Kay, M.J. (1995)  Diagnosis & Intervention Strategies for Disorders of Written Language. 
Association of School Psychologists of Pennsylvania

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The term dysgraphia has customarily been used to refer to a disorder of written language expression in childhood as opposed to a disorder of written language acquired in adulthood. Written language disorders have also been referred to as "developmental output failures."

Difficulties in writing have an adverse impact on academic achievement in school and subsequently on business and industry. It is currently estimated that dysgraphia costs American industry and business $30 billion per year.

Written language is the Graphomotor execution of sequential symbols to convey thoughts and information. Since writing represents the last and most complex skill to develop, it is the most vulnerable to insult, injury and adverse genetic influences (Deuel, 1994).


Multiple Brain Mechanisms

Writing represents a highly complex neurodevelopmental process, which involves multiple brain mechanisms. It requires the simultaneous and sequential integration of attention, multiple information sources, memory, motor skill, language, and higher cognition. Gross and fine-motor coordination, motor memory, and "kinetic melody", a term coined by Luria, requires balancing, flexing, and contracting movements as well as simultaneously stimulating some muscle groups while inhibiting other muscle groups.

In order to self-monitor writing output, visual, propriokinesthetic, automatic motor memory, and revisualization feedback mechanisms must be engaged. Visual feedback mechanisms include eye-hand coordination and visual-fine motor integration. Proprio-kinesthetic feedback mechanisms include awareness of the movement and location of the fingers in space, internal monitoring of rhythm and rate, and pencil grip. Motor memory feedback mechanisms include motor plans or engrams, visual-fine motor coordination to produce symbols, sequentialization, speed, and accuracy. Revisualization feedback mechanisms include visual memory for symbols, whole word memory, visual attention to detail, and spelling. All of these skills require developmental readiness and can be improved with practice.


Requirements for Written Language

The primary requirements for written language include an intact central nervous system, intact cognitive ability, intact language skills (both receptive and expressive), motivation, skill development, practice, and emotional stability. Secondary written language requirements include concepts of organization and flow, writing skill, spelling skill, syntax and grammar knowledge, mechanics, productivity, accuracy, visual and spatial organization, simultaneous processing, revisualization, and automatization.
 

Dysgraphia Classification Systems

Dysgraphia is often classified as either specific or non-specific (Deuel, 1994). Specific dysgraphia results from spelling disabilities, motor coordination problems, and language disabilities such as aphasia. The components of motor dysgraphia are sometimes related to anatomical problems, executive dysfunction, motor planning deficits, and visual-spatial perception problems.

Non-specific dysgraphia may result from mental retardation, psychosocial deprivation, or poor school attendance. Some children do not develop adequate handwriting skills because they have not received enough direct instruction in written language.

Deuel (1994) has divided dysgraphia into three subtypes:

• Dyslexic dysgraphia
  
  
• Dysgraphia due to motor clumsiness, and
  
  
• Dysgraphia due to a defect in the understanding of space.
  
  

In dyslexic dysgraphia, spontaneously written text is poorly legible and spelling is severely abnormal. Copying of written text is relatively preserved, however, and finger-tapping speed on a neuropsychological battery is generally normal.

Dysgraphia due to motor clumsiness is associated with poorly legible spontaneously written text, preserved spelling, and poorly legible copying of written text. Finger tapping speed in such cases is generally abnormal.

Dysgraphia due to a defect in understanding of space is associated with poorly legible spontaneously written text, preserved spelling, poorly legible copying of written text, and normal finger tapping speed.
 

Assessment Issues

There are a variety of assessment issues, which must be addressed in evaluating disorders of written language. These include the various characteristics of the dysgraphic writer, such as fine-motor/writing speed, attention and concentration, writing organization, spelling, knowledge and use of vocabulary, language expression, and perception of details.

Assessment instruments, which may be useful in diagnosing written language disorders include:

• Processing Speed Index scores from the WISC-IV
• Developmental Test of Visual-Motor Integration
• Bender-Gestalt
• Jordan Left-Right Reversal Test

In addition, a variety of excellent written language achievement measures include:

• The Test of Written Language
• Woodcock-Johnson Psycho-Educational Battery (Third Edition)
• Diagnostic Achievement Battery-Third Edition.
  

In addition to characteristics of the writer, the school psychologist must assess the type of instruction that has been provided to the learner and the student's response to the writing curriculum. Various characteristics of instruction, which should be incorporated into the background knowledge and included in the history taking of the student, include:

• Penmanship instruction
• Instruction on how to organize and arrange thoughts, and
• Instruction on written language rules including capitalization, punctuation, grammar, spelling and sentence structure.

The psychologist should determine whether direct instruction has been provided and whether note-taking methods have been taught and practiced.

Traditionally, in many classrooms currently, relatively little time is allocated to the cognitively complex business of writing (Graves, 1983). It may well be the case that many of the difficulties so many students experience with writing are due to the inopportune combination of difficult content to be learned and very little time allocated to learning it (Stein, Dixon & Isaacason, 1994).

Some current writing mechanics trends advocate teaching mechanics only as the student's interests dictate in the course of a planned composition instruction (DuCharme, Earl & Poplin, 1989). Advocates of such trends suggest that mechanical writing skills, such as spelling, should not be taught formally. Rather, students should be encouraged to invent spellings. Others are wary of this type of approach for several reasons.

First, descriptive research (Graham, 1990) indicates that spelling and handwriting difficulties experienced by many students with learning disabilities hamper their effective participation in composition instruction. Second, such an approach virtually preempts the possibility that many diverse learners will learn mechanics in such a way that their knowledge will transfer. Knowledge transference depends upon the careful selection of instruction examples (Gick & Holyoak, 1987). Third, a concerned shift away from teaching writing mechanics represents a swing in the educational pendulum that can produce deficits in knowledge of these important components of writing (Stein, et. al., 1994). Finally, there is little research support for the notion that writing mechanics will take care of themselves more or less automatically in the course of well-designed composition instruction (Isaacson, 1989; Stein, et al., 1994). Good writers have knowledge of all aspects of writing mechanics and composition alike.

Intervention for Written Language Disorders

Intervention for written language disorders depends upon an accurate localization and assessment of the student's specific deficiencies. When difficulties are related to the child's age or grade, age-specific remediation of deficit skills is recommended. When specific deficiencies are present, bypass strategies may be useful. When dysgraphia is the result of multiple deficiencies, remediation and bypass of the problem become more difficult.

Remediation strategies for early elementary age children with written language problems include writing readiness exercises, instruction and practice using appropriate pencil grip, formation of symbol skills, practice to increase fluency, and direct instruction to improve writing organization.

Writing studies indicate that students with learning disabilities benefit most from instruction that emphasizes writing as a process (Graham & Harris, 1989; Morrocco & Newman, 1986). This instructional model emphasizes the communicative purpose of writing by creating a social context in which students write for real audiences with real purposes. Secondly, it is based on the view of composing as a problem solving process involving planning, drafting, revision, and editing.

At the upper elementary level it is often important to begin introducing bypass strategies for the dysgraphic student. Examples include shortening assignments, increasing performance time, grading first on the content of the work and then on the quality, avoiding negative reinforcement, using oral exams and allowing oral presentations from the student, and giving tests in untimed conditions.

Bypass strategies utilizing computers and other assistive devices are also helpful for students with written language disorders. Prior to teaching the use of word processing software, keyboarding skills should be mastered. Keyboarding can be taught by any teacher who can type (Majsterk, 1990). An excellent program to teach keyboarding skills is Keyboarding Skills for All the Grades (1987) by Diana Hanbury-King. Keyboarding skills are best taught on a manual typewriter which requires force to push down the keys. This helps to lock in muscle memory for the position of the keys.


Summary

Written language is the ultimate, most complex method of expression. It involves infinitely complex multiple brain mechanisms, highly synchronized processing and has multiple sources and locations for disruption of activity. There is a need for accurate diagnosis of written language problems, realistic remedial strategies and realistic expectations for the learner. A combination of accurate diagnosis, remediation using direct instruction techniques, and the use of bypass strategies and assistive technology can be useful in supporting the needs of the learner with written language deficits.

References

Deuel, R.K. (1994). Developmental dysgraphia and motor skill disorders.  Journal of Child Neurology, 10 (1), 6-8.

DuCharme, C., Earl, J., & Poplin, M.S. (1989). The author model:  The constructivist view of the writing process.  Learning Disability Quarterly, 12, 237 - 242.

Gick, M.L. & Holyoke, K.J. (1987). The cognitive basis of knowledge transfer.   In S.M. Cormier & J.D. Hagman (Eds.), Transfer of Learning:   Contemporary research and applications (pp. 9-46). CA: Academic Press.

Graham, S. (1990). The role of production factors in learning disabled students' compositions.  Journal of Educational Psychology, 80, 356-361.

Graham, S. & Harris, K.R. (1989). Improving learning disabled students' skills at composing essays:  Self-instructional strategy training.  Exceptional Children, 56, 201-214.

Graves, D. (1983). Writing:  Teachers and children at Work.  NH: Heinemann.

Hanbury-King, D. (1987). Keyboarding skills for all the grades. MA: Educators Publishing.

Isaacson, S. (1989). Role of secretary vs. author:  Resolving the conflict in writing instruction.  Learning Disability Quarterly, 12, 209-217.

Majsterek, D.J. (1990). Writing disabilities:  Is word processing the answer?   Intervention in School and Clinic, 26 (2), 93-97.

Morrocco, C.C. & Newman, S.B. (1986). Learning disabled students' difficulties in learning to use a work processor: Implications for instruction and software evaluation.   Journal of Learning Disabilities, 19, 248-253.

Stein, M., Dixon, R.C., & Isaacson, S. (1994). Effective writing instruction for diverse learners.  School Psychology Review, 23 (3), 392-405.

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Last modified: July 11, 2010