What are the other names for this Condition? (Also known as/Synonyms)

• Developmental Expressive Writing Disorder
• DWE (Disorder of Written Expression)
• Dysgraphia

What is Disorder of Written Expression? (Definition/Background Information)

• Disorder of Written Expression (DWE) is a learning disability in which an individual’s ability to communicate in writing is noticeably low-to-poor and inconsistent to his/her age, intelligence, life experiences, educational background, or even physical impairment (if any)
• Disorder of Written Expression can affect both the physical production of writing (bad penmanship) as well as the structure of thoughts and ideas that are being written. DWE most commonly occurs simultaneously with other learning disabilities
• The exact cause for Disorder of Written Expression is unknown. Each aspect of the disorder may have a different cause, such as difficulties with forming letters may be caused by delays in hand-eye coordination, etc.
• Due to the limited information available on Disorder of Written Expression, treatment is directed more at the “understood” or “known” learning disabilities that occur simultaneously with DWE
• Information on long-term outcome for individuals with Disorder of Written Expression is sparse. However, the affected individuals may have low self-esteem and face a life-long barrier with certain limited occupational (employable) opportunities

Who gets Disorder of Written Expression? (Age and Sex Distribution)

• Disorder of Written Expression may be seen in individuals of any age, but it is most commonly diagnosed in elementary-school aged children around 8 years old
• Some literature informs that approximately 3-5% of students are diagnosed with this condition
• Both males and females can be affected equally by this disorder; and, Disorder of Written Expression is prevalent among all races and ethnic groups

What are the Risk Factors for Disorder of Written Expression? (Predisposing Factors)

Some known risk factors for Disorder of Written Expression include:

• Presence of other learning disabilities
• Abnormalities during embryonic development that may occur due to the following factors:
  • Exposure to high levels of testosterone
  • Eclampsia, or high blood pressure causing seizures during pregnancy
  • Placental insufficiency - complication of pregnancy in which the placenta cannot provide sufficient oxygen and nutrients to the developing baby
  • Umbilical cord compression - pressure on the umbilical cord causing mild compressions on the baby
  • Nutritional deficiencies
  • Bleeding during pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Disorder of Written Expression? (Etiology)

The exact cause of Disorder of Written Expression is unknown. Some possible causes may include:

• Mental delays in hand-eye coordination leading to difficulty in forming letters 
• Visual memory deficits, leading to trouble with memorizing what to write 
• Issues with cognitive processing, leading to problems in organizing thoughts on paper

What are the Signs and Symptoms of Disorder of Written Expression?

Some signs and symptoms of Disorder of Written Expression may include the following:

• Visual-spatial difficulties, leading to troubles with:
  • Shape-discrimination and letter spacing
  • Organizing words on page 
  • Writing from left to right
  • Writing words in a line 
  • Maintaining words within margins
  • Copying text
• Fine motor difficulties
  • Trouble holding a pencil correctly
  • Unable to use scissors or color inside the lines
  • Awkward body language/position while writing
• Language processing difficulties
  • Trouble getting ideas down on paper quickly
  • Trouble understanding rules
  • Difficulty following directions
  • Easily losing one’s train of thought
• Spelling/handwriting issues
  • Poor or illegible handwriting
  • Excessive spelling errors
• Grammar and usage problems
  • Excessive punctuation and grammar errors
  • Disorganized sentences and paragraphs
• Organization of written language
  • Inability to make a point; or, making the same point multiple times
  • Leaving out important details and information
  • Being better at conveying ideas through speaking than with writing

How is Disorder of Written Expression Diagnosed?

A diagnosis of Disorder of Written Expression is made based on the information gathered from the following methods:

• Complete physical evaluation
• Comprehensive analysis of medical history
• Assessment of signs and symptoms based on the criteria from the Diagnostic and Statistical Manual for Mental Disorders (DSM-5)
• Thorough neuropsychological evaluation
• Academic assessments and writing tests
• Differential diagnosis to rule out other disorders that may present similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Disorder of Written Expression?

Disorder of Written Expression may lead to complications such as:

• Low self-esteem and mental stress
• Difficulty of daily functioning (due to writing problems)
• Poor academic progress and achievements
• Limited occupational opportunities

How is Disorder of Written Expression Treated?

The treatment for Disorder of Written Expression may include:

• Simultaneously treating any associated learning disabilities, to improve the symptoms of Disorder of Written Expression
• Learning accommodation:
  • Use of electronic devices to type can be a good alternative to writing
  • Use of voice-recorded notes to keep work organized 
• Learning modification:
  • Writing shorter essays or answering fewer questions, to aid or help improve one’s learning
  • Allowing verbal presentations over written essays
• Remediation of learning:
  • Working on copying letters
  • Practicing writing in a straight line
  • Working on exercises to improve muscle strength and dexterity, as well as increase hand-eye coordination
• Therapy and support system for the affected child/adult to reduce anxiety and help improve self-esteem

How can Disorder of Written Expression be Prevented?

• At the present time, there are no methods or guidelines available for the prevention of Disorder of Written Expression
• Seeking early intervention including professional treatment soon after the onset of symptoms may help manage the condition and work better, even though constrained by certain limitations

What is the Prognosis of Disorder of Written Expression? (Outcomes/Resolutions)

The information on the prognosis of Disorder of Written Expression is limited.

• It is possible that affected individuals may struggle with low self-esteem and drop out of school
• Due to limitations in the types of occupations that are available where writing is not involved, those affected may face a life-long barrier and have reduced occupational opportunities

Additional and Relevant Useful Information for Disorder of Written Expression:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/diseases-conditions/rare-disorders/