Handwriting is a complex skill. There are several components that must be in place for a child to develop smooth and efficient handwriting. The role of the pediatric occupational therapist is to address the underlying components or deficits that may contribute to illegible handwriting.
Below are just a few of the components that we evaluate when children are referred for handwriting difficulties:
Postural Control: Lack of strength or stability in the trunk (or core) can lead to difficulty with hand control and hand function. Postural control includes the child’s ability to sit appropriately in a chair and maintain the appropriate neck and head control while using the hands for writing. Handwriting requires a significant level of stability, hand strength, and shoulder strength. A child must have stability of the trunk before he or she can gain mobility of the arm and hand.
Hand Skills: Hand dominance is a significant factor in learning to write. Without a dominant hand, experience and training are divided between the two hands. Hand dominance also contributes to bilateral hand use: the ability to (1) stabilize the paper with the helper hand while (2) the dominant hand works the writing utensil.
Included in hand skills or fine motor development are in-hand manipulation skills. These include the separation of the two sides of the hand and the ability to move objects around in your hand. Functional pencil grasp also needs to be evaluated.
The child’s stage of hand development needs to be taken into consideration. Research suggests that children should not be taught handwriting before they are ready. Typical grasping patterns follow a developmental progression. If the child has a maladaptive grasp that deviates from the normal progression, there may be an underlying problem, and an evaluation by a trained pediatric occupational therapist is recommended.
Visual Perceptual and Visual Motor Skills: The ability to use our eyes can significantly impact our ability to write. In short, visual motor skills are the ability of our eyes to guide our hands. Visual perceptual skills are the ability to organize and interpret information that is seen and give it meaning. These information-processing skills include figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, and visualization.
Sensory Processing: Deficits in force discrimination and kinesthesia (as well as many other sensory factors) can significantly impact writing skills. If a child presses too hard or lightly or grasps the utensil too hard or lightly, this can impact their writing performance. Our kinesthetic sense guides our body’s movement without the use of our eyes. If there are deficits in kinesthesia the child may require visual monitoring of their hands rather than having the freedom to focus on what the teacher is saying.
Cognition: Attention, motivation, memory, and sequencing play key roles in learning to write. There is also the concept of directionality, as well as the ability to identify position in space, such as top, bottom, under, and over. If a child is not familiar or competent with these concepts, finding the top or bottom of a line will be impossible.
It should be noted that this is not an all-inclusive list. Handwriting skills are dependent on all of these factors and many others. A well-trained pediatric occupational therapist will be able to identify underling issues related to difficulties in handwriting. A handwriting sample will only provide information regarding the end product. A good occupational therapy evaluation will address the underlying components and be able to give you information as to how to help.
From our family to yours,
Melissa Hough, OTR/L, C/NDT
Owner, Children’s Therapy Center, PSC
For information about our handwriting professional development workshops for teachers, please contact us.
Melissa Hough, OTR/L, C/NDT is an occupational therapist with over 20 years of pediatric experience and certifications in Sensory Integration (SI) and Neuro-Developmental Treatment (NDT). Melissa has a professional and personal perspective when working with children because she is also the adoptive parent of a child with special needs.
Since 2002, Children’s Therapy Center, PSC has served thousands of families in Louisville, Kentucky, by providing high-quality therapy services and parent education.