Dysgraphia

# Overview
Dysgraphia (or agraphia) is a deficiency in the ability to write, regardless of the ability to read, not due to intellectual impairment. People with dysgraphia often can write on some level, but often 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 Tourette syndrome, ADHD or an autism spectrum disorder such as Asperger's. The DSM IV identifies dysgraphia as a "Disorder of Written Expression" as "writing skills (that) ...are substantially below those expected given the person's ...age, measured intelligence, and age-appropriate education."

## The Cause
The cause of dysgraphia is unknown but whenever it occurs in an adult, it is usually caused by head trauma, some types of diseases or brain damage.  When it is found in children there is a tendency for there to be multiple dysgraphics in his or her family.  A parent or close relative of the child tend to also show signs of dysgraphia.
There have been few studies on Dysgraphia.

# 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 but are often comorbid.)

## 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. Writing is often slanted due to holding a pen or pencil incorrectly. 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, but normal spelling and 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.

# Symptoms 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, muscle spasms in the arm and shoulder(sometimes in the rest of the body), inability to flex(sometimes move) the arm (creating an L like shape), and general illegibility. Reluctance or refusal to complete writing tasks.

## Lesser known symptoms 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:
- Sufferers do not know that it is unusual to experience this type of pain with writing.
- If they know that it is different from how others experience writing, they know that few will believe them.
- Those who do believe that the pain while writing is real will often not understand it.  It will usually be attributed to muscle ache or cramping, and it will often be considered only a minor inconvenience.

# 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. This can be a result of any symptom of dysgraphia.

# 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 could be considered to 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.
Often small things can help a student with dysgraphia, such as allowing them to use a preferred writing utensil or allowing them to submit typed work instead of hand written documents.
Suggestions for teachers and parents:
- Use jumbo pencils (and grips for new writers)
- Use pre-lined paper that has yellow highlighting where the words are supposed to go
- Allow students extra time to complete in-class assignments; otherwise they won't get the benefit of the instructional practice
- Get students keyboarding early on; they can start on an Alphasmart word processor
- Allow children to dictate to an adult; they can then recopy if necessary
- Allow children to dictate into a tape recorder; they or an adult can transcribe later. This allows the creative output process to occur without being stopped by the execution problem.
- Have compassion and know that this issue has nothing to do with intelligence or behavior.