Specific Learning Disability - Impairment in Written Expression in Children and Adolescents

Writing impairments are characterized by one or more of the following domains:

• Spelling Accuracy: difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants)
• Grammar and Punctuation Accuracy: difficulties with grammar and punctuation (e.g., makes multiple grammatical or punctuation errors within sentences)
• Clarity or Organization of Written Expression: difficulties with written expression (e.g., employs poor paragraph organization, written expression of ideas lacks clarity).

Common characteristics of children with a writing impairment are:

• Handwriting
• Fine motor difficulty
• Inability to remember motor patterns associated with letters
• Inability to revisualize letters
• Graphomotor Dysfunction
• Graphomotor production deficit-awkward pencil grip, poor muscle coordination
• Motor feedback difficulty-trouble tracking pencil, face too close to paper, use of larger muscles or joints to write
• Spelling
• Difficulties analyzing sounds, syllabus and meaningful word parts
• Difficulties comprehending spelling rules, patterns, structures
• Lack of phonemic awareness
• Written Composition
• Complex errors in syntax, morphology or semantics
• Ideas that lack logical cohesion
• Paragraphs and stories that are missing elements, do not follow a linear progression, or lack logical transitions

It is not uncommon for children to have difficulties learning skills in one or two academic domains, such as reading and writing. Many children and adolescents with impairments with writing also have 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.

Although interventions should be individualized to take into account a child’s academic strengths and weaknesses, there are recommendations of what a writing intervention should include: Self-Regulated Strategy Development in Writing; Classroom Based Interventions; Strategies for Teaching Writing

First Line Treatments

• Self-Regulated Strategy Development (SRSD): SRSD is an instructional approach designed to help students learn, use and adopt strategies used by skilled writers. It encourages students to do what good writers do: plan, monitor, evaluate, revise and manage the writing process. This in turn reinforces self-regulation skills and independent learning. There are six basic stages of instruction: develop background knowledge, discuss it, model it, support it, memorize it, independent performance.
• Adaptation to general curriculum: Teachers will differentiate instructional content and activities to ensure student is provided practice on core objectives that have already been taught

• Common adjustments are: reducing the rate and complexity of writing assignments, as well as the amount of writing that must be completed; additional time to write; assisting the student in breaking the written task down into stages (brainstorming, drafting, editing, etc.); reducing the amount of writing by allowing dictation; use of assistive technology (positioning aids, contrast aids, adapted writing utensils, adapted paper, etc.)

• Occupational Therapy: Occupational therapists (OTs) are professionals who can work with children on handwriting skills. Using writing related tasks designed to provide frequent practice with letter and word formation, children become more automatic and accurate with their letter formation.  OT’s also work with children on correct pencil holding position and pencil grip to assist with automaticity of letter formations.

Second Line Treatments

When patients do not respond adequately to the first line treatments described above, other strategies might include:

• Evaluation for special education eligibility through school district’s Child Study Team
• Make it possible for students to use word processing as a primary tool to improve writing productivity