Understanding It
What Handwriting Difficulty Means
Handwriting draws on several skills at once: hand and shoulder strength, fine motor control, the ability to plan a movement, visual perception, the ability to track along a line, posture and core stability, attention, and letter knowledge.
A child can have difficulty with any one of these. Two children with equally untidy writing can have entirely different reasons for it, which is why the intervention that helps one may do nothing for the other.
Difficulty matters most when it affects participation: when a child avoids writing, cannot get their ideas onto the page, cannot finish work in the time available, is rushing to finish their work, or finds writing painful, effortful or fatiguing.
How does it usually present?
- Writing that is difficult to read, or inconsistent in size, spacing or letter formation
- Very slow writing, or unable to keep up with the class
- Letters reversed or formed in an unusual sequence, beyond the age where this is typical
- Awkward or tight pencil grip, or frequently changing grip
- Pressing very hard, or so lightly the writing is faint
- Complaining of a sore hand, or shaking the hand out often
- Difficulty writing on the line or within the space
- Poor posture at the desk, leaning heavily, propping to support head, or slouching
- Avoiding writing, drawing and colouring, or becoming distressed at writing tasks
- A clear gap between what a child can say and what they can write down
- Difficulty with other fine motor tasks: scissors, buttons, shoelaces, cutlery
Some variability is normal in the early school years. It is the persistence, the effort involved, pain or fatigue, and the gap from peers that indicate assessment is worthwhile.
When to Act
When to Seek Help
Consider an occupational therapy assessment if your child is in Year 1 or beyond and letter formation remains very inconsistent, writing is painful or your child tires very quickly, your child avoids or refuses writing tasks, written work does not reflect what your child clearly knows, your child's teacher has raised concerns, or handwriting is affecting confidence or school participation.Arrange a vision check for any child with handwriting or copying difficulty. Undetected vision problems are a common and easily corrected contributor, and a school screening is not always sufficient.
Speak to your GP promptly if your child:
- Loses handwriting or fine motor skills they previously had — regression in any skill warrants medical review
- Has a sudden change in handwriting, coordination or hand function
- Has hand or arm weakness, numbness, tremor, or difficulty using one side of the body
- Has persistent pain in the hand, wrist or arm
Causes & Risk
What Causes It and Who Is at Risk
Contributing factors include reduced core, shoulder or hand strength; underdeveloped fine motor control; difficulty with motor planning; visual perception or visual-motor integration difficulty; attention and working memory; and simply not having had much practice with pre-writing skills.
It is more common in children with developmental coordination disorder (sometimes called dyspraxia), ADHD, autism, low muscle tone, prematurity, and in children with vision problems.
Left-handedness does not cause handwriting difficulty, though left-handed children benefit from correct paper positioning and set-up, which is often not taught.
How We Help
How Our Team Can Help
Occupational therapy is the primary discipline here. Assessment identifies which underlying skills are contributing, rather than treating the handwriting itself as the whole problem.
Support may include:
- Building core, shoulder, trunk support, which often needs to come before fine motor work
- Fine motor and pencil control activities
- Correct letter formation, taught explicitly and consistently
- Seating, desk set-up and posture
- Pencil grips, weighted or thicker writing tools, slant boards, adapted paper and other equipment where useful
- Visual-motor and visual-perceptual activities
- Strategies for improving speed and endurance, so a child can complete written work in a timely manner
- Recommendations for the classroom, and, where appropriate, assistive technology such as typing or speech-to-text so a child's learning is not held back while handwriting develops
We work with teachers where the family wishes, because the classroom is where most writing happens and small adjustments can often produce the largest change.
Improvement generally comes from consistent short practice rather than long sessions, and we will work together to set up something realistic and can be sustained and generalised into the home.
Starting Out
What to Expect at Your First Appointment
Your occupational therapist will talk with you about your concerns, school reports and your child's history, then observe your child writing, drawing and completing other fine motor tasks.
Assessment looks at posture, grip, strength, motor control, visual-motor skills and endurance, and may include a standardised handwriting or fine motor assessment. Sessions can be held in clinic, at home or at school.
You will receive an explanation of what is driving the difficulty, a set of priorities, home activities to start with, and classroom recommendations where relevant.
Ready to book?
Ready to get started?
Contact inOne Healthcare on 1300 765 456 or submit a referral online. Handwriting and fine motor difficulties are addressed by our Occupational Therapy team.
info@inonehealthcare.com.au
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