Fact sheet on dysgraphia and comorbid disorders with Aspergers and Autism, two Autism Spectrum Disorders


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, although 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 children, 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 autism, Asperger’s Syndrome, Tourette syndrome or ADHD.

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”.


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

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.


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, and general illegibility. Reluctance or refusal to complete writing tasks.

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. This may be because they think pain in normal when writing, or that people won’t believe them.


Treatment of dysgraphia

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.


Vision therapy

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 include:
• Avoidance of near work
• Frequent loss of place
• Omission, insertion, or rereading of letters and words
• Confusion with similar looking words
• Failure to recognize the same word in the next sentence.

Any struggling student should have a complete evaluation by a behavioral 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, children and adults 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.


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Dysgraphia can be co-morbid with Autism Spectrum Disorders such as Aspergers and Autism