What’s in a Name? The Complexity of Developing Handwriting Skills and How Occupational Therapists Can Help


April is Occupational Therapy Month! One of the many roles occupational therapists may perform with children attending Sheppard Pratt schools is to assist students in developing and improving their handwriting skills. Let’s delve a little more into this! 

Occupational therapists (OTs) are professionals that assist clients in overcoming barriers to performing their daily occupations. The term “occupation” encompasses more than just someone’s job. Occupations include all things that people do to occupy their time that is meaningful to them, and/or required of them! For many children, handwriting is an important occupation! In their role as a student, handwriting is a way to communicate what they have learned. Writing their name is a way to identify themselves and their things.  For example, a student’s ability to write their name on their work enables the teacher to identify the student to whom the work belongs. Additionally, as our older students prepare for transitioning into adulthood, it is important to have a functional signature! 

While handwriting is an important skill for children to learn, handwriting is also one of the most complex tasks they are expected to perform in their day-to-day lives! The ability to write may seem simple for those without a disability, but handwriting actually encompasses an extraordinary number of body systems and underlying component skills. If a child has issues with any single one or combination of these skills, it will very often manifest as poor handwriting.

Here is something that may blow your mind!

Take a deep breath in ... OK, ready, set, go: To write successfully, first one needs to be able to sit in a chair. Just the act of sitting involves a lot, such as having the core strength and postural control to stay upright in the chair against gravity. Then there are also many visual elements to handwriting. There's visual acuity (being able to see and see clearly); occulomotor skills (the ability to move one's eyes to visually scan from left to right and top to bottom); visual perception (being able to interpret series of lines and curves as different and distinct letters); visual-motor integration (the capacity to write in between the lines), and visuospatial awareness (the capability to leave the correct amount of space between letters and words). Another key component to handwriting is fine motor skills. One needs to be able to grasp a pencil appropriately, and to manipulate it using very small movements. This involves having good control over the very small muscles of the wrist, hand, and fingers in addition to strength and endurance of these muscles. Also, there's praxis (motor planning), which is the skill necessary to plan and execute the specific movements required to form each letter consistently and correctly. Then there's other neurological components, such as the ability to sustain attention to task. There are also cognitive components, such as memory (one needs to remember the particular set of lines and curves that represent each letter). To write, a child needs to understand spatial concepts such as top, middle, and bottom. Then there are sensory processing components involved, such as being able to feel the pencil in one's hands, judging how much force to use, and having the ability to filter out excess sensory stimuli from the environment. These are just SOME of the many components and skills involved in handwriting!

As professionals, OTs have the knowledge and resources to break down the task and determine exactly which components are posing a barrier to the student's success in handwriting, and then to determine an appropriate intervention to help that student. The reason why OTs so often address handwriting is not so much the WHAT (the student writes poorly), but the WHY (i.e., poor fine motor coordination and endurance, poor visual perceptual skills, etc.), and most importantly, HOW it is affecting the student’s ability to be successful in school.

So, what exactly do OTs do to assist with handwriting?

At Sheppard Pratt schools---specifically, The Forbush School at Prince George’s County--- OTs use many strategies to help students improve handwriting. Among the approaches to teaching handwriting skills that we have found to work the best at The Forbush School at Prince George's County are strategies based on the handwriting program Handwriting Without Tears. The program was developed by an occupational therapist, Jan Olsen, and is backed up by years of research. Handwriting Without Tears encompasses underlying skills that support handwriting success, as well as using techniques that target the way children learn best: through multi-sensory, experiential learning. It's also fun, motivating, and easily adaptable for kids with many different special needs.

OTs understand that there is so much more to writing than pencil meets paper, which is why when children have handwriting issues we tend to be the ones requested to assist. To learn handwriting skills, we may first do activities using our whole bodies, exercise our fingers, color with crayons, form letters with objects such as wood pieces and play-doh, write on chalkboards, and more…all before ever sitting down and practicing letters with a pencil and paper! Occasionally we even sing songs about writing! 

Sometimes, due to a child’s specific disability, holding a pencil and learning to write letters is not an achievable goal. We see this with many of our students at The Forbush School at Prince George's County, and that is okay too! OTs also work on finding adaptations for clients to meet their needs when they are unable to perform the task. Some adaptations that we use with students at The Forbush School at Prince George's County involve using technology as a suitable alternative to handwriting, such as teaching some students typing skills and/or use of devices such as iPads or label makers for written communication. Other times, lower tech options work best. For example, we have taught students to use a Bingo dot marker to indicate their answers on worksheets, and helped students learn to use a personalized name stamp to put their name on their work. 

No matter what child’s skill level or disability may be, occupational therapists at Sheppard Pratt schools can work with them to develop ways to engage in the occupation of handwriting to have success in their role as a student! 

Kristin Tursky Tatelman, MS, OTR/L, has been an occupational therapist (OT) at The Forbush School at Prince George’s County since 2016. Before moving to Maryland, she worked as an OT in schools and a pediatric therapy center in New York City for six years. Kristin received her bachelor of science degree in occupational science from Ithaca College in May of 2008 as well as her master of science degree in occupational therapy from Ithaca College in October of 2009.