Dysgraphia is generally defined as difficulty with writing that is significant enough to impact school participation. There are three identified types of dysgraphia and an evaluation is needed to know where the problem is coming from in order to design an effective treatment plan.
Children with spatial dysgraphia demonstrate normal oral spelling and finger-tapping speed, but have problems with illegible writing or drawing because of a lack of understanding of space, due to their internal processing of the information. Words are spelled correctly (according to developmental expectations), and the child does not demonstrate a physical difficulty with writing (poor pencil grasp or pencil control or decreased strength/stamina). Written work may include letters that are not consistent in size, float or sink on the line, sentences that run off the line and into the margins or do not start at the left margin, or words written out of order or in seemingly random locations on the page.
Children with motor dysgraphia have difficulty writing and copying words along with problems with drawing and finger-tapping speed. Like spatial dysgraphia, the student’s written text is illegible, however the reasons behind this are rooted in physical issues which can include poor motor planning, decreased strength, inefficient pencil grasp and poor pencil control. Finger tapping speed when measured is deficient among children with motor dysgraphia which also makes typing difficult. Some children with motor dysgraphia also have retained primary reflexes which impact seated posture and contribute to increased muscle tension in neck, shoulder, forearm, wrist and hand leading to discomfort and fatigue. Children with retained reflexes often complain of physical pain when writing.
Dyslexic Dysgraphia is a student’s difficulty in writing or spelling words that are not associated with a lack of fine motor coordination, or a physical medical condition. Their writing is illegible and more pronounced when the writing context is complex, such as when writing a paragraph or a long essay. The problem in this case is with the students internal processing and output of the information. The student may also experience problems with spelling. These children usually test well on small sample tests such as the Test of Handwriting Skills where they are asked to write individual letters or words. Parents are often frustrated as they know that their children are capable of forming letters and words but their written work does not show these skills. When tested, children with Dyslexic Dysgraphia often demonstrate deficiencies with working memory. When Dyslexia Dysgraphia is determined to be the dominant issue impacting writing, SI therapists will refer these children out to more academic based therapy settings.
In addition to investigating the type of dysgraphia that a child might have, SI therapist also assess visual, postural, and spatial abilities to address underlying sensorimotor issues impacting writing execution and include interventions for foundational skills in each therapy session. For children with spatial dysgraphia, vision in space, puzzles, drawing in relation to space, rotation of shape, patterning, movement through space, and set up and navigation of obstacle courses including targeting tasks are implemented to improve processing of visual/spatial information in space as well as on paper. As treatment progresses, specialized paper and different colored pens/pencils are used when writing to give children more cues/information about the position of words/letters on the page.
For children with motor dysgraphia, therapy begins with a focus on posture and total body control and progresses from core out toward hands starting with gross motor activities and progressing to fine motor activities to improve strength and coordination. Children with motor planning difficulties may require direct hand over hand assistance to learn how to form letters and to hold writing implements. Children with retained reflexes may need extra work with specific exercises to integrate those reflexes, and children with joint laxity may need extra work with strengthening activities.
If a child’s dysgraphia co-occurs with other sensory processing disorders, then treatment will integrate a variety of tools and strategies to improve overall outcomes. Learn more about sensory integrative treatment for SPD.
SI treatment is tailored to each child’s sensory profile. Treatment occurs in sensory-rich gym environments with specialized suspended equipment and therapists trained in sensory integration theory and practice. Through playful and supportive interactions with the child, he/she learns how to explore and engage in sensory experiences that foster appropriate responses to sensory information. Treatment often begins with a focus on balancing self-regulation and skill development. As adaptive motor responses and postural control emerge, the body is then ready to engage in more complex demands. Vestibular input is used via use of suspended equipment (swings etc) to increase the connection between the vestibular (movement) system and the body to activate the muscles needed for dynamic postural control as well as the connection to the visual system for development of vestibular-mediated functional visual skills. Use of suspended equipment allows the therapist to facilitate a myriad of movement combinations to develop more efficient saccadic eye movement, gaze stability, visual fixation, and dynamic postural responses. Treatment then progresses to integrating postural and visual demands while building motor planning, praxis skills, and bilateral coordination.
What about fine motor and handwriting?
While many families often initially seek occupational therapy for help with fine motor skills, adequate postural-ocular control is necessary to create proximal stability and support visual attention. Therefore, focusing on fine motor and writing demands may not be appropriate until this foundation is in place or may only be embedded in short bursts during sessions to maximize the therapeutic benefit.
What about auditory deficits?
For children with auditory challenges, Sensational Achievements offers the Tomatis Method, a stand alone auditory intervention which can be implemented during treatment sessions or at home. Aubrey Schmalle (Owner and OTR/L) is a Level 3 Tomatis Consultant, which allows her to create custom listening programs designed specifically for your child’s Listening Profile and areas of need. To learn more about the Tomatis Method, Click Here.
How long does it take?
Research tells us that the first significant milestone for progress is around 30 hours of intervention. This includes not just treatment sessions but also how consistent you are with home programming and implementation of sensory support programs utilizing the Body Activated LearningTM framework.
While Sensory Integration Therapy and the Tomatis Method are not a cure for ADHD, these interventions can significantly improve many of the commonly seen behaviors and functional concerns that overlap with the diagnosis of ADHD. It starts with understanding your child’s unique profile and areas of need to create a targeted intervention plan.
Contact us to set up an evaluation
If you would like to be connected to a parent of a child with ADHD who has experienced success with sensory-based and/or Tomatis interventions, please let us know and we would be happy to connect you.
Dysgraphia Handouts: Click on the questions at the bottom of the page for downloadable, easy to read handouts