DEVELOPMENTAL EXPRESSIVE WRITING DISORDER
Developmental expressive writing disorder is often associated with other specific developmental disorders, but, since expressive writing is a skill that is acquired and mastered later than language and reading, the disorder is diagnosed somewhat later. Writing requires multimodal sensorimotor coordination and information processing. If the disorder persists through grade school, high school and adulthood, it can jeopardize the affected personís access to the most gainful and intellectually productive occupations. Development expressive writing disorder is a new diagnostic entity in the revised third edition is a new diagnostic entity in the revised third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II-R). Until recently, it had been little studied.
DSM-III-R defines developmental expressive writing disorder as an academic skills disorder first occurring during childhood, characterized by poor performance in writing childhood, characterized by poor performance in writing and composition (spelling words and expressing thoughts) considering the level of the personís schooling and intellectual capacity. That level is measured by a standardized test on which the person scores below the expected level.
This disorder is not due to a defect in visual or hearing acuity or a neurological disorder. Rather, this diagnosis is made only if the impairment significantly interferes with academic achievement or with activities of daily living that require expressive writing skills.
The prevalence of developmental writing disorder is not known but has been estimated at 3 to 10 percent of school age children. The male-to-female ratio is also unknown. There are some indications that affected children are more frequently from families with a history of this disorder.
One hypothesis holds that developmental expressive writing disorder results from the combined effects of one or more the following disorders, developmental expressive language disorder, developmental receptive language disorder and developmental reading disorder. This view suggests the possible existence of neurological and cognitive defects or malfunctions somewhere in the central information processing areas.
Hereditary predisposition to the disorder has been suggested on the basis of empirical findings that most children with developmental expressive writing disorder have relatives with the disorder.
Temperamental characteristic may play some role in developmental expressive writing disorder, especially such characteristics as short attention span and easy distractibility.
Children with developmental expressive writing disorder present difficulties very early in grade school in spelling words and expressing their thoughts according to age appropriate grammatical norms. Their spoken and written sentences contain an unusually large number of grammatical errors or poor paragraph organization. During and after the second grade, these children commonly make simple grammatical errors in writing a short sentence. For example, they frequently fail, despite constant reminders, to start the first letter of the first word in a sentence with a capital letter and to end a sentence with a capital letter and to end a sentence with a period.
As the grow older and progress toward higher grades in school, such childrenís spoken and written sentences become more conspicuously primitive, odd and inferior to what is expected of students in their grade level. Their word choice are erroneous and inappropriate their paragraphs are disorganized and not in proper sequence and spelling correctly becomes increasingly more difficult as their vocabulary becomes more abstract and larger in number and characters.
Associated features of developmental expressive writing disorder include refusal or reluctance to go to school and to do assigned written homework, poor academic performance in other areas (such as mathematics), general disinterest in school work, truancy and conduct disorder.
Most children with this disorder become frustrated and angry over their feelings of inadequacy and failure in their academic performance. They may have a chronic depression as a result of their growing sense of isolation, estrangement and despair.
Adults with developmental expressive writing disorder who do not receive remedial intervention continue to have difficulties in social adaptation involving writing skills and a continuing sense of incompetence, inferiority, isolation and estrangement. Some of them even try to avoid or procrastinate writing a response letter or a simple greeting card for fear that their writing incompetence will be exposed. When their coping mechanism fails, the severity of their psychopathology is likely to be increased. Most adults with the disorder choose occupations that require minimal writing skills, such as in trade, custodianship and other menial work seldom do they achieve or hold a socially desirable occupational position requiring a high level of expressive writing. Common associated disorders are developmental reading disorder, developmental expressive and receptive language disorders, developmental arithmetic disorder, developmental coordination disorder and disruptive behavior disorders.
Most children with this disorder become frustrated and angry over their feeling of inadequacy and failure in their academic performance. They may have a chronic depression as a resultís of their growing sense of isolation,
estrangement, and despair.
Adults with the developmental expressive writing disorder who do not receive remedial intervention continue to have difficulties in social adaptation involving writing skills and a continuing sense of incompetence, inferiority, isolation and estrangement. Some of them even try to avoid or procrastinate writing a response letter or a simple greeting cards for fear that their writing incompetence will be expose. When their coping mechanism fails, severity of their psychopathology is likely to be increased. Most adults with the disorder choose occupationís that requires minimal writing skills, such as in trade, custodianship, and other menial works; seldom do they achieve or hold a socially desirable occupational position requiring a high level of expressive writing. Common associated disorder developmental reading disorder, developmental expressive and receptive language disorders, developmental arithmetic disorder, developmental coordination disorder and disruptive behavior disorder.
Course and Prognosis
Because writing, language and reading disorders often coexist and a child normally speaks well before learning to read and reads well before writing well, a child with all three disorders has the language disorder diagnosed first and the writing disorder diagnosed last. In severe cases a developmental expressive writing disorder is apparent by age 7 (second grade), in less severe cases the disorder may not be apparent until age 10 (fifth grade) or later. Most personís with mild and moderate developmental expressive writing disorder fare rather well if they receive timely remedial educational intervention early in grade school. Severe developmental expressive writing disorder requires continual extensive remedial treatment through the late part of high school and even into college.
The prognosis depends on the severity of the disorder, the age or grade when the remedial intervention was started, the length and continuity of treatment and the presence or absence of associated or secondary emotional or behavioral problems.
Those persons who later became well compensated or who recover from developmental expressive writing disorder are usually from families of favorable socioeconomic backgrounds.
The diagnosis of developmental expressive writing disorder is made on the basis of the personís consistently poor performance on the composition of written text. Performance is markedly below the personís intellectual capacity, as confirmed by an individually administered standardized expressive writing test. The presence of a major disorder, such as pervasive developmental disorder or mental retardation, obviates the diagnosis of developmental expressive writing disorder. Other disorders to be differentiated from developmental expressive writing disorder are developmental expressive and receptive language disorders, developmental reading disorder and impaired vision and hearing.
Dyslexia is characterized by an inability to read and dysgraphia by an inability to write. From a diagnostic procedural viewpoint, it is important that any person suspected of having developmental expressive writing disorder first be given a standardized intelligence test, such as the Revised Wechsler Intelligence Scale for children (WISC-R) or the Revised Wechsler Adult Intelligence Scale (WAIS-R) to determine the personís intellectual capacity before administering a standardized expressive writing test.
Developmental expressive writing disorder responds to treatment. The best treatment to date is remedial educational intervention. Although controversy continues as to the effectiveness of various remedial expressive writing modalities, an intensive and continuous administration of individually tailored one-to-one expressive and creative writing therapy appears to show the most favorable treatment outcomes. Teachers in some special schools devote as much as two hours a day to such writing instruction.
The treatment of this disorder requires an optimal patient-therapist relationship, as in psychotherapy. The success or failure in sustaining the patientís motivation greatly affects the treatmentís long-term efficacy.
Associated and secondary emotional and behavioral problems should be given prompt attention, with appropriate psychiatric treatment and parental counseling.