Existing Interventions for the Management of Different Types of Dysgraphia or Specific Learning Disorder in written expression: A Scoping Review

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Identifying and remedying these children is a biggest challenge in academic institutes. Different interventions are used to rehabilitate these children. This scoping review aims to map existing interventions for different types of dysgraphia with their outcomes in multiple context i.e. schools, rehabilitation centers, home-based services, and clinics. Inclusion Criteria: This review included studies used educational, therapeutic, technological, or behavioural interventions on children, and adolescents with dysgraphia or written expression difficulties. Quantitative, qualitative, and mixed-methods studies conducted in the context of school, clinics, home settings, or rehabilitation centers were included. Studies focusing on unrelated disabilities, diagnostic studies, and theoretical papers without intervention focus were excluded. Methods: PubMed, EuroPMC, Cochrane Library, Science Direct, EBSCO, DOAJ and Google Scholar were searched for evidence based articles. Two independent reviewers screened titles and abstracts using Rayyan web app. Discrepancies were resolved by consensus with a third reviewer and the full texts were retrieved. Two Independent reviewers screened the full text articles. Disagreements were resolved through consultation with third reviewer. Data were charted using a standardized form. The extraction process independently conducted by two reviewers to ensure reliability, with discrepancies resolved by discussion with a third reviewer. Results: Forty seven articles included in the review, targeting educational, therapeutic, multisensory, computer-based, and combined interventions to address dysgraphia. Four themes were emerged: (a) Improvements in Foundational Writing Mechanics, (b) Advancements in Composition and Higher-Order Writing, (c) Broader Academic and Cognitive Benefits, (d) Positive Affective and Behavioral Outcomes. Each theme with their subtheme is linked with targeted intervention addressed in the studies. Conclusion: This review revealed computer-based and educational interventions were used in most of the studies and among themes foundational writing mechanics is widely addressed. Studies lack in addressing different types of dysgraphia. A holistic approach with a large scale study is recommended addressing multiple underlying writing mechanics along with psychological concerns. Psychology Disorder of Written Expression Dysgraphia Educational Intervention Therapeutic Intervention Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Strengths & Limitations Few Databases were accessed due to limited access. This review addressed articles using interventions for dysgraphia, comorbid conditions were excluded such as writing difficulties due to acquired neurological conditions. This review was restricted to articles in English language only. Start of 21 st Century is the era of mass adoption of technology and computer use so studies included from Jan, 2000 to June, 2025. Introduction Dysgraphia is a neurodevelopmental condition that is classified as a specific learning disorder (SLD) and manifests through persistent and severe difficulties in written expression skills [ 1 ]. It is not classified as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) but rather as Specific Learning Disability (SLD) with impairment in written expression [ 1 ]. Dysgraphia is evident through handwriting fluency, automatic letter formation, orthographic accuracy, fine-motor coordination, writing speed, and compositional aspects of written text [ 2 , 3 ]. An estimated prevalence between 7 to 15 per cent of the school aged population, dysgraphia poses a significant challenge both on the educational and clinical front [ 4 , 5 ]. It has traditionally been conceptualised by Deuels (1995) taxonomy that proposes three major subtypes: dyslexic dysgraphia (combined with deficits in linguistic processing), spatial dysgraphia (combined with visual-spatial integration impairments), and motor dysgraphia (combined with fine-motor and kinesthetic impairments) [ 6 ]. This classification continues to inform contemporary research and diagnostic practices to this day. Another distinction between its types is between acquired dysgraphia, which occurs after a neurological event such as traumatic brain injury or neurodegenerative disease, and developmental dysgraphia, which occurs in early childhood during the early stages of writing acquisition, even in individuals with normative intellectual function and adequate learning opportunities [ 2 , 4 ]. The consequences of dysgraphia extend beyond just handwriting challenges. Handwriting is one of the foundational academic skills by which students can display their knowledge, fulfil their assignments, and engage in self-expression throughout their school life [ 3 ]. Consequently, the condition directly disrupts academic achievement in virtually all areas of subject matter, creating a debilitating gap between a student's cognitive capabilities and their written performance [ 4 ]. The psychosocial effects are also equally serious and in some cases, devastating. A meta-analysis by Kavale and Forness (1996) found that about 75 per cent of specific learning disorder (such as dysgraphia) students have serious deficiencies in social skills as compared to their peers [ 7 ]. Dysgraphic children always complain of their poor academic performance, increased anxiety levels when they are engaged in writing activities, and poor self-esteem [ 8 ]. Such a negative self-perception creates a vicious cycle, which makes them less willing to practise writing. If not diagnosed and treated at early stages, dysgraphia may negatively impact children’s ability to learn academic skills, their emotional wellbeing, and vocational prospects later in life [ 9 ]. This calls for an urgent need for early diagnosis and implementation of evidence-based rehabilitation strategies. The landscape of interventions for dysgraphia has been dynamically evolved over the last 20 years, shifting towards a more balanced, innovative, technologically-advanced, and comprehensive approach. Han and Wang (2025) outline that technology-assisted interventions, such as special software, online handwriting applications, and real-time biofeedback systems, are the leading interventions, with their benefits in user engagement and measurable improvement of skills [ 4 ]. One of the most prominent frameworks of conceptualising support in school settings divides the interventions into three levels: (I) Accommodation, where the student receives the mainstream curricula, with the help of supportive aids (e.g., speech-to-text software, graphics organisers), without modifying the instructional content; (II) Modification, where the institution changes the learning goals and objectives of the student; and (III) Remediation, where interventions are aimed at directly alleviating the underlying deficiencies of the disability [ 2 ]. This global landscape is marked by high heterogeneity in dysgraphia interventions that are mostly associated with the variability in economic resources and healthcare infrastructure. Research in high income countries often examines specialised, resource-intensive interventions. For example, Psychomotor Therapy (PMT) is a popular treatment in Switzerland, although the empirical data show a statistically significant effect of PMT on fine motor proficiency of children during a five-month period, the treatment does not have similar effects on handwriting consistency and fluency [ 10 ]. Similarly, a study from France suggests a trans-disciplinary paradigm, demonstrating that children with dysgraphia have a heterogeneous spectrum of comorbid functional impairment, including oculomotor and neuropsychomotor impairments [ 5 ]. In contrast, interventions in Low and Middle Income Countries (LMICs) identify significant systemic failures. For instance, Maulik and Darmstadt (2007) emphasize that research on childhood disability in LMICs is pathetically inadequate; especially those investigated specific intervention and service utilisation [ 11 ]. This research gap highlights that the priority of research on childhood disability is often on overcoming the challenges in identification and allocation of resources. The urgency is further supported by a systematic review that assessed the intervention to improve the educational results of individuals with disabilities in LMICs. The review found that the available evidence base is mostly of individual-level interventions that aim to improve functioning, skills, and competencies of a child lacks research on systemic or school based interventions [ 12 ]. Furthermore, the review found most studies on this subject have a low level of confidence due to their methodological limitation, where specific disabilities such as dysgraphia are included in broader categories of rather than an individual focus. Although the evidence suggests that dysgraphia is prevalent in LMICs. For instance, a survey of school children carried out in Lahore, Pakistan, revealed high rates of SLD, especially in individuals with writing difficulties but the authors noted that prevalence estimates are not consistent in various settings [ 13 ]. Similarly, an experimental study was conducted in Khyber Pakhtunkhwa, Pakistan, to explore how effective fine-motor skills interventions are in enhancing the handwriting performance among both low and high achievers, and demonstrated that the effectiveness of group-based motor training in classroom settings [ 14 ]. This variation in the interventions in different economic settings establishes a notable disparity in equitable development, dissemination, and appraisal of evidence-based interventions for dysgraphia at the global front. The existing body of literature suggests that interventions for dysgraphia have been addressed in a chaotic manner and leaving a clear gap in mapping specific interventions. For example, an earlier scoping review by Kalenjuk et al. (2022) explored the perspectives of children, parents, and teachers on dysgraphia but did not synthesise the evidence on types of intervention [ 15 ]. Likewise, Bonneton-Botté et al. (2023) and Blanchet et al. (2022) provided insights regarding general handwriting therapy and motor deficits in people with SLD [ 16 , 17 ], but lacked explicit focus on dysgraphia, limiting generalisation of their findings Recently, Fajariani et al. (2025) examined moderating factors and contextual influences on handwriting improvement but lacked a categorisation of intervention strategies [ 18 ]. The literature on dysgraphia interventions represents a high degree of heterogeneity in methodologies, participant groups, intervention types, and reported outcomes. Thus, it makes it challenging to conduct a systematic review and meta-analysis intended to gauge the effectiveness of interventions for dysgraphia. Therefore, the most suitable methodological option in this case is a scoping review, which allows mapping and categorising of interventions in this wide and multifaceted body of literature. The scoping review will be the first to provide a comprehensive synthesis of interventions of studies published between 2000 and 2025 explicitly designed in geographical settings, such as low and high income countries, heterogeneous groups of participants, and diverse ways of delivery. This review aims to contribute to the existing evidence base and identifies critical gaps, such as the lack of focus on affective outcomes and long-term transfer effects. The results will give comprehensive and practical recommendations on future research and practice. Methodology Study Design The review was conducted using a scoping methodology, which was most suitable for mapping the wide range of interventions applied to dysgraphia and written expression difficulties. The framework of Arksey and O’Malley (2005) provided the foundation, while the refinements proposed by the Joanna Briggs Institute (JBI, 2020) were followed to ensure a systematic and transparent process) [19, 20]. The JBI approach emphasized structured data charting and allowed interventions to be grouped by theoretical orientation (e.g., motor-based, linguistic, or technological). Reporting adhered to the PRISMA extension for scoping reviews (PRISMA-ScR) [21]. A detailed protocol was developed before initiating the search and was made publicly available and revised prior to data charting on the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/D27AP ). Eligibility Criteria Studies were considered suitable for inclusion if they examined children or adolescents who were identified as to have dysgraphia or related written expression difficulties, and if they described an intervention designed to address these challenges. Both educational and therapeutic approaches were accepted, along with technology-assisted and behavioral programs. Empirical evidence in multiple formats, quantitative, qualitative, and mixed-methods, was included, provided it contained clear descriptions of intervention procedures and outcomes. Publications were restricted to English-language studies from Jan, 2000 to June, 2025. Studies conducted in schools, clinical services, rehabilitation centers, or home settings were all eligible. Exclusion criteria Studies with following features were excluded: Focused only on other conditions (e.g., dyslexia without a dysgraphia component, ADHD, autism spectrum disorders, motor-coordination disorder). Reported diagnostic approaches or theoretical discussions without testing interventions. Consisted of commentaries, editorials, or opinion-based pieces. Addressed workplace interventions unrelated to learning disabilities. Published before 2000. Written in languages other than English, where no reliable translation was available. Information Sources The evidence base was drawn from several bibliographic databases to capture a wide range of perspectives. Searches were performed in PubMed, Europe PubMed Central (Euro PMC), Directory of Open Access Journals (DOAJ), ScienceDirect, EBSCO, Cochrane, and Google Scholar. The decision to use these databases was guided by their coverage of both health sciences and education research, which are central to interventions for learning disorders. The search covered the period from Jan, 2000 to June, 2025. To supplement electronic searches, the reference lists of relevant articles and reports were also screened for additional studies. Search Strategy A comprehensive search was carried out in PubMed, Europe PMC, ScienceDirect, DOAJ, Google Scholar, and the Cochrane Library for studies published between 1 January 2000 and 30 June 2025. Search strategies combined controlled vocabulary (e.g., MeSH) and free-text terms relating to dysgraphia , interventions , and child/adolescent populations . Filters were applied for English-language articles, participants aged ≤18 years, and study types (e.g., clinical trials, randomized controlled trials, where available). Database-specific strategies were developed and adapted to indexing terms and functionalities. The full search strings for each database are provided in Supplementary Appendix 1 . Supplementary Appendix 1. Search Strategy Study Selection All search results were imported into Rayyan web app [22], which facilitated screening and comparison. Duplicate studies were removed. MA and another independent reviewer (MAP, US, SA, or SAJ) examined titles and abstracts to identify potential inclusions. Discrepancies were resolved among reviewers. Full texts of the included articles were retrieved and imported to Rayyan web app [22]. Two independent reviewers i.e. MA and another independent reviewer (MAP, US, SA, or SAJ) assessed against the eligibility criteria. When discrepancies occurred, they were first discussed between reviewers, and if consensus was not reached, a third reviewer was consulted. The full process of identification, screening, and final selection was documented and later summarized in a PRISMA-ScR flow diagram (Fig.1). Data Charting To capture essential study information in a consistent way, a data charting form was designed in MS Excel. Before its use, the form was tested with a small number of studies (i.e. three) to ensure clarity. The form was completed independently by two reviewers to minimize bias. Extracted information included bibliographic details, study design, participant characteristics, intervention type, frequency and duration, outcomes, and contextual information such as whether the program was delivered at school, clinic, or home were charted to give insight into acceptability and feasibility. Data Items The charting process focused on a core set of items: Study characteristics: author, publication year, and country. Design: quantitative, qualitative, or mixed-methods. Population: age group, diagnostic confirmation of dysgraphia or related written expression disorder. Interventions: type, theoretical basis, duration, and delivery format. Outcomes: measures of writing fluency, legibility, motor coordination, or participant experiences. Context: setting of the intervention (school, clinic, rehabilitation center, home). Critical Appraisal Consistent with JBI’s methodological guidance for scoping reviews, no formal critical appraisal of included studies was conducted. As the objective was to map available interventions rather than evaluate effectiveness or risk of bias, quality assessment was not considered appropriate. Collating, Summarizing, and Reporting the Results Two Independent reviewers i.e. MA and MAP reviewed all the charted data of the included studies and synthesized the extracted information descriptively. Studies were grouped by intervention (e.g. educational, therapeutic etc.) and their outcomes (e.g. improvement in handwriting legibility, higher order cognitive functions etc.). Extracted data made publically available on https://10.6084/m9.figshare.30476990. Following the Braun & Clarke (2006) framework, thematic analysis was conducted [23]. Initial codes were generated using manual color coding. Figure 2 shows codes of extracted findings from two studies. Codes were then collated and organized into sub-themes and themes (Figure 3). Prominent subthemes and themes were discussed with two reviewers (SP, and MAP) and reached to a consensus of final subthemes and themes (Figure 4). Results Characteristics of the Included Studies A total of 47 articles met the inclusion criteria (January 2000–June 2025). Relevant studies were identified beginning in 2008, with the highest number published in 2024 (n = 10). Five studies were published in 2014 and 2022, four in 2019, three in 2015, 2017, and 2018, and one or two in other years; no studies were published in 2012. Geographically, 24 studies were conducted in Asian countries (primarily Iran and India), 10 in the United States, and 8 in European countries, 4 in African countries, and 1 in an Arab country. Sample sizes ranged from a single case to 154 participants; 26 studies included ≤30 participants, while 21 involved >30 participants. Participants’ ages ranged between 5 and 19 years. Most studies employed experimental (n = 41) or quasi-experimental (n = 6) designs. Forty-two were quantitative, four used mixed methods, and one was observational. Interventions included educational (n = 23), assistive technology (n = 9), physical (n = 5), multisensory (n = 4), computerized (n = 3), and psychological approaches (n = 3; including behavioral, cognitive-behavioral, and cognitive-motor). Fourteen studies focused specifically on dyslexic dysgraphia, nine on motor dysgraphia, three on dysgraphia with dyscalculia, and one on spatial dysgraphia; the remainder did not specify the type. Mode of delivery was predominantly face-to-face (n = 38). Three studies used hybrid approaches, one was fully online, and five did not report. Interventions were delivered mainly in schools (n = 27), followed by learning disability centers or private clinics (n = 11), university research centers (n = 2), and homes (n = 3); four studies did not specify the setting. Interventions Map Across 47 studies, 6 types of interventions identified to address handwriting difficulty: Educational, Psychological, Therapeutic, technology based interventions, multisensory, and Combined/multimodal Approaches. Educational interventions (n = 13) primarily focused on structured writing instruction, sentence combining interventions, rote learning practice, ART (Ask, Reflect, Text) strategy, task-oriented teaching and self-regulated strategy development to improve writing accuracy and fluency. Computer-based programs were the most frequently reported (n = 15), utilizing computerized reading/writing and translation strategy, computerized visual perception training, software, and assistive technologies designed to enhance handwriting performance, provide feedback, or support practice through interactive learning tools. Psychological interventions (n = 4) employing cognitive motor exercises, cross-word puzzle games, and social cognitive model to address cognitive and perceptual functions of children with dysgraphia, and engagement, motivation, and self-efficacy enhancement. Therapeutic interventions (n = 7) concentrated on fine and gross motor exercises, visual–motor integration, and proprioception exercises to strengthen the physical components of handwriting. Multisensory approaches (n = 2) engaged multiple sensory components—visual, auditory, tactile, and kinesthetic—to reinforce letter formation and fine motor and perceptual motor skills through experiential learning activities. Combined or multimodal interventions (n = 6) integrated features from two or more categories, such as pairing educational and therapeutic interventions, or combining multisensory and educational elements, reflecting a growing preference for holistic approaches. Overall, the distribution of intervention types indicates a predominant reliance on educational and technology-based methods, with increasing attention to integrative and therapeutic models that address the multifaceted nature of dysgraphia. Fig. 5 illustrates the range of interventions identified in the scoping review. It highlights the breadth of intervention strategies currently described in the literature. Thematic Findings Thematic analysis was conducted to analyze the outcomes of different interventions of dysgraphia. Four themes were emerged (e.g. Improvements in Foundational Writing Mechanics, Advancements in Composition and Higher-Order Writing, Broader Academic and Cognitive Benefits, Positive Affective and Behavioral Outcomes). All themes, sub-themes, their contributing studies, types of interventions used and related outcomes are presented in Table 1: Each of these themes with respected subthemes is linked with types of interventions and are discussed below: 1. Improvements in Foundational Writing Mechanics This theme reflects interventions targeting the sensorimotor and transcription foundations of handwriting, including legibility, fluency, and spelling accuracy. Three subthemes were identified: 1.1 Enhanced Legibility and Letter Formation Multisensory, educational, physical, and assistive technology interventions consistently improved clarity of handwriting, including letter size, spacing, and alignment. For instance, assistive technology applications improved global legibility scores in small samples [24], while large-scale physical and educational programs led to both handwriting and academic improvements [25]. 1.2 Increased Writing Speed and Fluency Real-time auditory feedback (sonification), 26] and computerized instruction [27] enhanced writing fluency and reduced pauses without compromising legibility. Educational approaches also improved sentence construction and speed, though effects varied across participants. 1.3 Reduced Spelling and Transcription Errors Multisensory and play-based approaches reduced spelling mistakes, visual memory errors, and dictation problems, while also lowering anxiety and improving self-confidence [28, 29] While these interventions strengthened handwriting mechanics, they provided limited insights into higher-order composition and idea generation. The next theme addresses these broader writing skills. 2. Advancements in Composition and Higher-Order Writing This theme highlights interventions that enhanced text quality, productivity, and strategic writing skills. Three subthemes were as follows. 2.1 Improved Composition Quality and Structure Strategy-focused interventions such as Self-Regulated Strategy Development and sentence-combining programs improved organization, coherence, and writing quality among children with dysgraphia [30, 31]. 2.2 Gains in Productivity and Ideation Assistive technologies like speech-to-text supported students in producing longer, more meaningful texts with improved accuracy [32]. Direct instruction methods also improved fluency and comprehension [33]. 2.3 Development of Writing Strategies and Processes Computerized translation and planning strategies helped students strengthen narrative and summary writing, especially when paired with scaffolding across tasks [34, 35]. Although these studies advanced composition skills, they rarely examined whether gains transferred to other academic or cognitive domains. The next theme focuses on such broader benefits. 3. Broader Academic and Cognitive Benefits This theme captures evidence of cross-domain improvements beyond writing. Two following subthemes emerged. 3.1 Cross-Domain Academic Transfer Educational and hybrid interventions improved mathematics, reading fluency, and dictation accuracy. For example, peer-tutoring enhanced math skills in students with dysgraphia [36], while tele-rehabilitation programs improved both reading and executive functions [37]. 3.2 Enhanced Underlying Cognitive and Perceptual Functions Gamified and cognitive-motor interventions improved visual perception, attention, and motor skills, enabling participants to recognize symbols and improve handwriting accuracy [38] [39]. Despite these wider academic and cognitive benefits, relatively few studies explored emotional, motivational, or behavioral outcomes. These dimensions are covered in the final theme. 4. Positive Affective and Behavioral Outcomes This theme highlights interventions that supported motivation, engagement, and self-efficacy. 4.1 Increased Engagement, Motivation, and Self-Efficacy Physical therapy programs improved fine-motor stamina and reduced dysgraphia severity [40]. Strategy-based approaches enhanced self-efficacy and writing confidence, particularly among girls [38]. Creative and blended learning activities also fostered greater student engagement and enjoyment [41, 42]. These findings emphasize that targeting affective and behavioral aspects is essential to sustaining mechanical, compositional, and academic improvements. The bubble matrix (Figure 6) highlights the uneven distribution of evidence across intervention–outcome domains. It displays the relationship between intervention types (x-axis) and outcome measured (y-axis). The figure demonstrates that most interventions targeted foundational writing mechanics, while few address psychological outcomes or broader academic transfer. Table 1 Themes, Sub-themes, Contributing studies, Types of Interventions Used and Related Outcomes Discussion This review aimed to map existing interventions for different types of dysgraphia and writing disorders. Forty-seven studies met inclusion criteria, reflecting a diverse range of approaches including educational, therapeutic, multisensory approaches, computer based interventions, psychological and combined interventions. Most interventions targeted foundational handwriting mechanics, with fewer addressing higher-order composition and academic outcomes, and only limited attention given to affective and behavioral factors. Below, we synthesize these findings by major themes and subthemes. 1. Improvements in Foundational Writing Mechanics Children with dysgraphia frequently struggle with legibility, letter formation, and transcription accuracy, which compromise both the readability and efficiency of their writing. Twenty-one studies in this review focused on these core mechanics, highlighting promising but often small-scale interventions. The majority of studies emphasized legibility as a primary outcome, addressing important characteristics of dysgraphia-- letter reversals (e.g., confusing b with d, c with e etc.) [71]. Overall, multisensory and technology-assisted interventions consistently enhanced legibility and letter formation , though gains were often constrained by small samples. For instance, app-based tools (e.g., Write-Rite) improved alignment, spacing, and proportion [24], while occupational therapy kits integrating fine motor training with handwriting curricula such as Handwriting Without Tears demonstrated improvements in spacing and spelling [48]. These findings align with broader occupational therapy literature showing that multisensory handwriting programs produce significant improvements in legibility and fluency compared to traditional drill approaches [72]. Larger-scale studies, such as Indira & Vijayan (2015), revealed improvements in legibility were accompanied by increased academic confidence [25], which are consistent with Graham et al.’s (2012) meta-analysis that linked handwriting instruction to gains in both writing performance and motivation [73]. Evidence on writing speed and fluency varied across technology-based supports, including real-time auditory feedback [26], and visual-motor training [56] produced short-term fluency gains, but rarely tested sustainability beyond controlled sessions . Spelling and transcription accuracy received less attention in the reviewed articles, with only isolated findings from computerized writing instruction [ 27 ]. While such programs improved composing fluency, spelling accuracy remained a persistent challenge, which is consistent with research showing that orthographic encoding difficulties in dysgraphia are more resistant to remediation than motor-based impairments [74, 75]. This highlights the need for integrative approaches that couple handwriting fluency training with explicit spelling and orthographic instruction. Taken together, evidence suggests that multisensory and technology-supported approaches are effective in enhancing legibility and speed in the short term , but the field still lacks large-scale, longitudinal, and cross-linguistic trials to determine generalizability. Furthermore, while mechanical improvements are necessary, they may not be sufficient without concurrent support for spelling and higher-order writing [76]. Future studies should therefore integrate handwriting, transcription, and composition interventions within comprehensive writing frameworks to achieve enduring and transferable outcomes. 2. Advancements in Composition and Higher-Order Writing Beyond mechanical handwriting skills, eleven studies in this review focused on composition and higher-order writing processes. These interventions emphasized idea generation, organization, and strategy use, which are often compromised in children with dysgraphia due to the cognitive load imposed by transcription difficulties. This aligns with model of writing, which conceptualizes writing as an interplay of planning, translating, and reviewing processes [77]. Across studies, strategy-based educational interventions consistently improved composition quality and structure. Programs such as Plan It, Write It [58], sentence-combining tasks [31], and Self-Regulated Strategy Development [30] enhanced organization, idea expansion, and structural coherence. These findings resonate with Graham and Perin’s (2007) meta-analysis, which identified strategy instruction as one of the most effective approaches for struggling writers [78]. Interventions aimed at productivity and ideation such as speech-to-text (STT) and text-to-speech (TTS) support demonstrated increased text length, maintained accuracy, and greater punctuation use [32]. However, these studies were limited by very small samples and short intervention periods, consistent with broader concerns in the field that assistive technology such as word prediction and speech recognition can be beneficial for some students, highlighting a need for case studies using tools that fit children’s skills and address their challenges [79]. Similarly, direct instruction techniques [33] improved reading and comprehension skills, reinforcing evidence that targeted writing instruction supports broader writing gains [80]. Finally, evidence on the development of writing strategies and processes showed that computer-based translation training [34] enabled students to use more effective planning and revision strategies. These findings support Berninger et al. (2015), who argued that combining handwriting and spelling instruction with composing practice best predicts long-term writing outcomes [35]. Collectively, the evidence suggests that strategy instruction and assistive technologies are effective in improving higher-order writing outcomes for students with dysgraphia. However, the limited number of studies, small samples, and short intervention spans reduce confidence in the robustness of these findings. Future research should investigate how strategy-based interventions and technology supports can be sustained and generalized to authentic classroom writing tasks, while also testing integration of handwriting fluency and composition instruction in a single framework. 3. Broader Academic and Cognitive Benefits A smaller but notable subset of studies addressed whether interventions for dysgraphia can transfer beyond writing to benefit other academic domains and underlying cognitive functions. This aligns with the notion of “cross-domain academic transfer,” where improvements in one domain (e.g., handwriting fluency) free up cognitive resources for others such as reading and mathematics [81]. Several studies reported cross-domain academic improvements. For example, Rote Practice Technique (RPT) improved mathematical performance among dysgraphia learners [36], while tele-rehabilitation, a hybrid approach using flash cards and dictation interventions enhanced reading fluency and executive functions [37]. These findings consistent to previous research showing that targeted handwriting instruction can indirectly improve reading fluency and spelling in children with learning disorders [75]. Similarly, multimodal, multisensory interventions (Shabeeda, 2024) demonstrated broad benefits in both reading and writing [65]. Evidence for enhanced cognitive and perceptual functions was more limited. Previous study suggests that gamified learning interventions improved visual-perceptual skills and symbol recognition in Persian-speaking students [67]. Such findings are consistent with neurocognitive research indicating that visual-motor integration and working memory are strong predictors of writing performance [82, 83]. However, the extremely small samples (e.g., three participants) restrict generalizability. Overall, this body of evidence suggests that dysgraphia interventions can yield secondary gains in reading, mathematics, and cognitive-perceptual domains, but research remains fragmented and preliminary. More rigorous longitudinal designs are required to clarify whether these benefits reflect genuine transfer effects or are limited to overlapping skill domains (e.g., phonological processing supporting both spelling and reading). 4. Positive Affective and Behavioral Outcomes A final theme emerging from the review was the psychological and behavioral impact of interventions, particularly in relation to motivation, engagement, and self-efficacy. Although fewer studies addressed these outcomes directly, their inclusion is critical since motivational factors strongly mediate persistence and long-term success in writing [84]. Findings suggested that increased engagement and self-confidence often accompanied handwriting and strategy instruction. For instance, Balint (2015) reported that children receiving individualized physical therapy showed improved stamina and motor skills, but also greater willingness to participate in learning activities [40]. Similarly, Garcia & Fidalgo (2008) found that Self-Regulated Strategy Development and Social Cognitive models enhanced self-efficacy and engagement, particularly among girls [38]. These results are consistent with the broader literature, where SRSD has been shown to improve not only writing outcomes but also motivation and self-regulation [85]. However, evidence in this area remains limited and uneven. Most interventions were small-scale and did not systematically measure psychological outcomes as primary endpoints. This mirrors a broader gap in dysgraphia research, where affective variables such as writing anxiety, self-efficacy, and motivation are often neglected despite their strong influence on academic persistence [86]. In summary, while preliminary evidence indicates that dysgraphia interventions may foster positive emotional and behavioral outcomes, this remains an underexplored area. Future work should integrate standardized measures of engagement and self-efficacy into intervention studies, ensuring that affective outcomes are given equal weight alongside mechanical and cognitive measures of writing. This scoping review highlights that most interventions for dysgraphia focus on handwriting mechanics, with fewer addressing higher-order writing processes, broader academic skills, or affective outcomes. Evidence suggests that multisensory and strategy-based approaches are promising, yet studies are limited by small samples, short durations, and inconsistent reporting of dysgraphia subtypes. To advance the field, future research should employ rigorous, longitudinal, and culturally sensitive designs that integrate mechanical, cognitive, and motivational supports. Strengthening both methodological quality and practical applicability will be essential to inform educators, therapists, and policymakers working with children with dysgraphia. This review highlighted that large scale studies on dysgraphia interventions are scarce. There is a dire need to design interventions for a large scale multimodal intervention design across settings to generalize the study findings. Interventions lack addressing different types of dysgraphia with their intended aim addressing a core issue and resolving overall writing difficulties. A large scale study could be designed using multi modalities to address different types of dysgraphia. Limitations & Future Recommendations This scoping review mapped existing interventions for dysgraphia and synthesized their outcomes, still here exist several limitations. Each of these is discussed with future recommendations. Few databases were accessed for retrieving articles due to limited access. For future studies other databases (such as Medline, Scopus, etc.) should be approached for inclusion of studies from broader literature. This review addressed articles using interventions for dysgraphia, comorbid conditions were excluded such as writing difficulties due to acquired neurological conditions. Future studies could be designed considering developmental and acquired dysgraphia with focus on cross comparison. Further reviews (systematic/scoping) could be planned to address facilitators and barriers practitioners may encounter while tackling children with dysgraphia. This review was restricted to articles in English language, while the articles published in other languages were excluded. Future studies should be designed with a specific focus on using translating strategy for the articles in other languages. Declarations Author Contributions: MA has contributed in the concept of the study. MA and MAP have designed the study and coordinated with the research team. SP supervised the research project. MA, MAP, SAJ, US, & SA were involved in screening, and extraction of the data, and contributed in the write up of the manuscript. MA analyzed the data and performed Thematic Analysis. SP & MAP reviewed the manuscript and gave final approval. All authors approved the final version to be published. Availability of Supporting Data: ExtractedData is publically available on https://10.6084/m9.figshare.30476990. 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Self-Efficacy Beliefs, Motivation, and Achievement in Writing: A Review of the Literature. Reading &Writing Quarterly. 2000;19. Table Table 1 Themes, Sub-themes, Contributing studies, Types of Interventions Used and Related Outcomes Themes Subthemes Contributing studies Type of Intervention used Outcome of the study Improvements in Foundational Writing Mechanics Enhanced legibility and letter formation. Karimi Thani, 2022 [43] Group 1: Multi-sensory Intervention; Group 2: educational games Fernald’s multisensory educational method and educational games both reduced writing disorder compared to control. Fernald’s multisensory method had the greatest effect. Husni, 2022 [24] Assistive technology All criteria in the HLS improved significantly. Global legibility: 32% to 92%. Effort to read: 36% to 92%. Layout: 36% to 96%. Letter formation: 20% to 96%. Alteration: 52% to 100%. Darweesh, 2020 [44] Multisensory Educational Intervention Statistically significant improvement in handwriting scores and subtests (handwriting, fine motor, perceptual-motor) on the Dysgraphia Disability Scale. Ariyo, 2024 [45] Physical (hand exercises, play therapy) Significant main effect of hand exercise on handwriting legibility; no significant effect of gender or self-esteem; no significant interaction effects. John, 2018 [46] Assistive technology (iPad app, therapeutic hand exercises), educational Significant improvement in handwriting legibility and speed post-intervention; all measured parameters improved (letter formation, letter size, spacing, missing letters, handwriting speed). Indira, 2015 [25] Educational, multisensory, fine motor and writing-based intervention Significant improvement in handwriting skills (legibility, letter size, punctuation, spelling, written expression); greater academic achievement, improved confidence and behavior in experimental group; control group no significant change Raji, 2024 [47] Cognitive-behavioral intervention (attention training) Experimental group showed significant improvement in handwriting legibility, spelling accuracy, and organization of written expression compared to the control group; enhanced reading comprehension and mathematics performance. Verma, 2019 [48] Educational, physical, multisensory, fine-motor, handwriting curriculum (Handwriting Without Tears, HWT) OTK improved memory, placement, sentence formation, letter and word spacing (P<0.05 for main variables). Boys had more gains in memory, sequence, lowercase formation. Grade 4: word and capital cursive improved. Mehta, 2019 [49] Educational, perceptual-motor, visual-perceptual, individualized training Statistically significant improvement in all measures except far-point copying speed. TLL improved from 73.7% to 92.3%; TWL from 57.2% to 86.1%; NPS from 29.5 to 45.7 letters/min; all TVPS-3 subtests improved. Rahim, 2019 [50] Assistive technology, educational (tablet, app, tracing, visual-motor practice) Marked improvement in letter formation, slant, size/proportion, alignment, spacing, and line quality. Pre: scores 1-2 (poor/weak); post: scores 3-5 (satisfactory to outstanding) for all six characteristics. Rahim, 2025 [51] Assistive technology, educational (app, tracing, animation, repetition) Four of five students scored 5, one scored 4 in letter formation (post), compared to all scoring 1 (pre); students showed consistent improvement, more organized, confident, and error-free handwriting Increased Writing Speed and Fluency Datchuk, 2017 [52] Educational The intervention improved construction of simple sentences and word sequences per 1 min. Results across participants suggest a functional relation between the intervention and dependent measures observed on sentence construction probes. Tobolcea, 2010 [53] Computer-based speech therapy, computer-based exercises for dysgraphia-dyslexia The difference between the two means is statistically significant t(53) = -6,29; p < 0,01; therefore, the performance in sentence writing/reading for the children from the group that used the computer is significantly better than in the case of patients who followed the classical treatment. Tanimoto, 2015 (54] Computerized reading and writing instruction Significant improvement for the whole sample of SLDs in subword handwriting level skills, word level reading and spelling skills, and syntax level reading and writing skills. Group B showed more treatment effects and stronger effect sizes than Group A. Pankey, 2022 (55] Educational and Physical Analysis of the quantitative data indicated varying gains and losses in writing fluency but an overall favorable perception of the intervention. The participants responded positively to approximately 78.13% of the Likert scale statements. Content analysis of the open-ended questions indicated that the participants perceived the intervention as an aid to their ability to compose written text. While not every participant experienced an increase in both copying and composing fluency, the intervention did produce some increases for two participants. Danna, 2013 [26] Assistive technology (real-time auditory feedback) Improved movement time and fluency within and across sessions (loops and sentence). Handwriting legibility and speed on BHK greater after four weeks of rehabilitation. Beers, 2018 [27] Educational (computerized), assistive technology, handwriting, spelling, and composing instruction Significant improvement in composing fluency (words/minute), fewer pauses, shorter total time; dysgraphia group normalized on keyboarding; dyslexia group continued to differ from controls in spelling/keyboard measures post-intervention. Poon, 2010 [56] Assistive technology, educational, visual perception and visual-motor integration training, games Experimental group: improved visual perception (MVPT), reduced “On Paper” and “In Air” time; no significant difference in VMI or legibility; controls showed no significant change. Reduced Spelling and Transcription Errors Hashemabadi, 2024 [57] Educational following the implementation of the educational-therapeutic protocol for dysgraphia, spelling errors decreased by 74%, visual memory errors by 72%, visual accuracy by 81%, auditory accuracy by 58%, and educational errors by 37.5%. The participant did not exhibit any errors related to mirror writing, auditory memory, or visual sequential memory in any of the tests. Akhavan Tafti, 2014 [28] Educational, multisensory (visual/auditory, kinesthetic, and tactile (VAKT)), relaxation (progressive muscle, deep breathing) Significant decrease in spelling errors and anxiety in intervention group (not in control); changes visible in graphs and mean values. Khaledi, 2014 [29] Play therapy, educational games, Experimental group: spelling errors dropped from mean 14.66 to 3.33; control group: no significant change (20.86 to 20.66). Mean difference between pre-post experimental and control: 4.6 (t=7.042, p=0.002). Advancements in Composition and Higher-Order Writing Improved Composition Quality and Structure Levy, 2019 [58] Educational (scripted small-group writing intervention) Students’ writing quality and production improved; story elements inconsistently improved; CBM-WE (TWW, WSC, CWS) unchanged; high fidelity by interventionists; promising social validity. Walter, 2021 [31] Educational The SC intervention group made significant gains, with moderate to large effect sizes, in comparison to the MS and WLC groups, on the WIAT-II sentence combining task at t2. Differences between the SC and WLC groups were maintained at t3. Therrien, 2009 [59] Educational (strategy instruction; 6-step essay writing approach) Intervention group scored higher than control on strategy use (2.73 vs. 0.74, p<.0001, ES=1.69); and on ideas/content and organization (4.19 vs. 3.26, p=.024, ES=0.68). No sig. diff. to nondisabled students on these traits. Lane, 2011 [30] Educational (strategy instruction, self-regulation, genre-specific and general writing strategies) SRSD students had significantly higher scores on writing quality, structural elements, and engagement during writing (opinion essays), compared to control. Transfer to behavior and generalization effects were limited. Eslamian, 2023 [60] Educational (task-oriented teaching) Task-oriented teaching significantly improved reading and writing scores vs. control. Öğülmüş, 2021 [61] Educational, strategy-based, parent-implemented, SRSDM-based All three children met performance criterion for story-writing skill; skills maintained after 5 weeks. High parent fidelity (83.68–100%). Positive feedback from mothers and children. Dunn, 2013 [62] Educational, strategy-based, art-integrated, SRSD All students demonstrated rapid and stable improvement in story content (WWW, W D2, H D2 scores); all attained perfect scores in final intervention probes. Story quality improved for all; number of words written also improved for two students. Gains in Productivity & Ideation Almgren back 2024 [32] Assistive technology, educational, speech-to-text and text-to-speech training Seven of eight increased productivity; most maintained/improved accuracy; text quality (vocabulary diversity, word length) improved in most; some varied patterns; STT supported longer, more meaningful texts; individualized responses noted. Alanazi, 2017 [33] Educational (flashcards, Direct Intervention technique) Significant improvement in reading/writing skills for intervention group vs. control. ANCOVA: F (1,38)=22.03, p<0.001 for writing; similar effects for reading, identification, fluency, and comprehension. Development of Writing Strategies and Processes Berninger, 2015[35] Educational (computerized), assistive technology, handwriting, spelling, and composing instruction Cursive mode consistently predicted spelling/composing; keyboarding positively predicted composing in upper grades; SLD groups impaired on manuscript mode, copying fast, and timed composing; all letter production/selection modes correlated with writing outcomes. Niedo, 2016 [34] Computerized instruction The computer taught translation strategies, based on what typically developing writers used in their writing, were used in integrated reading-writing tasks and integrated listening-writing tasks by students with SLDs in transcription. Level I and Level II strategies were used across all writing tasks, but more so in personal narratives than writing summaries, and more so in summaries when the source material was read rather than heard. Broader Academic and Cognitive Benefits Cross-Domain Academic Transfer Umar, 2024 [36] Educational (peer-tutoring, conventional instruction) RPT significantly improves the academic performance of students with dysgraphia, irrespective of gender. Changizi, 2022 [63] Physical (balance/motor exercises) Experimental group showed significant improvements vs. control in dyscalculia and dysgraphia. Changizi, 2022 [64] Physical (proprioception/motor exercises) Significant improvement in dyslexia and dysgraphia for experimental vs. control (ANCOVA, p<0.01); mean post-test dysgraphia: experimental 77.83±15.89, control 60.93±19.36. Shabeeda, 2024 [65] Multisensory, educational, physical, cognitive All students showed significant improvement in their reading and writing abilities. Notable improvement observed in the development of reading and language skill. Boosted children’s confidence and self-esteem. Capodieci, 2023 [37] Assistive technology, educational, cognitive training (executive functions, reading, writing) Improved reading fluency (syll/sec), fewer errors in text dictation, increased executive function scores (Flanker test), effect sizes greater in intervention than waiting list group Enhanced Underlying Cognitive and Perceptual Functions Yanjana, 2020 [66] Behavioral The results in behavioural problems show a significant decrease in post-intervention for the experimental group. The mean of post-intervention behavioural problems score was lower than the mean of pre-intervention behavioural problems scores. The results in the total LD score show a significant increase in post-intervention for the experimental group. The mean of post-intervention total LD scores was slightly higher than the mean of pre-intervention total LD scores. The results in the total LD score show a significant increase in post-intervention for the experimental group. The mean of post-intervention total LD scores was slightly higher than the mean of pre-intervention total LD scores. But, the results in figure-ground perception, figure constancy, position-in-space, spatial relations, auditory perception, cognitive abilities, memory, receptive language, expressive language and intelligence showed a small non-significant change on post-intervention for the experimental group. The results in eye-hand coordination show a significant increase in post-intervention for the experimental group. The mean rank of post-intervention eye-hand coordination scores was higher than the mean rank of pre-intervention eye-hand coordination scores. Ashiani, 2014 [26] Cognitive-motor training (gross and fine motor, visual-motor, auditory-motor, visual control, shape recognition) Significant improvement in motor-writing skills for intervention group (P<0.001); no difference by age or gender; control group showed no improvement. Abbaszade Rougoushoee, 2024 [67] Educational, assistive technology (gamified, tablet-based, interactive game mechanics) All students improved in visual perception and dictation; all could independently write and recognize Persian symbols post-intervention. RCI for all measures >1.96; improvement % mostly >50%. Positive Affective and Behavioral Outcomes Increased Engagement, Motivation, and Self-Efficacy Borghese, 2017 [68] Mobile Gaming App The use of a digital device and exergames has recieved very positive feedback from children. Paler, 2024 [42] Educational- Structured practice with creative expression The overall engagement score increased from “2.37” (Low) in the pre-test to “3.90” (High) in the post-test. There is a significant difference between the pre-test and post-test. Njock, 2024 [41] Educational (blended learning: traditional + online/digital activities) Blended learning is an effective teaching strategy for improving writing skills among students with dysgraphia; effectiveness transcends gender. No significant interaction effect of method and gender on essay writing achievement. Balint, 2015 [40] Physical (physical therapy – massage, proprioceptive facilitation, active exercises, games) 6 children with dysgraphia: 2 mild, 2 medium, 2 severe. After intervention, 4/6 did not have motor dysgraphia anymore, 2 improved to milder type. All improved in endurance/strength and fine motor skills/perception. Anggriawan, 2018 [69] Educational, game-based (crossword puzzle) Improved reading and writing scores in experimental group post-intervention; significant difference compared to control group; positive student feedback. Azimi, 2014 [70] Assistive technology, educational multimedia, interactive software Significant improvement in dysgraphia scores in experimental group vs. control (pretest-posttest, Wilcoxon and Mann-Whitney U tests). García, 2008 [38] Educational, cognitive and self-regulation strategies Girls in experimental groups (SRSD, SCM) showed greater gains in self-efficacy, productivity (words), relational coherence, structure, and all reader-based measures vs. comparison. Boys: only number of words predicted by self-efficacy, with weak effect. Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryAppendix1Dysgraphia.docx Search Strategy Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":45846,"visible":true,"origin":"","legend":"\u003cp\u003eCodes of Extracted data from outcomes of two studies\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/c62652b76de8ba39b0840532.png"},{"id":99191560,"identity":"58148d1f-a395-4f7d-98d3-809711c18f26","added_by":"auto","created_at":"2025-12-30 00:56:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":67953,"visible":true,"origin":"","legend":"\u003cp\u003eInitial Thematic Map\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/e24f302fef9a8312715b04bf.png"},{"id":99191559,"identity":"adf55210-83dc-4d8b-9164-95ae16b54b02","added_by":"auto","created_at":"2025-12-30 00:56:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":62362,"visible":true,"origin":"","legend":"\u003cp\u003eFinal Thematic Map\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/f8676d6d8e0268e61376d657.png"},{"id":99316476,"identity":"fce5c1c0-6e5b-4858-921a-f4bb7bc6ae38","added_by":"auto","created_at":"2025-12-31 16:28:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":69350,"visible":true,"origin":"","legend":"\u003cp\u003eTypes and subtypes of interventions identified for dysgraphia.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/d9539c3d233b66e112542cf4.png"},{"id":99191562,"identity":"dfed7dd8-3bfe-403d-94d4-cc454f58573d","added_by":"auto","created_at":"2025-12-30 00:56:03","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":116881,"visible":true,"origin":"","legend":"\u003cp\u003eMapping of Dysgraphia Interventions against Reported Outcomes\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/8b1ddb6881430a40a61ead05.png"},{"id":99323686,"identity":"cf444f0c-f787-447a-8a26-847f7679963d","added_by":"auto","created_at":"2025-12-31 16:45:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1838825,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/6aad0db0-ba84-4ff1-8681-6f8a90e6fc60.pdf"},{"id":99191554,"identity":"818ca91f-1ce4-480a-b299-2bb2973a76fd","added_by":"auto","created_at":"2025-12-30 00:56:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15165,"visible":true,"origin":"","legend":"\u003cp\u003eSearch Strategy\u003c/p\u003e","description":"","filename":"SupplementaryAppendix1Dysgraphia.docx","url":"https://assets-eu.researchsquare.com/files/rs-8417573/v1/80598d2bdd7f240e025e2231.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eExisting Interventions for the Management of Different Types of Dysgraphia or Specific Learning Disorder in written expression: A Scoping Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Strengths \u0026 Limitations","content":"\u003cul\u003e\n \u003cli\u003eFew Databases were accessed due to limited access.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThis review addressed articles using interventions for dysgraphia, comorbid conditions were excluded such as writing difficulties due to acquired neurological conditions.\u003c/li\u003e\n \u003cli\u003eThis review was restricted to articles in English language only.\u003c/li\u003e\n \u003cli\u003eStart of 21\u003csup\u003est\u003c/sup\u003e Century is the era of mass adoption of technology and computer use so studies included from Jan, 2000 to June, 2025.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eDysgraphia is a neurodevelopmental condition that is classified as a specific learning disorder (SLD) and manifests through persistent and severe difficulties in written expression skills [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is not classified as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) but rather as Specific Learning Disability (SLD) with impairment in written expression [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Dysgraphia is evident through handwriting fluency, automatic letter formation, orthographic accuracy, fine-motor coordination, writing speed, and compositional aspects of written text [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. An estimated prevalence between 7 to 15 per cent of the school aged population, dysgraphia poses a significant challenge both on the educational and clinical front [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It has traditionally been conceptualised by Deuels (1995) taxonomy that proposes three major subtypes: dyslexic dysgraphia (combined with deficits in linguistic processing), spatial dysgraphia (combined with visual-spatial integration impairments), and motor dysgraphia (combined with fine-motor and kinesthetic impairments) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This classification continues to inform contemporary research and diagnostic practices to this day. Another distinction between its types is between acquired dysgraphia, which occurs after a neurological event such as traumatic brain injury or neurodegenerative disease, and developmental dysgraphia, which occurs in early childhood during the early stages of writing acquisition, even in individuals with normative intellectual function and adequate learning opportunities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consequences of dysgraphia extend beyond just handwriting challenges. Handwriting is one of the foundational academic skills by which students can display their knowledge, fulfil their assignments, and engage in self-expression throughout their school life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Consequently, the condition directly disrupts academic achievement in virtually all areas of subject matter, creating a debilitating gap between a student's cognitive capabilities and their written performance [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The psychosocial effects are also equally serious and in some cases, devastating. A meta-analysis by Kavale and Forness (1996) found that about 75 per cent of specific learning disorder (such as dysgraphia) students have serious deficiencies in social skills as compared to their peers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Dysgraphic children always complain of their poor academic performance, increased anxiety levels when they are engaged in writing activities, and poor self-esteem [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Such a negative self-perception creates a vicious cycle, which makes them less willing to practise writing. If not diagnosed and treated at early stages, dysgraphia may negatively impact children\u0026rsquo;s ability to learn academic skills, their emotional wellbeing, and vocational prospects later in life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This calls for an urgent need for early diagnosis and implementation of evidence-based rehabilitation strategies.\u003c/p\u003e \u003cp\u003eThe landscape of interventions for dysgraphia has been dynamically evolved over the last 20 years, shifting towards a more balanced, innovative, technologically-advanced, and comprehensive approach. Han and Wang (2025) outline that technology-assisted interventions, such as special software, online handwriting applications, and real-time biofeedback systems, are the leading interventions, with their benefits in user engagement and measurable improvement of skills [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. One of the most prominent frameworks of conceptualising support in school settings divides the interventions into three levels: (I) Accommodation, where the student receives the mainstream curricula, with the help of supportive aids (e.g., speech-to-text software, graphics organisers), without modifying the instructional content; (II) Modification, where the institution changes the learning goals and objectives of the student; and (III) Remediation, where interventions are aimed at directly alleviating the underlying deficiencies of the disability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis global landscape is marked by high heterogeneity in dysgraphia interventions that are mostly associated with the variability in economic resources and healthcare infrastructure. Research in high income countries often examines specialised, resource-intensive interventions. For example, Psychomotor Therapy (PMT) is a popular treatment in Switzerland, although the empirical data show a statistically significant effect of PMT on fine motor proficiency of children during a five-month period, the treatment does not have similar effects on handwriting consistency and fluency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, a study from France suggests a trans-disciplinary paradigm, demonstrating that children with dysgraphia have a heterogeneous spectrum of comorbid functional impairment, including oculomotor and neuropsychomotor impairments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, interventions in Low and Middle Income Countries (LMICs) identify significant systemic failures. For instance, Maulik and Darmstadt (2007) emphasize that research on childhood disability in LMICs is pathetically inadequate; especially those investigated specific intervention and service utilisation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This research gap highlights that the priority of research on childhood disability is often on overcoming the challenges in identification and allocation of resources. The urgency is further supported by a systematic review that assessed the intervention to improve the educational results of individuals with disabilities in LMICs. The review found that the available evidence base is mostly of individual-level interventions that aim to improve functioning, skills, and competencies of a child lacks research on systemic or school based interventions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, the review found most studies on this subject have a low level of confidence due to their methodological limitation, where specific disabilities such as dysgraphia are included in broader categories of rather than an individual focus.\u003c/p\u003e \u003cp\u003eAlthough the evidence suggests that dysgraphia is prevalent in LMICs. For instance, a survey of school children carried out in Lahore, Pakistan, revealed high rates of SLD, especially in individuals with writing difficulties but the authors noted that prevalence estimates are not consistent in various settings [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, an experimental study was conducted in Khyber Pakhtunkhwa, Pakistan, to explore how effective fine-motor skills interventions are in enhancing the handwriting performance among both low and high achievers, and demonstrated that the effectiveness of group-based motor training in classroom settings [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This variation in the interventions in different economic settings establishes a notable disparity in equitable development, dissemination, and appraisal of evidence-based interventions for dysgraphia at the global front.\u003c/p\u003e \u003cp\u003eThe existing body of literature suggests that interventions for dysgraphia have been addressed in a chaotic manner and leaving a clear gap in mapping specific interventions. For example, an earlier scoping review by Kalenjuk et al. (2022) explored the perspectives of children, parents, and teachers on dysgraphia but did not synthesise the evidence on types of intervention [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Likewise, Bonneton-Bott\u0026eacute; et al. (2023) and Blanchet et al. (2022) provided insights regarding general handwriting therapy and motor deficits in people with SLD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but lacked explicit focus on dysgraphia, limiting generalisation of their findings Recently, Fajariani et al. (2025) examined moderating factors and contextual influences on handwriting improvement but lacked a categorisation of intervention strategies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The literature on dysgraphia interventions represents a high degree of heterogeneity in methodologies, participant groups, intervention types, and reported outcomes. Thus, it makes it challenging to conduct a systematic review and meta-analysis intended to gauge the effectiveness of interventions for dysgraphia. Therefore, the most suitable methodological option in this case is a scoping review, which allows mapping and categorising of interventions in this wide and multifaceted body of literature. The scoping review will be the first to provide a comprehensive synthesis of interventions of studies published between 2000 and 2025 explicitly designed in geographical settings, such as low and high income countries, heterogeneous groups of participants, and diverse ways of delivery. This review aims to contribute to the existing evidence base and identifies critical gaps, such as the lack of focus on affective outcomes and long-term transfer effects. The results will give comprehensive and practical recommendations on future research and practice.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe review was conducted using a scoping methodology, which was most suitable for mapping the wide range of interventions applied to dysgraphia and written expression difficulties. The framework of Arksey and O\u0026rsquo;Malley (2005) provided the foundation, while the refinements proposed by the Joanna Briggs Institute (JBI, 2020) were followed to ensure a systematic and transparent process) [19, 20]. The JBI approach emphasized structured data charting and allowed interventions to be grouped by theoretical orientation (e.g., motor-based, linguistic, or technological). Reporting adhered to the PRISMA extension for scoping reviews (PRISMA-ScR) [21]. A detailed protocol was developed before initiating the search and was made publicly available and revised prior to data charting on the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/D27AP ). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies were considered suitable for inclusion if they examined children or adolescents who were identified as to have dysgraphia or related written expression difficulties, and if they described an intervention designed to address these challenges. Both educational and therapeutic approaches were accepted, along with technology-assisted and behavioral programs. Empirical evidence in multiple formats, quantitative, qualitative, and mixed-methods, was included, provided it contained clear descriptions of intervention procedures and outcomes. Publications were restricted to English-language studies from Jan, 2000 to June, 2025. Studies conducted in schools, clinical services, rehabilitation centers, or home settings were all eligible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies with following features were excluded:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFocused only on other conditions (e.g., dyslexia without a dysgraphia component, ADHD, autism spectrum disorders, motor-coordination disorder).\u003c/li\u003e\n \u003cli\u003eReported diagnostic approaches or theoretical discussions without testing interventions.\u003c/li\u003e\n \u003cli\u003eConsisted of commentaries, editorials, or opinion-based pieces.\u003c/li\u003e\n \u003cli\u003eAddressed workplace interventions unrelated to learning disabilities.\u003c/li\u003e\n \u003cli\u003ePublished before 2000.\u003c/li\u003e\n \u003cli\u003eWritten in languages other than English, where no reliable translation was available.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInformation Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe evidence base was drawn from several bibliographic databases to capture a wide range of perspectives. Searches were performed in PubMed, Europe PubMed Central (Euro PMC), Directory of Open Access Journals (DOAJ), ScienceDirect, EBSCO, Cochrane, and Google Scholar. The decision to use these databases was guided by their coverage of both health sciences and education research, which are central to interventions for learning disorders. The search covered the period from Jan, 2000 to June, 2025. To supplement electronic searches, the reference lists of relevant articles and reports were also screened for additional studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive search was carried out in PubMed, Europe PMC, ScienceDirect, DOAJ, Google Scholar, and the Cochrane Library for studies published between 1 January 2000 and 30 June 2025. Search strategies combined controlled vocabulary (e.g., MeSH) and free-text terms relating to \u003cem\u003edysgraphia\u003c/em\u003e\u003cem\u003e, \u003cem\u003einterventions\u003c/em\u003e, and \u003cem\u003echild/adolescent populations\u003c/em\u003e\u003c/em\u003e. Filters were applied for English-language articles, participants aged \u0026le;18 years, and study types (e.g., clinical trials, randomized controlled trials, where available). Database-specific strategies were developed and adapted to indexing terms and functionalities. The full search strings for each database are provided in \u003cstrong\u003eSupplementary Appendix 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eSupplementary Appendix 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSearch Strategy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll search results were imported into Rayyan web app [22], which facilitated screening and comparison. Duplicate studies were removed. MA and another independent reviewer (MAP, US, SA, or SAJ) examined titles and abstracts to identify potential inclusions. Discrepancies were resolved among reviewers. Full texts of the included articles were retrieved and imported to Rayyan web app [22]. Two independent reviewers i.e. MA and another independent reviewer (MAP, US, SA, or SAJ) assessed against the eligibility criteria. When discrepancies occurred, they were first discussed between reviewers, and if consensus was not reached, a third reviewer was consulted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe full process of identification, screening, and final selection was documented and later summarized in a PRISMA-ScR flow diagram (Fig.1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Charting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo capture essential study information in a consistent way, a data charting form was designed in MS Excel. Before its use, the form was tested with a small number of studies (i.e. three) to ensure clarity. The form was completed independently by two reviewers to minimize bias. Extracted information included bibliographic details, study design, participant characteristics, intervention type, frequency and duration, outcomes, and contextual information such as whether the program was delivered at school, clinic, or home were charted to give insight into acceptability and feasibility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Items\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe charting process focused on a core set of items:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eStudy characteristics:\u003c/strong\u003e author, publication year, and country.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDesign:\u003c/strong\u003e quantitative, qualitative, or mixed-methods.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePopulation:\u003c/strong\u003e age group, diagnostic confirmation of dysgraphia or related written expression disorder.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInterventions:\u003c/strong\u003e type, theoretical basis, duration, and delivery format.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOutcomes:\u003c/strong\u003e measures of writing fluency, legibility, motor coordination, or participant experiences.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eContext:\u003c/strong\u003e setting of the intervention (school, clinic, rehabilitation center, home).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCritical Appraisal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsistent with JBI\u0026rsquo;s methodological guidance for scoping reviews, no formal critical appraisal of included studies was conducted. As the objective was to map available interventions rather than evaluate effectiveness or risk of bias, quality assessment was not considered appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCollating, Summarizing, and Reporting the Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo Independent reviewers i.e. MA and MAP reviewed all the charted data of the included studies and synthesized the extracted information descriptively. Studies were grouped by intervention (e.g. educational, therapeutic etc.) and their outcomes (e.g. improvement in handwriting legibility, higher order cognitive functions etc.). Extracted data made publically available on https://10.6084/m9.figshare.30476990. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing the Braun \u0026amp; Clarke (2006) framework, thematic analysis was conducted [23]. Initial codes were generated using manual color coding. Figure 2 shows codes of extracted findings from two studies. Codes were then collated and organized into sub-themes and themes (Figure 3). Prominent subthemes and themes were discussed with two reviewers (SP, and MAP) and reached to a consensus of final subthemes and themes (Figure 4).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of the Included Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 47 articles met the inclusion criteria (January 2000\u0026ndash;June 2025). Relevant studies were identified beginning in 2008, with the highest number published in 2024 (n = 10). Five studies were published in 2014 and 2022, four in 2019, three in 2015, 2017, and 2018, and one or two in other years; no studies were published in 2012.\u003c/p\u003e\n\u003cp\u003eGeographically, 24 studies were conducted in Asian countries (primarily Iran and India), 10 in the United States, and 8 in European countries, 4 in African countries, and 1 in an Arab country. Sample sizes ranged from a single case to 154 participants; 26 studies included \u0026le;30 participants, while 21 involved \u0026gt;30 participants. Participants\u0026rsquo; ages ranged between 5 and 19 years.\u003c/p\u003e\n\u003cp\u003eMost studies employed experimental (n = 41) or quasi-experimental (n = 6) designs. Forty-two were quantitative, four used mixed methods, and one was observational. Interventions included educational (n = 23), assistive technology (n = 9), physical (n = 5), multisensory (n = 4), computerized (n = 3), and psychological approaches (n = 3; including behavioral, cognitive-behavioral, and cognitive-motor). Fourteen studies focused specifically on dyslexic dysgraphia, nine on motor dysgraphia, three on dysgraphia with dyscalculia, and one on spatial dysgraphia; the remainder did not specify the type.\u003c/p\u003e\n\u003cp\u003eMode of delivery was predominantly face-to-face (n = 38). Three studies used hybrid approaches, one was fully online, and five did not report. Interventions were delivered mainly in schools (n = 27), followed by learning disability centers or private clinics (n = 11), university research centers (n = 2), and homes (n = 3); four studies did not specify the setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions Map\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross 47 studies, 6 types of interventions identified to address handwriting difficulty: Educational, Psychological, Therapeutic, technology based interventions, multisensory, and Combined/multimodal Approaches. Educational interventions (n = 13) primarily focused on structured writing instruction, sentence combining interventions, rote learning practice, ART (Ask, Reflect, Text) strategy, task-oriented teaching and self-regulated strategy development to improve writing accuracy and fluency. Computer-based programs were the most frequently reported (n = 15), utilizing computerized reading/writing and translation strategy, computerized visual perception training, software, and assistive technologies designed to enhance handwriting performance, provide feedback, or support practice through interactive learning tools. Psychological interventions (n = 4) employing cognitive motor exercises, cross-word puzzle games, and social cognitive model to address cognitive and perceptual functions of children with dysgraphia, and engagement, motivation, and self-efficacy enhancement.\u003c/p\u003e\n\u003cp\u003eTherapeutic interventions (n = 7) concentrated on fine and gross motor exercises, visual\u0026ndash;motor integration, and proprioception exercises to strengthen the physical components of handwriting. Multisensory approaches (n = 2) engaged multiple sensory components\u0026mdash;visual, auditory, tactile, and kinesthetic\u0026mdash;to reinforce letter formation and fine motor and perceptual motor skills through experiential learning activities. Combined or multimodal interventions (n = 6) integrated features from two or more categories, such as pairing educational and therapeutic interventions, or combining multisensory and educational elements, reflecting a growing preference for holistic approaches.\u003c/p\u003e\n\u003cp\u003eOverall, the distribution of intervention types indicates a predominant reliance on educational and technology-based methods, with increasing attention to integrative and therapeutic models that address the multifaceted nature of dysgraphia. Fig. 5 illustrates the range of interventions identified in the scoping review. It highlights the breadth of intervention strategies currently described in the literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThematic Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis was conducted to analyze the outcomes of different interventions of dysgraphia. Four themes were emerged (e.g. Improvements in Foundational Writing Mechanics, Advancements in Composition and Higher-Order Writing, Broader Academic and Cognitive Benefits, Positive Affective and Behavioral Outcomes). All themes, sub-themes, their contributing studies, types of interventions used and related outcomes are presented in Table 1: Each of these themes with respected subthemes is linked with types of interventions and are discussed below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Improvements in Foundational Writing Mechanics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme reflects interventions targeting the sensorimotor and transcription foundations of handwriting, including legibility, fluency, and spelling accuracy. Three subthemes were identified:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 Enhanced Legibility and Letter Formation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultisensory, educational, physical, and assistive technology interventions consistently improved clarity of handwriting, including letter size, spacing, and alignment. For instance, assistive technology applications improved global legibility scores in small samples [24], while large-scale physical and educational programs led to both handwriting and academic improvements [25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Increased Writing Speed and Fluency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReal-time auditory feedback (sonification), 26] and computerized instruction [27] enhanced writing fluency and reduced pauses without compromising legibility. Educational approaches also improved sentence construction and speed, though effects varied across participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Reduced Spelling and Transcription Errors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultisensory and play-based approaches reduced spelling mistakes, visual memory errors, and dictation problems, while also lowering anxiety and improving self-confidence [28, 29]\u003c/p\u003e\n\u003cp\u003eWhile these interventions strengthened handwriting mechanics, they provided limited insights into higher-order composition and idea generation. The next theme addresses these broader writing skills.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Advancements in Composition and Higher-Order Writing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme highlights interventions that enhanced text quality, productivity, and strategic writing skills. Three subthemes were as follows.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Improved Composition Quality and Structure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStrategy-focused interventions such as Self-Regulated Strategy Development and sentence-combining programs improved organization, coherence, and writing quality among children with dysgraphia [30, 31].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Gains in Productivity and Ideation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssistive technologies like speech-to-text supported students in producing longer, more meaningful texts with improved accuracy [32]. Direct instruction methods also improved fluency and comprehension [33].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Development of Writing Strategies and Processes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComputerized translation and planning strategies helped students strengthen narrative and summary writing, especially when paired with scaffolding across tasks [34, 35]. Although these studies advanced composition skills, they rarely examined whether gains transferred to other academic or cognitive domains. The next theme focuses on such broader benefits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Broader Academic and Cognitive Benefits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme captures evidence of cross-domain improvements beyond writing. Two following subthemes emerged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Cross-Domain Academic Transfer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEducational and hybrid interventions improved mathematics, reading fluency, and dictation accuracy. For example, peer-tutoring enhanced math skills in students with dysgraphia [36], while tele-rehabilitation programs improved both reading and executive functions [37].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Enhanced Underlying Cognitive and Perceptual Functions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGamified and cognitive-motor interventions improved visual perception, attention, and motor skills, enabling participants to recognize symbols and improve handwriting accuracy [38] [39]. Despite these wider academic and cognitive benefits, relatively few studies explored emotional, motivational, or behavioral outcomes. These dimensions are covered in the final theme.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Positive Affective and Behavioral Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme highlights interventions that supported motivation, engagement, and self-efficacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Increased Engagement, Motivation, and Self-Efficacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical therapy programs improved fine-motor stamina and reduced dysgraphia severity [40]. Strategy-based approaches enhanced self-efficacy and writing confidence, particularly among girls [38]. Creative and blended learning activities also fostered greater student engagement and enjoyment [41, 42].\u003c/p\u003e\n\u003cp\u003eThese findings emphasize that targeting affective and behavioral aspects is essential to sustaining mechanical, compositional, and academic improvements.\u003c/p\u003e\n\u003cp\u003eThe bubble matrix (Figure 6) highlights the uneven distribution of evidence across intervention\u0026ndash;outcome domains. It displays the relationship between intervention types (x-axis) and outcome measured (y-axis). The figure demonstrates that most interventions targeted foundational writing mechanics, while few address psychological outcomes or broader academic transfer.\u003c/p\u003e\n\u003cp\u003eTable 1\u003c/p\u003e\n\u003cp\u003eThemes, Sub-themes, Contributing studies, Types of Interventions Used and Related Outcomes\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review aimed to map existing interventions for different types of dysgraphia and writing disorders. Forty-seven studies met inclusion criteria, reflecting a diverse range of approaches including educational, therapeutic, multisensory approaches, computer based interventions, psychological and combined interventions. Most interventions targeted foundational handwriting mechanics, with fewer addressing higher-order composition and academic outcomes, and only limited attention given to affective and behavioral factors. Below, we synthesize these findings by major themes and subthemes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Improvements in Foundational Writing Mechanics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChildren with dysgraphia frequently struggle with legibility, letter formation, and transcription accuracy, which compromise both the readability and efficiency of their writing. Twenty-one studies in this review focused on these core mechanics, highlighting promising but often small-scale interventions.\u003cbr\u003eThe majority of studies emphasized legibility as a primary outcome, addressing important characteristics of dysgraphia-- letter reversals (e.g., confusing b with d, c with e etc.) [71]. Overall, \u003cstrong\u003emultisensory and technology-assisted interventions consistently enhanced legibility and letter formation\u003c/strong\u003e, though gains were often constrained by small samples. For instance, app-based tools (e.g., Write-Rite) improved alignment, spacing, and proportion [24], while occupational therapy kits integrating fine motor training with handwriting curricula such as \u003cem\u003eHandwriting Without Tears\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003edemonstrated improvements in spacing and spelling [48]. These findings align with broader occupational therapy literature showing that \u003cstrong\u003emultisensory handwriting programs produce significant improvements in legibility and fluency compared to traditional drill approaches\u003c/strong\u003e [72]. \u0026nbsp;Larger-scale studies, such as Indira \u0026amp; Vijayan (2015), revealed improvements in legibility were accompanied by increased academic confidence [25], which are consistent with Graham et al.\u0026rsquo;s (2012) meta-analysis that linked handwriting instruction to gains in both writing performance and motivation [73].\u003c/p\u003e\n\u003cp\u003eEvidence on \u003cstrong\u003ewriting speed and fluency\u003c/strong\u003e varied across technology-based supports, including real-time auditory feedback [26], and visual-motor training [56] \u0026nbsp; produced short-term fluency gains, but rarely tested sustainability beyond controlled sessions\u003cstrong\u003e. \u003cstrong\u003eSpelling and transcription accuracy\u003c/strong\u003e\u003c/strong\u003e received less attention in the reviewed articles, with only isolated findings from computerized writing instruction\u0026nbsp;[\u003ca href=\"#_ENREF_25\" title=\"Beers, 2018 #82\"\u003e27\u003c/a\u003e]. While such programs improved composing fluency, spelling accuracy remained a persistent challenge, which is consistent with research showing that \u003cstrong\u003eorthographic encoding difficulties in dysgraphia are more resistant to remediation than motor-based impairments [74, 75].\u0026nbsp;\u003c/strong\u003eThis highlights the need for integrative approaches that couple handwriting fluency training with explicit spelling and orthographic instruction.\u003c/p\u003e\n\u003cp\u003eTaken together, evidence suggests that\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003emultisensory and technology-supported approaches are effective in enhancing legibility and speed in the short term\u003c/strong\u003e\u003c/strong\u003e, but the field still lacks large-scale, longitudinal, and cross-linguistic trials to determine generalizability. Furthermore, while mechanical improvements are necessary, they may not be sufficient without concurrent support for spelling and higher-order writing [76]. Future studies should therefore integrate handwriting, transcription, and composition interventions within comprehensive writing frameworks to achieve enduring and transferable outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Advancements in Composition and Higher-Order Writing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeyond mechanical handwriting skills, eleven studies in this review focused on composition and higher-order writing processes. These interventions emphasized idea generation, organization, and strategy use, which are often compromised in children with dysgraphia due to the cognitive load imposed by transcription difficulties. This aligns with model of writing, which conceptualizes writing as an interplay of planning, translating, and reviewing processes [77].\u003c/p\u003e\n\u003cp\u003eAcross studies, strategy-based educational interventions consistently improved composition quality and structure. Programs such as Plan It, Write It [58], sentence-combining tasks [31], and Self-Regulated Strategy Development [30] enhanced organization, idea expansion, and structural coherence. These findings resonate with \u0026nbsp;Graham and Perin\u0026rsquo;s (2007) meta-analysis, which identified strategy instruction as one of the most effective approaches for struggling writers [78].\u003c/p\u003e\n\u003cp\u003eInterventions aimed at productivity and ideation such as speech-to-text (STT) and text-to-speech (TTS) support demonstrated increased text length, maintained accuracy, and greater punctuation use [32]. However, these studies were limited by very small samples and short intervention periods, consistent with broader concerns in the field that assistive technology such as word prediction and speech recognition can be beneficial for some students, highlighting a need for case studies using tools that fit children\u0026rsquo;s skills and address their challenges [79]. Similarly, direct instruction techniques [33] improved reading and comprehension skills, reinforcing evidence that targeted writing instruction supports broader writing gains [80].\u003c/p\u003e\n\u003cp\u003eFinally, evidence on the development of writing strategies and processes showed that computer-based translation training [34] enabled students to use more effective planning and revision strategies. These findings support \u0026nbsp;Berninger et al. (2015), who argued that combining handwriting and spelling instruction with composing practice best predicts long-term writing outcomes [35].\u003c/p\u003e\n\u003cp\u003eCollectively, the evidence suggests that strategy instruction and assistive technologies are effective in improving higher-order writing outcomes for students with dysgraphia. However, the limited number of studies, small samples, and short intervention spans reduce confidence in the robustness of these findings. Future research should investigate how strategy-based interventions and technology supports can be sustained and generalized to authentic classroom writing tasks, while also testing integration of handwriting fluency and composition instruction in a single framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Broader Academic and Cognitive Benefits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA smaller but notable subset of studies addressed whether interventions for dysgraphia can transfer beyond writing to benefit other academic domains and underlying cognitive functions. This aligns with the notion of \u0026ldquo;cross-domain academic transfer,\u0026rdquo; where improvements in one domain (e.g., handwriting fluency) free up cognitive resources for others such as reading and mathematics [81].\u003c/p\u003e\n\u003cp\u003eSeveral studies reported cross-domain academic improvements. For example, Rote Practice Technique (RPT) improved mathematical performance among dysgraphia learners [36], while tele-rehabilitation, a hybrid approach using flash cards and dictation interventions enhanced reading fluency and executive functions [37]. These findings consistent to previous research showing that targeted handwriting instruction can indirectly improve reading fluency and spelling in children with learning disorders [75]. Similarly, multimodal, multisensory interventions (Shabeeda, 2024) demonstrated broad benefits in both reading and writing [65].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEvidence for enhanced cognitive and perceptual functions was more limited. Previous study suggests that gamified learning interventions improved visual-perceptual skills and symbol recognition in Persian-speaking students [67]. Such findings are consistent with neurocognitive research indicating that visual-motor integration and working memory are strong predictors of writing performance [82, 83]. However, the extremely small samples (e.g., three participants) restrict generalizability.\u003c/p\u003e\n\u003cp\u003eOverall, this body of evidence suggests that dysgraphia interventions can yield secondary gains in reading, mathematics, and cognitive-perceptual domains, but research remains fragmented and preliminary. More rigorous longitudinal designs are required to clarify whether these benefits reflect genuine transfer effects or are limited to overlapping skill domains (e.g., phonological processing supporting both spelling and reading).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Positive Affective and Behavioral Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA final theme emerging from the review was the psychological and behavioral impact of interventions, particularly in relation to motivation, engagement, and self-efficacy. Although fewer studies addressed these outcomes directly, their inclusion is critical since motivational factors strongly mediate persistence and long-term success in writing [84].\u003c/p\u003e\n\u003cp\u003eFindings suggested that increased engagement and self-confidence often accompanied handwriting and strategy instruction. For instance, Balint (2015) reported that children receiving individualized physical therapy showed improved stamina and motor skills, but also greater willingness to participate in learning activities [40]. \u0026nbsp;Similarly, Garcia \u0026amp; Fidalgo (2008) found that Self-Regulated Strategy Development and Social Cognitive models enhanced self-efficacy and engagement, particularly among girls [38]. These results are consistent with the broader literature, where SRSD has been shown to improve not only writing outcomes but also motivation and self-regulation [85].\u003c/p\u003e\n\u003cp\u003eHowever, evidence in this area remains limited and uneven. Most interventions were small-scale and did not systematically measure psychological outcomes as primary endpoints. This mirrors a broader gap in dysgraphia research, where affective variables such as writing anxiety, self-efficacy, and motivation are often neglected despite their strong influence on academic persistence [86].\u003c/p\u003e\n\u003cp\u003eIn summary, while preliminary evidence indicates that dysgraphia interventions may foster positive emotional and behavioral outcomes, this remains an underexplored area. Future work should integrate standardized measures of engagement and self-efficacy into intervention studies, ensuring that affective outcomes are given equal weight alongside mechanical and cognitive measures of writing.\u003c/p\u003e\n\u003cp\u003eThis scoping review highlights that most interventions for dysgraphia focus on handwriting mechanics, with fewer addressing higher-order writing processes, broader academic skills, or affective outcomes. Evidence suggests that multisensory and strategy-based approaches are promising, yet studies are limited by small samples, short durations, and inconsistent reporting of dysgraphia subtypes. To advance the field, future research should employ rigorous, longitudinal, and culturally sensitive designs that integrate mechanical, cognitive, and motivational supports. Strengthening both methodological quality and practical applicability will be essential to inform educators, therapists, and policymakers working with children with dysgraphia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis review highlighted that large scale studies on dysgraphia interventions are scarce. There is a dire need to design interventions for a large scale multimodal intervention design across settings to generalize the study findings. Interventions lack addressing different types of dysgraphia with their intended aim addressing a core issue and resolving overall writing difficulties. A large scale study could be designed using multi modalities to address different types of dysgraphia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations \u0026amp; Future Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scoping review mapped existing interventions for dysgraphia and synthesized their outcomes, still here exist several limitations. Each of these is discussed with future recommendations. Few databases were accessed for retrieving articles due to limited access. For future studies other databases (such as Medline, Scopus, etc.) should be approached for inclusion of studies from broader literature. This review addressed articles using interventions for dysgraphia, comorbid conditions were excluded such as writing difficulties due to acquired neurological conditions. Future studies could be designed considering developmental and acquired dysgraphia with focus on cross comparison. Further reviews (systematic/scoping) could be planned to address facilitators and barriers practitioners may encounter while tackling children with dysgraphia. This review was restricted to articles in English language, while the articles published in other languages were excluded. Future studies should be designed with a specific focus on using translating strategy for the articles in other languages.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMA has contributed in the concept of the study. MA and MAP have designed the study and coordinated with the research team. SP supervised the research project. MA, MAP, SAJ, US, \u0026amp; SA were involved in screening, and extraction of the data, and contributed in the write up of the manuscript. MA analyzed the data and performed Thematic Analysis. SP \u0026amp; MAP reviewed the manuscript and gave final approval. All authors approved the final version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Supporting Data:\u0026nbsp;\u003c/strong\u003eExtractedData is publically available on https://10.6084/m9.figshare.30476990.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u0026nbsp;\u003c/strong\u003eAuthors declare no Conflict of Interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eThe study analyzed publicly available literature, so ethics approval was not required.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYoung AR, Beitchman JH. Chapter 5. \u003cem\u003eSpecific Learning Disorder. 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Characterizing the magnitude of the relation between self-reported childhood parentification and adult psychopathology: a meta-analysis. \u003cem\u003eJournal of clinical psychology.\u003c/em\u003e 2011;67(10):1028-43.\u003c/li\u003e\n\u003cli\u003eMcCutchen D. Phonological, Orthographic, and Morphological Word-Level Skills Supporting Multiple Levels of the Writing Process1. \u003cem\u003eInPast, present, and future contributions of cognitive writing research to cognitive psychology.\u003c/em\u003e 2012; 197-216. Psychology Press.\u003c/li\u003e\n\u003cli\u003eZimmerman BJ, Risemberg R. Self-regulatory dimensions of academic learning and motivation. \u003cem\u003eInHandbook of academic learning\u003c/em\u003e. 1997; 105-125. Academic Press.\u003c/li\u003e\n\u003cli\u003eHarris K, Graham S, Mason L. Improving the Writing, Knowledge, and Motivation of Struggling Young Writers: Effects of Self-Regulated Strategy Development With and Without Peer Support. \u003cem\u003eAmerican Educational Research Journal - AMER EDUC RES J.\u003c/em\u003e 2006;43. \u003c/li\u003e\n\u003cli\u003ePajares F. Self-Efficacy Beliefs, Motivation, and Achievement in Writing: A Review of the Literature. \u003cem\u003eReading \u0026amp;Writing Quarterly. \u003c/em\u003e2000;19.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 Themes, Sub-themes, Contributing studies, Types of Interventions Used and Related Outcomes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"901\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubthemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContributing studies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Intervention used\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome of the study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"21\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eImprovements in Foundational Writing Mechanics\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eEnhanced legibility and letter formation.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eKarimi Thani, 2022 [43]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGroup 1: Multi-sensory Intervention; Group 2: educational games\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFernald\u0026rsquo;s multisensory educational method and educational games both reduced writing disorder compared to control. Fernald\u0026rsquo;s multisensory method had the greatest effect.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eHusni, 2022 [24]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAll criteria in the HLS improved significantly. Global legibility: 32% to 92%. Effort to read: 36% to 92%. Layout: 36% to 96%. Letter formation: 20% to 96%. Alteration: 52% to 100%.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eDarweesh, 2020 [44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMultisensory Educational Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 372px;\"\u003e\n \u003cp\u003eStatistically significant improvement in handwriting scores and subtests (handwriting, fine motor, perceptual-motor) on the Dysgraphia Disability Scale.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAriyo, 2024 [45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePhysical (hand exercises, play therapy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant main effect of hand exercise on handwriting legibility; no significant effect of gender or self-esteem; no significant interaction effects.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eJohn, 2018 [46]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology (iPad app, therapeutic hand exercises), educational\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in handwriting legibility and speed post-intervention; all measured parameters improved (letter formation, letter size, spacing, missing letters, handwriting speed).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eIndira, 2015 [25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, multisensory, fine motor and writing-based intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in handwriting skills (legibility, letter size, punctuation, spelling, written expression); greater academic achievement, improved confidence and behavior in experimental group; control group no significant change\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eRaji, 2024 [47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCognitive-behavioral intervention (attention training)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExperimental group showed significant improvement in handwriting legibility, spelling accuracy, and organization of written expression compared to the control group; enhanced reading comprehension and mathematics performance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eVerma, 2019 [48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, physical, multisensory, fine-motor, handwriting curriculum (Handwriting Without Tears, HWT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eOTK improved memory, placement, sentence formation, letter and word spacing (P\u0026lt;0.05 for main variables). Boys had more gains in memory, sequence, lowercase formation. Grade 4: word and capital cursive improved.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eMehta, 2019 [49]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, perceptual-motor, visual-perceptual, individualized training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eStatistically significant improvement in all measures except far-point copying speed. TLL improved from 73.7% to 92.3%; TWL from 57.2% to 86.1%; NPS from 29.5 to 45.7 letters/min; all TVPS-3 subtests improved.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eRahim, 2019 [50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational (tablet, app, tracing, visual-motor practice)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eMarked improvement in letter formation, slant, size/proportion, alignment, spacing, and line quality. Pre: scores 1-2 (poor/weak); post: scores 3-5 (satisfactory to outstanding) for all six characteristics.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eRahim, 2025 [51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational (app, tracing, animation, repetition)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eFour of five students scored 5, one scored 4 in letter formation (post), compared to all scoring 1 (pre); students showed consistent improvement, more organized, confident, and error-free handwriting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eIncreased Writing Speed and Fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eDatchuk, 2017 [52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe intervention improved construction of simple sentences and word sequences per 1 min. Results across participants suggest a functional relation between the intervention and dependent measures observed on sentence construction probes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eTobolcea, 2010 [53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eComputer-based speech therapy, computer-based exercises for dysgraphia-dyslexia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe difference between the two means is statistically significant t(53) = -6,29; p \u0026lt; 0,01; therefore, the performance in sentence writing/reading for the children from the group that used the computer is significantly better than in the case of patients who followed the classical treatment.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eTanimoto, 2015 (54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eComputerized reading and writing instruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement for the whole sample of SLDs in subword handwriting level skills, word level reading and spelling skills, and syntax level reading and writing skills. Group B showed more treatment effects and stronger effect sizes than Group A.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003ePankey, 2022 (55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational and Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAnalysis of the quantitative data indicated varying gains and losses in writing fluency but an overall favorable perception of the intervention. The participants responded positively to approximately 78.13% of the Likert scale statements. Content analysis of the open-ended questions indicated that the participants perceived the intervention as an aid to their ability to compose written text. While not every participant experienced an increase in both copying and composing fluency, the intervention did produce some increases for two participants.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eDanna, 2013 [26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology (real-time auditory feedback)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eImproved movement time and fluency within and across sessions (loops and sentence). Handwriting legibility and speed on BHK greater after four weeks of rehabilitation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eBeers, 2018 [27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (computerized), assistive technology, handwriting, spelling, and composing instruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in composing fluency (words/minute), fewer pauses, shorter total time; dysgraphia group normalized on keyboarding; dyslexia group continued to differ from controls in spelling/keyboard measures post-intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003ePoon, 2010 [56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational, visual perception and visual-motor integration training, games\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExperimental group: improved visual perception (MVPT), reduced \u0026ldquo;On Paper\u0026rdquo; and \u0026ldquo;In Air\u0026rdquo; time; no significant difference in VMI or legibility; controls showed no significant change.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eReduced Spelling and Transcription Errors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eHashemabadi, 2024 [57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003efollowing the implementation of the educational-therapeutic protocol for dysgraphia, spelling errors decreased by 74%, visual memory errors by 72%, visual accuracy by 81%, auditory accuracy by 58%, and educational errors by 37.5%. The participant did not exhibit any errors related to mirror writing, auditory memory, or visual sequential memory in any of the tests.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAkhavan Tafti, 2014 [28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, multisensory (visual/auditory, kinesthetic, and tactile (VAKT)), relaxation (progressive muscle, deep breathing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant decrease in spelling errors and anxiety in intervention group (not in control); changes visible in graphs and mean values.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eKhaledi, 2014 [29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePlay therapy, educational games,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExperimental group: spelling errors dropped from mean 14.66 to 3.33; control group: no significant change (20.86 to 20.66). Mean difference between pre-post experimental and control: 4.6 (t=7.042, p=0.002).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eAdvancements in Composition and Higher-Order Writing\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eImproved Composition Quality and Structure\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eLevy, 2019 [58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (scripted small-group writing intervention)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eStudents\u0026rsquo; writing quality and production improved; story elements inconsistently improved; CBM-WE (TWW, WSC, CWS) unchanged; high fidelity by interventionists; promising social validity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eWalter, 2021 [31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe SC intervention group made significant gains, with moderate to large effect sizes, in comparison to the MS and WLC groups, on the WIAT-II sentence combining task at t2. Differences between the SC and WLC groups were maintained at t3.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eTherrien, 2009 [59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (strategy instruction; 6-step essay writing approach)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eIntervention group scored higher than control on strategy use (2.73 vs. 0.74, p\u0026lt;.0001, ES=1.69); and on ideas/content and organization (4.19 vs. 3.26, p=.024, ES=0.68). No sig. diff. to nondisabled students on these traits.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eLane, 2011 [30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (strategy instruction, self-regulation, genre-specific and general writing strategies)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSRSD students had significantly higher scores on writing quality, structural elements, and engagement during writing (opinion essays), compared to control. Transfer to behavior and generalization effects were limited.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eEslamian, 2023 [60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (task-oriented teaching)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eTask-oriented teaching significantly improved reading and writing scores vs. control.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003e\u0026Ouml;ğ\u0026uuml;lm\u0026uuml;ş, 2021 [61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, strategy-based, parent-implemented, SRSDM-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAll three children met performance criterion for story-writing skill; skills maintained after 5 weeks. High parent fidelity (83.68\u0026ndash;100%). Positive feedback from mothers and children.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eDunn, 2013 [62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, strategy-based, art-integrated, SRSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAll students demonstrated rapid and stable improvement in story content (WWW, W D2, H D2 scores); all attained perfect scores in final intervention probes. Story quality improved for all; number of words written also improved for two students.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eGains in Productivity \u0026amp; Ideation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAlmgren back 2024 [32]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational, speech-to-text and text-to-speech training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSeven of eight increased productivity; most maintained/improved accuracy; text quality (vocabulary diversity, word length) improved in most; some varied patterns; STT supported longer, more meaningful texts; individualized responses noted.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAlanazi, 2017 [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (flashcards, Direct Intervention technique)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in reading/writing skills for intervention group vs. control. ANCOVA: F (1,38)=22.03, p\u0026lt;0.001 for writing; similar effects for reading, identification, fluency, and comprehension.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eDevelopment of Writing Strategies and Processes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eBerninger, 2015[35]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (computerized), assistive technology, handwriting, spelling, and composing instruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eCursive mode consistently predicted spelling/composing; keyboarding positively predicted composing in upper grades; SLD groups impaired on manuscript mode, copying fast, and timed composing; all letter production/selection modes correlated with writing outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eNiedo, 2016 [34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eComputerized instruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe computer taught translation strategies, based on what typically developing writers used in their writing, were used in integrated reading-writing tasks and integrated listening-writing tasks by students with SLDs in transcription. Level I and Level II strategies were used across all writing tasks, but more so in personal narratives than writing summaries, and more so in summaries when the source material was read rather than heard.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eBroader Academic and Cognitive Benefits\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eCross-Domain Academic Transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eUmar, 2024 [36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (peer-tutoring, conventional instruction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eRPT significantly improves the academic performance of students with dysgraphia, irrespective of gender.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eChangizi, 2022 [63]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePhysical (balance/motor exercises)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eExperimental group showed significant improvements vs. control in dyscalculia and dysgraphia.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eChangizi, 2022 [64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePhysical (proprioception/motor exercises)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in dyslexia and dysgraphia for experimental vs. control (ANCOVA, p\u0026lt;0.01); mean post-test dysgraphia: experimental 77.83\u0026plusmn;15.89, control 60.93\u0026plusmn;19.36.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eShabeeda, 2024 [65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMultisensory, educational, physical, cognitive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAll students showed significant improvement in their reading and writing abilities. Notable improvement observed in the development of reading and language skill. Boosted children\u0026rsquo;s confidence and self-esteem.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eCapodieci, 2023 [37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational, cognitive training (executive functions, reading, writing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eImproved reading fluency (syll/sec), fewer errors in text dictation, increased executive function scores (Flanker test), effect sizes greater in intervention than waiting list group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eEnhanced Underlying Cognitive and Perceptual Functions\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eYanjana, 2020 [66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eBehavioral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe results in behavioural problems show a significant decrease in post-intervention for the experimental group. The mean of post-intervention behavioural problems score was lower than the mean of pre-intervention behavioural problems scores. The results in the total LD score show a significant increase in post-intervention for the experimental group. The mean of post-intervention total LD scores was slightly higher than the mean of pre-intervention total LD scores. The results in the total LD score show a significant increase in post-intervention for the experimental group. The mean of post-intervention total LD scores was slightly higher than the mean of pre-intervention total LD scores. But, the results in figure-ground perception, figure constancy, position-in-space, spatial relations, auditory perception, cognitive abilities, memory, receptive language, expressive language and intelligence showed a small non-significant change on post-intervention for the experimental group. The results in eye-hand coordination show a significant increase in post-intervention for the experimental group. The mean rank of post-intervention eye-hand coordination scores was higher than the mean rank of pre-intervention eye-hand coordination scores.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAshiani, 2014 [26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCognitive-motor training (gross and fine motor, visual-motor, auditory-motor, visual control, shape recognition)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in motor-writing skills for intervention group (P\u0026lt;0.001); no difference by age or gender; control group showed no improvement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAbbaszade Rougoushoee, 2024 [67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, assistive technology (gamified, tablet-based, interactive game mechanics)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eAll students improved in visual perception and dictation; all could independently write and recognize Persian symbols post-intervention. RCI for all measures \u0026gt;1.96; improvement % mostly \u0026gt;50%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003ePositive Affective and Behavioral Outcomes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 15.2709%;\"\u003e\n \u003cp\u003eIncreased Engagement, Motivation, and Self-Efficacy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eBorghese, 2017 [68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMobile Gaming App\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe use of a digital device and exergames has recieved very positive feedback from children.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003ePaler, 2024 [42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational- Structured practice with creative expression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eThe overall engagement score increased from \u0026ldquo;2.37\u0026rdquo; (Low) in the pre-test to \u0026ldquo;3.90\u0026rdquo; (High) in the post-test. There is a significant difference between the pre-test and post-test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eNjock, 2024 [41]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational (blended learning: traditional + online/digital activities)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eBlended learning is an effective teaching strategy for improving writing skills among students with dysgraphia; effectiveness transcends gender. No significant interaction effect of method and gender on essay writing achievement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eBalint, 2015 [40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePhysical (physical therapy \u0026ndash; massage, proprioceptive facilitation, active exercises, games)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003e6 children with dysgraphia: 2 mild, 2 medium, 2 severe. After intervention, 4/6 did not have motor dysgraphia anymore, 2 improved to milder type. All improved in endurance/strength and fine motor skills/perception.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAnggriawan, 2018 [69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, game-based (crossword puzzle)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eImproved reading and writing scores in experimental group post-intervention; significant difference compared to control group; positive student feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eAzimi, 2014 [70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAssistive technology, educational multimedia, interactive software\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eSignificant improvement in dysgraphia scores in experimental group vs. control (pretest-posttest, Wilcoxon and Mann-Whitney U tests).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.4352%;\"\u003e\n \u003cp\u003eGarc\u0026iacute;a, 2008 [38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEducational, cognitive and self-regulation strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 372px;\"\u003e\n \u003cp\u003eGirls in experimental groups (SRSD, SCM) showed greater gains in self-efficacy, productivity (words), relational coherence, structure, and all reader-based measures vs. comparison. Boys: only number of words predicted by self-efficacy, with weak effect.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Shaheed Benazir Bhutto Women University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Disorder of Written Expression, Dysgraphia, Educational Intervention, Therapeutic Intervention ","lastPublishedDoi":"10.21203/rs.3.rs-8417573/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8417573/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eDysgraphia is the Specific Learning Disorder with difficulties in written expressions. Identifying and remedying these children is a biggest challenge in academic institutes. Different interventions are used to rehabilitate these children. This scoping review aims to map existing interventions for different types of dysgraphia with their outcomes in multiple context i.e. schools, rehabilitation centers, home-based services, and clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria: \u003c/strong\u003eThis review included studies used educational, therapeutic, technological, or behavioural interventions on children, and adolescents with dysgraphia or written expression difficulties. Quantitative, qualitative, and mixed-methods studies conducted in the context of school, clinics, home settings, or rehabilitation centers were included. Studies focusing on unrelated disabilities, diagnostic studies, and theoretical papers without intervention focus were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e PubMed, EuroPMC, Cochrane Library, Science Direct, EBSCO, DOAJ and Google Scholar were searched for evidence based articles. Two independent reviewers screened titles and abstracts using Rayyan web app. Discrepancies were resolved by consensus with a third reviewer and the full texts were retrieved. Two Independent reviewers screened the full text articles. Disagreements were resolved through consultation with third reviewer. Data were charted using a standardized form. The extraction process independently conducted by two reviewers to ensure reliability, with discrepancies resolved by discussion with a third reviewer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Forty seven articles included in the review, targeting educational, therapeutic, multisensory, computer-based, and combined interventions to address dysgraphia. Four themes were emerged: (a) Improvements in Foundational Writing Mechanics, (b) Advancements in Composition and Higher-Order Writing, (c) Broader Academic and Cognitive Benefits, (d) Positive Affective and Behavioral Outcomes. Each theme with their subtheme is linked with targeted intervention addressed in the studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This review revealed computer-based and educational interventions were used in most of the studies and among themes foundational writing mechanics is widely addressed. Studies lack in addressing different types of dysgraphia. A holistic approach with a large scale study is recommended addressing multiple underlying writing mechanics along with psychological concerns.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Existing Interventions for the Management of Different Types of Dysgraphia or Specific Learning Disorder in written expression: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:55:52","doi":"10.21203/rs.3.rs-8417573/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c54df51c-c26d-4c3f-ae24-7ab718ad0853","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":60020042,"name":"Psychology"}],"tags":[],"updatedAt":"2025-12-30T00:55:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 00:55:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8417573","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8417573","identity":"rs-8417573","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}