Monday, May 09, 2005

Sensory-Motor Dysgraphia Mis-Diagnosed as Underachievement

In our practice, unrecognized dysgraphia is a common cause of 'underachievement' and 'oppositionally-defiant disorder' in school age children, particularly boys. For some reason, dysgraphia has not garnered the attention of 'attention deficit disorder' or or other learning disabilities, and therefore children who are struggling with undiagnosed disabilities are mistaken for being lazy or defiant.

A child who is lame, rarely will be scolded or told to run extra laps at home, but a child with fine motor or other causes of dysgraphia is may be publicly disgraced about 'sloppy work', told to finish work at home (though it could take hours or be practically impossible), or denied recess on a regular basis to 'finish work.'

There are several types of dysgraphia, but in this post, we will discuss motor dysgraphia, or difficulty writing due to impaired fine motor or sensory-motor coordination.

In the figure below, are a variety of dysfunctional hand grips that occur in a variety of clinical settings - but most often mild birth injury or prematurity. Though motor / sensory-motor dysgraphia is remarkably common in today's classroom (perhaps because of rising prematurity or greater survival of high risk pregnancies), teachers receive little instruction in its occurrence, and accommodations are woefully underutilized. Dysfunctional grips often have the pencil tipped forward or out of the webspace. The first three fingers are not brought together in a pinch, but rather fisted or awkwardly positioned with the sides of fingers. When children are forced to writing with very dysfunctional grasps, then pain or even repetitive stress injuries can result. Often children develop behavioral problems like task or school avoidance. Occupational therapy may help many children, but sometimes time and accommodation are needed to allow handwriting to develop to a functional level.



The first link below is to a paper describes how brain-based injury to sensory-motor systems causes individuals to press harder than normal to compensate for their loss of control. The paper concludes, "When sensory information is degraded, an increase of grip force is interpreted as a compensatory strategic increase of the safety margin to protect against unexpected load perturbations that cannot be rapidly and accurately sense ands responded by a reactive grip force increase."

Children with mild neurological injury may use a very tight grasp on the pen or pencil that results in heavy pencil pressure, poor writing endurance, and hand cramping. Some teachers or administrators fear that providing a student with appropriate dysgraphia-related accommodations will result in a child "never learning to write"; however, this is not true. In fact, by denying children appropriate accommodations, these students may never be given adequate practice with higher order writing tasks like paragraph organization or redrafting, because they can't get much down on the page by hand.

Tighter Grip to Compensate for Lack of Control
Pencil Grasps

7 comments:

  1. There is a passage in your article that makes me ... angry !

    I read:

    When children are forced to writing with very dysfunctional grasps, then pain or even repetitive stress injuries can result. Often children develop behavioral problems like task or school avoidance. Occupational therapy may help many children, but sometimes time and accommodation are needed to allow handwriting to develop to a functional level.

    Isn't it about time that we stop labeling children as 'underachievers' or 'problematic', and seriously start rethinking on how schools really work?

    It's not the students that are dysfunctional, it's the schools!

    > Schools of today are not designed for optimal learning, they are designed for selecting.

    > How important is a neat and fast handwriting today? And tomorrow?

    I wrote some posts about this.
    If I may:

    http://mylearningblog.org/2005/05/11/staggering-statistics-on-teaching/
    http://mylearningblog.org/2005/05/05/john-taylor-gatto/

    Thank you for your great blog, I've been learning a lot from it the past months. Keep up the good work!

    ReplyDelete
  2. Hi - say, you're doing a great job with your blog too. There is a lot to make you angry - and the results can be devastating for kids.

    Often teachers don't mean to be insensitive or cruel, they may even think they are trying to positively motivate children so they care more about writing.

    A big problem is that dysgraphia is a 'silent disability'. A child may look 'fine' but just have trouble forming letters or write incredibly slow. They may not realize that to complete an assigned homework page could take them 2 hours.

    We have to confess that if we hadn't seen it in one of our kids, we wouldn't have realized the extent to which it could affect all aspects of his school performance and self esteem.

    You are right that schools are not designed for optimal learning, but rather for selecting. And what if it's you or your child who is selected out?

    The notion of building on a child's strengths is talked about a lot, but rarely implemented. Sometimes it takes a bit of troubleshooting, but redirecting an educational plan based on a child's strengths in memory or learning preference, accommodations or technology, can have a dramatic impact on everything - academic achievement, confidence, and outlook for the future.

    ReplyDelete
  3. redirecting an educational plan based on a child's strengths in memory or learning preference, accommodations or technology, can have a dramatic impact on everything - academic achievement, confidence, and outlook for the future.

    Is that so?

    How about the impact of forcing children into a way of learning that is not suited for them, and then letting them fail tests... Is that good for confidence and future learning?

    I am involved in a school that takes the child's own interests as the central basis for learning, so you made me really curious with your statement above. Do you have any data about this?

    Thanks, Tuur

    ReplyDelete
  4. We see kids individually and we advocate for them in the school system when they are having trouble. We have seen some dramatic improvements when teachers are able to flexibly accommodate weaknesses, yet providing practice when practice is needed. 'Behavioral' problems may melt away, and grades or test scores make a dramatic turn around. We've also seen when teachers or parents take a 'hard line' or won't accept the notion of a disability. And that can really hurt kids.

    I'm not sure if you're disagreeing with something here. We're certainly not for trapping children in unending cycles of failure. In fact, some of the parents of these kids decide to change schools, or even take them out of school to homeschool because the performance expectations were physically unrealistic by a school. What is your experience? How do approach the dilemma of providing challenge but also seeking to accommodate? Are you opposed to any sort of assessment?

    ReplyDelete
  5. I am against schools as they exist today. I was talking about it with a friend yesterday, and I agree on him that there are two ways of logical thinking about people: the logics of trust and the logics of distrust.

    Schools as we know them choose the path of distrust: children are not able to learn for themselves, to choose wat they find interesting themselves, so school has to offer it to them. This has a lot of consequenses:
    Children are not motivated
    => we have to try and make them believe that they truly wánt to learn wat we tell them to. This is the core of the whole motivation-problem: we try and motivate children to learn something they never chose to learn!

    Did you know that basic math can be learnt in 20 hours? If a child is ready for it, and motivated, it can learn what is taught in schools in six years in 20 hours on average.

    I looked up the word assessment (I'm learning;O)) and it said:
    the classification of someone or something with respect to its worth
    So I take it the question was if I am against some form of evaluation?

    I am against an external form of learning evaluation, yes.

    By doing this, you take away the initiative of the child. If a child is really digging into a subject or skill, it will surround itself with many examples and will be perfectly able to evaluate its own achievement. Evaluation of learning achievement is something that should not be left over to others. Self-evalution is something very important for someone's self. In life, everyone has to make choices and decide on wether they were good or could be better.

    Learning is pull , not push.
    Learning is active, not passive

    There is three dimensions to learning: discovery, play, and then passion. All of them can come from within, if given the trust.

    I think is very great that you dare question something seemingly obvious. If you are interested in any of the above, I can recommend www.sudval.org. It contains an online library with very interesting articles of people who have over 35 years experience with full-trust education.

    ReplyDelete
  6. Creative Painting for the Young Artist (Paperback) By Jason Mark Alster MSc

    A self help support book for the young person who wants to choose art as a subject or the youngster who thinks art is not for him. This book shows the steps one needs to be a creative artist early on. It includes how to get over the fear of failure, develop and artist statement, how to choose a subject to paint, develop an artist's mode of seeing, develop a composition, relaxation exercises for the young artist, art self critique and self promotion. The book is also of value to art teachers and art therapists. The book is especially useful for anyone with dysgraphia and wanting to learn to paint.
    http://www.amazon.com/gp/product/9659025122/
    ISBN: 9659025122

    ReplyDelete
  7. AdamD6:10 PM

    I always struggled in school as a child, especially with handwriting
    I can type fine and spelling was never a problem, infact, spelling was something I was pretty darn good at, but writing was and continues to be, a real issue for me.
    I to, was looked down apon by teachers for my poor writing, they to blamed me for my inability to write properly and they claimed I was being lazy and needed "practice", but no amount of practice seemed to help.
    I remember being embarrassed and made to stand up in class and my poor handwriting shown to the rest of the pupils there, in both middle and high school.
    As a result of all that, I was penalized during exams for poor writing and left school with subpar grades as a result, surely that in itself is discrimination against people with a recognised disability? But alas, they never actually "diagnosed" me with a problem.
    I'm now 28 and writing seems even harder these days, having to fill out an application form for anything is incredibly difficult and indeed, physically painful, as I get a cramp like feeling in my hand.

    ReplyDelete