What is a Disorder of Written Expression?

child writing in notebook

March 27, 2018

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Posted in: Grade School, Parenting Concerns, You & Your Family

Topics: Learning + Attention Issues

Paul was a frustrated 6th grader. He had always thought of himself as smart – and in fact was the best reader in his class. But when it came time to write about what he’d read, he fell apart. First, it was difficult for him to organize his thoughts. He didn’t seem to have trouble discussing the book he’d read but something happened when he had to write about it. He would find himself staring at the paper while the minutes ticked by. Second, when he finally did manage to write something, it never turned out as good as he’d expected. Finally, when he showed his work to his teacher, she could barely read what he’d written as his handwriting was so poor. Paul’s teacher referred him for an evaluation and he was diagnosed with a Disorder of Written Expression. His mother asked… “What is a disorder of written expression?”

Children with a learning disability in writing, sometimes referred to as dysgraphia, have problems with handwriting, spelling, and composition. Their problems go far beyond just bad penmanship to the point at which their writing is illegible. It can take them a very long time to come up with a composition topic, and once they do, they can be slow at the act of writing. Spelling can be a problem and their writing can consist of short sentences that lack a theme or details. They typically don’t use strategies such as planning out their story, organizing the story, writing a rough draft, or editing.

Although writing problems are often noticed by age 8 (the time when children are asked to do more writing in school), these problems often go undiagnosed until middle or high school. By that time, the problem has taken another form in that it looks like the child or adolescent is just poorly motivated or “not trying.” Furthermore, a disorder of written expression is frequently found in combination with a reading or math disorder, and many children with ADHD also struggle with writing issues, making this a complicated issue to appropriately diagnose and treat.

The act of writing involves language, visual skills, and the motor skills needed to form letters. Because of this, a disorder of written expression can include some combination of fine motor problems, language problems, visual-spatial problems, and attention and memory problems. Some children may have difficulty tracing shapes or writing letters; others may be able to form letters well, but they may be very slow; still other children have good penmanship but cannot organize their thoughts well enough to write a well-formed paragraph or story. Because research on this disorder and in this area is lacking, psychologists know less about this disorder than other types of learning disabilities, but we do estimate that it affects about 8 to 15% of school-aged children and that many of these children have other learning issues as well.

How is Disorder of Written Expression Assessed?

A comprehensive evaluation, such as a neuropsychological evaluation, that looks at many aspects of writing and associated skills is used to make a diagnosis of a disorder of written expression. Typically, this includes a measure of intelligence, tests of academic achievement (with a particular emphasis on writing skills), tests of visual-motor abilities, and tests that may be needed to rule out comorbid conditions, such as ADHD. The evaluator will make qualitative assessments, looking at how the child writes letters or sentences. The evaluator may also ask to see samples of the child’s writing from school.

For example, when I evaluated Paul, his mother brought in a folder of classroom writing assignments, completed within the past year. I noticed immediately that he had many spelling and writing errors, alternated between printing and cursive, and used simple sentence structure. Sometimes his writing was illegible. On the tests of writing that he completed with me, Paul’s performance fell below the average range. He took a long time to do any paper-and-pencil tasks and exhibited slow processing speed. Despite having above average intelligence, his use of complex language was quite limited.

What Are the Best Treatments for Disorder of Written Expression?

Interventions for learning disabilities in writing have been developed but are not very well-studied. It can be difficult to study because writing involves so many processes including formulating ideas, organizing the ideas, using correct grammar, spelling the words correctly, and writing legibly. Many treatment programs focus on just one or two of these issues.

In terms of the physical ability to write legibly, occupational therapy (OT) is frequently recommended.  OTs assist children in learning the mechanics of letter formation. They evaluate a child’s pencil grip and treat any associated fine motor and sensorimotor weaknesses that a child might have. One particular program, Handwriting without Tears, is frequently used by OTs and teachers to teach handwriting to children.

Other treatment programs focus on the ability to put one’s thoughts on paper. Most programs teach writing as a process that includes prewriting activities—like organizing and sequencing ideas—the writing itself, and post-writing activities such as editing. Some programs help children organize their ideas by using prepared templates for the mapping or webbing of ideas. These are sometimes referred to as graphic organizers. They can come in various shapes, such as a topic wheel or a sequential outline.

In addition to teaching children the skills they need, accommodations to the learning environment are typically made. These can include the use of a computer, assistance with note-taking (such as getting notes from a friend or teacher), allowing students to tape lectures, providing extra time on tests and written assignments, and providing opportunities to demonstrate knowledge through means other than written work (such as an oral, instead of a written, book report). Programs such as Dragon Naturally Speaking, in which a computer prints text as the person speaks into the microphone, can also be helpful.

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If you suspect your child might have a learning disability in written expression, or other areas of academics, it will be important to have a thorough evaluation. You can receive this type of evaluation through your local school system or by a psychologist who works in private practice or a medical center. Above all, the evaluation should be your first step in determining treatment. Following through with recommendations is the next step in making sure your child gets the help he or she needs.

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Ellen Braaten

Ellen Braaten, Co-Director

Ellen Braaten, Ph.D. is co-director of The MGH Clay Center for Young Healthy Minds, and director of the Learning and Emotional Assessment Program (LEAP) at Massachusetts General Hospi...

To learn more about Ellen, or to contact her directly, please see Our Team.