Dysgraphia sometimes termed agraphia is a specific deficiency in the ability to write not associated with ability to read, or due to intellectual impairment.

There can be a number of different reasons why an individual may have a specific writing problem but in some cases it can result from immaturity in the neurological pathways involved in the coordination of head, arm, hand and eye movements confirmed by the presence of an Asymmetrical Tonic Neck Reflex (ATNR) in the school aged child. The ATNR is a primitive reflex, normally present in the full-term neonate, which should be inhibited by the developing brain in the first 6 months of post natal life.

A retained or residual ATNR in an older individual can result in specific difficulties in learning to write. This is because, when the head turns to follow the direction of the writing hand, the arm and hand want to extend, making it difficult to hold on to the pen, bend the arm and bring the hand back to write on the left side of the page. Most children learn to “accommodate” the problem by compensating in a number of ways: Adjusting posture by pushing the chair back and leaning back into the chair so that the arm is straight while continuing to write; posture may be twisted or the page rotated by as much 90° so that writing is carried out with the arm extended; an awkward or very tight pen grip may be used to try to keep the fingers closed and the pen under control. Irrespective of the strategy used, the physical action of writing does not become automatic. If a physical action fails to become automated, it can interfere with the ability to think and carry out the physical action as the same time.

Beyond the early stages of learning to form letters, most of education requires the ability to think and write at the same time. The effects of a retained ATNR on written work can occur irrespective of intelligence – indeed the more intelligent and orally articulate the child – the more likely they are to be accused of laziness and to be told, ” you could do better if only you tried”; “could do better if only he applied himself” etc. and to under-achieve. If the ATNR is the only aberrant primitive reflex, the child can usually learn to read, (managing to compensate for control of eye movements) but will have a specific handwriting problem. Reading requires control of eye movements (oculo-motor functioning), but writing needs the eyes and hand to work together (visual-motor integration -VMI). Retention of the ATNR in the school aged child can result in specific writing problems in the absence of reading difficulties or other specific learning difficulties – in other words – a specific form of Dysgraphia.

If your child has been diagnosed, or is showing other symptoms of NMI, please complete a free NMI Child Screening Test. Alternatively, for adults, if you think neuromotor immaturity (NMI) may be a factor in your problems, please contact INPP to request a full adult information pack.