Dysgraphia: Poorly Understood Learning Disorder - Case Study Example

Running Head: Clinically Based Case Study-Dysphagia Tittle: Clinically Based Case Study-Dysphagia Name: Institution: Course: Lecturer/Professor: Date of submission: Introduction Differences in the abilities and skills of learners create a platform for the need to embrace diversity in learning programs that seek to address the unique needs of the learners. There is a dire need for learning programs to pay close attention to these diverse differences that make learning difficult and a challenge to many students (Honigsfeld* & Schiering, 2004). Nima aged 15 years presented with writing challenges particularly not being able to write letters legibly. Dysgraphia is a poorly understood learning disorder that causes multiple social and academic challenges for children. The complexity of handwritten language requires the several neurological systems working together in harmony. Dysgraphic students often present with several problems during the school going period as well as adulthood based on other people’s poor perception of their handwriting. Dysgraphia makes learning a great challenge due to the associated disabilities such as poor pencil grip thus impairing their learning (Virginia Wise Berninger & Wolf, 2009). Dysgraphia encompasses writing difficulties whereby one is unable to write clearly and accurately despite adequate teaching, motivation, physical and mental health. The condition affects twenty percent of children with a high prevalence in boys. Children with dysgraphia may also present with dyslexia amongst other medical conditions. The inability to express oneself in writing makes communication impossible due to the difficulty of putting his/her thoughts on paper hence frustration, depression and other reactive behaviors may set in due to poor coping mechanisms and the feeling of inadequacy (Bryant, Bryant, & Hammill, 2000; Graham & Weintraub, 1996; Miceli & Capasso, 2006). Nima manifested with illegible handwriting, amounting to a transcription disability that is often associated with learning difficulties, which may range from coordination disorder, attention deficit and speech impairment. In accordance with the Diagnostic and Statistical Manual of Mental Disorders DSM-IV, dysgraphia falls under learning disabilities. The causes of dysgraphia include challenges in information sequencing as well as organizing, processing visual information, understanding auditory information and orthographic coding (Chung & Patel, 2015; Crouch & Jakubecy, 2007). Nima’s needs included expressing her thoughts in writing and boosting her moral esteem. I designed an individualized learning program assist Nima address the learning difficulties through remedial and compensatory measures. The basis of the individualized learning program was the symptoms she presented with following her assessment. Literature Review Evidence of written language spans approximately 3500 years ago that marked the recording of the first phonetic alphabet. Handwriting is complex task involving cognitive, biophysical and psychomotor processes. Developing high-level proficiency in handwriting requires prolonged timeframes and practice subject to neurological differences. The skills necessary for handwriting include sound distinction (phonemic analysis), transcription rules (capitalization, grammar and spelling), and morphemic analysis (prefixes and suffixes) (Ravid, 2012; Treiman & Kessler, 2014). Development of functional writing occurs on reading, oral, and aural systems. The systems develop sequentially from aural language based on what infants hear followed by the oral language when the child utters sound and thirdly the visual system that establishes a relationship between aural and oral language (Virginia W. Berninger, 2008). The child then develops the reading language system and finally writing language whereby there is production of written language using the hand. All the first four systems of language are extremely essential for the development of written language and consequently paving way for written instructions. In order to start writing, children must develop midline crossing which is development of hand dominance during eating, using scissors and writing instruments (Ravid, 2012). Thus, development of the brain and specialization are very significant in dysgraphia. Research studies confirm lateralization of language processing in the brain’s left hemisphere hence dysgraphia is closely associated with poor development of this hemisphere prior to introducing handwriting. The right hemisphere is useful in learning written tasks as opposed to the left hemisphere (Smith, 2012). Introduction of handwriting to children before acquisition of readiness of the left hemisphere potentially leads to dysgraphia and dyslexia (Schlaggar & McCandliss, 2007). This is due to the absence of motor dominance of the left hemisphere that is essential in integration of the neurological processes essential for handwriting skills. There is a close association between dysgraphia and difficulties in integrating visual motor and visual perceptual functions, memory deficiencies, attention disorders, dyslexia, non-verbal learning disorders, Autism Spectrum disorders, and Sensory Integration/Processing Disorders (Chung & Patel, 2015; Ravid, 2012). Handwriting is a fine motor skill hence grossly affected in the presence other gross motor skills. Children with dysgraphia also present with additional learning disabilities and hence the condition has both educationally and medically. Writing instruction in within the education system focusses primarily on written work and secondary emphasis paid to legible handwriting, grammar, spelling and punctuation. Poor handwriting negatively influences the achievement of a student hence a handwriting difficulty amounts to a writing disability. Students in academic institutions write more often and students express most of their learning experiences through writing (Pense, 2009). Language and communication are very important for the academic success of any student since writing is the way students demonstrate learned knowledge. Similarly, the writing skill is very critical to one’s life due to its intimate linkage with basic literacy. The understanding of writing disabilities remains poor in comparison to reading disabilities. Dysgraphic students experience several academic difficulties namely fluency, legibility, though processes, memory, academic motivation and organization. The perception accorded to dysgraphic students revolves around lacking intelligence and most often, they have to redo their work. This perception is false since their failure to write legibly does not result from laziness but lack of development of automaticity of handwriting. Consequently, due to the constant mind pressure put on dysgraphics, their performance may be less impressive (Pense, 2009; Westwood, 2008). Dysgraphic students have capacity to write legibly but the process is very laborious and time-consuming causing fatigue. Functional writing for dysgraphics is very slow and may lack fluency. Dysgraphia results from malfunctioning of some neurological processes involved in the writing language system and students with the condition have poor organization due to the constant struggle with functional components essential for handwriting. Detection of dysgraphia may occur by the time the student joins second grade when they start writing paragraphs hence corrective measures may be initiated at this early stage (Virginia W. Berninger & Wolf, 2009). The fluency of one’s handwriting determines the proportion of available memory for the composing component of writing. In addition, the dysgraphic students experience delayed development of higher cognitive, composing and linguistic processes since much of their effort goes strengthening their handwriting skills. Consequently, the dysgraphic student under produces as compared to their peers concerning their verbal abilities (Torrance & Galbraith, 2006). The student is at risk of being labelled lazy and unmotivated by teachers, peers as well as parents. In addition to the physical pain suffered by dysgraphic students due to awkward pencil grips and postures assumed during writing, they also suffer emotional pain. Without adequate corrective measures and support structures, dysgraphia permanently affects the academic potential of a student and causes a lot of frustration (Virginia W. Berninger & Wolf, 2009). Methodology The purpose of case study was application of two techniques namely drill activities as well as fine motor activities, and establish their efficacy in helping improve Nima’s handwriting. This intervention lasted a total of eight weeks to completion. This qualitative study utilized a descriptive single subject design to ascertain the technique that worked best for Nima. Subject Nima is a 15-year-old female with intellectual disability suffering from full body muscle weakness. She is an only child and lives with her parents and a very happy student with a very quick sense of humour. She is very polite, loves to sing and dance although denies liking the activities. She goes to school by bus and is at the top of her class of ten pupils with a benchmark reading level of four (4) while her maths ability is at VELS standard of 1. She is very systematic and organizes herself and other students well. Nima has no observable behaviour issues and her class has low expectations requiring much repetition to cement the most basic concept. She has a slurry articulation and speaks in whispers, which is audible. She likes reading picture books in order to derive meaning and has an illegible handwriting with large letters that lack formation. Procedure Nima and I met every day for thirty minutes five days per week over a period of three weeks during the intervention phase when I was on placement. I conducted a pre-assessment and collected baseline data, which included extracts of her writing and descriptions of her letter formation. With my guidance, Nima was able to set a goal of writing me a letter by the end of the intervention period. The intervention started with exercises to strengthen the muscles of the arm, hand and wrist using a squeeze ball. This was followed by fine motor trials by working on her pencil grip with and without a fingertip, tracing feint lines, circles, waves, and the alphabet on premade work sheets. I gave Nima instructions to assist with her handwriting and conducted practice drills to help her usage of fine motor skills. Data Collection Every day I collected copies of Nima’s work and charted her progress in comparison to the pre-assessment data. I took anecdotal notes on her progress and recorded comments from her teacher regarding the changes in her handwriting. Following completion of the three weeks intervention phase, I made a post-assessment of Nima’s writing and changes recorded. Interventions Strategies for Dysgraphia Accommodation The intervention should involve reducing the impact of writing on learning experiences without necessarily adjusting the process. In the first place, the rate of work produced should be accommodated by allowing more time particularly for the written tasks such as writing notes and taking exams. The student should be allowed to start her exercises early on time so that she is able to complete. Moreover, the student’s schedule should be evaluated and more time created for purposes of catching up whenever the she is left behind. Typing and key boarding should be introduced in order to improve the speed as well as legibility of her work (Feder & Majnemer, 2007). Secondly, accommodation of the work volume involved can be realized through use of templates, which the student would use instead of writing the complete notes. Spelling and neatness should be given little concern little concern as a grading option. Thirdly, a model of written work should be made available to help reduce writing complexity. In addition, the student should be taught to write in stages namely brainstorming, writing a draft, editing and finally proof reading. The student should also learn how to use a spell checker and obtain assistance to have her work proofread (Crouch & Jakubecy, 2007). In addition, the student should be allowed to use a manuscript, which helps in accommodating tools used in production of written work. The student should be allowed to chose a favourite pen and writing material and also allowed to make a choice on her preferred line width. Keyboarding instructions are also made available for the student in order to support her learning process (Crouch & Jakubecy, 2007). Modification It is important to modify instructions for the student. Changing of the assignment expectations to meet Nima’s learning needs would prove very useful. Further modification of assignments is done through reduction of copying during assignments and tests. Secondly, the length requirements on written tests should be reduced and quality but not quantity emphasized. This served to help modify the degree of complexity during written assignments (Harwell & Jackson, 2014; Phipps-Craig, Waltz, & Seaside, 2006). Review of the writing projects should be done to enable the student play various roles namely brainstorming, information organization, illustrator, writer and proofreader. More guidelines and a structure for written assignments should be made available for the student. The format for the assignments should be modified through provision of alternatives for written assignments with subsequent evaluation of the student’s presentation of the tasks in an alternative format (Phipps-Craig et al., 2006). Remediation Various options that help in provision of instructions to the student for improvement of handwriting. Integration of handwriting instructions should be implemented into the student’s schedule and were very useful as a reference point for the student. The student also should learn alternative methods for handwriting for instance writing without Tears (Jublee, 2006; Phipps-Craig et al., 2006). Outcomes Nima’s overall handwriting skills drastically improved over the three weeks of intervention. Each day her classroom teacher noted small improvements in her writing skills particularly the formation of her letters and the decrease in the size of her letters. She was able to write clearly on the whiteboard, her math sheets were more legible and she herself was seeing the difference, which made her very happy with the results. She was able to hold the pencil better allowing her to write over longer periods. She started of leaving little notes (on A4 ruled paper) for her friends to find in their tubs and around the classroom for everyone to see. Discussion of findings and implications for future teaching In today’s society, having a neat and clear handwriting is of absolute importance especially on critical issues like signing legal documents, checks, and communicating ideas. Despite the fact that technology helps to undertake some of these functions, total reliance on it is not a guarantee in addition to a technology gap whereby several homes and offices lack computers. Moreover, computers may be lacking in some of the circumstances that would otherwise require their use (Poobrasert & Gestubtim, 2015). Similarly, it is impractical for children learning formulation of thoughts to transfer the same thoughts to a word program before learning the prerequisite writing skills. The findings of this study confirm fine motor activities coupled with practice drills significantly ameliorate dysgraphia. Drastic improvement was recorded during the three weeks period following the implementation of interventions on Nima. Undoubtedly, Nima’s writing skills improved following her gained ability to use fine motor skills although she still had some weaknesses in fitting her writing onto a smaller piece of paper than what she is used to. Limitations and potential impact to practice This study only analyzed findings from one subject hence very difficult to generalize its outcomes. Nevertheless, the study provides a benchmark for learning about dysgraphic students and possible models for intervention by teachers. This information is valuable in guiding handwriting remediation for children with handwriting difficulties regardless of whether they have a writing disability or not. All instruction programs for effective writing should focus on equipping learners with skills in automating their handwriting. Limitations on the short duration of time made it impossible to address all the areas of effective handwriting evidence by the outcomes of this research whereby Nima was unable to address the envelope with fitting letters due to the small size of the envelope. In future studies, extension of such programs should be considered and a further integration of classroom teaching in order to address all the needs of the leaner. Conclusion This case study sought to establish the needs of Nima who suffers from dysgraphia and device appropriate interventions based on available scientific data to assist her cope with learning experiences. There is no doubt that with appropriate interventions, victims of dysgraphia improved markedly and have potential to live much normal lives using the learned skills. Children with dysgraphia require academic skills, basic life skills and social emotional skills in order to live quality lives. Dysgraphia is also associated with other conditions such as dyslexia and the children present with writing difficulties as well as spelling problems. A comprehensive assessment of the child’s handwriting as well as related skills is paramount in planning specialized interventions and improves the learning outcomes for the child. Interventions for the children are multidisciplinary involving teachers, caregivers, student colleagues and health experts. The interventions selected for Nima relied on the pre-assessment data collected and various evidence-based approaches designed through previous studies. Based on this study, learning fine motor movements and practice drills are very useful in correcting dysgraphia. This information is very vital for all teachers in elementary school who undoubtedly may be unaware of dysgraphia as a learning disability or may lack appropriate strategies to intervene the problem. This study has enriched my practice particularly my approach in dealing with dysgraphic students and other associated neurological challenges by preparing me based on scientific data. References Berninger, V. W. (2008). Written language instruction during early and middle childhood. Evidence-Based Interventions for Students with Learning and Behavioral Challenges, 215–235. Berninger, V. W., & Wolf, B. (2009). Helping Students with Dyslexia and Dysgraphia Make Connections: Differentiated Instruction Lesson Plans in Reading and Writing. ERIC. Retrieved from http://eric.ed.gov/?id=ED507538 Berninger, V. W., & Wolf, B. J. (2009). Teaching students with dyslexia and dysgraphia: Lessons from teaching and science. Paul H Brookes Pub Co. Bryant, D. P., Bryant, B. R., & Hammill, D. D. (2000). Characteristic behaviors of students with LD who have teacher-identified math weaknesses. Journal of Learning Disabilities, 33(2), 168–177. Chung, P., & Patel, D. R. (2015). Dysgraphia. International Journal of Child and Adolescent Health, 8(1), 27. Crouch, A. L., & Jakubecy, J. J. (2007). Dysgraphia: How It Affects a Student’s Performance and What Can Be Done about It. TEACHING Exceptional Children Plus, 3(3), n3. Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 49(4), 312–317. Graham, S., & Weintraub, N. (1996). A review of handwriting research: Progress and prospects from 1980 to 1994. Educational Psychology Review, 8(1), 7–87. Harwell, J. M., & Jackson, R. W. (2014). The complete learning disabilities handbook: Ready-to-use strategies and activities for teaching students with learning disabilities. John Wiley & Sons. Honigsfeld*, A., & Schiering, M. (2004). Diverse approaches to the diversity of learning styles in teacher education. Educational Psychology, 24(4), 487–507. Jublee, F. (2006). E-Dyslexic: an Interactive Learning System using Multisensory Approach. University of Malaya. Retrieved from http://repository.um.edu.my/62/ Learning disorders - children, causes, DSM, functioning, adults, withdrawal, person, people. (n.d.). Retrieved December 19, 2015, from http://www.minddisorders.com/Kau-Nu/Learning-disorders.html Miceli, G., & Capasso, R. (2006). Spelling and dysgraphia. Cognitive Neuropsychology, 23(1), 110–134. Pense, S. L. (2009). Curricular Needs of Students with Specific Learning Disabilities in Illinois Secondary Agricultural Education Programs. Journal of Agricultural Education, 50(2), 89–101. Phipps-Craig, D., Waltz, S., & Seaside, C. A. (2006). Early and Appropriate Remediation and Accommodation for Dysgraphic Students. Retrieved from http://capstone.csumb.edu/world/2006/phipps-craig_denise.pdf Poobrasert, O., & Gestubtim, W. (2015). WHEN WRITE IS (NOT) WRONG: ASSISTIVE TECHNOLOGY TOOLS FOR DYSGRAPHIA. Retrieved from http://www.ijcea.com/wp-content/uploads/2015/07/13-Onintra-Poobrasert.pdf Ravid, D. D. (2012). The Psycholinguistics of Spelling: Phonology and Beyond. In Spelling Morphology (pp. 21–39). Springer. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4419-0588-8_2 Schlaggar, B. L., & McCandliss, B. D. (2007). Development of neural systems for reading. Annu. Rev. Neurosci., 30, 475–503. Smith, F. (2012). Understanding reading: A psycholinguistic analysis of reading and learning to read. Routledge. Retrieved from https://books.google.com/books?hl=en&lr=&id=Qd7FBQAAQBAJ&oi=fnd&pg=PT7&dq=The+right+hemisphere+is+useful+in+learning+written+tasks+as+opposed+to+the+left+hemisphere&ots=ycyHsXQDW3&sig=FJjqzzCSv5SC6y8qAVF3h15qn5E Torrance, M., & Galbraith, D. (2006). The processing demands of writing. Handbook of Writing Research, 67–80. Treiman, R., & Kessler, B. (2014). How Children Learn to Write Words. Oxford University Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=uG-VAwAAQBAJ&oi=fnd&pg=PP1&ots=8NSLB1Zw1m&sig=eEh1d3W_vUjKEdFpsPDaqduj0yo Westwood, P. S. (2008). What teachers need to know about reading and writing difficulties. Aust Council for Ed Research. Retrieved from https://books.google.com/books?hl=en&lr=&id=WNXVFda4t0AC&oi=fnd&pg=PR5&dq=Dysgraphic+students+experience+several+academic+difficulties+namely+fluency,+legibility,+though+processes,+memory,+academic+motivation+and+organization&ots=_P4gnDD61l&sig=eKsCvqN-_gc3mZqfjui2iLB-LG4  Appendices a) consent forms (parent/carer, principal, teacher) b) data/observation sheets c) interview data / checklists completed by teachers / parents / etc d) assessments you administered to determine the student’s level of functioning e) notes from meetings Read More

Literature Review

Evidence of written language spans approximately 3500 years ago that marked the recording of the first phonetic alphabet. Handwriting is a complex task involving cognitive, biophysical and psychomotor processes. Developing high-level proficiency in handwriting requires prolonged timeframes and practice subject to neurological differences. The skills necessary for handwriting include sound distinction (phonemic analysis), transcription rules (capitalization, grammar and spelling), and morphemic analysis (prefixes and suffixes) (Ravid, 2012; Treiman & Kessler, 2014).

Development of functional writing occurs on reading, oral, and aural systems. The systems develop sequentially from aural language based on what infants hear followed by the oral language when the child utters sound and thirdly the visual system that establishes a relationship between aural and oral language (Virginia W. Berninger, 2008).

The child then develops the reading language system and finally writing language whereby there is the production of written language using the hand. All the first four systems of language are extremely essential for the development of written language and consequently paving way for written instructions. In order to start writing, children must develop midline crossing which is the development of hand dominance during eating, using scissors and writing instruments (Ravid, 2012).

Thus, the development of the brain and specialization are very significant in dysgraphia. Research studies confirm lateralization of language processing in the brain’s left hemisphere hence dysgraphia is closely associated with poor development of this hemisphere prior to introducing handwriting. The right hemisphere is useful in learning written tasks as opposed to the left hemisphere (Smith, 2012).

Introduction of handwriting to children before acquisition of readiness of the left hemisphere potentially leads to dysgraphia and dyslexia (Schlaggar & McCandliss, 2007). This is due to the absence of motor dominance of the left hemisphere that is essential in the integration of the neurological processes essential for handwriting skills. There is a close association between dysgraphia and difficulties in integrating visual motor and visual perceptual functions, memory deficiencies, attention disorders, dyslexia, non-verbal learning disorders, Autism Spectrum disorders, and Sensory Integration/Processing Disorders (Chung & Patel, 2015; Ravid, 2012).

Handwriting is a fine motor skill hence grossly affected in the presence of other gross motor skills. Children with dysgraphia also present with additional learning disabilities and hence the condition has both educationally and medically. Writing instruction is within the education system focuses primarily on written work and secondary emphasis paid to legible handwriting, grammar, spelling and punctuation. Poor handwriting negatively influences the achievement of a student hence a handwriting difficulty amounts to a writing disability. Students in academic institutions write more often and students express most of their learning experiences through writing (Pense, 2009).

Language and communication are very important for the academic success of any student since writing is the way students demonstrate learned knowledge. Similarly, the writing skill is very critical to one’s life due to its intimate linkage with basic literacy. The understanding of writing disabilities remains poor in comparison to reading disabilities.

Dysgraphic students experience several academic difficulties namely fluency, legibility, thought processes, memory, academic motivation and organization. The perception accorded to dysgraphic students revolves around lacking intelligence and most often, they have to redo their work. This perception is false since their failure to write legibly does not result from laziness but lack of development of automaticity of handwriting. Consequently, due to the constant mental pressure put on dysgraphic, their performance may be less impressive (Pense, 2009; Westwood, 2008).

Read More