Dysgraphia is a deficiency in the ability to write, primarily handwriting, but also coherence.[2] Dysgraphia is a specific learning disability as well as a transcription disability, meaning that it is a writing disorder associated with impaired handwriting, orthographic coding, and finger sequencing (the movement of muscles required to write).[3] It often overlaps with other learning disabilities such as speech impairment, attention deficit hyperactivity disorder, or developmental coordination disorder.[4] In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), dysgraphia is characterized as a learning disability in the category of written expression when one's writing skills are below those expected given a person's age measured through intelligence and age-appropriate education. The DSM is not clear in whether or not writing refers only to the motor skills involved in writing, or if it also includes orthographic skills and spelling.[4]

SpecialtyPsychiatry, Pediatrics
SymptomsPoor handwriting, spelling and spacing
Differential diagnosisdyslexia, oral-written language learning disability [1]

The word dysgraphia comes from the Greek words dys meaning "impaired" and γραφία graphía meaning "writing by hand".[3]

There are at least two stages in the act of writing: the linguistic stage and the motor-expressive-praxic stage. The linguistic stage involves the encoding of auditory and visual information into symbols for letters and written words. This is mediated through the angular gyrus, which provides the linguistic rules which guide writing. The motor stage is where the expression of written words or graphemes is articulated. This stage is mediated by Exner's writing area of the frontal lobe.[5]

People with dysgraphia can often write on some level and may experience difficulty with other fine motor skills, such as tying shoes. However, dysgraphia does not affect all fine motor skills. People with dysgraphia often have unusual difficulty with handwriting and spelling[3] which in turn can cause writing fatigue.[4] Unlike people without transcription disabilities, they tend to fail to preserve the size and shape of the letters they produce if they can’t look at what they are writing. They may lack basic grammar and spelling skills (for example, having difficulties with the letters p, q, b, and d), and often will write the wrong word when trying to formulate their thoughts on paper. The disorder generally emerges when the child is first introduced to writing.[3] Adults, teenagers, and children alike are all subject to dysgraphia.[6]

Dysgraphia should be distinguished from agraphia, which is an acquired loss of the ability to write resulting from brain injury, stroke, or progressive illness.[7]


Dysgraphia is nearly always accompanied by other learning disabilities such as dyslexia, attention deficit disorder, or an oral and written language learning disability (OWL LD)[3][8][9] and this can impact the type of dysgraphia a person might have. Tourette’s syndrome and ASD are other common diagnoses among dysgraphic individuals.[10] Developmental dysgraphia was originally described as being a disorder that occurs solely in dyslexic individuals. Dysgraphia was not studied as separate entity until mid-20th century when researchers discovered there were different types that occur without dyslexia. Methods for evaluating, managing and remedying dysgraphia are still evolving,[11] but there are three principal subtypes of dysgraphia that are recognized. There is little information available about different types of dysgraphia and there are likely more subtypes than the ones listed below. Some people may have a combination of two or more of these, and individual symptoms may vary in presentation from what is described here. Most common presentation is a motor agraphia resulting from damage to some part of the motor cortex in the parietal lobes.[citation needed]


There are several features that distinguish dyslexic-dysgraphia (sometimes called “linguistic dysgraphia”) from the other types.  People with dyslexic dysgraphia have poor oral & written spelling that’s typically phonemic in nature. Their spontaneously written work is often illegible, has extra or deleted syllables or letters, and contains unnecessary capitalization or large spaces in the middle of words which can make each individual word unrecognizable. They may also insert symbols that do not resemble any letter of the alphabet. Writing production generally requires long periods of contemplation and correction.

Dyslexic-dysgraphic individuals have fairly good copied work, and their ability to draw is also preserved. Their finger tapping speed (a method for identifying fine motor problems) is normal, indicating that the deficit does not likely stem from cerebellar damage.[11]


Dysgraphia can be difficult to diagnose because the handwriting starts out clear and slowly degrades, making the writer appear lazy.

Motor dysgraphia is due to deficient fine motor skills, poor dexterity, poor muscle tone, or unspecified motor clumsiness. 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 it cannot be sustained for a significant length of time, as it can cause arthritis-like tensing of the hand. Overall, their written work is poor to illegible even if copied by sight from another document, and drawing is impaired. Oral spelling for these individuals is normal, and their finger tapping speed is below normal. This shows that there are problems within the fine motor skills of these individuals. People with developmental coordination disorder may be dysgraphic. Writing is often slanted due to holding a pen or pencil incorrectly.[3] Average writing speed is slower than that of non-dysgrapic individuals, but this seems to improve with age. Motor skill deficits appears to be a common cause of dysgraphia; 78% of children with the disorder present kinematic difficulties, while 58% of them display issues with pressure skills.[12]


A person with spatial dysgraphia has a defect in the understanding of space. They will have illegible spontaneously written work, illegible copied work, and problems with drawing abilities. They have normal spelling and normal finger tapping speed, suggesting that this subtype is not fine motor based. Symptoms in actuality may vary in presentation from what is listed here.[citation needed]


Other subtypes and informal classification systems have been proposed by researchers; this includes but is not limited to surface phonological dysgraphia,[13] deep dysgraphia and surface dysgraphia.[11]

Signs and symptomsEdit

The symptoms to dysgraphia are often overlooked or attributed to the student being lazy, unmotivated, not caring, or having delayed visual-motor processing. In order to be diagnosed with dysgraphia, one must have a cluster, but not necessarily all, of the following symptoms:[3]

  • Odd wrist, arm, body, or paper orientations such as bending an arm into an L shape
  • Excessive erasures
  • Mixed upper case and lower case letters
  • Inconsistent form and size of letters, or unfinished letters
  • Misuse of lines and margins
  • Inefficient speed of copying
  • Inattentiveness over details when writing
  • Frequent need of verbal cues
  • Relies heavily on vision to write
  • Difficulty visualizing letter formation beforehand
  • Poor legibility
  • Poor spatial planning on paper
  • Difficulty writing and thinking at the same time (creative writing, taking notes)
  • Handwriting abilities that may interfere with spelling and written composition
  • Difficulty understanding homophones and what spelling to use[14]
  • Having a hard time translating ideas to writing, sometimes using the wrong words altogether
  • May feel pain while writing (cramps in fingers, wrist and palms)[3]

Dysgraphia may cause students emotional trauma often due to the fact that no one can read their writing, and they are aware that they are not performing to the same level as their peers. Emotional problems that may occur alongside dysgraphia include impaired self-esteem, lowered self-efficacy, heightened anxiety, and depression.[3][8] They may put in extra efforts in order to have the same achievements as their peers, but often get frustrated because they feel that their hard work does not pay off.[8]

Dysgraphia is a hard disorder to detect as it does not affect specific ages, gender, or intelligence.[8] The main concern in trying to detect dysgraphia is that people hide their disability behind their verbal fluency/comprehension and strong syntax coding because they are ashamed that they cannot achieve the same goals as their peers.[8] Having dysgraphia is not related to a lack of cognitive ability,[3] and it is not uncommon in intellectually gifted individuals, but due to dysgraphia their intellectual abilities are often not identified.[8]

Associated conditionsEdit

There are some common problems not related to dysgraphia but often associated with dysgraphia, the most common of which is stress. Often children (and adults) with dysgraphia will become extremely frustrated with the task of writing specially on plain paper (and spelling); younger children may cry, pout, or refuse to complete written assignments. This frustration can cause the child (or adult) a great deal of stress and can lead to stress-related illnesses. This can be a result of any symptom of dysgraphia.[6][8]


Dysgraphia is a biologically based disorder with genetic and brain bases.[3] More specifically, it is a working memory problem.[8] In dysgraphia, individuals fail to develop normal connections among different brain regions needed for writing.[8] People with dysgraphia have difficulty in automatically remembering and mastering the sequence of motor movements required to write letters or numbers.[3] Dysgraphia is also in part due to underlying problems in orthographic coding, the orthographic loop, and graphmotor output (the movements that result in writing) by one's hands, fingers and executive functions involved in letter writing.[3] The orthographic loop is when written words are stored in the mind's eye, connected through sequential finger movement for motor output through the hand with feedback from the eye.[8]


Several tests exist to diagnose dysgraphia like Ajuriaguerra scale, BHK for children or teenagers, DASH and HHE scale.[15]

With devices like drawing tablets, it is now possible to measure the position, tilt, and pressure in real time. From these features, it is possible to compute automatic features like speed and shaking and train a classifier to diagnose automatically children with atypical writing.[15][16] The features extracted have different importances in the classification through development and allow to characterize different subtypes of dysgraphia that could have different origins, outcomes and could require different remediation strategies.[17]

It’s not uncommon for dysgraphia individuals to be intellectually gifted, possess a rich vocabulary and have strong comprehension of language when speaking or reading, though their disorder is often not detected or treated; which may also be in part to developmental dyslexia receiving far more academic and medical attention than developmental dysgraphia.[18] In addition, gifted children with transcription disabilities seldom receive programming for their intellectual talents due to their difficulties in completing written assignments.[3]


Treatment for dysgraphia varies and may include treatment for motor disorders to help control writing movements. The use of occupational therapy can be effective in the school setting, and teachers should be well informed about dysgraphia to aid in carry-over of the occupational therapist's interventions. Treatments may address impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid the problems of handwriting. Dysgraphia can sometimes be partially overcome with appropriate and conscious effort and training.[3] The International Dyslexia Association suggests the use of kinesthetic memory through early training by having the child overlearn how to write letters and to later practice writing with their eyes closed or averted to reinforce the feel of the letters being written. They also suggest teaching the students cursive writing as it has fewer reversible letters and can help lessen spacing problems, at least within words, because cursive letters are generally attached within a word.[citation needed]


There is no special education category for students with dysgraphia;[3] in the United States, The National Center for Learning Disabilities suggests that children with dysgraphia be handled in a case-by-case manner with an Individualized Education Program, or provided individual accommodation to provide alternative ways of submitting work and modify tasks to avoid the area of weakness.[6] Students with dysgraphia often cannot complete written assignments that are legible, appropriate in length and content, or within given time.[3] It is suggested that students with dysgraphia receive specialized instructions that are appropriate for them. Children will mostly benefit from explicit and comprehensive instructions, help translating across multiple levels of language, and review and revision of assignments or writing methods.[8] Direct, explicit instruction on letter formation and guided practice will help students achieve automatic handwriting performance before they use letters to write words, phrases, and sentences.[3] Some older children may benefit from the use of a personal computer or a laptop in class so that they do not have to deal with the frustration of falling behind their peers.[8]

It is also suggested by Berninger that teachers with dysgraphic students decide if their focus will be on manuscript writing (printing) or keyboarding. In either case, it is beneficial that students are taught how to read cursive writing as it is used daily in classrooms by some teachers.[3] It may also be beneficial for the teacher to come up with other methods of assessing a child's knowledge other than written tests; an example would be oral testing. This causes less frustration for the child as they are able to get their knowledge across to the teacher without worrying about how to write their thoughts.[6]

The number of students with dysgraphia may increase from 4 percent of students in primary grades, due to the overall difficulty of handwriting, and up to 20 percent in middle school because written compositions become more complex. With this in mind, there are no exact numbers of how many individuals have dysgraphia due to its difficulty to diagnose.[3] There are slight gender differences in association with written disabilities; overall it is found that males are more likely to be impaired with handwriting, composing, spelling, and orthographic abilities than females.[8]

The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) doesn't use the term dysgraphia but uses the phrase "an impairment in written expression" under the category of "specific learning disorder". This is the term used by most doctors and psychologists.[19] To qualify for special education services, a child must have an issue named or described in the Individuals with Disabilities Education Act (IDEA). While IDEA doesn't use the term "dysgraphia", it describes it under the category of "specific learning disability". This includes issues with understanding or using language (spoken or written) that make it difficult to listen, think, speak, read, write, spell or to do mathematical calculations.[citation needed]

See alsoEdit


  1. ^ Berninger, Virginia W.; Richards, Todd L.; Abbott, Robert D. (2015). "Differential diagnosis of dysgraphia, dyslexia, and OWL LD: Behavioral and neuroimaging evidence". Reading and Writing. 28 (8): 1119–1153. doi:10.1007/s11145-015-9565-0. PMC 4553247. PMID 26336330.
  2. ^ Chivers, M. (1991). "Definition of Dysgraphia (Handwriting Difficulty). Dyslexia A2Z. Retrieved from http://www.dyslexiaa2z.com/learning_difficulties/dysgraphia/dysgraphia_definition.html Archived 2011-02-19 at the Wayback Machine
  3. ^ a b c d e f g h i j k l m n o p q r s t Berninger, Virginia W.; Wolf, Beverly J. (2009). Teaching Students with Dyslexia and Dysgraphia: Lessons from Teaching and Science. Baltimore, Maryland: Paul H. Brooks Publishing Co. ISBN 978-1-55766-934-6.
  4. ^ a b c Nicolson, Roderick I.; Fawcett, Angela J. (January 2011). "Dyslexia, dysgraphia, procedural learning and the cerebellum". Cortex. 47 (1): 117–27. doi:10.1016/j.cortex.2009.08.016. PMID 19818437. S2CID 32228208.
  5. ^ Roux, Franck-Emmanuel; Dufor, Olivier; Giussani, Carlo; et al. (October 2009). "The graphemic/motor frontal area Exner's area revisited". Annals of Neurology. 66 (4): 537–45. doi:10.1002/ana.21804. PMID 19847902. S2CID 205341904.
  6. ^ a b c d "What is Dysgraphia?". National Center for Learning Disabilities. December 9, 2010. Archived from the original on August 7, 2012.
  7. ^ "agraphia". the Free Dictionary by Farlex. Retrieved 7 July 2013.
  8. ^ a b c d e f g h i j k l m Berninger, Virginia W.; O'Malley May, Maggie (2011). "Evidence-Based Diagnosis and Treatment for Specific Learning Disabilities Involving Impairments in Written and/or Oral Language". Journal of Learning Disabilities. 44 (2): 167–83. doi:10.1177/0022219410391189. PMID 21383108. S2CID 44786460.
  9. ^ "Bright Solutions - Free On-Line Videos". www.dys-add.com. Retrieved 23 March 2018.
  10. ^ "Fact sheet: Dysgraphia, a co-morbid disorder associated with Autism Spectrum Disorders". www.autism-help.org.
  11. ^ a b c Deuel, Ruthmary K. (1995-01-01). "Developmental Dysgraphia and Motor Skills Disorders". Journal of Child Neurology. 10: S6–S8. doi:10.1177/08830738950100S103. PMID 7538525. S2CID 1665903.
  12. ^ Asselborn, Thibault; Chapatte, Mateo; Dillenbourg, Pierre (2020-02-21). "Extending the Spectrum of Dysgraphia: A Data Driven Strategy to Estimate Handwriting Quality". Scientific Reports. 10 (1): 3140. Bibcode:2020NatSR..10.3140A. doi:10.1038/s41598-020-60011-8. ISSN 2045-2322. PMC 7035284. PMID 32081940.
  13. ^ Rapcsak, Steven Z.; Beeson, Pélagie M.; Henry, Maya L.; Leyden, Anne; Kim, Esther; Rising, Kindle; Andersen, Sarah; Cho, HyeSuk (May 2009). "Phonological Dyslexia and Dysgraphia: Cognitive Mechanisms and Neural Substrates". Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 45 (5): 575–591. doi:10.1016/j.cortex.2008.04.006. ISSN 0010-9452. PMC 2689874. PMID 18625494.
  14. ^ Faust, Miriam (2012-02-13). The Handbook of the Neuropsychology of Language. Wiley - Blackwell. p. 912. ISBN 9781444330403. Retrieved 16 February 2016.
  15. ^ a b Asselborn, Thibault; Gargot, Thomas; Kidziński, Łukasz; Johal, Wafa; Cohen, David; Jolly, Caroline; Dillenbourg, Pierre (August 31, 2018). "Automated human-level diagnosis of dysgraphia using a consumer tablet" (PDF). NPJ Digital Medicine. 1 (1): 42. doi:10.1038/s41746-018-0049-x. ISSN 2398-6352. PMC 6550155. PMID 31304322. S2CID 52244820.
  16. ^ Perrin, Sarah (September 28, 2018). "New software helps analyze writing disabilities". Medical Xpress.
  17. ^ Gargot, Thomas; Asselborn, Thibault; Pellerin, Hugues; Zammouri, Ingrid; Anzalone, Salvatore M.; Casteran, Laurence; Johal, Wafa; Dillenbourg, Pierre; Cohen, David; Jolly, Caroline (2020-09-11). "Acquisition of handwriting in children with and without dysgraphia: A computational approach". PLOS ONE. 15 (9): –0237575. Bibcode:2020PLoSO..1537575G. doi:10.1371/journal.pone.0237575. ISSN 1932-6203. PMC 7485885. PMID 32915793.
  18. ^ Miceli, Gabriele; Silveri, M. Caterina; Caramazza, Alfonso (1985-07-01). "Cognitive analysis of a case of pure dysgraphia". Brain and Language. 25 (2): 187–212. doi:10.1016/0093-934X(85)90080-X. ISSN 0093-934X. PMID 4063789. S2CID 16855570.
  19. ^ Patino, Erica. "Understanding Dysgraphia". Understood.org. Retrieved September 22, 2016.

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