Handwriting and Occupational Therapy

What is writing?  Writing is a complex process that requires the integration of touch, proprioception, kinesthesia, vision, motor coordination and language.  This blog is about handwriting and occupational therapy for developmentally delayed children.

Every sense must be well-developed and collaborate with each other sense to produce the memory, motor coordination, perception and attention necessary to put thoughts on paper.

Writing is one aspect of written language that depends on the interaction of a multitude of developmental skills.

Some children move smoothly through the sequential steps necessary to write.  For children with developmental delays, however, writing can be extremely frustrating.

Until young bodies are ready, we must not demand paper and pencil results.  To assure success, we must understand how handwriting skills develop.

“Write” from the Start – The ability to write starts devel­oping in infancy and evolves into adulthood.  Small muscles of the hands begin to strengthen as babies push themselves up from their tummies.  (The recent recommendation to place babies on their backs to prevent sudden infant death syndrome has probably retarded this process.) When awake, babies should be on their stomachs.

Toddlers start writing and drawing with their fingers, large crayons and paintbrushes, while standing at an easel for upper body stability and better control.  The hand, with the crayon, is an extension of the shoulder, elbow and wrist.  Command of each of these joints individually, as well as the entire arm and upper body, must precede good hand control.

Motor Skills – Muscle control develops from gross to fine, or large to small.  Proprioceptive messages from the hips, shoulders and wrist inform the writer’s brain about where the body, arm and hand are relative to the desk.

After learning to “write” while standing, children can sit down and begin to isolate the movements necessary for a specific task.  As control increases, the elbow moves the hand along the page, and the wrist provides stability for the fingers.  As the grasp improves from fisted to mature, the thumb, index and middle fingers extend this leverage to control the writing implement further.

Vision – Vision plays an important role in writing.  Eyes must be able to focus at paper distance. Visual memory allows children to recall how letters look.  Understanding of visual! spatial concepts drives motor planning and organization.  Visualization permits ideation, the ability to translate concepts into words.

Motor plus Vision – Most five-year-olds have learned to move their eyes independently from their head.  The two eyes and two sides of the body must work together as a team. Then students can sit still and pay attention.

The hand can then cross the midline, that invisible center of the body.  If writing is introduced before good laterality is established, a child may develop some decompensatory techniques such as laying the head down on the table or holding up the head with one hand.  Rotating the paper to avoid horizontal or diagonal strokes can indicate immaturity. (For a struggling kindergartner, standing or even kneeling may solve these problems.)

Early “writing” consists of large, often poorly controlled, strokes.  Have you ever watched a three-year-old draw a picture?  He may decide to draw Daddy and end up with Fido!  Why? Because motor and visual skills are not yet well-integrated.  The hand did not do what the mind dictated.

Children’s writing tends to be slow, tedious, visually guided and not automatic, while most adult handwriting is quick, kinesthetic and automatic.  Good handwriting requires practice.  Practicing perfect strokes is less important than practicing to write quickly.  Both legibility and speed are imperative to the 20-40 words per minute necessary to take notes in the upper grades.

Remediation – If a child is having difficulty with writing, consult both an occupational therapist and a developmental optometrist. Making a differential diagnosis regarding the delay is essential. Then an appropriate therapeutic program can be prescribed.  An excellent video available from AOTA (1-877-404-2682) is Getting a Grip on Handwriting.  Produced by occupational therapists Barbara Hanft and Dorothy Marsh, the video helps OTs and teachers collaborate to assist the struggling writer.

Let’s give our kids a healthy start at writing.  Guiding them through the developmental steps and encouraging their imagi­native ideas will help them become expressive writers.