Dysgraphia Treatment

As a pediatric occupational therapist, I often get referrals to evaluate school-age patients who have been given a diagnosis of dysgraphia. When a physician or a school diagnostician labels a child as dysgraphic, it is usually based on the fact that a student has illegible handwriting. But, in reality, dysgraphia encompasses several deficits of written expression, and treatment, therefore, will depend on the type of dysgraphia exhibited by the child.

Writing is a complex activity requiring multiple brain functions: attention to task, visual-motor integration, sequential thinking, memory, language skills, and spatial organization. In addition, the student must have adequate gross motor skills (trunk control, balance, and proximal stability) and fine motor skills (mature grasp, adequate strength in the intrinsic muscles of the hand, visual attention and tracking). Deficits in any of these areas can result in poorly developed writing skills.

Three types of dysgraphia have been identified by experts in learning disabilities:
Dyslexic dysgraphia is the subtype characterized by self-generated writing which is illegible and has numerous spelling errors. Writing copied from a model, however, is of adequate quality and motor speed is normal.
Motor dysgraphia describes handwriting which is of poor quality, whether spontaneous or copied, but with adequate spelling. The student demonstrates abnormal motor speed on neuropsychological testing.
Spatial dysgraphia describes writing which is poorly formed and illegible both in spontaneous and in copied work, with normal spelling and normal motor speed.

It is therefore essential that a student with writing difficulties be thoroughly assessed to determine which type of dysgraphia is affecting her work, as some treatment and classroom strategies are specific to each type.

For a student with dyslexic dysgraphia, remediation is focused on improving spelling, phonetics, and visual memory. Many accommodations can be employed, including making use of instructional word processing programs such as Write: Outloud or CoWriter 4000. These programs use auditory feedback, word prediction, and other strategies to assist students struggling with spelling and sequencing.

A student with motor dysgraphia is a prime candidate for a referral to an occupational therapist. The therapist will evaluate and treat many physical factors that can hamper the development of handwriting, including sitting balance, reflex integration, proximal stability, hand strength, prehension patterns, manipulation skills, motor accuracy, visual perceptual skills, and visual-motor integration. The therapist may recommend certain accommodations, such as the use of pencil grips, special writing papers, changes in classroom seating, or the use of assistive technology. Use of computers is often suggested as an alternative to writing, but unfortunately students with motor difficulties usually lack the coordination for traditional keyboarding as well. Many older students, however, can learn to use voice recognition effectively to bypass their motor difficulties.

Students with spatial dysgraphia may respond to remediation directed at improving visual-spatial perception skills. They can benefit from accommodations such as use of specialized papers that help organize the writing space visually. For example, highlighting the lower half of the writing space provides a visual cue to guide letter size and placement. Graph paper can be used to improve spacing between words or alignment of math problems. Primary age children with spatial dysgraphia can sometimes benefit from learning to write cursive rather than manuscript. Cursive has several advantages, in that there is less lifting and replacing of the pencil, it is harder to reverse letters, and spacing between words is reinforced.

For all students with dysgraphia, there are many strategies for modifying classroom work. Teachers may reduce the amount of written work required, give alternative methods such as oral reports or tests, provide copies of lecture notes. The most important thing is that difficulty with writing should not impede the student’s progress in other areas of learning.

References:

Accommodations and Modifications for Students with Handwriting Problems and/or Dysgraphia http://www.resourceroom.net/readspell/dysgraphia.asp

Diagnosis and Intervention Strategies for Disorders of Written Language http://www.udel.edu/bkirby/asperger/dysgraphia_mjkay.html

Dysgraphia. http://www.knowledgenetwork.ca/literacy/resources/literature/dysgraphia.pdf