The Science of Dysgraphia
Our understanding of the science of dysgraphia is incomplete because a lot more research is needed. (This is something Dysgraphia Life would like to change - check out the research section!)
Dysgraphia was first described in the scientific literature by Samuel T. Orton who described five different kinds of learning disorders including special disability in writing (1).
Learning to write involves many different processes at the same time:
motor skills (using hands for letter formation)
sensory systems (listening and viewing letters, touch of pencil)
language systems (producing and saying letters from memory)
cognitive processes or thinking (translating ideas into written text)
attention and executive function (focus and sustained attention)
social and emotional systems (understanding that writing is key to communication)
Researchers recommend teaching approaches (such as the Orton-Gillingham approach) that take all of these factors into consideration and help students use their strengths to overcome their weaknesses (2).
Scientists are identifying key questions about the pathways that contribute to dysgraphia to prioritize and accelerate dysgraphia research (3).
There are official medical definitions for written expression disorder/dysgraphia. Currently, there is debate and confusion around the specific terminology. Many use the word dysgraphia as a term specific to handwriting and motor coordination, but others use it to describe any type of disability in written expression. Dysgraphia Life uses the broader definition, consistent with the World Health Organization's newest classification system.
The World Health Organization now defines dysgraphia as "developmental learning disorder with impairment in written expression"(ICD-11 code 6A03.1). This is a new classification released in 2022 as part of the International Classification of Diseases 11th Revision, which is commonly called ICD-11. In ICD-11, dysgraphia is noted as a matching term for this disorder.(4) Unfortunately, it takes many years for ICD revisions to be implemented.
"Developmental learning disorder with impairment in written expression is characterized by significant and persistent difficulties in learning academic skills related to writing, such as spelling accuracy, grammar and punctuation accuracy, and organization and coherence of ideas in writing."
- World Health Organization, International Classification of Diseases 11th Revision
In the currently used ICD-10 system, this disorder is defined under a “specific developmental disorder of scholastic skill.” Its ICD-10 diagnosis code system has code F81.81 for "disorder of written expression." This applies to either a specific learning disorder with impairment in written expression or a specific spelling disorder (or both). This is the diagnosis that most of our community would receive. In ICD-10, the word dysgraphia is only mentioned under R27.8 under "other and unspecific lack of coordination disorder"and refers specifically to motor coordination issues.
The American Psychological Association similarly utilizes "specific learning disorder with impairment in written expression” (diagnostic code 315.2 in DSM-5).
It is then divided into problems with either:
Grammar and punctuation accuracy
Clarity or organization of written expression
There is still a lot of work to be done to fully understand and correctly classify dysgraphia/written expression disorders. There have been up to seven different types of dysgraphia described: Information Processing, Visual-Spatial, Motor, Memory, Word Formation, Sentence Formation, and Paragraph Formation (5).
(1) Orton S. Reading, Writing and Speech Problems in Children: A Presentation of Certain Types of Disorders in the Development of the Language Faculty,1937.
(2) Berninger and Wolf. Dyslexia, Dysgraphia, OWL LD, and Dyscalculia: Lessons from Science and Teaching. 2016
(3) McCloskey and Rapp. Cogn Neuropsychol. 2017
(4) International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11.
(5) Dotterer, Handwriting Brain-Body Disconnect, 2018.