Dysgraphia

Dysgraphia
The term dysgraphia has customarily been used in reference 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." 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). Difficulties in writing have an adverse impact on academic achievement in school and the different careers chosen throughout life. Dysgraphia can be seen in letter inconsistencies, mixture of upper/lower case letters or print/cursive letters, irregular letter sizes and shapes, unfinished letters, and struggle to use writing as a communications tool. "It is not laziness, not trying, not caring, sloppy writing, general sloppiness, careless writing, and visual-motor delay" (Kay, 2002).
Dysgraphia is a difficulty in automatically remembering and mastering the sequence of muscle motor movements needed in writing letters or numbers. This difficulty is out of harmony with the person?s intelligence, regular teaching instruction, and (in most cases) the use of the pencil in non-learning tasks. It is neurologically based and exists in varying degrees, ranging from mild to moderate. 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, 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. The causes of dysgraphia can be related to other learning disabilities such as sequencing problems, attention deficit hyperactivity disorder, or auditory weakness. First, 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 (Scott, 2001). Next, Students with an attention deficit disorder (especially with hyperactivity) often experience significant difficulty with writing and particularly in handwriting. 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 (Scott, 2001). 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. Also 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 (Scott, 2001). Understanding what dysgraphia is and knowing some root causes through other disorders, I will know begin to explain ways to assess dysgraphia. 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: wisc-iii, Beery Developmental Test of Visual Motor Integration, Peabody Picture Vocabulary Test ? Third Edition (ppvt-iii) along with the Expressive Vocabulary Test (evt), and Woodcock Johnson iii Tests of Achievement (WJ iii). Also several tests like the WRAT3 Spelling, Writing Samples, Writing Fluency, Editing owls: Written Expression, Spontaneous Writing Sample, wiat-II Spelling, Basic Writing Skills Cluster, or Written Expression can be used to assess dysgraphia. The wisc-iii consists of 13 subtests. Scores of the subtests are added together in different ways to produce several summary scores: Verbal IQ, Performance IQ, and Full-scale IQ (the most general measure). The Index scores are summary scores designed to give better estimates of several factors underlying wisc-iii. These are Verbal Comprehension Index, Perceptual Organization Index, and Freedom from Distractibility Index or Processing Speed Index. When diagnosing dysgraphia there would a significant lower score on the subtests of writing (Broad Written Language Cluster), the poi (Perceptual Organization Index), ffdi (Freedom from Distractibility Index) and psi (Processing Speed Index). (On the next page is an example of a learning disability profile for a child with dysgraphia. Scores outside the shaded area in the chart are significantly different from average. Statistically, scores within the shaded area are less than one standard deviation from average. This child?s score on writing achievement is almost 2 standard deviations below average, while his intellectual ability scores are average). The wisc-iii aids in assessing the differences between dysgraphic and dyslexics students through measuring both reading and writing skills. With dyslexic students the score on reading would be incredible low compared to writing. Thus with dysgraphic students the result is opposite, the score on writing is lower then reading. Also dysgraphic students may display unorganized thoughts (unable to stick to a topic, random sentences), or trouble formulating idea (creative ideas). 130 115 Intellectual Abilities Achievement (wisc- iii) (wjiii) [image][image][image][image] ======== 85 100 [image][image][image][image][image] 70 [image][image][image][image][image][image][image][image][image][image] [image]viq piq fsiq vci poi ffdi psi Reading Math Writing Knowledge =============== Key: Intellectual Measures (wisc-iii) Academic Measures (wjiii) viq = Verbal IQ Reading = Broad Reading Cluster piq = Performance (nonverbal) IQ Math = Broad Mathematics Cluster fsiq = Full-Scale (overall) IQ Writing = Broad Written Language Cluster vci = Verbal Comprehension Index Academic Knowledge = a combination of Science, poi = Perceptual Organization Index Social Studies, and Humanities achievement ffdi = Freedom from Distractibility Index psi = Processing Speed Index
Richards, 1998
Another test commonly used when assessing a writing disorder is Beery Developmental Test of Visual Motor Integration. This test requires the child to copy increasingly difficult geometric designs from a drawn sample. It measures the child?s visual motor development, both assessing fine motor control as well as visual perception. The progression from very easy designs (which consist of straight lines, at first) to complex designs is very gradual. As such, children find this test generally easy and non-threatening (Richards, 1998). A child with dysgraphia will have trouble with composing simple designs. Some may think the child is making mistakes due to laziness, however the child is truly trying to organize the simple or complex designs. Dysgraphic?s will have trouble replicating objects. Due to motor integration trouble with placing together a puzzle to a story can be difficult. Results from this test are often comparable to those found on the Performance Scale of the Wechsler. Both results indicate the level of the child?s nonverbal development. How well a child performs in drawing activities as measured on this test have direct implications on how well the child will be able to produce written material in the classroom (Richards, 1998). Beery Developmental Test of Visual Motor Integration can help in assessing dysgraphia, however several other tests should also be administered. Dysgraphia is also assessed with the Peabody Picture Vocabulary Test - Third Edition (ppvt-iii) along with the Expressive Vocabulary Test (evt). The ppvt-iii is an achievement test of receptive vocabulary that measures listening comprehension of spoken words for children and adults. The Expressive Vocabulary Test (evt) assesses expressive vocabulary and word retrieval for children and adults. Word retrieval is evaluated by comparing expressive and receptive vocabulary skills using standard score differences between evt and ppvt-iii. The ppvt-iii assist is designed to aid in the scoring and interpretation of the ppvt-iii. The ppvt-iii assist also will provide interpretation of the Score Comparison between ppvt-iii and evt (Cortez, 2002). The results for a dysgraphic child or adult would display little knowledge of vocabulary, and show difficulty or lack of word when expressing their answer (thus their answer is broad). The lack of vocabulary and comprehension is noticeable by examining each standard score and 90% confidence interval. The confidence interval would show around 80 ? 90 % with low standard scores (scores arrange from 50 - 60) (Cortez, 2001). The final test discussed is Woodcock Johnson iii Tests of Achievement (WJ iii) is the most widely used comprehensive assessment system- with two separated distinct test batteries: Cognitive Abilities and Achievement. This test consists of around 20 different subtests. In order to take a closer look at dysgraphia the focus on the achievement battery. Within the achievement battery there are three main clusters that need to be examined. The first cluster is Oral Expression, which is composed of Test 3 (Story Recall) and Test 14 (Picture Vocabulary). Then Broad Written Language consists of Test 7 (Spelling), Test 8 (Writing Fluency) and Test 11 (Writing Samples). Finally, the Written Expression subtest, uses Test 8 (Writing Fluency) and Test 11 (Writing Samples). Low recall scores in any of these clusters can display evidence for a learning disorder in writing (Schrank, 2001). With use of any achievement, intelligence, or perceptual motor test it is suggested that further testing are needed to find accurate results. As dysgraphia is a closely related to dyslexia many of the assessment tests used for dyslexics can be interchangeable with assessing dysgraphia.

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