Revised Oct 12, 2005

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Revised Oct 12, 2005 Powered By Docstoc
					                                                                                 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.

				
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