Understanding Dysgraphia

Learning how to write is a complex and challenging process for all young students, and everybody learns and develops at their own pace. But if a child is facing consistent problems with writing, from holding pencils to expressing their thoughts, it’s possible that they might have a learning disorder called dysgraphia.

Dysgraphia is a learning disability that makes it difficult for children to write. There are two sides to dysgraphia — motor weaknesses that affect the physical process of writing, and cognitive challenges with written expression.

Dysgraphia, like all learning disorders, is not something that is outgrown or cured, and is not a reflection of a child’s intellectual abilities or creativity. With the right treatment and support, dysgraphia can be effectively managed so that kids can learn to write and keep up with their peers.

There are two categories of symptoms related to dysgraphia — motor weaknesses and cognitive challenges. Children may experience challenges with just one area or both of them.

Children may show signs of these motor issues:

• Consistent difficulty with forming letters, making them the same size, and spacing them correctly. Letters may be clustered together without spaces or not in a straight line.
• Trouble holding a pencil, such as holding it awkwardly or needing to grip it extra tight.
• Writing fatigue — Writing can be tiring and cause hand cramps or pain.

On the cognitive side, children with dysgraphia may struggle with:

• Difficulties with writing mechanics, like spelling, grammar, punctuation, and sentence structure.
• Trouble organizing their writing — they might have great ideas, but have a hard time getting them down onto paper in a coherent, structured way.

When it comes to noticing signs of dysgraphia, it’s important to look for consistency and patterns. “The more consistent something is, the more signs you have, the more concerned you’re going to be,” says Daryaneh Badaly, PhD, a clinical neuropsychologist at the Child Mind Institute. For example, if a child’s handwriting is occasionally messy, it likely isn’t a problem, but if they’re struggling to form letters most of the time, there may be an issue to address.

It’s important to understand that in the DSM-5 (the diagnostic manual that clinicians use), dysgraphia itself isn’t considered an official diagnosis anymore. That’s because it’s really comprised of two separate disorders — development coordination disorder (the motor issues, like difficulty forming letters) and “specific learning disorder, with impairment in written expression” (the cognitive aspects).

Approaching the two sides of dysgraphia separately in diagnosis is helpful because it allows clinicians to more accurately assess and address each child’s specific needs. Some children may have both disorders associated with dysgraphia, while others will only have one.

If you’re concerned about your child’s handwriting, you can seek an evaluation with an occupational therapist.

“For kids who are in the public school system, this can be requested as a school evaluation,” explains Dr. Badaly. “Parents could also do it as an outpatient evaluation. The reason why I recommend occupational therapists is that they know motor skills really well, and so they’ll be better able to assess them. And then if treatment is needed, they’re the ones who are going to do the treatment.”

If your child is struggling more with expressing themselves in writing, it’s best to seek an evaluation by a licensed neuropsychologist. There are many cognitive skills that go into the process of learning how to write, Dr. Badaly notes. “To spell, you need to have a good understanding of the sounds in words and how to manipulate them,” she says. “You also have to keep in mind the orthographic representation of the words, so you have to have a good working memory.”

Neuropsychologists can assess your child’s cognitive skills — like executive functions, working memory, phonological awareness, and more — to identify exactly what kinds of support will be most helpful for them.

There are many ways dysgraphia can be managed, both through specialized therapies and through accommodations that can help your child in the classroom.

Occupational therapists can use interventions to help kids develop their fine motor skills and dexterity, like physical exercises to strengthen hand muscles, or even practicing writing letters in the air or in sand. Multisensory instruction, which is used to help children with dyslexia, can also be effective. 

To help with written expression, there are special instructional approaches that psychologists and teachers or educational specialists can utilize. A couple examples are the Hochman Method, also called The Writing Revolution, and self-regulated strategy development (SRSD). Both of these approaches teach writing in a very structured way, which can be useful for children with dysgraphia.

There are several accommodations you can ask for at your child’s school. The therapist or psychologist you work with can help recommend specific adaptive tools or technology, but some examples that often benefit kids with dysgraphia include:

• Using a pencil grip to help them hold the pencil correctly and comfortably.
• Using a keyboard in class for note-taking and written assignments.
• Getting notes from the teacher.
• Using a recorder or dictation (speech-to-text) tool.
• Writing on graph paper or in graphic organizers (which are often available online for free) to help them organize their letters and thoughts on paper.
• Getting extra time for writing assignments, note-taking, and written tests.

If you’re noticing consistent issues with your child’s handwriting or ability to express ideas through writing, you can start by talking to their teacher. You can likely request an evaluation and then services through the school, or go to an outside provider if you prefer. The earlier a child receives support and intervention, the faster they’ll be able to get on track and keep up with their peers.

At home, you can help your child practice spelling and writing letters. If they have writing assignments for homework, you can help them get started in an organized way (like prompting “What are the pieces we need for this story?”) and remind them to check their work.

Kids with dysgraphia may struggle in the classroom. It might take them a long time to complete tasks, like written tests and homework. They may fall behind if they can’t keep up with taking notes during lessons. And their grades may be impacted negatively.

All of this can cause emotional distress for children. It can be frustrating to struggle translating your ideas and knowledge onto paper like your peers. Kids may experience anxiety and a loss of self-esteem and confidence. If their disorder is not understood or acknowledged, others might think that kids with dysgraphia are lazy or messy — and they might start to wonder if that’s true.

If you’re noticing that your child is having feelings of frustration, anxiety, or low self-esteem, there are many ways to help them, including:

• Talking through what a learning disability is, and how it has nothing to do with intelligence.
• Praising them for hard work. As with all learning disorders, managing dysgraphia is not about reaching perfection; it’s about improving. “We always emphasize the idea of grit or perseverance,” says Dr. Badaly. “It’s really not about always having things right or being perfect or succeeding. It’s about making sure that you’re learning from your errors and growing over time.”
• Checking in with teachers and making sure they’re understanding and supportive, maybe even defining a subtle signal that the child can use when they need extra help.

With the right support, kids with dysgraphia can excel in school, gain self-esteem, and express their ideas with confidence.