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Throughout the ages, humans inscribed written language onto papyrus, stone, and cave walls. Verbal, physical, and written modes of expressing thoughts and ideas have been passed from generation to generation. It is by studying and encrypting written text and ancient codes that we better understand our ancestors and their fascinating stories.
Today, occupational therapists assist with deficits in handwriting skills in many settings. Problems with handwriting occur in the general population, as well as in children who have autism. While OTs are not handwriting teachers, we are skilled in evaluating students in order to determine underlying difficulties with the task of writing. Handwriting does not simply involve the formation of letters and numbers, it also involves many body systems and the following: applying the correct pressure on the pencil, grasping the pencil efficiently, staying within the lines of the paper, and spacing letters and words appropriately.
Children need to develop handwriting skills as they progress through school and life. However, even among therapists there exists a great debate about the appropriate time to enact keyboarding accommodations. Many OTs express concern that cursive handwriting is becoming a lost art. Additionally, if we do not teach writing to our children, they may not be able to read historical documents written in cursive or interpret letters passed down throughout generations.
Handwriting utilizes skills that are developed long before a child grasps a pencil. As babies learn to self-feed, point, and manipulate toys, they are strengthening muscles of the hand. However, skills involving the entire body must develop for proper support during writing. Imagine a pyramid.
The bottom (largest section) represents the stability that is needed for table-top tasks. Core muscles in the trunk provide structure upon which the extremities (arms and legs) are built. Thus, trunk stability learned during weight bearing activities and gained when the human body works against gravity builds a strong foundation. We have all seen the student who is unable to support herself and thus leans in fatigue onto her desk while writing. She lacks the basic stability of her core muscles. Therefore, we need to assist her in building gross motor (large muscle) through fun physical activities, like obstacle courses, scooters, and therapeutic swinging.
Oftentimes, an occupational therapist receives a request to evaluate a child with handwriting difficulty. We are expertly trained in assessing the many body systems that must operate properly in order to participate in handwriting. The eyes need to function as a team to focus on the paper and they must change focus from the near paper to the distantly placed Smartboard®. The child needs to maintain attention and remain alert during the classroom or homework time. Many other factors contribute to the task of handwriting.
A type of learning disability known as dysgraphia (difficulty with writing) exists much more frequently than we realize. There is no specific cause of the disability and often professionals and teachers have not heard of the condition. Students with dysgraphia may have difficulty with fine motor tasks along with visual spatial issues. Often, students with dysgraphia are so worried about the task of writing that they forget what it is they are actually writing about. When dysgraphia is not found early, students may have eventual difficulty taking notes and completing written assignments.
Signs of dysgraphia include:
- frequent erasing or errors
- letters that tilt/slant in many different directions
- reversals of letters and numbers
- slow handwriting compared with peers
- mixed print/cursive or mixed upper/lower case
- language skills are excellent, but spelling difficulties are noted
- the hand tires easily/difficulty with development of a proper grasp
When handwriting becomes such a problem that it is interfering with the demonstration of knowledge and/or speed of expressive writing, changes in the way a student participates in the curriculum are appropriate, such as: Using paper with raised lines to give a physical cue; offering a choice of wide or narrow-ruled paper so the student may choose what is most comfortable, addition of talk-to-text programs or use of a recorder; and providing increased time to complete written assignments. Of course, this list is not exhaustive and accommodations should be made on an individual basis.
Handwriting can be complex, so here are some suggestions to encourage fine motor development:
- Cut a small area out of the bottom of a sock. Make sure only the thumb, index, and middle fingers are exposed. Encourage children to practice picking up small objects with the sock over the hand to help encourage a ‘tripod’ grasp.
- Tennis balls are fabulously therapeutic. Cut a long slit in the ball to form a “mouth” and place googly eyes or draw eyes with marker to give it a face. Provide small items that can be fed to the tennis ball. Squeezing the ball helps to strengthen hands and picking up the small items builds finger strength.
- Place small objects into putty or homemade dough and ask children to use finger muscles to find the items. After the items are found, use plastic utensils to cut the dough into small pieces.
- Use an inclined surface while writing and working at a desktop helps to position the hand properly. Turn a three-inch binder sideways and place a clip to hold paper. Writing on a vertical area such as a chalk or whiteboard also encourages correct grasp and wrist position.
Keep in mind that children should engage in pre-writing activities before writing letters. A child will not succeed in writing a letter if he cannot draw the ‘parts’ of the letter. For example, a letter A requires the child to draw a horizontal line and two diagonal lines. Letter b requires a circle and vertical line. It’s also critical that children understand the difference between left-right and top-bottom.
Ideas to help with pre-writing skills:
- Draw a stick person together and talk about the different directions of the lines. Foam craft sheets are found at craft stores. Cut out circles, large lines, and small lines and see how many creative pictures kids form.
- Play different types of music and ask kids to scribble or draw along with the beat. Share your work with each other.
- Play ‘Simon Says’ and give directions such as, “Simon says to draw a huge circle in the air with your right hand.” Directions can also include drawing a square on their friend’s back with their finger.
When it’s time to write letters, it’s important to ask the school which handwriting program they use. For example, the Handwriting Without Tears® method adopts a certain terminology to refer to the lines which form letters. Regardless of the method, teachers and parents need to be consistent when teaching the child. Uniformity and carryover of concepts taught at school yield the best results.
Some additional multi-sensory approaches:
- Play with magnetic letters in the kitchen, add plastic letters to the bathtub, and write letters and shapes in whipped crème. Write giant letters with sidewalk chalk and instruct children to walk along the letters.
- When reading to your child, point out different letters that you are working on. Copy a page from the reading book and place into plastic binder sheets so that the activity can be repeated with another letter. Ask students to circle the letters that you call out with a dry-erase marker.
- Provide students with a model of the letter as they practice writing it. Children who are learning should always have a ‘perfect model’ from which to copy. Never use worksheets in which the example is only given at the beginning. Inevitably, children will fatigue and begin to use the letter they had written seconds earlier as the model. They are then learning from their own bad habits.
In conclusion, handwriting involves the cooperation of many body systems. When handwriting challenges are present, a thorough evaluation by an occupational therapist is warranted. Any treatment plan should involve teamwork and an at-home program to assist with carryover of therapeutic activities. Above all, every child is different and should enjoy working with his therapist. It’s our mission as occupational therapists to have FUN while learning.
Cara Koscinski is a long-time pediatric occupational therapist, speaker, and author of The Pocket Occupational Therapist books. She is the mother to two sons with autism. Her books include The Pocket Occupational Therapist for Caregivers of Children with Special Needs and The Special Needs SCHOOL Survival Guide for Autism, ADHD, and More! For more information, visit her website at www.PocketOT.com
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