WRITING and DYSGRAPHIA in ADHD
Background: Difficulties in writing is a common complaint among children with attention deficit hyperactivity disorder (ADHD).
Objective: To examine whether the problem is one of dysgraphia or attentional problems masquarading as dysgraphia.
Methods: Possible sources of writing difficulty tested were: "lingual", associated with reading and expressed mainly in spelling mistakes, "peripheral motor-output" designated as the orthographic buffer and expressed in omission or repetition of strokes while writing and "attention deficit" expressed as consistence in production in all domains of graphic production. Participants underwent an extensive reading/writing assessment (Shani & Ben-Dror Pivotal Test, 2000), and a set of lingual and peripheral agraphia tests using a digitizing tablet. General kinematic performance in graphic production was assessed using a 30 sec. repetitious tracing of an ellipse.
Participants: Twelve boys with ADHD, aged 11-13 years (unmedicated for at least
1 week) and controls matched for gender, age I.Q, handedness and socio-economic class. Children were eligible to participate if their IQ was > 85, and had no known reading difficulty. ADHD children and controls did not differ significantly in reading scores or in the speed of letter naming.
Results: Lingual: ADHD children spelling scores were significantly lower than controls in most spelling tests.
Motor-peripheral: ADHD children had significantly more stroke omission/repetition errors than controls when writing repetitiously similar-letter words.
Attention deficits: ADHD children were significantly less consistent than controls in a repetitious tracing of an ellipse.
One of the digitized tasks was circle drawing, once as a letter, once as a number, and once as an eye. Duration of writing/drawing did not differ between groups, but variance of duration over repetitions was larger for ADHD children, especially in the written-letters task.
Conclusions: Children with ADHD demonstrated deficits in the lingual and peripheral domains of writing as well as attention deficits in the graphic domain. Although ADHD children were less consistent than controls on graphic tests, for very simple tasks this was significant for writing but not drawing. We conclude that children with ADHD have a true dysgraphia that is exacerbated by the attention deficits.
Key words: Dysgraphia, ADHD, Writing.