DSM-IV-TR › Disorders usually first diagnosed in infancy, childhood, or adolescence › Learning disorders (formerly academic skills disorders) › Disorder of written expression 

315.2 Disorder of Written Expression

Diagnostic Features

The essential feature of Disorder of Written Expression is writing skills (as measured by an individually administered standardized test or functional assessment of writing skills) that fall substantially below those expected given the individual's chronological age, measured intelligence, and age-appropriate education (Criterion A). The disturbance in written expression significantly interferes with academic achievement or with activities of daily living that require writing skills (Criterion B). If a sensory deficit is present, the difficulties in writing skills are in excess of those usually associated with it (Criterion C). If a neurological or other general medical condition or sensory deficit is present, it should be coded on Axis III. There is generally a combination of difficulties in the individual's ability to compose written texts evidenced by grammatical or punctuation errors within sentences, poor paragraph organization, multiple spelling errors, and excessively poor handwriting. This diagnosis is generally not given if there are only spelling errors or poor handwriting in the absence of other impairment in written expression. Compared with other Learning Disorders, relatively less is known about Disorders of Written Expression and their remediation, particularly when they occur in the absence of Reading Disorder. Except for spelling, standardized tests in this area are less well developed than tests of reading or mathematical ability, and the evaluation of impairment in written skills may require a comparison between extensive samples of the individual's written schoolwork and expected performance for age and IQ. This is especially the case for young children in the early elementary grades. Tasks in which the child is asked to copy, write to dictation, and write spontaneously may all be necessary to establish the presence and extent of this disorder.

Associated Features and Disorders

See the "Associated Features and Disorders" section for Learning Disorders (p. 50). Disorder of Written Expression is commonly found in combination with Reading Disorder or Mathematics Disorder. There is some evidence that language and perceptual-motor deficits may accompany this disorder.

Prevalence

The prevalence of Disorder of Written Expression is difficult to establish because many studies focus on the prevalence of Learning Disorders in general without careful separation into specific Disorders of Reading, Mathematics, or Written Expression. Disorder of Written Expression is rare when not associated with other Learning Disorders.

Course

Although difficulty in writing (e.g., particularly poor handwriting or copying ability or inability to remember letter sequences in common words) may appear as early as the first grade, Disorder of Written Expression is seldom diagnosed before the end of first grade because sufficient formal writing instruction has usually not occurred until this point in most school settings. The disorder is usually apparent by second grade. Disorder of Written Expression may occasionally be seen in older children or adults, and little is known about its long-term prognosis.

Differential Diagnosis

See the "Differential Diagnosis" section for Learning Disorders (p. 51). A disorder in spelling or handwriting alone, in the absence of other difficulties of written expression, generally does not qualify for a diagnosis of Disorder of Written Expression. If poor handwriting is due to impairment in motor coordination, a diagnosis of Developmental Coordination Disorder should be considered.

Diagnostic criteria for 315.2 Disorder of Written Expression

1. 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.
2. 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).
3. 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.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision^TM. Copyright 2000 American Psychiatric Association. All Rights Reserved.