Covadonga García San Nicolás Cantero, a general health psychologist and neuropsychologist, explains in this article all the necessary information to correctly understand what dysgraphia entails.

Dysgraphia is a specific learning disorder related to a difficulty in writing that affects a person’s academic performance and daily life.

What is dysgraphia?

There are differences among authors in defining dysgraphia, but all agree on emphasizing that the existing difficulty is related to graphism or graphomotor skills, not to spelling and/or syntactic rules. These children do not have problems with overall body movement planning, but they do find it challenging to coordinate the hand or arm when writing in an orderly manner.

The DSM-5 specifies that these complications are not due to inadequate teaching, neurological and/or mental disorders, uncorrected auditory or visual disorders, psychosocial difficulties, or intellectual disabilities.

Causes of dysgraphia

According to its origin, dysgraphia can be acquired or developmental:

• Acquired: When a person initially has no difficulties in writing ability but, due to a brain injury, loses their writing skill.

• Developmental: When early stimulation of the child has not been sufficient to learn to write.

In dysgraphia, various skills or abilities can be affected. Some of these abilities include:

• Fine motor skills: Some affected capacities in dysgraphia are related to motor planning, visuomotor coordination or eye-hand coordination, and graphomotor skills.

• Executive functions: Linked to the ability to retain and manipulate information (working memory) which can affect organization and planning when writing. Processes related to drafting, revising, and editing what is written may also be affected.

• Psycholinguistic skills: Alographic alterations, difficulties in writing fluency or in phoneme-grapheme conversion. Difficulties may arise in phonology, syntax, morphology, pragmatics, and semantic aspects of language.

• Space-time skills: Afferent dysgraphia, i.e., inappropriate use of paper space, is common in dysgraphia. They tend to write in an ascending or descending manner, lacking control over letter and word spacing and the page in general.

• Laterality and body schema: In cases where laterality is poorly defined, such as in ambidextrous individuals, this disorder is common. Body schema is crucial as it can affect how one holds the writing tool and the body posture while writing.

Types of dysgraphia

As with the definitions of this learning disorder, there are different classifications for the types of dysgraphia. Generally, a distinction is made between:

• Motor dysgraphia: When a child has no difficulties mentally representing symbols but has trouble reproducing them in writing due to motor difficulties.

• Specific dysgraphia: When the issue is related to recognizing forms to reproduce symbols, as well as difficulties in spatial-temporal orientation and writing rhythm. In this type of dysgraphia, there are no motor problems.

According to the altered processing route:

• Phonological: When there are alterations in the phoneme-grapheme conversion due to difficulty in integrating word forms. Difficulties in writing pseudowords are common.

• Surface: When difficulties are related to the visual route, requiring dependence on the phonological route. These individuals do not have integrated word construction, leading to errors in the graphemes of polygraphic and homophonic words.

• Mixed or deep: When dysgraphia affects both processing routes.

Treatment of dysgraphia

To treat dysgraphia, one must be aware of the signs or symptoms exhibited by the child. It’s worth noting that every individual is unique, so each case will present different challenges, requiring a specific and individualized intervention by a professional.

Symptoms and signs of dysgraphia

Signs and symptoms of dysgraphia are usually identified during the writing learning stage of a child. However, these problems may not be identified until academic demands increase, making the difficulties more evident.

Here are some warning signs of dysgraphia:

• Inappropriate physical position and paper posture when writing.

• Difficulties in holding the pencil properly.

• Excessive motor rigidity or laxity when writing, meaning there is no control over pencil pressure, occasionally piercing the paper.

• Hand or arm discomfort.
• Irregular varying strokes.
• Different sizes of letters and words.
• Slow writing.
• Trouble with joined-up letters.
• Illegible writing.
• Difficulty in organizing letters in words, leaving some incomplete.
• Failure to respect paper margins, with irregular spaces throughout the page among letters and words.
• Lack of motivation and frustration when writing.

Support for children with dysgraphia

The key to helping a child with dysgraphia is early detection of these difficulties. As mentioned earlier, these difficulties may be observed during the learning phase of reading and writing; however, sometimes these issues are not noticed until academic demands increase.

Therefore, it’s important for both the school and family environment to pay attention to the child’s learning process. This approach allows for an assessment and tailored intervention for the individual, aiming to prevent the child’s difficulties from worsening and mitigate any academic, socioemotional, and self-esteem consequences that may arise from dysgraphia.

Below are some general recommendations to consider in the case of dysgraphia in a child, emphasizing the importance of an individualized process:

• Understand and validate the person’s feelings when writing or thinking about it.
• Facilitate adaptations in the school environment.
• Strengthen fine motor skills and coordination.
• Provide tools to compensate for difficulties.
• Promote proper body and paper posture when writing.
• Use tools that facilitate a correct pencil grip.
• Teach relaxation techniques.
• Work on visuo-motor, psycholinguistic, temporal-spatial, and body schema skills.
• Address any frustration or pressure the person may feel regarding writing.
• Graphism reeducation.

Dysgraphia and dysorthography

Dysgraphia and dysorthography are two concepts that are commonly confused, so it is important to identify them in order to distinguish and address them correctly.

Dysorthography relates to difficulties that affect spelling rules when writing a word, without any graphomotor or reading problems. Dysgraphia often presents spelling difficulties.

Dysgraphia and dyslexia

Dyslexia can also entail difficulties in expressing oneself in writing. However, it is a specific learning disorder referring to difficulties in reading and writing that may also result in challenges in understanding written text, accessing vocabulary, spatiotemporal errors, and distinguishing left from right, among other issues.

The following are general examples of the three mentioned disorders. It is essential to note that, akin to dysgraphia, these difficulties manifest with varying symptoms depending on the child. Due to the generality of these examples, the aim is to differentiate between the disorders. However, thorough evaluation by a professional is necessary to confirm the diagnosis:

• Example of dysgraphia: Raquel is 7 years old and struggles to write in an organized manner on paper, being unable to write straight even when the paper has lines or squares. She does not maintain appropriate pressure when holding the pencil, gripping it too tightly and sometimes piercing the paper. Her letters are irregular and illegible, displaying poor handwriting. Raquel has a normal IQ and no comprehension issues.

• Example of dysorthography: Ana is 8 years old and has difficulty recognizing and applying spelling rules, frequently making mistakes even in simple words. Ana has normal language development and IQ, with no complications in reading or writing.

• Example of dyslexia: Daniel is 9 years old and has difficulty understanding what he reads. Additionally, when reading, he does so slowly, making errors. Sometimes he omits or reverses letters. Daniel has normal language development and IQ, with no writing complications.

Conclusions

Dysgraphia is a specific learning disorder affecting writing, stemming from various interacting factors, with a focus on graphomotor skills. Early detection of these problems is crucial for effective intervention. Additionally, dysgraphia is often accompanied by other difficulties, highlighting the importance of distinguishing them for a correct differential diagnosis and providing appropriate and tailored intervention in each case.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
• Duque, M. E. Á., Vega, O., & Alvarez, F. V. (2003). Neurocognitive approach to reading and writing disorders as a basis for recovery programs in patients with brain damage. Spanish Journal of Neuropsychology, 5(3), 227-249.
• Gil, I. A. (2019). Specific learning difficulties: dysgraphia. Linguistic Competence in Communication: multidisciplinary perspectives, 129.
• González-Agulló, L., Rodríguez-Sánchez, M., & Lapinet-Azuaga, J. L. (2021). Dysgraphia in educational processes. Science Portal, 2(1), 1-14.
• González, L., Rodríguez, M., & Lapinet, J. L. (2022). Dysgraphia in educational processes. Science Portal, 2(1), 1–14. https://doi.org/10.51247/pdlc.v2i1.295
• Granda, L. M. C., González, E., Arias, G. L., Suing, J., Calvopiña, R. E., & Silva, S. M. (2022). Graphomotor reeducation and its incidence in dysgraphia problems in second-year children of basic education. Latin Science Multidisciplinary Scientific Journal, 6(4), 6142-6165. https://doi.org/10.37811/cl_rcm.v6i4.3533
• López, M. (2016). Dysgraphia and dysorthography: diagnosis and treatment in 2nd-grade students (BA thesis). [Bachelor’s thesis, University of Cantabria]. https://repositorio.unican.es/xmlui/bitstream/handle/10902/8728/LopezPecesMirian.pdf?s.
• Rivas-Torres, R. M., & López-Gómez, S. (2017). Reeducation of dysgraphias: neuropsychological and psycholinguistic perspectives. Psychological Thinking, 15(1), 73-86.
• Veintimilla, A. L., & Barba, P. A. (2023). Dysgraphia and its impacts on children’s learning. Pentascience Scientific Arbitrated Multidisciplinary Journal, 5(6), 467–475. https://doi.org/10.59169/pentasciences.v5i6.869

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