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ADHD and Dysgraphia

Posted Apr 10 2011 12:09pm

Handwriting is an amazing skill. When all the components necessary for handwriting to emerge are considered, it is a wonder that anyone learns to write. I remember a class I had in graduate school. I had to describe all the discrete parts of a task. I chose the task of stringing beads. By the time I finished my paper, it was four typed pages. Well, stringing beads is simple compared to the task of handwriting.

There are many factors which influence handwriting. Poor or illegible handwriting is not necessarily a function of intellect. Many very bright students have handwriting problems. Dysgraphia is a disorder which is common to children with ADHD and related disorders. It is a broad term which refers to a difficulty with expressing thoughts in writing. It is generally characterized by poor handwriting.

The underlying causes of dysgraphia are not specific and measureable. Visual perceptual problems, sequencing problems, orthographic coding (ability to store info and then access) and organizational problems are all potential factors. Then again, attention, focus, proprioception , motor planning and sensory processing can influence handwriting too. Additionally, students with auditory processing or receptive language problems can have handwriting issues.

The narrow definition of dysgraphia indicates that the term is only applicable when there is no other social or academic problem present. At least, that is according to NINDS (National Institute of Neurologic Disorders and Stroke). However, because there are no measureable criteria, many clinicians will use the term dysgraphia when any child has significant handwriting problems.

Here are some of the symptoms of dysgraphia
· Illegible writing
· Cramped or unusual pencil grip
· Writing from the wrist instead of dynamic hand
· Mixing uppercase and lowercase letters in the same word
· Omitted words, unfinished words or misplaced words
· Difficulty thinking and writing at the same time
· Talking to self while writing
· Random or non-existent punctuation
· Difficulty with syntax and grammar
· Writing that is legible but laboriously produced

Personally, I don’t think it matters what term you use to describe illegible handwriting. The important thing is to treat the problem so that the student can meet his or her academic goals. Children with ADHD and those with co-morbid conditions have enough of a struggle dealing with the demands of school. Frustration with handwriting can make a bad situation far worse. Everything academic revolves around graphic output. Lack of skill with handwriting usually means deficient skill in producing numbers. That means math work is affected as well. The end result is that a child with ADHD faces intake and output problems. How can a child succeed given these obstacles?

The situation gets more complicated. Most attempts to correct the problem result in the child taking more time to ensure accuracy. That causes them to fall behind and not get their work done. Additionally, if the child is concentrating primarily on letter formation, they may lose their train of thought.

Dysgraphia needs to be considered separately from handwriting issues that result from motor skill deficits. Those types of handwriting problems can be remedied with exercises and activities. Children with dysgraphia tend to have sequencing, organizational and praxis (motor planning) problems. They also have problems with accurately recalling visual information. These problems may look like a visual perceptual issue, but they are not.

As both a parent and a therapist, I recommend taking a good look at the severity of the problem, of your child’s interest in actually improving this skill, and of the overall priority in fixing the problem. I would also take into consideration your child’s age. I say this because there are solutions which don’t necessitate working on handwriting per se. There is a variety of software on the market these days which can enable your child to be successful in school without writing. Programs like Dragon dictation convert words to text. There are word processing programs and text programs which do word prediction. There are computers which are adapted to work via speech rather than keyboard. If a child is older and has had therapy to treat the dysgraphia without improvement, then I would choose this as an alternative. I think the overarching goal is success in the classroom. Handwriting is hardly needed anymore outside the classroom except for legal documents and check signatures.

If the child is younger, then I believe it is worth the time and effort to try and improve their handwriting. There is a program called WIN (Write Incredibly Now) that is based on color coding and breaks the writing into 3 forms which are simple to learn. Handwriting Without Tears and similar programs use discrete shapes which combine to form letters. All these programs use multi-sensory tools to facilitate letter formation.

For a child who has difficulty with grasp, there are adaptive grips and fatter pencils. You can also have your child try holding the pencil between the index and third fingers with the pencil resting on the thumb pad. It takes a little bit of getting used to, but it reduces the strain of holding the pencil. By the way, this is a great technique for anyone with arthritis.

Here are some additional tips
1. Give your child a chart of the alphabet with upper and lower case letters. Have your child put the chart on the corner of their desk or workspace.
2. Buy paper with raised lines which will act as a guide
3. Provide a list of common “sight” words
4. Allow a child to only use upper case letters or lower case letters to prevent confusion
5. Ask your child’s teacher to overlook spelling errors and grammatical mistakes whenever possible (obviously not okay in English class)
6. Check with the teacher to see if oral exams are acceptable in place of written exams
7. Have your child place cues on their desk to indicate where the paper should be placed
8. Provide an electronic dictionary or spellchecker

Many handwriting problems are mechanical in nature. What I mean is that if you can improve hand strength, posture, grasp and control, the formation of letters can be improved. Dysgraphia is a learning disability and traditional therapy exercises may not resolve the problem. While it is certainly worthwhile to work on the motor skills, your child may still need some adaptive options. Don’t let your child’s self-esteem become eroded by the handwriting issue. Remember to praise them for their efforts and avoid criticizing if you see your child making an effort. Work together with their teacher to come up with reasonable alternatives. After all, handwriting is only one of many means to the same end. School performance should not be synonymous with or dependent upon handwriting skill. Don’t break a child’s spirit. Creativity and content are more important than esthetics.

Nancy Konigsberg is a pediatric occupational therapist and child development expert with more than 16 years of clinical experience. She specializes in neuro-muscular disorders, behavior problems and genetic disorders. Read her O.T. blog Milestone Mom in which she describes developmental disorders and offers treatment protocols and advice.

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