99 Disorder of Written Expression (315.2)

DSM-IV-TR criteria

• A. Writing skills, as measured by individually administered standardized tests (or functional assessments of writing skills), are substantially below those expected given the person’s chronological age, measured intelligence, and age-appropriate education.
• B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g., writing grammatically correct sentences and organized paragraphs).
• C. If a sensory deficit is present, the difficulties in writing skills are in excess of those usually associated with it.
• Coding note: If a general medical (e.g., neurological) condition or sensory deficit is present, code the condition on Axis III.

Associated features

• This disorder was previously called developmental expressive writing disorder. This disabilitiy affects both the physical reproduction of letters and the organization of thoughts and ideas in written compositions. Disorder of written expression is one of the more poorly understood learning disorders. Learning disabilities that only manifested themselves in written work were first described in the late 1960’s. These early studies described three types of written disorders: 1.) Inability to form letters and numbers correctly, also called dysgraphia 2.) inability to form words spontaneously or form dictation 3.) inability to organize words into meaningful thoughts.
• There are several in studying disorder of written expression and in implementing a remedial program. Disorder of written expression usually appears in conjunction with other reading and learning disorders, making it difficult to seperate manifestations of the disability related to only to written expression. Delays are noted in attention, visual-motor integration, visual processing, and expressive language.
• Children with Disorder of Written Expression experience great difficulty with the use of their writing skills. The writing skills of these students are significantly lower than their peers according to a typical child’s age, acumen, and schooling. Writing complete sentences and forming adequate paragraphs are challenges for those with disorder of written expression. Also, the individuals with the disorder tend to make excessive errors and appear to have poor understanding in the areas of punctuation, grammar, and spelling. Some common symptoms of people with disorder of written expression include: poor or illegible handwriting, poorly formed letters or numbers, excessive spelling errors, excessive punctuation errors, excessive grammar errors, sentences that lack logical cohesion, paragraphs and stories that are missing elements and that do not make sense or lack logical conclusions, and dificient writing skills that significantly impact academic achievement or daily life.
• Disorder of written expression is almost always associated with other learning disorders like a reading or mathematics disorder, and it is frequently accompanied by low self-esteem, social problems, increased rates of school dropout, conduct disorder, attention deficit disorder, and possibly depression. Often times, people assume because a person is diagnosed with a learning disability, such as disorder of written expression, the individual must also have lower intelligence. However, people diagnosed with disorder of written expression often have average or above average intelligence.

Child vs. adult presentation

Typically, an individual is diagnosed with disorder of written expression around the age of eight, which is usually around the time that children begin to read and write. Due to the fact that a child’s motor skills are still developing, the diagnosis is not usually made prior to age eight. Parents tend to recognize signs and symptoms of disorder of written expression in their children around grades four and five when writing skills become a big part in the classroom exercises. Ddsorder of written expression has no cure. Therefore, while the disorder is typically diagnosed in young children, it continues to be present throughout adulthood as well.

Gender and cultural differences in presentation

Most researchers say males are more commonly diagnosed with the disorder of written expression than females. In these cases, studies pertaining with learning disabilities, no significant gender difference has been found. On the other hand, general or special education teachers identify twice as many males than females. For the purpose of identifying cultural differences, a random sample of the population is tested, as well as the individualized testing that is performed to diagnose the disorder. Equally vital, is the inclusion of a similar socioeconomic and educational status for the participants that are being researched.

Epidemiology

• Three to ten percent of school aged children in the United States are estimated to have disorder of written expression. Fifteen percent of the United States population are said to have a type of Learning Disability. When it is not comorbid with other learning disorders, a solitary experience with the disorder of written expression is extremely rare.
• Deficits in written work may be attributed to a reading, language, or attention disorder, limited educational background, or lack of fluency in the language of the institution.

Etiology

• The cause of disorder of written expression is unknown because of lack of research surrounding the disorder. Certain facts support the idea that biological and environmental factors can contribute to learning disorders. Research has shown that high levels of testosterone in the fetus may cause language delays. Which could contribute to the idea that disorder of written expression is more prevalent in boys. Also, the particular conditions to which the fetus is exposed to while in utero may be linked to learning disorders, but not just specifically disorder of written expression. Environmental factors can also cause learning disorders, however, there is no certain cause of disorder of written expression.
• There are different factors that could contribute to written expression disorder. Some of these factors include: prenatal, environmental, and intrinsic factors. Prenatal factors refer to potential toxins, infections, and/or nutritional deficits to a fetus. Intrinsic factors refers to neurobiology, biochemical, genetic, and other medical conditions.

Empirically supported treatments

• There are no standard tests specifically designed to evaluate disorder of written expression.
• Some 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 (TAL).
• Intense writing remediation may help, but no specific method or approach has proved particularly successful. The person being evaluated should also perform tasks such as writing from dictation or copying written material as part of diagnostic testing.
• The most effective treatment approach for disorder of written expression is remedial education. Because little is known about disorder of written expression, treatment is often aimed toward learning disorders that are more common or familiar. Noticeable improvement is frequently seen after treatment, but the degree to which one recovers depends on the severity of the disorder.
• 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 symptoms should be evaluated in light of a person’s age, intelligence, educational experience, and culture or life experience. Written expression must be substantially below the samples of produced by other’s of the same age, intelligence, and background.