes difficult (It often does not affect all fine motor skills). They can also lack basic spelling skills (having difficulties with p,q,b,d), and often will write the wrong word when trying to formulate thoughts (on paper). In childhood, the disorder generally emerges when they are first introduced to writing. They make inappropriately sized and spaced letters, or write wrong or misspelled words despite thorough instruction. Children with the disorder may have other learning disabilities; however, they usually have no social or other academic problems. Cases of dysgraphia in adults generally occur after some neurological trauma or it might be diagnosed in a person with an autism spectrum disorder such as Asperger's, Tourette syndrome or ADHD. The DSM IV (US ‘Diagnostic and Statistical Manual of Mental Disorders’) identifies dysgraphia as a "disorder of written expression": "writing skills (that) ...are substantially below those expected given the person's ...age, measured intelligence, and age-appropriate education".

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Types of dysgraphia

Dyslexic dysgraphia

With dyslexic dysgraphia, spontaneously written work is illegible, copied work is fairly good, and spelling is bad. Finger tapping speed (a method for identifying fine motor problems) is normal, indicating the deficit does not likely stem from cerebellar damage. A dyslexic dysgraphic does not necessarily have dyslexia. (Dyslexia and dysgraphia appear to be unrelated.)

Motor dysgraphia

Motor dysgraphia is due to deficient fine motor skills, poor dexterity, poor muscle tone, and/or unspecified motor clumsiness. Generally, written work is poor to illegible, even if copied by sight from another document. 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 cannot be sustained for a significant length of time. Spelling skills are not impaired. Finger tapping speed results are below normal.

Spatial dysgraphia

Dysgraphia due to a defect in the understanding of space has illegible spontaneously written work, illegible copied work, normal spelling, but normal tapping speed.

Some children may have a combination of any two or all three of these. Symptoms in actuality may vary in presentation from what is listed here.

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Indicators of dysgraphia

A mixture of upper/lower case letters, irregular letter sizes and shapes, unfinished letters, struggle to use writing as a communications tool, odd writing grip, many spelling mistakes (sometimes), pain when writing, decreased or increased speed of writing and copying, talks to self while writing, and general illegibility. Reluctance or refusal to complete writing tasks.

Lesser known indicators of dysgraphia

Pain while writing

Many people who are dysgraphic will experience pain while writing. The pain usually starts in the center of the forearm and then spreads along the nervous system to the entire body. This pain can get worse or even appear when a dysgraphic is stressed. Few people who do not have dysgraphia know about this, because many with dysgraphia will not mention it to anyone. There are a few reasons why pain while writing is rarely mentioned:

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Common problems that are often associated with dysgraphia

Stress

There are some common problems not related to dysgraphia but often associated with dysgraphia, the most common of which is stress. Often children (and adults) with dysgraphia will become extremely frustrated with the task of writing (and spelling); younger children may cry or refuse to complete written assignments. This frustration can cause the child (or adult) a great deal of stress and can lead to stress related illnesses. Other common environmental sources of stress in the classroom setting are (a) high levels of environmental noise, and (b) over-illumination.

Treatment

Treatment for dysgraphia varies and may include treatment for motor disorders to help control writing movements. Other treatments may address impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid the problems of handwriting.

Occupational therapy should be considered to correct an inefficient pencil grasp, strengthen muscle tone, improve dexterity, and evaluate eye-hand coordination. Dysgraphic children should also be evaluated for ambidexterity, which can delay fine motor skills in early childhood.

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Learning related vision problems

People who struggle with symptoms of dysgraphia usually benefit from vision therapy. Seventy percent of what a child learns in school is processed through the visual system. Even a minor visual processing problem will interfere with a child or adult performing to their potential and could cause symptoms of dysgraphia.

Symptoms of Vision Problems:

If a student experiences the above, it is advisable for them to have a learning related vision examination by a suitable optometrist. Testing should be done at distance and nearpoint to assure that both eyes are working together as a team. Vision is more than clarity, and is a complex combination of learned skills, including tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, people can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

The above information was taken from wikipedia: http://en.wikipedia.org/wiki/Dysgraphia (accessed 12th Jan 2007).

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The following additional information is from the International Dyslexia Association website (www.interdys.org):

Dysgraphia can interfere with a student's ability to express ideas. Expressive writing requires a student to synchronize many mental functions at once: organization, memory, attention, motor skill, and various aspects of language ability. Automatic accurate handwriting is the foundation for this juggling act. In the complexity of remembering where to put the pencil and how to form each letter, a dysgraphic student forgets what he or she meant to express. Dysgraphia can cause low classroom productivity, incomplete homework assignments, and difficulty in focusing attention.

Emotional factors arising from dysgraphia often exacerbate matters. At an early age, these students are asked to forego recess to finish copying material from the board, and are likely to be sent home at the end of the day with a sheaf of unfinished papers to be completed. They are asked to recopy their work but the second attempt is often no better than the first. Because they are often bright and good at reading, their failure to produce acceptable work is blamed on laziness or carelessness. The resulting anger and frustration can prevent their ever reaching their true potential.

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What causes dysgraphia?
A few people with dysgraphia lack only the fine-motor coordination to produce legible handwriting, but some may have a physical tremor that interferes with writing. In most cases, however, several brain systems interact to produce dysgraphia. Some experts believe that dysgraphia involves a dysfunction in the interaction between the two main brain systems that allows a person to translate mental into written language (phoneme-to-grapheme translation, i.e., sound to symbol, and lexicon-to-grapheme translation, i.e., mental to written word). Other studies have shown that split attention, memory load, and familiarity of graphic material affect writing ability. Typically, a person with illegible handwriting has a combination of fine-motor difficulty, inability to re-visualize letters, and inability to remember the motor patterns of letter forms.

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Who is qualified to diagnose dysgraphia?
Dysgraphia cannot be diagnosed solely by looking at a handwriting sample. A qualified clinician must directly test the individual. Such a test includes writing self-generated sentences and paragraphs and copying age-appropriate text. The examiner assesses not only the finished product, but also the process, including posture, position, pencil grip, fatigue, cramping, or tremor of the writing hand, eyed-ness and handedness, and other factors. The examiner may assess fine-motor speed with finger tapping and wrist turning.

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What is the treatment for dysgraphia?
Prevention, remediation and accommodation are all important elements in the treatment of dysgraphia. Many problems can be prevented by early training. Young children in kindergarten and grade one should learn to form letters correctly; kinaesthetic memory is powerful and incorrect habits are very difficult to eradicate.

Muscle training and over-learning good techniques are both critical for the remediation of dysgraphia. Specifically designed exercises are needed to increase strength and dexterity. A specialist can recommend the most appropriate plan of exercises. For all students, kinaesthetic writing, that is writing with eyes closed or averted, is a powerful reinforcer. Work needs always to begin with the formation of individual letters written in isolation. Alphabets need to be practiced daily, often for months.

Finally, individuals can benefit from a variety of modifications and accommodations. One effective method is to teach the use of a word processor, by-passing the complex motor demands of handwriting. Many students may find learning the keyboard by the alphabet method easier than beginning with the home keys. For many, touch typing offers a whole new opportunity to learn to spell through a different kinaesthetic mode. Students should also experiment with different writing tools; some people with dysgraphia may find pencil grips helpful. Other bypass methods include allowing the student to answer questions orally or into a tape recorder instead of writing, modifying written assignments so that less writing is required, and allowing extended time to complete tests and assignments. Copying from the board is an especially difficult task. Teachers need to provide notes. Photocopying the notes of another student is one possibility. Providing an outline, with spaces left for the student to fill in information, is another. Writing on a slightly inclined plane may be helpful.

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Should people with dysgraphia use cursive writing instead of printing?
For many children with dysgraphia, cursive writing has several advantages. It eliminates the necessity of picking up a pencil and deciding where to replace it after each letter. Each letter starts on the line, thus eliminating another potentially confusing decision for the writer. Cursive also has very few reversible letters, a typical source of trouble for people with dysgraphia. It eliminates word-spacing problems and gives words a flow and rhythm that enhances learning. For children who find it difficult to remember the motor patterns of letter forms, starting with cursive eliminates the traumatic transition from manuscript to cursive writing. Writers in cursive also have more opportunity to distinguish b, d, p, and q because the cursive letter formations for writing each of these letters is so different.

Although the URL does not indicate it, there is also information about dysgraphia here: http://www.dyscalculia.org/Edu563.html

The following is taken from www.ldinfo.com:

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Underlying causes of dysgraphia

Sequencing Problems - As with dyslexia, written language difficulty is often believed to be the result of underlying visual or perceptual processing weakness. However, research on brain functioning has not found much evidence to support the notion of a visual basis for dysgraphia. In fact, what usually appears to be a perceptual problem (reversing letters/numbers, writing words backwards, writing letters out of order, and very sloppy handwriting) usually seems to be directly related to sequential/rational information processing. In other words, when students experience difficulty sequencing and organizing detailed information, they often have difficulty with the sequence of letters and words as they write. As a result, the student either needs to slow way down in order to write correctly or experiences rather extreme difficulty with the 'mechanics' of writing (spelling, punctuation, etc.). Usually they have difficulty even when they do slow down. And by slowing down or getting 'stuck' with the details of writing they often lose the great thoughts that they are trying to write about. Sometimes the creative writing skills of such a student are surprisingly strong when the mechanics of writing don't get in the way. This is because their 'conceptual' processing skills are often quite strong enabling them to express 'deeper meaning' in spite of difficulty with the details.

Attention Deficit hyperactivity Disorder (ADHD) - Students with an attention deficit disorder (especially with hyperactivity) often experience rather significant difficulty with writing in general and handwriting in particular. This is because ADHD students also have difficulty organizing and sequencing detailed information. In addition, ADHD students are often processing information at a very rapid rate and simply don't have the fine-motor coordination needed to 'keep up' with their thoughts.

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Auditory Processing Weakness - Other students experience writing difficulty because of a general auditory or language processing weakness. Because of their difficulty learning and understanding language in general, they obviously have difficulty with language expression. And written language is the most difficult form of language expression. A generalized auditory processing weakness is frequently referred to as a verbal or language-based learning disability and typically affects the areas of reading and writing. Math may be a relative strength.

Visual Processing Weakness - Although most writing disabled or 'dysgraphic' students do not have visual or perceptual processing problems, some students with a visual processing weakness will experience difficulty with writing speed and clarity simply because they aren't able to fully process the visual information as they are placing it on the page. Again, this is probably the least likely cause of a written language problem. A visual processing weakness is sometimes referred to as a nonverbal learning disability and typically affects the areas of spelling and math much more than reading.

There is a useful article about supporting dysgraphic students at school (“Dysgraphia accommodations and modifications”) here: http://www.ldonline.org/article/6202

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