ICD-10 code: F81.81
Specific Learning Disorder, Impairment in Written Expression is part of a cluster of diagnoses called Specific Learning Disorders. Specific Learning Disorders are a group of psychiatric conditions that include:
These disorders are categorized by a persistent difficulty learning keystone academic sills with an onset during the years of formal schooling. Key academic skills include reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic calculation, and mathematical reasoning. Difficulties learning to map letters with the sound of one's language- to read printed words- is one of the most common manifestations of specific learning disorder.
Learning difficulties are usually readily apparent in the early school years in most individuals. Academic skills that were not mastered during the school-age years remain difficult. They are a persisting problem that evolves throughout the developmental continuum. The academic difficulties an individual might experience as a grade-school student can be very different from what is manifested as an adult with a learning disability. Thus, learning disabilities in adulthood present different themes, challenges, and issues. Social and emotional problems are not uncommon with adults with learning disabilities. An overall feeling of lack of self-worth, low self-esteem, and a poor self-concept can be pervasive. Many adults with learning disabilities have had negative experiences since their school-age years. Consequently, it is not uncommon for them to have carried their self-attributions of feeling incompetent and unintelligent into adulthood. Adults with learning disorders also have considerable strengths that include development of compensatory strategies to bypass academic impairments and resiliency to recover and persist despite challenges.
Adults with Specific Learning Disorders perform well below average for their age, and average achievement is only attained through extraordinarily high levels of effort or support. The low academic skills cause significant interference with vocational or workplace skills. These learning difficulties are considered "specific" for four reasons: (1) they are not attributable to an intellectual disability; (2) they cannot be attributed to external factors such as economic or environmental disadvantage, chronic absenteeism, or lack of education in the individual's community context; (3) they cannot be attributed to a neurological or motor disorder and (4) the difficulties may be restricted to one academic skill or domain (i.e., reading single words, retrieving or calculating number facts).
Note that Dysgraphia is a general term used to describe difficulty in written expression. If dysgraphia is used to specify this particular pattern of difficulties, it is important to specify what difficulties are present.
Approximately 4% of adults in the general population have a learning disorder. In the 2010 census, 4.6 million adults reported have a learning disorder. The prevalence of a writing impairment in adults is currently unknown.
One or more of the following domains characterizes writing impairments:
Common characteristics of adults with a writing impairment are:
Impairments in writing severity can range from mild to severe. In severe cases, speech and language and visual-spatial abilities can also be impaired. This can result in difficulty with balance, posture, hand-eye coordination; poorly established hand dominance; or difficulty organizing the content and sequence of their speech.
Many adults with impairments with writing also have comorbid neurodevelopmental disabilities such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, autism spectrum disorders, anxiety, depression, and bipolar disorder.
As with most learning disabilities, the exact cause of writing disabilities is unknown. However, research to date has shown orthographic coding in working memory is related to handwriting. Orthographic coding refers to the ability to store unfamiliar written words in working memory while the letters in the word are analyzed during word learning, or the ability to create permanent memory of written words linked to their pronunciation and meaning.
Impairments in written expression are treatable using a targeted, individualized intervention. The intervention is uniquely tailored to remedy the individual's weaknesses in a targeted area of writing (e.g., spelling, grammar and punctuation, clarity or organization of written expression).
Although interventions should be individualized to take into account an individuals' academic strengths and weaknesses, there are recommendations of what a writing intervention should include: Self-Regulated Strategy Development in Writing; Strategies for Teaching Writing; Adult Education Guide for Writing Interventions
Under the Americans with Disabilities Act (ADA), particularly Title I, employers are required to provide workplace accommodations for individuals with learning disabilities, but only for disabilities that have been disclosed. Individuals have the right to determine whether, when, how, and to whom to disclose their disabilities, and many choose to withhold disability information. The following sources provide recommendations of workplace accommodations for adults with learning disabilities: ProLiteracy.org, LdAmerica.org.
First Line Treatments
Second Line Treatments
When patients do not respond adequately to the first line treatments described above, other strategies might include:
Occupational Therapy: Occupational therapists (OTs) are professionals who can work with adults on handwriting skills. Using writing related tasks designed to provide frequent practice with letter and word formation, adults become more automatic and accurate with their letter formation. OTs also work with adults on correct pencil holding position and pencil grip to assist with automaticity of letter formations.