Dysgraphia

What Causes Dysgraphia?

The precise causes of dysgraphia aren’t clear, but they are likely the result of atypical function or development in the parts of the brain responsible for language processing, fine muscle movement, or spatial perception. Dysgraphia may be either acquired or developmental, depending on its origin.

• Acquired dysgraphia. This type of the disorder is the result of brain damage caused by an injury, stroke, disease, or another brain-related event. A person with acquired dysgraphia experiences the disability only after the triggering event, not throughout their life.
• Developmental dysgraphia. This type typically affects children and results in problems developing written communication skills.

Developmental dysgraphia may be classified into several subtypes depending on the part of the brain that seems to be affected. Subtypes include:

• Motor dysgraphia. This subtype is characterized by difficulties with the fine motor movements required to write or draw.
• Spatial dysgraphia. This subtype also affects writing and drawing skills, but the difficulties are related to the spatial relationships between letters and shapes rather than the muscle control needed to make them.
• Linguistic dysgraphia. This subtype affects written expressiveness more than the physical control required for writing and drawing. It is likely caused by problems in the brain’s language processing centers.

Is Dysgraphia Hereditary?

Children who have a history of dysgraphia and other learning disabilities in their families have a much greater risk than the general population of having the disorder. Environmental factors could play a role in the prevalence of learning disabilities within families, but studies of identical twins–who are genetically identical to one another–suggest that genetic similarities are at least part of the reason for increased risk in some families.

Researchers have not yet determined which genes or gene variants might contribute to the risk of developing dysgraphia. The process of neurological development that results in dysgraphia is complex, however, and, likely, there is not a single genetic cause for the disorder. Instead, it’s more likely that an interplay of multiple genes and environmental factors is to blame.

How Is Dysgraphia Detected?

The problems caused by dysgraphia are most often noticed when they begin to interfere with a child’s schoolwork, usually in elementary or middle school. However, some signs may be apparent much earlier. Early detection of the disorder can help the child learn to cope and ensure that they get adequate support at home and school from the very beginning.

Potential early symptoms of dysgraphia include:

• Dislike of coloring, drawing, or art activities
• Awkardness in holding crayons
• Complaints that drawing or writing hurts their hands
• Problems with fine motor control (e.g., picking up small objects, tying shoes)
• Problems following drawn patterns (e.g., tracing, connecting the dots)

How Is Dysgraphia Diagnosed?

Dysgraphia doesn’t have an easily identifiable physical cause, so there is no physical exam or laboratory test that can detect the disorder. Instead, a doctor will focus on assessing a child’s developmental and educational performance to determine whether the child’s symptoms are consistent with dysgraphia. There will also probably be an effort to rule out other possible causes for the symptoms. An actual diagnosis of dysgraphia will typically come from a psychologist.

• Developmental history. Your healthcare provider will ask questions about your child’s language development and current language skills. They will also ask about the child’s medical history to rule out other health factors that could contribute to the symptoms.
• Family history. The provider will look for a family history of dysgraphia or other learning disorders.
• Physical and neurological exams. These exams will check the child’s vision, hearing, and neurological functions to rule out physical problems other than dysgraphia that could be causing the symptoms.
• Psychological assessments. The provider may also administer exams or questionnaires intended to rule out psychological conditions such as depression or anxiety that could be responsible for learning difficulties.
• Cognitive and educational assessments. These exams and questionnaires are aimed at accurately assessing the child’s writing and language skills to pinpoint exactly where the learning difficulties lie.

How Is Dysgraphia Treated?

There is no cure for dysgraphia, and no known treatment will consistently and reliably improve symptoms. Treatment focuses on helping the person with dysgraphia compensate for the writing disability to minimize its impact. For the most part, the disorder is treated by developing educational plans that support the person’s skills. Different individuals respond to different approaches, so individualized education plans are essential.

Some common treatment approaches include:

• Using specialized pencils or writing instruments
• Using lined paper to guide writing
• Getting extra time for writing-related work
• Doing work in alternative ways, such as giving oral rather than written presentations
• Using assistive technologies such as speech-to-text apps

How Does Dysgraphia Progress?

When dysgraphia goes undiagnosed and untreated, difficulties with written expression can interfere in many other learning areas, leading to escalating and long-lasting developmental and social problems.

Long-term complications of dysgraphia can include:

• Broad learning difficulties. Children with dysgraphia often have other learning disabilities and may struggle in multiple areas of school.
• Social difficulties. Problems with written expression can also harm other aspects of a child’s life. For example, if the child lags behind their peers academically, they can be vulnerable to depression, anxiety, bullying, and social isolation.
• Life-long consequences. Language-processing struggles can impact adults, too. Learning difficulties can hinder an adult’s career prospects, and ongoing language problems can affect job performance. The result can be long-term financial and social challenges.

How Is Dysgraphia Prevented?

There is no known way to prevent dysgraphia. However, parents can take steps to support their child’s early learning and hopefully limit the negative impact of the condition in the future.

• Look for warning signs and seek help early. Early detection and treatment of dysgraphia is the single most significant factor in effectively managing the disorder.
• Support, encourage, and facilitate your child’s learning. Acknowledge your child’s dysgraphia and encourage them to find ways to deal with the learning disability. Don’t criticize them for their struggles, and praise them for their successes.
• Make sure your child is getting support at school. Work with the school to develop an individualized educational plan, and remain involved as this plan is carried out.

Dysgraphia Caregiver Tips

Many people with dysgraphia also suffer from other brain-related issues, a condition called co-morbidity. Here are a few of the disorders sometimes associated with dyslexia:

• Dysgraphia is often co-morbid with attention-deficit/hyperactivity disorder (ADHD).
• Dysgraphia and autism are sometimes associated.

Dysgraphia Brain Science

To understand the neurological basis of dysgraphia better, researchers have used an imaging technology called functional magnetic resonance imaging (fMRI) to produce a visual representation of brain activity. An fMRI scan uses a magnetic field to make an image showing activity patterns in different parts of the brain. One study looked at brain activity in three different groups of children. One group had been diagnosed with dysgraphia. The second group had been diagnosed with dyslexia, and the third group of children showed no identified disability in language skills.

The study’s fMRI scans, which were conducted as the children did language-related tasks, showed marked differences between the three groups. The typical-learner control group exhibited robust connections between the parts of their brains responsible for language processing and thinking. Both the dyslexic and dysgraphic children had fewer connections, suggesting that their brains had to work harder to accomplish the language-related tasks.

Another significant finding was that patterns of connections and the areas affected differed between the dyslexic and dysgraphic children. This suggests that although the two disorders often co-occur and have similar symptoms, they may have entirely different origins in the brain.

Dysgraphia Research

Title: Neurobiology of Language Recovery in Aphasia: Natural History and Treatment-Induced Recovery

Stage: Completed

Study Director: Cynthia K. Thompson, PhD

Northwestern University 

Evanston, IL

This study aims to investigate the effects of treatment for specific language deficits in people with aphasia. In addition to language and cognitive measures, changes in brain function will also be gathered before and after the treatment is administered to track any changes resulting from receiving treatment.

Naming Impairments (Anomia): The labs of Dr. Swathi Kiran (Boston University) and Dr. David Caplan (Harvard University, Massachusetts General Hospital) will be studying language recovery in adults with anomia (naming impairments) following a stroke. Participants will receive treatment focusing on the semantic features of common objects (e.g., that birds can fly). The study will examine how naming and other language abilities change in response to treatment, as well as how the brain changes, as measured by magnetic resonance imaging (MRI) and other techniques.

Spelling/Writing Impairments (Dysgraphia): At Johns Hopkins University, the lab of Dr. Brenda Rapp will investigate the neurobiology of language recovery in individuals with dysgraphia (spelling/writing impairments) resulting from a stroke. In this study, treatment will focus on improving spelling ability. The study will examine how spelling and other language abilities change in response to treatment, as well as how the brain changes, as measured by magnetic resonance imaging (MRI) and other techniques.

Deficits in Sentence Comprehension & Production: Dr. Cynthia Thompson’s lab at Northwestern University will investigate language recovery in individuals with deficits in sentence production and comprehension. Treatment focuses on the production and comprehension of complex sentences. At baseline (week 0) and after the treatment period (at week 12), participants take part in language, eye-tracking, and MRI testing, to learn how the processing of language, as well as brain function, changes as a result of treatment.

Title: Low-Intensity Focused Ultrasound for Learning and Memory (LIFUPMEM)

Stage: Recruiting

Principal Investigator: Taylor P. Kuhn, PhD

University of California, Los Angeles 

Los Angeles, CA

Hippocampus and medial temporal lobe (MTL)-dependent memory is impacted by a wide range of psychiatric and neurologic conditions. These cognitive limitations often result in limited functional abilities for patients. Currently available pharmacologic and behavioral treatments are somewhat controversial and have minimal evidence-based effectiveness. Recently, deep brain stimulation was used to modulate MTL activity and subsequently improve memory performance. However, such implantable devices require neurosurgery with significant associated health risks. At present, no publications are reporting non-invasive neurostimulation targeting MTL regions to improve memory. The central hypothesis of this project is that non-invasive, low-intensity focused ultrasound pulsation (LIFUP) can selectively increase regional MTL activity and thus be used as a cognitive neural prosthetic capable of improving memory performance. The aims of this study focus on whether LIFUP can increase blood oxygen level dependent (BOLD) activation in the entorhinal cortex and functionally associated regions, whether this increased activation is greater using short train or long train LIFUP parameters, and whether this LIFUP-induced activation, when applied during learning, results in improved memory.

Title: Transcranial Magnetic Stimulation for BECTS (TMS4BECTS)

Stage: Recruiting

Principal Investigator: Fiona M. Baumer, MD

Stanford University 

Palo Alto, CA

Benign epilepsy with centrotemporal spikes (BECTS) is the most common pediatric epilepsy syndrome. Affected children typically have a mild seizure disorder, but yet have moderate difficulties with language, learning, and attention that impact quality of life more than the seizures. Separate from the seizures, these children have very frequent abnormal activity in their brain known as interictal epileptiform discharges (IEDs, or spikes), which physicians currently do not treat. These IEDs arise near the motor cortex, a region in the brain that controls movement.

In this study, the investigators will use a form of non-invasive brain stimulation called transcranial magnetic stimulation (TMS) to determine the impact of IEDs on brain regions important for language to investigate: (1) if treatment of IEDs could improve language; and (2) if brain stimulation may be a treatment option for children with epilepsy.

Participating children will wear electroencephalogram (EEG) caps to measure brain activity. The investigators will use TMS to stimulate the brain region where the IEDs originate to measure how this region is connected to other brain regions. Children will then receive a special form of TMS called repetitive TMS (rTMS) that briefly reduces brain excitability. The study will measure if IEDs decrease and if brain connectivity changes after rTMS is applied.

The investigators hypothesize that the IEDs cause language problems by increasing connectivity between the motor cortex and language regions. The investigators further hypothesize that rTMS will reduce the frequency of IEDs and also reduce connectivity between the motor and language regions.