What is dysgraphia? | 什麼是書寫障礙(Dysgraphia)？

I would like to tell you something about dysgraphia, a difficulty that hindered me for years. Many people do not have a good understanding of dysgraphia.  Here is my overview based on both research and my personal journey.

Dysgraphia is a learning disability that is also known as a specific learning disorder (difficulties with written expression) in the Diagnostic and Statistical Manual of Mental Disorders.  Basically, dysgraphia means that children have difficulties in writing.  Dysgraphia is often confused with dyslexia, which means reading difficulties.  In an early definition, dyslexia was considered to represent both reading and the writing difficulties.  However, writing difficulties by themselves were separated from reading difficulties in the late 80’s due to the discovery of their unique features.  The prevalence of dysgraphia has been estimated to vary between 5% to 33%; this wide range of variance is due to a lack of standardized assessment methods for tapping dysgraphia.

There are two main types of dysgraphia.  These are dysgraphia with handwriting difficulties and dysgraphia with spelling difficulties.  They can be co-occurring or stand-alone problems.   Dysgraphia with handwriting difficulties is characterized by poor motor control and poor perception of space.  Children with this type of dysgraphia will easily feel tired when writing. They write very slowly with poor legibility.  In addition to their writing problem, others often perceive these children as clumsy.

Children with dysgraphia with spelling difficulties usually have problems in recalling how to spell the words.  However, recent research has shown that there might be possibilities that they are either better at recalling Chinese or English, instead of performing poorly on both scripts.  Psychologists believe that we have two separate mechanisms when spelling and reading words, the lexical route and the  non-lexical route , which can be considered to represent more the direct visual matching route and the phonetic transcribing route (Jobard, Crivello, & Tzourio-Mazoyer, 2003 ; Tainturier & Rapp, 2001).  Japanese agraphia patients show difficulties in writing either Kana or Kanji, which correspond to the lexical route or the non-lexical route (Furumoto, 2001; Sakurai, Matsumura, Iwatsubo, & Momose, 1997).  Chinese students with writing difficulties perform poorly on Chinese character dictation, but they have high accuracy in using pinyin, a phonetic transcription system of Chinese (Li, 2004).  These research findings lead to a theory that dysgraphia in Chinese is separate from dysgraphia in alphabetical language (Tin, Chia, & Wong, 2008).  Children with spelling dysgraphia may have impairments in only one of the processing routes rather than both. That is to say, they either have difficulties in visualizing the words, or they have difficulties with phonetic spelling.  English is an alphabetic orthography, so recalling an English word usually demands more in terms of phoneme grapheme conversion. In contrast, Chinese places a larger demand on retrieving the features and the structure of words.  Therefore, children with impairment in the non-lexical route usually have greater difficulties with English and perform better with Chinese, and vice versa.  For my case, I am better at spelling English regular words than in writing Chinese words.

If children show the symptoms mentioned above, parents should seek help from professionals to provide suitable assistance for children.  Meanwhile, parents can support their children by providing adaptations and some simple practice.  Note that adaptation, instead of training, should always have the priority, so that children’s development in other aspects can be less severely affected (O’Hare & Brown, 1989).  For example, parents can request teachers to use oral presentations or computer tasks to replace traditional written assessments.  That could be a possible measure to alleviate the adverse effect of dysgraphia on other aspects of education (Lie, O’Hare, & Denwood, 2000).  For practice, handwriting training, such as letter formation practice and composition writing, are elpful in improving handwriting legibility, but do not have a significant effect on writing speed (Howe, Roston, Sheu, & Hinojosa, 2013).  Teaching children phonetics spelling rules is also helpful for children with dysgraphia (Kohnen, Nickels, & Coltheart, 2010).

Reference

Furumoto, H. (2001). 漢字書字と仮名書字の差異. 失語症研究, 21(2), 142-151.

Li, Y.T. (2004). Writing characteristics of Taiwanese students with handwriting difficulties. Journal of Taiwan

normal university: education, 49(2), 43-64.

Howe, T. H., Roston, K. L., Sheu, C. F., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: A two-group controlled study. American Journal of Occupational Therapy, 67(1), 19-26.

Jobard, G., Crivello, F., & Tzourio-Mazoyer, N. (2003). Evaluation of the dual route theory of reading: a metanalysis of 35 neuroimaging studies. Neuroimage,20(2), 693-712.

Kohnen, S., Nickels, L., & Coltheart, M. (2010). Training ‘rule‐of‐〈 E〉’: further investigation of a previously successful intervention for a spelling rule in developmental mixed dysgraphia. Journal of Research in Reading, 33(4), 392-413.

Lie, K. G., O’Hare, A., & Denwood, S. (2000). Research Section: Multidisciplinary Support and the Management of Children with Specific Writing Difficulties. British Journal of Special Education, 27(2), 93-99.

O’Hare, A. E., & Brown, J. K. (1989). Childhood dysgraphia. Part 1. An illustrated clinical classification. Child: care, health and development, 15(2), 79-104.

Sakurai, Y., Matsumura, K., Iwatsubo, T., & Momose, T. (1997). Frontal pure agraphia for kanji or kana: dissociation between morphology and phonology.Neurology, 49(4), 946-952.

Tainturier, M. J., & Rapp, B. (2001). The spelling process. The handbook of cognitive neuropsychology: What deficits reveal about the human mind, 263-289.

Tin, Y. Y., Chia, N., & Wong, M. E. (2008). Understanding dyslographia (Chinese dysgraphia) and what is known about the disorder. Journal of the American Academy of Special Education Professionals (JAASEP), Summer 2008, 93

_____________________________________________________________________________________

This article was written by our guest blogger Mr. CHEUNG, Hong Kei Edmond.  Mr. Cheung is currently a research assistant in the Life Span Development Laboratory of The Chinese University of Hong Kong.

Mr. CHEUNG, Hong Kei Edmond.

BSsc. (CUHK)

Research assistant 

Life Span Development Laboratory

Department of Psychology, The Chinese University of Hong Kong

Email: cheunghongkei@link.cuhk.edu.hk

---

書寫障礙是一學習障礙，在美國精神醫學學會出版的精神疾病診斷與統計手冊中被列為特殊學習障礙中的書寫表逹困難。簡單來說，就是指寫作有困難的孩子。不少人經常把書寫障礙與閱讀障礙混淆，而閱讀障礙又被翻譯為讀寫障礙，更為人添上不少誤解。原來在初期的研究，讀與寫的而且確是被視作同一學習障礙，所以以前把“dyslexia”一字翻譯為讀寫障礙確是非常準確。可是，由於後來研究發現閱讀障礙與書寫障礙實在是有很大的差異，所以早於八十年代後期，學術界便將兩者分開處理，分別稱為閱讀障礙(dyslexia)和書寫障礙(Dysgraphia)。學術界估計書寫障礙的普及程度大約是5%至33%，當中的差異是因為各地學者並沒有對評定書寫障礙有著很高程度的共識。

書寫障礙主要分為兩大類，手寫問題以及默寫問題。孩子可能只有其中一樣問題，亦有可能同時被兩個問題困擾。手寫問題的主要成因是肌肉控制協調能力的問題以及對空間感知的誤差。被手寫問題困擾的孩子在書寫的時候很容易感到疲累，他們的書寫速度很慢，而且字體往往也很不公整。他們除了書寫問體外，多數也會在日常生活中顯得比較笨拙。

書寫障礙中的默寫問題又被稱為聽寫障礙，被這種問題困擾的孩子經常不能回想起字詞的寫法或串法。可幸的是近年的研究顯示他們或許能在中文或英文的表現會比較好，而不會同時地在兩種語言中也表現得很差。心理學家普遍認為人有著兩個系統處理文字，分別為詞彙通路(lexical route)與非詞彙通路(non-lexical route)，詞彙通路是直接把字詞配對視覺記憶的系統，而非詞彙通路則是拼音系統 (Tainturier & Rapp, 2001; Jobard, Crivello, & Tzourio-Mazoyer, 2003)。在日本的失寫症患者往往只在二者其一有著困難，因詞彙通路受損而無法默寫漢字或因非詞彙通路而無法拼寫假名 (Sakurai, Matsumura, Iwatsubo, & Momose, 1997; Furumoto, 2001)。在台灣的有著聽寫障礙的孩子即使有著默寫中文的困難，可是也同時有著良好的拼音能力，能以台灣注音拼出所需字詞(Li, 2004)。因此，近年有研究人員指出中文聽寫障礙與出現與字母文字的聽寫障礙為兩種獨立相異的問題(Tin, Chia, & Wong, 2008)。受聽寫障礙影響的孩子很大機會是腦袋提取字詞記憶的詞彙通路或非詞彙通路其中之一出現了問題，以致不能記起字詞的樣子或是不會拼字。由於英語是表音文字，所以很著重拼字；而中文是語素文字，所以很著重字詞的形狀結構。所以要是孩子只是在拼字方面有問題，他會在英語出現較大的問題，而在中文的表現則比較好，反之亦然。以本人為例，本人在拼寫英語常規字詞的時候並沒有大問題，可是於中文默寫方面卻有著顯著困難。

假如你發現孩子出現上述的情況，應該馬上尋求專業的協助。與此同時，家長可以為孩子提供適應的措施以及少量簡單的練習。而且一切應以適應措施為先，書寫訓練為次，為求孩子其餘方面發展盡量不受影響(O’Hare & Brown, 1989)。比如說，家長能要求老師把書寫課業改為口述報告或電腦作業，從而減少書寫障礙賽對孩子正常學習的影響(Lie, O’Hare, & Denwood, 2000)。至於練習方面，研究顯示書寫訓練能提高字體工整程度，可是於書寫速度並無幫助(Howe, Roston, Sheu, & Hinojosa,2013)。另一方面，教授孩子拼音法為聽寫障礙孩子於英語拼寫有明顯幫助(Kohnen, Nickels, & Coltheart, 2010)。

在協助這類孩子的時候，老師或家長可以把測驗功課改以口頭匯報或電腦作業模式進行，盡量減少書寫對孩子正常學習的影響。

Reference:

Furumoto, H. (2001). 漢字書字と仮名書字の差異. 失語症研究, 21(2), 142-151.

Li, Y.T. (2004). Writing characteristics of Taiwanese students with handwriting difficulties. Journal of Taiwan normal university: education, 49(2), 43-64.

Howe, T. H., Roston, K. L., Sheu, C. F., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: A two-group controlled study. American Journal of Occupational Therapy, 67(1), 19-26.

Jobard, G., Crivello, F., & Tzourio-Mazoyer, N. (2003). Evaluation of the dual route theory of reading: a metanalysis of 35 neuroimaging studies. Neuroimage,20(2), 693-712.

Kohnen, S., Nickels, L., & Coltheart, M. (2010). Training ‘rule‐of‐〈 E〉’: further investigation of a previously successful intervention for a spelling rule in developmental mixed dysgraphia. Journal of Research in Reading, 33(4), 392-413.

Lie, K. G., O’Hare, A., & Denwood, S. (2000). Research Section: Multidisciplinary Support and the Management of Children with Specific Writing Difficulties. British Journal of Special Education, 27(2), 93-99.

O’Hare, A. E., & Brown, J. K. (1989). Childhood dysgraphia. Part 1. An illustrated clinical classification. Child: care, health and development, 15(2), 79-104.

Sakurai, Y., Matsumura, K., Iwatsubo, T., & Momose, T. (1997). Frontal pure agraphia for kanji or kana: dissociation between morphology and phonology.Neurology, 49(4), 946-952.

Tainturier, M. J., & Rapp, B. (2001). The spelling process. The handbook of cognitive neuropsychology: What deficits reveal about the human mind, 263-289.

Tin, Y. Y., Chia, N., & Wong, M. E. (2008). Understanding dyslographia (Chinese dysgraphia) and what is known about the disorder. Journal of the American Academy of Special Education Professionals (JAASEP), Summer 2008, 93

______________________________________________________________________________________

此文章由我們的客席博客張康祺先生撰寫。張先生現為香港中文大學心理學系的研究助理。

張康祺先生

BSsc.(香港中文大學)

研究助理 香港中文大學心理學系 生命全期發展實驗室

電郵: cheunghongkei@link.cuhk.edu.hk