The Many Faces of Dysgraphia

Individuals with dysgraphia may struggle with translating their ideas into written form. In other words, they have trouble “getting it on paper.”  There are three types of dysgraphia: motor-based, language-based, and combined.

Motor-based Dysgraphia

People with motor-based dysgraphia experience difficulties with fine motor skills that affect their penmanship. Signs of motor-based dysgraphia may include:

• Writing unclear, irregular, and/or inconsistent letters, which may have different slants, shapes, and/or a mixture of upper- and lower-case letters

• May Frequently erase their work or missing letters

• Pushes down on the paper very hard

• Copying and writing slowly

• Unusual or awkward pencil grasp

• Poor spacing of letters and words

  
  

Language-based dysgraphia

Individuals with language-based dysgraphia may have difficulties putting their thoughts into written form. This form of dysgraphia is an expressive language and can be significantly impacted by working memory, processing speed, and executive function skills. Some signs of this type include:

• May demonstrate a significant difference between spoken and written comprehension of a topic

• Difficulty with sentence structure when writing but not when speaking

• Having difficulty organizing sentences and ideas on paper and keeping track of thoughts

• Having issues with writing and thinking simultaneously

• Poor spelling; may spell words correctly in isolation but not in context

• May have a tough time getting started on a writing task

Combined Type

Some individuals have both fine motor difficulties and expressive language/executive function aspects of dysgraphia.

Supports and strategies

There are many ways to help improve written expression, both inside and outside of the classroom.

Therapeutic approaches

Motor-based dysgraphia: For this type of dysgraphia, an occupational therapist or reflex integration specialist will evaluate the child and look for the presence of developmental patterns that may be preventing the development of their fine motor skills. Specific activities that improve gross and fine motor coordination and development may be employed. 

Language-based dysgraphia: A speech and language pathologist may be able to work with a student to strengthen the transfer of oral language to written language. Therapies that strengthen working memory and other executive functions,

 such as neurofeedback, interactive metronome, or other similar programs, can be used to improve brain function in the frontal lobe and prefrontal cortex specifically.

Primitive and Postural Reflexes

Primitive reflexes such as the palmar, ATNR, STNR, Palmar, and Babkin Palmomental emerge in infancy from the brainstem to support survival and early movement. These reflexes should gradually integrate and be replaced by voluntary, cortically driven motor patterns and postural reflexes in the first years of life. When they remain active, the child’s nervous system is forced to “work around” automatic patterns during tasks that demand stability and precision, like handwriting.

In motor dysgraphia, retained palmar and Babkin Palmomental reflexes can lead to an excessively tight pencil grip, excessive pressure, fatigue, and poor fine motor isolation of the fingers. A retained ATNR can cause the writing arm to extend or the hand to open when the head turns, making it difficult to keep the line straight, stabilize the paper, and coordinate the two hands together. STNR and other immature postural reflexes contribute to slumped sitting, “wrapped” legs, or constant movement in the chair, which disrupts proximal stability of the shoulder girdle, which is essential for controlled distal hand movements.

Because so much neural energy is spent compensating for these reflex-driven patterns, less capacity remains for automatic letter formation, spacing, and overall legibility. Children may know exactly what they want to say, but their motor system cannot efficiently translate that intention into written output, which is the hallmark of motor dysgraphia

Classroom-based approaches

Teachers may use a combination of these approaches to differentiate instruction for students with dysgraphia.

·      Pencil grips, tripod pencils, raised-line paper, and slant desks

·      Speech-to-text software

·      Editing software such as Grammarly

·      Word processing software

·      Sentence and paragraph frames

·      Sentence starters

·      Word and vocabulary banks

·      Chunking assignments into smaller parts

·      Color-coding for organization

·      Opportunities for robust discussion to facilitate idea development

·      Graphic organizers to chunk assignments and assist with organization

·      Writing models such as anchor papers

·      Shared writing models