Revised June 9, 2007 Helping Children With Handwriting Problems Compiled by Hasmig Adjeleian, Occupational Therapist Jennifer Boggett-Carsjens, Occupational Therapist Michael Cheng, Child Psychiatrist Children’s Hospital of Eastern Ontario Where to Get this Handout This handout is available from http://www.drcheng.ca in the Mental Health Information section. Any comments and suggestions are welcome and will help ensure this handout is helpful. Purpose of this Handout This handout provides information about handwriting difficulties, and is meant for children/youth, parents and families. Disclaimer The content of this document is for general information and education only. The accuracy, completeness, adequacy, or currency of the content is not warranted or guaranteed. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should always seek the advice of physicians or other qualified health providers with any questions regarding a health condition. Any procedure or practice described here should be applied by a health professional under appropriate supervision in accordance with professional standards of care used with regard to the unique circumstances that apply in each practice situation. The authors disclaim any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, or the use and application of any of the contents of this document. This work is “licensed” under a Creative Commons License (Attribution-Non Commercial-Sharelike 2.0, http://creativecommons.org/licenses/by-nc-sa/2.0/) which means that you are free to copy, distribute, display and perform the work, and make derivative works as long as you give the original author credit, the work is not used for commercial purposes, and if you alter, transform, or build upon this work, you may distribute the resulting work only under a license identical to this one. Introduction Many students have troubles with handwriting. In the Diagnostic and Statistic Manual of Mental Diseases (DSM-IV), the official term for troubles with handwriting is “Dysgraphia”, which is a “Disorder of Written Expression”. Dysgraphia is defined as having “writing skills (that) ...are substantially below those expected given the person's ...age, measured intelligence, and age- appropriate education”. Troubles with writing can be seen along with various conditions and situations: Physical conditions that limit aspects such as a student‟s posture or strength. Poor handwriting habits Attention deficit / hyperactivity disorders (AD/HD), which can occur since the student with ADHD has trouble organizing and sequencing detailed information, and/or the student thinks so rapidly that s/he doesn‟t have the motor coordination to „keep up‟ with their thoughts. Non-verbal learning disabilities, a condition where individuals have good verbal abilities, but troubles with non-verbal abilities (non-verbal communication skills like „reading others‟, tone of voice, gestures, social skills and visuospatial skills). Lastly, troubles with writing may occur in children who otherwise don‟t have any other major difficulties. Types of Dysgraphia Retrieved Nov 2, 2006 from http://en.wikipedia.org/wiki/Dysgraphia Dyslexic dysgraphia With dyslexic dysgraphia, spontaneously written work is illegible, copied work is fairly good, and spelling is bad. Finger tapping speed (a method for identifying fine motor problems) is normal, indicating the deficit does not likely stem from cerebellar damage. A Dyslexic Dysgraphia does not necessarily have dyslexia. (dyslexia and dysgraphia appear to be unrelated) Motor dysgraphia Dysgraphia due to motor clumsiness has illegible spontaneously written work, illegible copied work, normal spelling, and abnormal finger tapping speed Spatial dysgraphia Dysgraphia due to a defect in the understanding of space has illegible spontaneously written work, illegible copied work, normal spelling, but normal tapping speed. Some children may have a combination of any two or all three of these. Symptoms in actuality may vary in presentation from what is listed here. What can be done about it? There are two main ways to help individuals with handwriting problems: 1) Improving the person’s handwriting, by improving planning, sequencing and motor coordination. 2) Reducing the expectations on that person for handwriting, which allow the student to go around his/her difficulties with writing so that he/she can focus more completely on the content. Usually, a combination of strategies is the best approach. Improving Handwriting Ensure good posture and physical set up Make sure the chair and desk fit the student: Hips, knees and ankles should all be at 90º i.e. feet flat on the floor and elbows should be able to comfortably rest on the desk top. Improve Planning Especially for longer written assignments, try the POWER approach P)lan your paper O)rganize your thoughts and ideas W)rite your draft E)dit your work R)evise your work, producing a final draft Encourage students to get the „big picture‟ and start by outlining their thoughts – use techniques such as „mind maps‟, or other strategies to get the main concepts on paper first, without worrying fine details of spelling, punctuation, etc. The first draft isn‟t going to be perfect! Allow visual strategies, such as drawing a picture of a thought Verbal/auditory strategies Allow verbal/auditory strategies, which may particularly be helpful for youth with non-verbal learning disabilities. Encourage the student try talking softly to him/herself while thinking. Dealing with Visuospatial Difficulties Special Paper such as: Graph paper for math calculation to keep columns and rows straight. Consider raised-line paper to improve orientation to baseline Such as P9071 Narrow line, or P8673 wide line, available from Flaghouse, 1 (800) 265-6900, www.flaghouse.com Consider large (8 mm) red/blue ruled paper for other written work, to help with letter placement, size constancy and organization on page Using paper with a green and red line. So, the letter starts on the green line and goes down to the red line. (Green for „go‟ and red for „stop‟). Tape an alphabet strip for printing and numbers on the student‟s desk, so that the student can easily refer to it The strip should have the correct starting places marked with a dot and arrow showing the direction to continue in for printing and numbers To help the student put the right amount of space after writing words, give the child a large bright color paperclip or popsicle stick when doing written words, and ask the child to slide it on the page after each word to keep the space Strategies for Motor Issues Ergonomic Equipment / Writing Tools Ergonomic Pens such as the PenAgain ™ from http://www.penagain.com/ A pencil grip to encourage proper position of the fingers on the pencil, and decrease excessive effort E.g. Pencil Grip ™ available for $2.99 at Scholar‟s Choice, in Carlingwood Mall Strategies to prevent fatigue If the student‟s hands get tired or sore, consider trying the following (retrieved from http://www.as.wvu.edu/~scidis/dysgraphia.html) : Shake hands fast, but not violently. Rub hands together and focus on the feeling of warmth. Rub hands on the carpet in circles (or, if wearing clothing with some mild texture, rub hands on thighs, close to knees) Use the thumb of the dominant hand to click the top of a ballpoint pen while holding it in that hand. Repeat using the index finger. Perform sitting pushups by placing each palm on the chair with fingers facing forward. Students push down on their hands, lifting their body slightly off the chair. Other strategies to improve the child’s handwriting skills include Programs available from Therapy Skill Builders (602) 323-7500 Hands at Work and Play Big Strokes for Little Folks Body Breaks Give frequent „body breaks‟ for the child to stretch, stand up, walk around or get a drink of water. Consider allowing a squeezable stress ball, or other strategies for self- regulation Compensatory Strategies Remember that students who have difficulties with written output may be able to produce small amounts of high quality (neat) work. However, as the day goes on and they get tired they may try to take short cuts (i.e. not writing as much) to decrease the stress. Make accommodations by grading the student on content (ideas, concepts), rather than neatness and legibility. Reducing Expectations/Demands of Writing Note Taking: provide a partially completed outline so the student can fill in the details under major headings. A Scribe or “Note taking buddy”: If the teacher is not able to provide notes, then consider allowing the student to borrow notes from a „scribe‟, i.e. another student who is a good note taker. Print or cursive: Allow the student to use either print or cursive. Many children with attention problems are more comfortable with manuscript printing. Allow and encourage use of abbreviations for in-class writing assignments (such as b/4 for „before‟, or b/c for „because‟). Remove neatness as a grading criterion, except on computer-generated papers. Computer/Keyboard Accommodations Allow the student to use a keyboard to type. As laptops may have too many extra distractions on them, consider systems such as the Alpha Smart ™, which is a laptop specifically designed to be a writing tool and no more. Visit http://www.alphasmart.com for details. In early grades, emphasis should be on learning how to write in print, with less emphasis on keyboarding. For later grades (e.g. Grade 5,6,7), increasing use of the keyboard is acceptable. For helping youth with typing, one example of a good typing program is Type to Learn http://www.k12software.com/view_details.php?ID=679 Encourage consistent use of spell checker to decrease the overall demands of the writing task and encourage the student to wait until the end to worry about spelling. Handwriting Programs Consider using the program “Handwriting Without Tears”, available at www.hwtears.com. It is particularly helpful for students with visual motor problems. Where to Get Help If things are not improving, then steps to get help include: Seeing the family physician to see if other professionals are warranted It is important to also address any other underlying conditions that are contributing to the handwriting difficulties Seeing an Occupational Therapist (OT), to focus on fine motor strategies, and strategies to help improve it Speak to your child‟s teacher about OT resources in the school; if the school does not have sufficient OT resources, then one may consider hiring a private practice OT See http://www.ementalhealth.ca and look under Health Providers > Occupational Therapists for how to find an occupational therapist in the Ottawa area References Dysgraphia, , retrieved Nov 2, 2006 from http://www.as.wvu.edu/~scidis/dysgraphia.html.