Fun Strokes Presents… The ADHD and Handwriting Series: Part One

This is a two-part series that will dive into why children with ADHD often struggle with learning how to write and written expression skills.  This problem often leads to a revulsion of all writing tasks.  Know any kids who shut down as soon as you give them a pencil?  This series will explain why in plain terms.  My hope is to provide insight to teachers and parents and offer ways to help children who grapple with this issue.

What is ADHD?

ADHD is one of the most common childhood disorders.  According to the CDC, the estimated number of children ever diagnosed with ADHD is 6.1 million or (9.4%). ADHD is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills. (Schwarz & Cohen, 2013) 

How is ADHD Diagnosed?

ADHD has no definitive test.  Diagnosis is made only by speaking extensively with patients, parents, and teachers, and ruling out other possible causes. (Schwarz & Cohen, 2013)

Is ADHD a learning disability?

No, ADHD is a neurodevelopmental disorder, not a learning disability.  However, ADHD can impair learning. (Cleveland Clinic, 2021)

Is there a link between ADHD and handwriting difficulties?

Yes, kids with ADHD often have trouble with handwriting. 

According to research, between 90–98% of children with ADHD struggle with learning how to write. (Chung, Patel, & Nizami 2020).  Unfortunately, children with ADHD are often viewed as lazy, messy, or sloppy writers.  Many do not realize just how complex the skill of handwriting is and that it can be quite daunting for kids with ADHD.  

Why is it so hard for many children with ADHD to learn how to write?

Learning how to form letters and numbers follows a developmental progression of skills.  It begins in preschool with drawing lines and simple shapes and is typically mastered by second grade. During this time, children also learn the relationship between letter sounds and phonemes (the smallest unit of sound that distinguishes one word from another word) while continuing to grow in motor skills.  By the time children reach third grade, handwriting should be automatic, meaning they no longer need to think about how to write, they just can.  Much like riding a bike, once you can do it, it becomes automatic. 

Children with ADHD often have difficulty learning how to write despite having adequate instruction.  In order words, after being taught in preschool, kindergarten, and first grade. This is called dysgraphia.  

There are many possible reasons why.  Children with ADHD often have one or more of the following coexisting conditions:  

  • fine motor delays
  • difficulties with motor planning and coordination (also known as dyspraxia)
  • visual perceptual and/or visual-motor deficits
  • executive functioning difficulties
  • learning disabilities- 30% to 40% of children with ADHD (Cleveland Clinic 2021)

When primary issues are compounded by a comorbid condition, the issue becomes even greater.  When a child is grappling in one or more of these areas, it’s pretty easy to imagine how they will soon be lost in the classroom.  On average, writing tasks occupy up to half of the school day (Chung, Patel, Nizami).  This can be very frustrating for children with ADHD.  Oftentimes these kids may also struggle with anxiety, depression and behavior problems. (Centers for Disease Control and Prevention, 2020)

Why are the handwriting struggles of kids with ADHD often overlooked?

Children with ADHD are typically diagnosed around age 7, although symptoms typically first appear between the ages of 3 and 6 (Holland & Riley, 2014).  At the age of 7 most kids are in second grade.  The time when they should be nearing mastery of handwriting skills and automaticity.  If diagnosed in second grade, it is unlikely that their kindergarten and first-grade teachers were fully aware of their struggles.  They may have appeared lazy or sloppy, rather than struggling with learning how to write.   

What happens if handwriting skills do not become automatic?

This is the key question! The issue often has a domino effect.  

Oftentimes children are taught how to write letters and letter sounds simultaneously. When there is a struggle with learning formations due to impaired motor planning, weak motor skills or whatever the issue may be, it may consume all of the child’s attention. This can take away from his or her ability to absorb additional information like learning letter sounds and phonemes. Oftentimes this lends to further trouble down the road when trying to put letters together to spell a word and then put words together to build a sentence.

Once children enter third grade, handwriting demands increase tremendously.  Children are no longer learning to write, but rather, they are writing to demonstrate what they have learned.  If a child has failed to gain automaticity with handwriting skills, many classroom expectations become an uphill battle. 

Writing projects require the additional ability to organize, plan, and implement a complete written product.  In other words, writing tasks require executive functioning skills which many kids with ADHD are lagging in.  For example, let’s take a look at the steps required to write a sentence.  First, one needs to create the thought.  Then, formulate that thought into a complete sentence.  Then, remember all parts of the sentence while trying to remember how to write the letters, where to place them on the line, and how to apply the rules of grammar.  Hopefully once all things are considered and executed, the written product matches the original thought. That’s just one sentence!  By third grade, the child must put together many thoughts to create sentences and build them into a whole paragraph or several paragraphs that make sense.  Children who fail to acquire writing automaticity by third grade have a much greater chance of struggling with more complex writing tasks. They are likely to have a hard time keeping up with their peers’ growth in writing ability. The skills of automaticity are connected to superior writing products in high school and college.  (Chung, Patel, & Nizami, 2020). 

What happens if skills become automatic but writing is still illegible?

As stated earlier, oftentimes children with ADHD also struggle with executive functioning skills.  Self-monitoring (keeping track of what you’re doing) is required for neat and legible handwriting.  Poor executive functioning skills can impact a child’s ability to self-monitor or pace his/herself while writing.  In other words, impulsive behavior or acting without thinking about the outcome can result in a child rushing to finish writing just to be done with it.  This can have a huge impact on legibility.  It’s not that the child doesn’t know how to write neatly, but has a really hard time pacing his/herself in the moment in order to do so.  

Get this free infographic which quickly explains the link between ADHD & Poor Handwriting

Can handwriting difficulties in children with ADHD lead to other problems?

Yes, it can.  Difficulty developing handwriting skills often has larger harmful effects. For many children with ADHD, any writing assignment is an ordeal; the struggle to spell words correctly or produce legible handwriting is immensely frustrating, and also takes attention away from the more meaningful aspects of the assignment. (McCloskey & Rapp, 2017)

It can have a huge impact on the completion of homework as well.  For example, a child who has a hard time writing numbers legibly and aligning them neatly in a column or line will work harder in math while learning less.  Homework will take longer to complete than the child with typical handwriting skills. (McCloskey, & Rapp, 2017)

Deficient handwriting has been associated with lower self-perception, lower self-esteem, and poorer social functioning. (Chung, Patel, & Nizami, 2020). 

Bottom line, the ability to write is a fundamental component of literacy and is crucial for success not only in school but also in most workplace environments.  (McCloskey &, Rapp 2017). 

Stay tuned for part two where I will dive into what can be done to help children with ADHD and dysgraphia. 

ADHD and Handwriting

References:

Centers for Disease Control and Prevention. (2020, September 4) Other Concerns and Conditions with ADHD  https://www.cdc.gov/ncbddd/adhd/conditions.html

Chung, P. J., Patel, D. R., & Nizami, I. (2020). Disorder of written expression and dysgraphia: definition, diagnosis, and management. Translational Pediatrics, 9(Suppl 1), S46–S54. https://doi.org/10.21037/tp.2019.11.01

Cleveland Clinic.  Attention-Deficit/Hyperactivity Disorder (ADHD) (2021, January 12) https://my.clevelandclinic.org/health/diseases/4784-attention-deficithyperactivity-disorder-adhd

Holland, K. & Riley, E., (2014, September 4) ADHD Numbers: Facts, Statistics, and You The ADD Resource Center https://www.addrc.org/

McCloskey, M., & Rapp, B. (2017). Developmental dysgraphia: An overview and framework for research. Cognitive neuropsychology, 34(3-4), 65–82. https://doi.org/10.1080/02643294.2017.1369016

Schwarz, A., & Cohen, S.. New York Times (March 31, 2013). A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise https://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html

Published by Linda Craig Dennis

Pediatric Occupational Therapist, Author and Creator of Fun Strokes Pre-writing Program

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