Sadie: A Case Study of Mixed Dysgraphia

Children spend nearly 60% of their school day engaged in written expression or some type of fine-motor activity (Feder & Majnemer, 2007). Whether students are taking notes, writing a story, responding to math problems, or simply jotting down their homework assignment for that evening, writing skills are critical to school success. However, approximately 7-15% of school-aged children exhibit some kind of developmental writing deficit (Dohla and Heim, 2016).

The following case shows how one student was given the Feifer Assessment of Writing (FAW) to get to the root of her writing issues—and how her school was able to use this test data to help provide the support needed to help them succeed.

The concern

Sadie is a 9-year-old student who is about to complete 4th grade at an elementary school in Massachusetts. She was referred to her school’s intervention team for a diagnostic educational assessment after continued concerns regarding her lagging academic progress in language arts and mathematics.

Background from teachers

Sadie has an individualized education plan (IEP) in place where she receives 1½ hours per week of special education services for learning disabilities as well as 1 hour per week of speech and language therapy services and consultative occupational therapy services.

According to her special education teacher, Sadie showed difficulty with her oral reading skills. In math, Sadie was working significantly below grade level and had difficulty with word problems. Particularly concerning, though, was her overall written expression, as she struggled with her spelling and grammar skills when writing, tended to write in short phrases rather than complete sentences, and did not always separate her ideas into paragraphs.

Her classroom teacher mentioned that Sadie seemed to lack confidence when writing and had a hard time getting started on assignments. He noted that Sadie experienced some anxiety when working on extended writing assignments.

Test results

Sadie was given the FAW as part of her evaluation. Her FAW Total Index score was in the moderately below average range and showed significant weaknesses with both the motoric demands and the cognitive–linguistic demands of the written language process. The school psychologist looked further into her scores to see what other information would be helpful when creating interventions.

• Sadie’s Graphomotor Index score was in the moderately below average range. Lower scores on the Graphomotor Index often suggest difficulty with the physical act of penmanship. Sadie was left-handed and used an awkward four-finger pencil grasp when writing. She often rotated her paper nearly 90 degrees vertically when she was writing in a horizontal format. Sadie’s overall motor output speed was somewhat slower paced, and it seemed as though she tended to sacrifice speed for accuracy in many writing tasks. Additionally, Sadie’s letters were not always the appropriate size for the allotted space. Her teacher noted that she held her pencil with a very tense and pressured grip and would shake her hand after completing a writing task.
• Sadie’s overall Dyslexic Index score was in the moderately below average range. Lower scores on the Dyslexic Index suggest significant difficulty with spelling skills, which often reflects the impact of a reading disability on the written language process. In fact, Sadie was previously diagnosed with a language-based learning disability due to deficits with reading and oral expression. On the FAW, Sadie demonstrated very poor general spelling skills but performed better when asked to recognize the correct spelling of a word from four choices.
• On the Executive Index, Sadie scored in the below average range. Lower scores on the Executive Index suggest weaknesses with a wide range of written language skills including planning, organizing, retrieving, and/or sequencing thoughts and ideas to produce a written response. Sadie was able to retrieve and self-organize language prior to crafting a written response. However, Sadie showed difficulty when asked to write a paragraph. In her writing sample, there were many spelling and grammatical errors, a simple sentence structure, and several run-on sentences. Before beginning to write, Sadie required an excessive amount of time to begin working and ultimately ran out of time.
• On the Compositional Writing Index, Sadie scored in the below average range, suggesting difficulty with foundational written language skills and an inability to grammatically self-check her own work. Sadie was able to self-correct a variety of spelling and grammatical miscues in sentences, however she merely identified sentences that did not capitalize the first word or include an ending punctuation mark. She was not able to identify other grammatical or spelling concerns. Sadie performed well when asked to construct a story from specific story elements that were provided to her but had trouble writing passages when she was responsible for self-generating, organizing, and structuring her own work. This implies that she may be having difficulties with the working memory demands of the writing process.
  

Recommendations and interventions

Sadie’s scores were consistent with an individual with a learning disability in written language, specifically someone who struggles with both the motoric and cognitive linguistic demands of the writing process.

Sadie’s IEP team reviewed her FAW scores and determined that she demonstrated global difficulty with most fine motor tasks. They recommended further assessment by an occupational therapist to examine fine motor coordination and dexterity.

It was noted that Sadie’s previous diagnosis of a language-based learning disability was hindering her spelling skills. Her spelling miscues suggested mixed dysgraphia, which is a severe type of spelling disability. Generally, examinees with mixed dysgraphia have difficulty across the entire language spectrum and are characterized by a combination of poor phonological processing skills, poor orthographic skills, limited working memory, and somewhat unusual error patterns in their spelling.

Finally, the team noted Sadie’s working memory deficits, which seemed to be exacerbated by her anxiety. This hindered her ability to generate writing and monitor her work in a timely fashion. They noted that Sadie worked best when the story elements were already provided, mitigating the working memory demands of the writing process, and determined she was able to self-monitor her work more accurately when looking for just one attribute at a time.

The team decided to implement some new prewriting techniques, including a proofreading strategy and the introduction of graphic organizers and a word bank to help take the pressure off the organizational demands inherent in the writing process.

The school was also able to provide a “smart” pen that would help Sadie by recording lecture information and transcribing those notes onto Sadie’s computer.

The outcome

Sadie began fifth grade with her new smart pen. It has allowed her to organize her notes better. Her classroom teacher said she is doing well with word problems in math. She also noted that Sadie does not seem to be stressed or anxious during writing assignments and is spending less time getting started. While further improvement is needed, Sadie is spending time during her special ed block each week to learn more techniques to help proofread her work and organize her thoughts.

After further assessment by the school’s occupational therapist, Sadie is spending more time each week focusing on better pencil grasp and fine motor dexterity.

Sadie will be reassessed with select subtests of the FAW later this year to monitor her progress.

Could the FAW help your struggling writers? Learn more.

References

Dohla, D., & Heim, S. (2016). Developmental dyslexia and dysgraphia: What can we learn from the one about the other? Frontiers in Psychology, 6, article 2045. https://doi.org/10.3389/fpsyg.2015.02045

Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 49, 312–317. http://doi.org/fc2sbc