Disorder of written expression, formerly called developmental expressive writing disorder, is a learning disability in which a person's ability to communicate in writing is substantially below the level normally expected based on the individual's age, intelligence, life experiences, educational background, or physical impairments. This disability affects both the physical reproduction of letters and words and the organization of thoughts and ideas in written compositions.
Description
Disorder of written expression is one of the more poorly understood learning disabilities. Learning disabilities that manifest themselves only in written work were first described in the late 1960s. These early studies described three main types of written disorders:
inability to form letters and numbers correctly, also called dysgraphia
inability to write words spontaneously or from dictation
inability to organize words into meaningful thoughts
There are several difficulties in studying disorder of written expression and in implementing a remedial program. Disorder of written expression usually appears in conjunction with other reading or language disabilities, making it hard to separate manifestations of the disability related only to written expression. Delays in attention, visual-motor integration, visual processing, and expressive language may also contribute to writing disorders. Also, there are no standard tests specifically designed to evaluate disorder of written expression.
Causes
The causes of disorder of written expression are unknown. Different manifestations of the disorder may have different causes. For example, people who cannot form letters correctly on the page (dysgraphia) may have delays in hand-eye coordination and difficulties concentrating. People who are unable to write words from memory or dictation appear to have deficits in their visual memory. They cannot remember what the words look like. People who produce legible script but cannot organize their thoughts on paper may be suffering from cognitive processing problems. Because disorder of written expression is a little-studied disorder, specific causes have not yet been determined.
paragraphs and stories that are missing elements and that do not make sense or lack logical transitions
deficient writing skills that significantly impact academic achievement or daily life.
These symptoms must be evaluated in light of the person's age, intelligence, educational experience, and cultural or life experience. Written expression must be substantially below the level of samples produced by others of the same age, intelligence, and background. Normally, several of the symptoms are present simultaneously.
Demographics
Several studies have estimated that between 3% and 5% of students have disorder of written expression. However, it is difficult to separate this disorder from other learning disorders. Deficits in written work may be attributed to a reading, language, or attention disorders, limited educational background, or lack of fluency in the language of instruction. Disorder of written expression unassociated with any other learning disability is rare.
Diagnosis
There are no specific tests to diagnose disorder of written expression. This disorder is not normally diagnosed before age eight because of the variability with which children acquire writing skills. It is most commonly diagnosed in the fourth or fifth grade. Requests for testing usually originate with a teacher or parent who notes multiple symptoms of the disorder in a child's writing.
Several standardized tests accurately reflect spelling abilities, but do not assess other writing skills with the same reliability. Tests that might be helpful in diagnosing disorder of written expression include the Diagnostic Evaluation of Writing Skills (DEWS), the Test of Early Written Language (TEWL) and the Test of Adolescent Language. However, assessment using standardized tests is not enough to make a diagnosisof disorder of written expression. In addition, a qualified evaluator should compare multiple samples of the student's written work with the written work normally expected from students of comparable backgrounds. The person being evaluated may also be asked to perform tasks such as writing from dictation or copying written material as part of diagnostic testing. The American Psychiatric Association places disorder of written expression in the miscellaneous category of learning disorders not otherwise specified. It is likely to remain a poorly understood and diagnosed disability until more research findings are available.
Treatments
Little is known about how to treat disorder of written expression. Intense writing remediation may help, but no specific method or approach to remediation has proved particularly successful. Since disorder of written expression usually occurs in conjunction with other learning disabilities, treatment is often directed at those better-understood learning problems.
Prognosis
Little is known about the long-term outcome for people with disorder of written expression. However, it appears that those who have this disorder may develop low self-esteem and social problems related to their lack of academic achievement. Later in life they may be more likely to drop out of school and find employment opportunities that require writing skills closed to them.
Prevention
There are no known ways to prevent disorder of written expression.
American Psychiatric Association Diagnostic and StatisticalManual of Mental Disorders.4th ed. text revised. Washington DC: American Psychiatric Association, 2000.
Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry.7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.
ORGANIZATIONS
American Academy of Child and Adolescent Psychiatry. P. O. Box 96106, Washington, D.C. 20090. (800) 333-7636. <www.aacap.org>.
Learning Disabilities Association of America. 4156 Library Road Pittsburgh, PA 15234-1349. Telephone: (412) 341-1515. Web site: <www.ldanatl.org>.
National Center for Learning Disabilities, 381 Park Avenue South, Suite 1401, New York, NY 10016. (888) 575-7373 (toll free) or 212-545-7510. <www.ncld.org>.
