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Expressive Writing Disorders

RUNNING HEAD: Expressive Writing Disorders

Expressive Writing Disorders in Young Adults: Memory Measures Predict Performance

Thomas G. Bowers
Karen Gibson
Stephen Hinkle
Penn State Harrisburg

Poster presented at the National Academy of Neuropsychology (NAN), November, 2009,

New Orleans. LA

For additional information please contact:

Thomas G. Bowers, Ph.D.
Penn State Harrisburg
777 W. Harrisburg Pike
Middletown, PA 17057

Expressive Writing Disorders


Expressive Writing Disorders

There has been only limited interest in understanding expressive writing disorders or in
predicting the nature of disorders of written expression. A sample (N = 87) of young adult
college students who were being evaluated for specific learning disabilities were
evaluated on cognitive capacity, memory abilities and academic skills by using the
WAIS-III, WMS-III and WJAT-III. Initial efforts to cross validate previous findings on
abstract sequential processing and attention were not productive, so an exploratory
stepwise regression on the basis of the intellectual and memory measures was applied.
The resulting model was significant (R =.55), with the inclusion of auditory delayed
memory, visual delayed memory, visual immediate memory and processing speed
significantly predicting the WJAT-III written expression cluster score. However, beta
weights for visual delayed memory scores were unexpectedly negative, and it is difficult
to consider these scores as true suppressor variables. It is recommended there be
continued efforts to develop a theoretical descriptive model of writing behavior and
expressive writing disorders, and the application of functional neuroimaging analysis
may assist the development of theoretical models.

Expressive Writing Disorders in

Young Adults: Memory Measures Predict Performance

Despite the relatively high incidence of writing disorders, there appears to be little
research specific to the nature of the expressive writing problems (Lyon, 1996). Often,
writing disorders are simply described as secondary elements of reading disorders, and
remediation appears to be secondary to intervention on reading as well. Also, given the
complexity of writing behavior, a straight forward neurological analysis seems unlikely
to account for writing difficulties, despite apparent success in describing reading
disabilities in neuropsychological terms (Duane, 1989; Obrzut & Hynd, 1993). The

Expressive Writing Disorders

complexity of the cognitive demands in writing makes demands on virtually all aspects of
neuropsychological organization of the brain.
Theories of writing disorders have developed, focusing on neuropsychological
deficits as deficits in memory or working memory, dysgraphic behaviors related to fine
motor dysfunction, information processing deficiencies, or global neurological
impairment. However, tests of these theories to date have been preliminary (Bowers,
DeMulder, Struck & Bedard, 2003). Neurophysiological descriptions of writing
disorders focus on the dorsal aspects of the third frontal convolution, the Exner Area, as
the locus of relative pure writing disorders or dysgraphia, but the complexity of writing
behavior appears to argue for a more complex level of analysis.
Many researchers have theorized that writing involves 3 stages or processes:
Planning, translating, and reviewing (McCutchen, Covill, Hoyne, & Mildes, 1994). The
planning step involves nothing more than planning what to say or write. Translating is
the action of orienting the plans from the previous stage into written words of a text or
speech. Finally, the last stage is reviewing the written text or plans to make any
necessary revisions before commitment. In a study conducted with 210 students,
McCutchen et al. (1994) found that skilled writers have a more rapid and accurate lexical
retrieval of individual words, than that of people with learning or writing disorders.
Retrieval of lexical information is involved with the short-term or working memory.
Olive (2004) discovered that there is a component of memory also involved in
writing, namely, the short-term, working memory. He theorized that part of this shortterm, working memory is a phonological loop, which specializes in processing verbal and
acoustic information. When the phonological loop receives information, it commits the

Expressive Writing Disorders

information to short-term, working memory, which over time will fade unless it is
frequently used. He also concluded that planning processes require a visiospatial
sketchpad which is important in picturing the arrangement of ideas. Verbal working
memory is needed for the running dialogue in ones mind while writing sentences, and
visual working memory is necessary for image-based content.
Adi-Japha, Landau, Frenkel, Teicher, Gross-Tsur, & Shalev (2005) studied the
relationship between ADHD and dysgraphia, and it turns out that there is also a memory
component important in the attention to and retention of correct orthographic
information, which is mainly a product of short-term memory. Adi-Japha et al. (2005)
tested 3 components of dysgraphia in children with ADHD; linguistic, motor
programming, and motor kinematic production. The results of the linguistic component
was that the children with ADHD had reading abilities that were similar to typical
children being tested, however they made qualitatively worse errors. The results of the
motor programming was that children with ADHD made more graphemic buffer errors,
and confused similar shaped letters The graphemic buffer refers to the conversion of a
word into specific letter shapes. Finally, the result of the motor kinemtatic production is
that the children with ADHD exhibited poor time-management, and disproportionate
Another study, conducted by Cirino & Morris (2002), examined the effects of
short-term memory on writing skills, and they theorized that writing and mathematical
calculations are closely related by way of visiospatial skills. These skills are important in
not only the shape of letter or words, but in geometry. They found when testing 300

Expressive Writing Disorders

college students with learning disabilities that the working memory is an important part
of the executive-procedural skills involved in calculation as well.
Glosser, Roeltgen, & Friedman (1996) hypothesized that individuals are able to
pronounce, spell, and perceive words by way of symantic lexicons that are stored within
our memory. They believed that there are two components written language; the written
output, which deals with spatial forms of letters; and the spoken output, which deals with
speech motor schema. Their theory suggested that certain words are placed into memory
by relation to another known or familiar word. There are two types of words: real words
which are familiar and have real meaning and pseudo words which are unfamiliar which
have meaning, but not with an individual. Glosser et al. (1996) studied a 6-year old
hyperlexic boy with mental retardation and found that he could decode all types of
pseudo words with real orthographic analogies, but had difficulties decoding those
without lexical analogies. They concluded that many of these problems came from
semantic memory, rather than lexical orthography.
Current studies are being conducted on individuals with neural injuries, and Rapp
(2005) examined the rehabilitation of the brain and cognitive processes following an
injury. She studied the effects of item-specific treatment on 3 individuals with acquired
dysgraphia, which focuses on rehabilitation of a specific skill. Her theory stressed that
remediation or repeated practice of any particular skill will increase the effectiveness of
that skill. They found that there were still apparent benefits 40-112 weeks after the end
of treatment. She also hypothesized that there are two types of processes involved with
spelling-to-dictation; lexical and sublexical. She stated that the lexical process involves

Expressive Writing Disorders

information being stored in long-term memory, and that sublexical is learned information
about the relationship between sounds and letters.
In an attempt to continue to develop a neuropsychological model of expressive
writing disorders, a sample of 87 individuals undergoing assessment for specific learning
disorders was used to construct a regression model predicting writing scores on the
Woodcock Johnson Tests of AchievementIII (WJTA-II). Because earlier findings had
suggested that measures of attention, abstract processing and memory were predictive of
overall writing behavior, index scores from the WAIS-III and WMS-III were applied as
predictor variables in a regression analysis. Because the analyses were preliminary, a
relatively lenient procedure using a p of < 1.0 to enter in the regression. A stepwise
procedure was applied in hopes of reducing the number of variables to a more
manageable model.
The resulting model predicting writing scores was significant (R = .55, F(4,55) =
5.81, p < .01). The significant variables predicting writing scores included Auditory
Delayed Memory Index scores, (t = 3.11, p < .01), Visual Delayed Memory Index scores
(t = -3.41, p < .01), Visual Immediate Index scores (t = 2.56, p < .05) and the WAIS-III
Processing Speed Index (t = 1.92, p = .06).
These results represented a somewhat different model of writing behavior than
generally expected. Other models of writing have emphasized processing speed, visual
motor functions and similar skills. In contrast, this model emphasized the contribution of
both auditory and visual delayed memory functions, visual immediate memory, and
measures of processing speed abilities. The atypical pattern of results found here may
reflect that memory affects writing behavior either directly by reducing the effectiveness

Expressive Writing Disorders

of writing behavior, or indirectly as memory measures can serve as a sensitive indices of

overall cortical integrity.
This model of writing suggests additional research on writing behavior should
consider increased emphasis on memory function in the relationship to writing.
Application of imaging studies to explore the relations of memory with writing behaviors
could prove to be fruitful and is recommended in the future.

Expressive Writing Disorders

Adi-Japha, E., Landau, Y.E., Frenkel, L., Teicher, M., Gross-Tsur, V., & Shalev, R.S.
(2005). ADHD and dysgraphia: underlying mechanisms. Cortex, 43(6), 700-709.
Bowers, T. G., Demulder, J., Struck, D.M., & Bedard, B. (2003). Expressive writing
disorders: An analysis of theoretical views. Perceptual and Motor Skills, 96,
Cirino, P.T., Morris, M.K., & Morris, R.D. (2002). Neuropsychological concomitants of
calculation skills in college students referred for learning difficulties.
Developmental Neuropsychology, 21(2), 201-218.
Glosser, G., Roeltgen, D.P., & Friedman, R.B. (1996). Clues to the cognitive
organization of reading and writing from developmental hyperlexia. Journal of
Neuropsychology, 10(2), 168-175.
McCutchen, D., Covill, A., Hoyne, S.H., & Mildes, K. (1994). Individual differences in
writing: implications of translating fluency. Journal of Educational Psychology,
86(2), 256-266.
Olive, T. (2004). Working memory in writing: empirical evidence from the dual-task
technique. European Psychologist, 9(1), 32-42
Rapp, B. (2005). The relationship between treatment outcomes and the underlying
cognitive deficit: evidence from the remediation of acquired dysgraphia.
Aphasiology, 19(10/11), 994-1008.

Expressive Writing Disorders


Table 1. Beta and standardized beta weights, t-tests and significance level on memory
measures and processing speed measures.






















Expressive Writing Disorders


Figure 1. Regression of memory indices and processing speed on writing scores.