Dysgraphia (Disorder of Writing)

Handwriting is one of the most complex skills that is learnt and taught. It requires motor, sensory, perceptual, praxis (motor planning) and cognitive functions and the integration of these functions (Chu, 1997). When the complexity of this skill is considered it is not surprising that many children experience difficulty in mastering this skill.

When handwriting difficulties affect a student’s academic performance, intervention is warranted, and a referral to an occupational therapist may be recommended. Occupational Therapists usually adopt a diagnostic approach to the assessment of handwriting difficulties and diagnosis of dysgraphia.

Evaluation of handwriting difficulties can include and may not be limited to:

1. Assessing Neuromuscular mechanisms – including postural control, upper limb stability and muscle tone.
2. Sensory integrative functioning – poor perception and discrimination of touch can influence pencil grip, visual perceptual deficits and poor motor planning skills can influence quality and speed of writing.
3. Motor control – poor fine motor control and dexterity. Lack of exposure and refinement of skills during preschool can exacerbate handwriting difficulties.
4. Cognitive and psychosocial behaviours – attention span, memory, behaviour, motivation and self-concept are all important factors incorporated in the evaluation of handwriting skills.

Following assessment of handwriting, it is important to establish what approach is most appropriate for the student. In some cases, remediation is not possible without significant effort and financial burden. In this current technologically advanced climate, alternative options provide a range of choices that can be both cost effective and preferred by the student. In all cases, consultation and collaboration with parents and teachers is recommended.

Treatment approaches include:

• Remedial approaches – aims to address underlying inefficiencies in sensory processing, motor coordination and perceptual skills that will result in improved handwriting performance. Therapy can be clinic based (sensory motor approaches) or school/home based.
• Functional approaches – emphasises mastering the skills through practice and repetition. Like other acquistional skills (learning to tie laces) handwriting may be improved through sequencing, tracing, templates, practice and modelling.
• Compensatory approaches – pencil grips, slant boards, Dictaphones, use of word processors/ PC’s, a scribe, voice activated software. Due to technological advancement, these options are becoming more commonplace, appropriate and affordable.

From all perspectives, Handwriting is a complex “end product.” Identifying and seeking assistance at the earliest stages supports students achieving to their potential. For further advice and information contact an Occupational Therapist specialising in paediatrics.