Dysgraphia is a neurological condition that causes someone to struggle with handwriting because of impaired fine motor skills. People with dysgraphia don’t just have “bad handwriting” — because of differences in their brains, they struggle to turn their thoughts into written language at the same level of complexity as their typically developing peers.
To talk through the details of diagnosis, the different interventions, and how to approach dysgraphia if your child has other co-occurring diagnoses, we reached out to Jennifer King, PhD, from Dysgraphia Life and Cherie Dorreen, an education advocate based in Los Angeles.
Dysgraphia can occur as a result of developmental differences or after experiencing a traumatic brain injury, according to the Cleveland Clinic. Symptoms usually emerge in children as soon as they start learning to write but can present at any age.
Dysgraphia, like other learning disabilities, might cause uninformed teachers or parents to label a child as “lazy” or “just not trying hard enough.” Jennifer King says this couldn’t be further from the truth. “In this case, it's really due to how difficult it is for the child to undergo that writing process,” King says. “If I ask my child a question, they know the answers, but if it comes to putting it down on a worksheet or a test or something like that, they can't get it out.”
There are five dysgraphia subtypes: dyslexic dysgraphia, motor dysgraphia, spatial dysgraphia, phonological dysgraphia, and lexical dysgraphia. The manner in which your child struggles with writing will dictate their subtype diagnosis — for example, if they struggle to properly space their letters and words when writing, they would be diagnosed with spatial dysgraphia. If they struggle with writing because of underdeveloped fine motor skills, they would be diagnosed with motor dysgraphia. Additionally, it is possible to be diagnosed with multiple dysgraphia subtypes.
Researchers estimate that anywhere from 5 to 20% of people have dysgraphia, making it a common condition. The range varies widely because dysgraphia often goes undiagnosed or misdiagnosed. Symptoms exist on a spectrum and can be mild, moderate, or severe. Furthermore, some disagreement exists among medical professionals regarding the definition of dysgraphia, King says.
Dysgraphia is considered a Specific Learning Disorder in the DSM-5, like other learning disabilities including dyslexia and dyscalculia. You can read more in our article Specific Learning Disabilities 101.
According to the DSM-5, a person must experience the following symptoms persistently for at least six months in order to qualify for an SLD diagnosis:
Early signs of dysgraphia and other learning disabilities usually begin before children start learning to read. For example, if your child struggles to space words and letters out on paper within the margins or does so inconsistently, they could be struggling with dysgraphia. Other signs include frequent erasing, poor spelling, cramped grip, and unusual wrist, body, or paper position while writing.
Similar to other learning disabilities, dysgraphia commonly co-occurs with other learning disabilities like dyslexia and dyscalculia as well as ADHD, autism, and sensory processing disorder.
It’s important to note that not all struggles with handwriting are caused by dysgraphia, according to Cherie Dorreen, an advocate for children with disabilities who has dysgraphia herself. Dyspraxia, also known as Developmental Coordination Disorder (DCD), can cause someone to struggle with handwriting because of impaired motor skills and coordination.
ADHD, which causes issues with executive functioning, can also mimic dysgraphia, according to Dorreen. “ADHD can cause these things too.…I’m trying to conceptualize what I’ve got to write, but I don’t have the working memory to be able to hold that information and to be able to convert that into what I’m wanting to write,” Dorreen says. “And that’s why when we do these assessments for an IEP, they’re doing a barrage of tests. They’re testing for all areas.”
Children can be screened for learning disabilities, including difficulties with handwriting, as early as preschool. As with other learning disabilities, early intervention for dysgraphia is key — as your child ages, their brain plasticity decreases, and dysgraphia treatments can become less effective.
Who can diagnose dysgraphia?
According to the California Association of School Psychologists (CASP), any licensed educational psychologist (including those working in school districts) can make a diagnosis “if they have the training and knowledge in that area.” This may differ depending on the state where you live.
A dysgraphia diagnosis typically comes by way of an IEP assessment, where a team of special education teachers, occupational therapists, speech therapists, physical therapists, and educational psychologists work together to identify and diagnose any and all potential disabilities. You can learn more about the assessment process and how to request one for your child in our IEP Assessments decoder.
What assessments are used?
To test for dysgraphia, evaluators might use formalized handwriting assessments such as the Detailed Assessment of Speed of Handwriting and visual-motor integration assessments such as the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI), according to a 2020 study from Translational Pediatrics. Your child should be evaluated for other learning differences as well because dysgraphia often co-occurs with dyslexia and other learning disabilities.
School-based IEP assessments, while comprehensive, are designed to find out whether a student meets the criteria for a disability that would impact learning. Depending on the qualifications of the assessor, a school-based assessment may not be thorough enough to diagnose dysgraphia.
What if you disagree with the school's assessment?
Parents who feel their child was not assessed accurately or thoroughly have the right to request additional assessments, including an Independent Educational Evaluation (IEE), at public expense. An IEE is typically done by a clinical psychologist or a neuropsychologist who is not associated with the school district. This can be especially important if a child has more than one diagnosis.
If your child’s school district doesn’t agree to provide an IEE, an alternative option is to check with private health insurance to learn whether a psychoeducational assessment can be covered medically. (You’ll want to check with your insurance company to see whether that’s true for your family — IEEs are not cheap; costs vary but generally run upwards of $3,000.)
Assessments do more than identify a diagnosis
Dorreen says it’s important to note that a child with an IEP or 504 plan doesn’t need an official dysgraphia diagnosis in order to qualify for handwriting accommodations and services at school.
“If you can look at a child and say, well, this child is struggling with writing, but they've only got a language eligibility [under IDEA], we don't say, well, the child's not going to get help for writing,” Dorreen says. “What we do in evaluations is we identify areas of need by testing all areas of disability, and then those identified areas of need drive goals, and goals drive services. It’s not based on a specific diagnosis.”
While dysgraphia cannot be treated with medication, different therapies and teaching methods can help your child develop effective compensatory strategies for their handwriting issues. The interventions and remediations best suited for your child depend on their unique dysgraphia-related struggles, King says.
Some common dysgraphia interventions and remediations, according to King and Dorreen, include:
These interventions will likely be overseen by an occupational therapist, and the team may also include a physical therapist, an SLP, a school psychologist, and the child's special education teacher.
Psychoeducational programs and support groups can also be useful interventions for children with dysgraphia and their families, especially at the middle and high school levels. Any interventions and remediations should be explicitly outlined in your child’s IEP and have goals directly attached to them for progress-tracking purposes. Learn more about progress-tracking in our article Progress Reporting for IEPs.
Of the 13 eligibility categories that qualify a child for an IEP, dysgraphia falls into the classification of Specific Learning Disability (SLD). But because IDEA is very specific about what qualifies as a disability, sometimes children are denied services unless the dysgraphia is shown to be severe enough to cause major impairment and adversely impact educational performance. Children who are unable to qualify for an IEP may still be able to receive accommodations under a 504 plan.
The following are some common dysgraphia accommodations that could be included in a child’s IEP or 504 plan to help them succeed in school:
King says assistive technologies like voice-to-text and typing can be great accommodations if your child struggles with dysgraphia but warns against introducing them too early in your child’s academic career.
To best support your child in their handwriting-related struggles, King says it’s critical to regularly check in with them regarding their progress. “Having those conversations at home, particularly before IEP meetings and planning, about ‘Hey, what’s working? What do you like? What don’t you like? What changes could we make? Or what do you absolutely want to keep?’ Those conversations are really important,” King says.
It’s also important to remind your child that their struggles with handwriting don’t define their character, intelligence, or capabilities, Dorreen says.
Some additional ways to support your student at home include the following:
Unsurprisingly, learning disabilities like dysgraphia are usually identified after a child starts school. Some states require public schools to proactively screen all students for potential learning disabilities, but most deal with it on a student-by-student basis. The lack of proactivity in screening for learning disabilities can be explained by inadequate school funding, Dorreen says, which makes students from low-income areas the most at risk of falling through the cracks without intervention.
“We're never going to break that cycle of poverty until we start investing more into those low-income schools by having smaller classrooms and by more actively going out and identifying learning disabilities and providing supports for those children that perhaps might not be able to get that support at home,” Dorreen says.
