Letter Reversals, Should You Be Concerned?

What are letter reversals?  Letter reversals simply means writing letters backward. Letter Reversals are actually quite common in all children.  They typically resolve by the age of 7.  By third grade reversals may still be present, but only occasionally.   In typical development, it takes time for children to gain a solid picture in their minds of what each letter looks like.  Then they must come up with and carry out the motor plan required to mimic the visual image in their brain.  Believe it or not, there is still more to developing the skill of handwriting, but that is not the focus of this post.  Here I will focus on the topic of reversals.  

Although letter reversals can be typical up to third grade, the earlier you help the child to resolve the problem the better.  School-age children spend a great amount of time writing, up to 50% of their day.  Many bad habits can develop, reversals being one of them.  Try to stop the issue before it becomes habitual.

What causes letter reversals?

Reversals are a result of difficulties in visual processing skills and/or executive functioning skills.  

Visual Processing Difficulties Explained:

Visual Memory

Some children have a hard time remembering what letters look like.  So when they are attempting to write letters from recall or without a model, reversals occur because they simply can not remember what it looks like.  This is particularly confusing for those letters that are a mirror image of each other like b and d or letters that can be flipped like p and q.  These letters are most commonly reversed. Some children have trouble with w and m, n, and u.  

Directional Awareness

Knowing left from right, and developing a dominance for the use of one hand over the other plays a large role in the development of handwriting skills.  If a child struggles with this, they may also struggle with the position of letters.  If unable to discriminate between left and right, how can a child discriminate between b and d?  

How can you tell if a child struggles in this area?  You will probably notice the following behaviors:

  • Switching hands when coloring, drawing, or writing
  • Using both hands when coloring, drawing, or writing
  • Putting shoes on the wrong feet
  • Starting in the middle of the paper or random locations on the paper when writing sentences  
  • Failure to demonstrate left to right progression in reading and writing

Spatial Awareness

Some children have great difficulty figuring out where to start letters and/or how big or small to make letters.

Visual Discrimination

Being able to recognize how images are different is extremely important when learning letters and their sounds.  If subtle differences are hard to discern, it will be quite difficult to learn this skill.  

Visual-Motor Integration

Being able to copy shapes and write letters requires visual-motor integration.  This is the ability to look at a form (shape or letter) and process the visual information in your brain.  Then your brain must come up with a motor plan.  Meaning your brain must tell the muscles in your hand how to move to copy the shape or letter using a writing utensil.

How can you tell if a child struggles in this area?  You will probably notice the following behaviors:

  • Difficulty learning pre-writing strokes, the basic shapes that serve as the foundation for all letters and numbers
  • Unable to draw or write with fluid strokes meaning the child needs to pick up their utensil every time they change the direction of their stroke, like from horizontal to vertical.  This is also referred to as segmental drawing.
  • Unable to change the direction of the stroke without turning the paper.  This is a compensatory behavior where the child will help themselves by turning the paper instead of their hand to execute the stroke.
  • Children who write letters from the bottom up versus top to bottom.  This is another compensatory technique where the child feels more grounded by starting at the bottom of the line.
  • Difficulty crossing the midline or reaching an arm/leg across the body to the opposite side when playing, getting dressed, drawing, or anytime it makes sense to approach a task in this manner to be most efficient.  

Executive Functioning Difficulties Explained: 

What is executive functioning?  This brain function is responsible for many skills.  Here I will focus on the executive functioning skills that play a huge role in the acquisition and execution of handwriting skills.  Executive functioning provides working memory, allows us to pay attention, and to self-monitor our actions.  

Working Memory

Working memory is the ability to retain information long enough to accomplish a task.  For example, remembering a telephone number long enough to enter the digits into your phone.  When children are learning to write letters, they must remember the stroke sequence.  This often requires several steps, some letters more complex than others.  Let’s emphasize letter b, the stroke sequence is “start at the top, make a vertical line, climb back up the vertical line, upon reaching the mid-point of the line, form a circle on the right side of the line that closes on the bottom of the line.  Sound complicated?  Of course, those of us who learn this skill readily don’t have to think about it that much, but those who struggle need to think about it too much!

Attention Span 

So I’ve just covered how complicated and complex learning the stroke sequence to letter formations can be.  Imagine if you also struggle with paying attention to the instruction when you are learning how to write.  No doubt, you will compensate by coming up with your own method which may or may not be a legible version of the letter.

Self-Monitoring

Executive functioning allows one to pace oneself.  Early writers or those learning to write, need to think about how to form every letter before writing it.  This is a meticulous effort that requires self-control.  Those who struggle in this area will write without forethought, often resulting in poor formations and reversals.

Other factors may also play a role.  Often times children who are learning to write are also learning letter sounds, phonetics, and other components of language. Sometimes problems learning these concepts may lead to trouble learning to write.  Sometimes problems learning to write may lead to trouble learning language components.  The bottom line, every child is different and may have unique struggles.     

Do children who write letters backward have dyslexia?  

Dyslexia is a learning disability that impacts reading.  Letter reversals are not necessarily a sign of dyslexia. Some kids with dyslexia have trouble with this, but many don’t. In fact, most kids who reverse letters before age 7 end up not having dyslexia. Source: www.understood.org

Letter Reversals Explained At A Glance:

Letter Reversals, Should You Be Concerned?
Infographic: Letter Reversals, Should You Be Concerned?

What Can You Do?

Teach children letters following developmental guidelines

An OT’s dream would be for schools/parents to teach letters following developmental guidelines.  Meaning, pre-writing strokes first, then uppercase letters, and finally lowercase letters.  It is also ideal to teach letters that have a similar stroke sequence in groups.  My favorite handwriting program is Handwriting Without Tears.  It was created by an occupational therapist.  Handwriting Without Tears follows the developmental progression of skills and group letters according to stroke sequence.  For example “magic c letters”.  All letters that begin with “c” are taught as a group.  Those letters are c, a, o, d, g, q.  Some schools use the Handwriting Without Tears program as part of their curriculum.  I strongly believe that it helps to prevent letter reversals and helps to correct letter reversals.  Unfortunately, many schools choose to utilize other handwriting curriculums.

Kindergarten Workbook

First-grade workbook

Check out the Handwriting Without Tears Program by clicking the images above.

Use a multi-sensory approach

  • Use visuals:  color contrast, varying colors for each stroke and visual aids like the one presented on the right can be very helpful. Download the PDF on the right or the ones below and place it on the child’s desk or the wall in your classroom.
  • Provide tactile input which will give more feedback to the child when learning the motor sequence to form letters:  use textures like writing on sandpaper, or make letters in sand, shaving cream, pudding, rice, etc.
  • Provide kinesthetic input:  air writing (form letters with pointer finger in the air). Use hands as visual aids.
  • Provide auditory input:  have the child state the stroke sequence while writing the letter.  Make up a song to accompany the stroke sequence to the letter. Sing it to a familiar tune like…Head, Shoulders, Knees, and Toes.

Build Visual Processing Skills:

  • Mazes
  • Games (Connect 4, Trouble, Perfection)
  • Hidden Picture Exercises
  • Word Searches
  • Color By Number

For some children, teaching cursive handwriting may help.  Cursive handwriting naturally lends itself to correct reversals as letters are connected and words are formed as one continuous stroke.  This method may not work with children who struggle with motor planning however as cursive requires more complex stroke sequences with many directional changes. 

Do you have a go-to strategy to combat letter reversals? I’d love to hear about it. Please share in the comments section below.

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

Eight Handwriting Strategies for Children With Autism

As a school-based occupational therapist, I’ve had the wonderful opportunity to work with many autistic children over the years. I soon discovered the value in being able to think outside the box and quick on my feet. This was often necessary to keep my autistic kiddos engaged and motivated to do what I needed them to do during therapy sessions. It is with great enthusiasm that I share an article that I’ve written for the outstanding publication Autism Parenting Magazine. In the May 2021 issue, I share strategies that parents can use to prepare their children for the handwriting demands of kindergarten and beyond. These strategies are also recommended for teachers, those who homeschool, or anyone who provides care for children with autism. I hope you find this information useful!

Eight Handwriting Strategies for Children With Autism
Children with autism often have handwriting impairments.
Foster a strong foundation by making sure your child can form the prerequisite pre-writing strokes before attempting letters.
Foster a strong foundation by making sure your child can form the prerequisite pre-writing strokes before attempting letters.
Use simple and consistent verbal prompts.  When working on pre-writing strokes, use the same verbal prompt for each stroke until they can do it.
Use simple and consistent verbal prompts.
Children with autism tend to be visual learners rather than auditory learners.
Children with autism tend to be visual learners rather than auditory learners.
Children with autism, like all children, benefit from structure and routine.  Knowing what to expect reduces stress and anxiety.
Children with autism, like all children, benefit from structure and routine. Knowing what to expect reduces stress and anxiety.

I hope you’ve enjoyed this article. Please feel free to share with anyone who may be interested! If you would like to see more of what Autism Parenting Magazine’s May 2021 issue entails, please click on the following link:

Autism Parenting Magazine Volume 123
Autism Parenting Magazine Volume 123

Autism Parenting Magazine Issue 123 Autism In Girls

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

ADHD and Handwriting: Part Two

Children with ADHD often have difficulty learning how to write, also known as dysgraphia. In this post, I will dive into what can be done to help children reach fine motor developmental milestones as they relate to handwriting readiness. I will also talk about what can be done to help those who may be struggling with learning how to write or who struggle with written expression. Please refer to Part One of this series to learn more about ADHD and dysgraphia: The ADHD and Handwriting Series…Part One Let’s get to it!

Number One…Start Early

Take preventive measures by monitoring the child’s development. One of the primary goals of starting my blog is to inform parents, grandparents, teachers, and caregivers of what to expect during the crucial early years. Before children learn to write there are very important developmental milestones that must be met to ensure handwriting readiness. These milestones are typically acquired during the preschool years and equip children with the foundation that is needed to meet the handwriting demands of school.

Is the child between the ages of 3 to 5?

Prepare children for handwriting demands by ensuring that they can form prewriting strokes in preschool or before starting kindergarten. Prewriting strokes are simple lines and shapes that are the basis of all letters. Children must be able to form prewriting strokes before they can to learn how to write letters.  Making sure that children are proficient in this skill will prepare them for the very complex task of learning how to write.  I’ve purposefully created the Fun Strokes program to teach children this skill.  Fun Strokes is a super fun and engaging program that addresses all facets of fine motor skills.  Learn more by clicking here: Fun Strokes Prewriting Program

Fun Strokes Book and Magnet Pack

I also recommend having children work on a vertical surface or easel when learning how to form prewriting strokes. Children benefit in so many ways when working on a vertical surface. Learn more by clicking here: Benefits of Working On a Vertical Surface

Is the child in kindergarten?

If you notice a child struggling with learning how to write in kindergarten, take action.  This is a crucial time where intervention can have the greatest impact. Work with the child by providing extra support. The following suggestions will help with motor planning, muscle memory, and visual memory.

  • Have the child verbalize the stroke sequence for each letter while writing it
  • Have the child write the letter with eyes closed in the air
  • Provide sensory input by forming letters with various mediums (shaving cream, pudding, whipped cream, sand, Play-Doh, etc.)

Address pencil grip if needed. If a child’s grip looks awkward or if the child complains of discomfort, chances are he or she will benefit from additional support. Learn more about typical development and what to expect by clicking the following link: Pencil Grasp Development: What To Expect

Here are my go-to pencil grips from Amazon:

Grotto Grips

The Pencil Grip Original Universal Ergonomic Writing Aid for Righties and Lefties 

Always Use Primary Paper

Children this age need the structure and visual guidelines provided by primary paper. Do not try to skip this stage by having kindergarten children write on standard wide- ruled paper. Developmentally they are not ready and this can create unnecessary problems.

In addition to the visual guidelines primary paper provides, some kids need additional sensory input. There are many forms of modified paper that offer sensory input. Providing paper with color contrast and visuals assists children with learning how to orient letters on the line and letter placement skills. For example, the Smart Start paper featured below has a top blue line with a picture of the sun and clouds. This helps children with the placement of tall letters like t, l, and f. The baseline is green with a picture of a flower that represents grass. This helps children to learn that all letters need to be grounded on the baseline. Provide even more support by providing auditory cues like “tall letters start on the blue sky”. Some children need tactile input. Providing paper that offers raised lines allows kids to see and feel where letters should be placed on the line. Here are two of my favorite types of paper from Amazon.

Smart Start K-1 Writing Paper

Pacon Multi-Sensory Raised Ruled Tablet

Improve fine motor skills via activities. Here are several fun activities to promote fine motor skills.

Addressing the problem in the crucial primary years is paramount.  Try to remediate struggles before academic demands increase.  If you’ve worked with the child for a considerable amount of time and they are still having a hard time or very little progress has been made, a referral to an occupational therapist may be warranted. Especially if the child is nearing the end of kindergarten.

What can you do if the child is in first or second grade?

If the child continues to struggle with learning how to write consult with an occupational therapist.  Talk with your child’s teacher to learn about your school’s process.  He or she may recommend an occupational therapy evaluation.  If the child is experiencing problems in other areas as well, additional testing may be recommended to determine if your child needs specialized instruction (individualized education plan also known as an IEP) or a 504 accommodation plan.  You may also seek an OT evaluation through your pediatrician.  Most major insurances will cover the assessment if it is deemed medically necessary.

What can you do if the child is already in 3rd grade or higher?

Continuing to address handwriting automaticity is still important typically via OT services. Additionally, modifications may need to be made in the classroom via specialized instruction (IEP) or a 504 accommodation plan. If you homeschool, you can also implement these strategies at home. At this grade level, children are no longer expected to learn how to write but to write to show what he or she has learned.  Sometimes reducing or eliminating the manual aspect of handwriting is necessary if you want a true assessment of what the child can express. Getting thoughts out of one’s head and onto the paper is the ultimate goal. Eliminating the need to think about how to form letters, how to spell many of the words, and how to apply the rules of grammar will help the child focus on the content they’d like to write about. Typically the IEP or 504 teams will use their expertise to determine what modifications or accommodations would be appropriate and most beneficial.  It is important to strive for the maximum level of student participation and independence when determining the level of support needed. There are several options that can be trialed to determine what works for the kiddo. Everyone is unique so there is no catch-all. Children may benefit from one or a combination of the strategies listed below:

1. Graphic Organizers

Help with producing and organizing thoughts with graphic organizers. Graphic organizers are visual thinking tools that prompt ideas and facilitate building those ideas into detailed paragraphs. Houghton Mifflin Harcourt offers over 30 templates of various graphic organizers that you can download for free! Click on this link:   Free Graphic Organizers

Sandwich Chart courtesy of Houghton Mifflin Harcourt
Sandwich chart courtesy of Houghton Mifflin Harcourt

2. Franklin Spellers

Franklin Spellers are a form of assistive technology that helps children self-correct spelling errors. How does it work? A child simply types in his or her phonetic spelling of a word,  and the Franklin Speller will present a list of words that the child probably meant to spell. It helps children learn how to edit or check their work for spelling errors with greater independence. If selected, each word will be presented with a definition. This way the child can figure out if it is the correct word.  Some electronic spellers come equipped with built-in text-to-speech functions which are very helpful for those who need assistance reading.

Franklin SPQ109 Collins Pocket Speller

3. Sentence Starters

Sentence starters do just that. They provide the beginning of a sentence to stimulate a thought or idea. The child then builds on that thought to complete the sentence. For example: “What excited me was….; What surprised me most was…

4. Sentence Frames

Sentence frames are fill-in-the blank sentences. The structure of the sentence is already built to support kiddos who have trouble writing a complete sentence. The sentence frame prompts the student to think of responses or words to make the sentence complete. For example: “My favorite ____________ is ____________ because _____________.

5. Word Banks

Word banks are a list of words provided to children to assist them while they are writing. The words provided relate to the content you want them to write about. Children are encouraged to use the words when creating sentences.

6. Grammatical Checklists

Provide checklists to support the editing process. Once the student has written a paragraph they can go over their work using a checklist to ensure that they have started each sentence with a capital letter, used punctuation, etc.

7. Expect neat handwriting ONLY when copying a final draft

Reduce frustration and anxiety by eliminating all other demands (letter formation, spelling, grammar) while developing content. Once finished, the child can rewrite their composition neatly and correct spelling and grammatical errors.

8. Build Keyboarding Skills

As middle and high school approaches, is important to work on building keyboarding skills. Preparing children before handwriting expectations increase will equip them with the tools they need to keep up with the rigor. Having this skill may also reduce the anxiety associated with written tasks. Many websites offer free tutorials, lessons, and games. Spending just 10-15 minutes a day can make a huge difference. Here are my favorite websites:

Dance Mat Typing

Free Typing Lessons and Games

Free Typing Games

Typing Club

9. Allow the child to type instead of writing when appropriate

Again, eliminating other demands (trying to remember letter formations, line orientation, spacing, spelling) can reduce frustration, anxiety and yield better content.

Here’s a free infographic that summarizes these strategies.

Final Note

It is important to continue working on handwriting legibility skills or keyboarding skills to develop as much independence and autonomy as possible. Written communication is an essential life skill needed for both school and the workplace.

Have a suggestion to share? Know of a strategy that has helped a child in your life? Please leave a comment below. I’d love to hear about it!

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

The Frugal OT Series: Butterflies on a Budget

May’s Dollar Tree Find of the Month: Butterflies on a Budget

Spring is in the air and so are butterflies. Children will enjoy making a cute little colorful bug of their own. Of course, while working on fine motor and visual processing skills.

The Frugal OT Series…Dollar Tree Find of the Month

Materials Needed:

  • 1 full pipe cleaner
  • 3/4 pipe cleaner
  • 1/2 pipe cleaner
  • assorted beads
  • pencil or straw to form antennae

How to Make:

Butterflies on a Budget

Skills Addressed:

This fun activity addresses the following skill areas:

  • pincer grasp and 3 jaw chuck (tripod grasp)
  • hand separation
  • bilateral coordination
  • visual discrimination
  • visual sequencing
  • visual tracking
  • eye-hand coordination
  • crossing the midline

Grade Down (Make it Easier)

Have the child place beads onto the pipe cleaner and the adult assists with bending the pipe cleaner as needed to form the butterfly.

Hold the straw or pencil to stabilize it as the child wraps the pipe cleaner to make antennae.

Grade Up (Make it Harder):

Make sequencing and scanning more difficult by placing plenty more beads onto the pipe cleaners.

Build in-hand manipulation skills:

Translation is the ability to move objects from the palm of one’s hand to the fingertips and from the fingertips to the palm. Have the child practice this skill with the beads. Ask the child to grab a handful of beads and move them from the palm to fingertips to put them onto the pipe cleaner.

Frugal OT Series: Butterflies on a Buget
Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

The Frugal OT Series: Egg-cellent Fine Motor Fun

Dollar Tree Find Of the Month

April’s activity is egg-cellent! Yes, I couldn’t resist saying that!

Spring has sprung and Easter is right around the corner. Grab the following items from your local Dollar Tree and your kiddos will be delighted!

Dollar Tree

This months activity works on the following skill areas:

Tripod Grasp

Hand Separation (developing separation of the sides of the hand improves fine motor skills)

Fine Motor Control

Eye-hand Coordination

Bilateral coordination

Visual Discrimination (scanning the eggs to find its pair, then putting to two sides together so that the cute little face is correctly aligned)

How to Make:

Fine Motor Egg-cellence

Grade Down or Make it Easier:

Use fingers to pick up the candy and place it into the eggs

Grade Up or Make it Harder:

Help children build their fine motor skills in the following areas with this fun “cracking egg” task:

Develop intrinsic musculature (all the little muscles in the hands)

Learn how to grade pressure (figuring out whether more force is needed or if applying too much force)

Develop proprioceptive awareness (sense of self-movement and body awareness)

Egg-cellent Challenge!

Add On Activity:

An Easter egg hunt of course:) I hope you and your kiddos enjoy this activity. Have any ideas that would make this activity even better? Please share in the comment section below.

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

ADHD and Handwriting: 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.  I hope 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 rather has a really hard time pacing his/herself in the moment to do so.  

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
Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

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

The Frugal OT Series: Lil’ Pot of Gold

March Activity of the Month

The Frugal OT Series...March Dollar Tree Pick of the Month: Lil' Pot of Gold

Here is a really simple but super fun St. Patrick’s Day themed activity. Many skills are addressed while children enjoy searching for everyone’s St. Patty’s dream…a pot of gold!

Here’s How:

Music Credit: Sunshine Day by Mixaund | https://mixaund.bandcamp.com
Music promoted by https://www.free-stock-music.com

The Frugal OT Dollar Tree Pick of the Month...Scavenger Hunt for Gold
The Frugal OT Series...Dollar Tree Pick of the Month: Kids Jumbo Tweezers

Skilled addressed in this activity:

  • bilateral coordination
  • hand strengthening
  • grasping skills
  • tripod grasp for handwriting readiness
  • eye-hand coordination

Visual perceptual skills addressed during scavenger hunt:

  • figure- ground
  • form constancy
  • spatial relations

During the Covid 19 pandemic, it’s not easy coming up with safe activities that are not shared or can be sanitized between uses. At less than 3 bucks per kit, this is a very economical way to supply each child with their own materials. Have peace of mind while enjoying this activity with your little ones. Leave a comment or pic of your experience. Share your spin on this activity, have any ideas? Leave a comment:)

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

How to Improve Handwriting Legibility: Line Orientation

Many children have a hard time learning how to form letters and numbers. As a school-based occupational therapist, I receive many referrals for this problem. Handwriting is a very complex function that requires many underlying skills. This post will focus on how to help kids learn how to print letters with correct line orientation or how to place letters correctly on the line. Difficulty with line orientation can make handwriting very difficult to read. For more information on the importance of handwriting legibility check out this post.  Handwriting Legibility: Why Is It So Important?

Several factors can make a child’s writing difficult to read.  

  1. Poorly formed letters
  2. Letters that are squished together or spread too far apart
  3. Words that are squished together or spread too far apart
  4. Poorly organized writing that is all over the page instead of aligned along the margin and lines of ruled paper
  5. Very faint print that is difficult to see due to inadequate pressure
  6. Very dark print that appears messy due to too much pressure

What Does Trouble With Line Orientation Look Like?

Letters may be written on top of the lines, or float above and/or below the lines. Letters may be too big to fit within the lines. Writing may consist of a mix of big and small letters that vary in placement on the lines. Some children may write with no regard for the lines at all. In this case, letters are typically very large and are randomly placed on the paper. In this post, the focus is on line orientation or letter placement. Being able to discern if letters are tall, short, or descending, and place them correctly on the lines of ruled paper is an important component of handwriting legibility. Problems with line orientation can make handwriting very difficult to read.

Why Do Some Kids Have Trouble With Line Orientation?

  1. Lack of fine motor control
  2. Inefficient pencil grasp
  3. Poor eye-hand coordination
  4. Poor visual-motor integration 
  5. Poor visual processing skills
    1. visual closure
    2. visual discrimination
    3. visual scanning
    4. form constancy

How Can You Address Poor Line Orientation?

There are several ways to help kids learn how to place letters on the line correctly. Here are some things you can do:

Activities

  • Draw lines on a piece of paper. Place the paper in a page protector. Have the child try to form letters and place them correctly on the line using play dough, Wikki Sticks, dry erase markers, and/or theraputty.
  • Roleplay. Allow the child to act as the therapist or teacher. Illustrate errors with line orientation by writing a word or sentence containing a few mistakes. Have the child try to identify and fix your mistakes. Kids love this!

Use Checklists

Checklists help kids organize and plan out the steps needed to edit their handwriting. Some provide a visual model to help kids learn how to identify their errors. Also, checklists are interactive providing a hands-on approach to the editing process. Who doesn’t like to check off boxes? It can be very satisfying.

Therapist tip! Use checklists at the student’s pace. Handwriting checklists often try to tackle too many components at once. This can be overwhelming for students because it’s too much information to process. I recommend gradually building children’s legibility skills and increasing the challenge as they progress. Determine what deficit is impacting their legibility the most and start there.

The checklists below addresses only one legibility component, letter placement in progressive steps. The amount of visual cues is faded to match the child’s needs as he or she improves.

Letter Placement Checklist Level One
Letter Placement Checklist Level Two
Letter Placement Checklist Level Three

I like to laminate checklists or put them in page protectors so they can be used over and over again with a dry erase marker. It is helpful for some kids to have the checklist adhered to their desks. You can shrink the image and tape it to the corner of the desk or place it in plain sight. This will serve as a visual reminder to edit their handwriting.

Would you like to use these checklists with your little ones? Get your free PDFs here:

Change the Paper

If the child is in kindergarten or first grade, make sure they are using primary paper. Children this age need the visual structure this type of paper provides. Sometimes children are given wide-ruled paper too soon and this can be the cause of the problem. In addition to the visual guidelines primary paper provides, some kids need additional sensory input. There are many forms of modified paper that offer sensory input. Providing paper with color contrast and visuals assists children with learning how to orient letters on the line and letter placement skills. For example, the Smart Start paper featured below has a top blue line with a picture of the sun and clouds. This helps children with the placement of tall letters like t, l, and f. The baseline is green with a picture of a flower that represents grass. This helps children to learn that all letters need to be grounded on the baseline. Provide even more support by providing auditory cues like “tall letters start on the blue sky”. Some children need tactile input. Providing paper that offers raised lines allows kids to see and feel where letters should be placed on the line. Here are two of my favorite types of paper from Amazon.

Smart Start K-1 Writing Paper

Pacon Multi-Sensory Raised Ruled Tablet

These are just a few of the many types of adapted paper on the market to help kids with letter placement and written organization skills.


To further reinforce line orientation skills, you can have the child scan written material (their handwriting or any text). Ask them to draw a circle around or highlight a certain category of letters. For example, highlight all of the tall letters, or draw a circle around all of the “diver” letters. This will improve awareness of variations in letter size. It will also help with visual scanning skills.

Want to learn more on this topic? Check out these posts from my Handwriting Series:

How To Improve Handwriting Legibility: Pressure Grading (how-much-force-to-apply)

How To Improve Handwriting Legibility: Spacing

As always, have fun!

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

How To Teach Grade-Schoolers Organizational Skills…Starting With the Disorganized Desk

Having a disorganized desk can make school hard to manage.  When the teacher asks his or her students to take out their science books and turn to page 57, the child who is lost in their desk trying to find the book often can not remember the page number once it is found. Many times this student will remain lost in the lesson because of their fraught start.  Tasks that should be simple become overwhelming and time- consuming often leading to stress and frustration.  Organization can be an elusive skill that many kids struggle to acquire.  The fact of the matter is there’s a lot that goes into being organized.  Organization is part of a set of skills called executive functions.  Keeping a desk organized requires more than just putting things away.  Managing school materials requires planning, prioritizing, decision making, sequencing, task initiation, and following through with those tasks to completion.  Some kids need extra help to set up and maintain an organized desk space at school.  This post will focus on how to provide grade-schoolers with the support they need to establish and sustain a functional workspace at school.

Use Visuals

Visuals paint a picture of exactly what is expected of the child. Often kids just don’t know what teachers mean when they say, “clean your desk”. Providing kids with a visual helps them to wrap their heads around what they are supposed to do when challenging requests are made.

How to Fix...The Disorganized Desk: Create a Desk Map

Create a desk map by organizing the contents of the desk and then taking a picture of your expectation. Designate time to work on organizing the desk. How often you do this will depend on the student’s needs. Some will need to do this every couple of days, other students may just need it once a week. Over time, you should expect the amount of time and support needed to decrease and the student develops the skills needed to stay organized.

Teach students how to decide whether to trash items or keep them. Old graded papers should go home for parents to see. Create a location (folder/envelope) for these papers to go. Important papers like class notes and worksheets need to be placed in a binder or glued into a notebook, whatever system is in place.

Throw away old crumbled papers, wrappers, leftover snacks, crayon paper shavings, eraser bits, and whatever else can be disposed of. This makes it easier to keep the desk neat and organized.

Place homework in a folder designated as such. Label the compartments, for example, “keep at home” and “bring to school” or “to do” and “completed”.

Create Divisions

Divisions assist the student with knowing where to place items. For example, place books on one side, notebooks/folders on the other, pencil box, pouch, and other compartments on top.

Use Checklists

Checklists help children with breaking down the steps of a task. In this case, checklists tell the child exactly what should go in each division of the desk.

How to Fix...The Disorganized Desk: Make a Checklist for Each Division
How to Fix...The Disorganized Desk: Make a Checklist for Each Division

Checklists are also interactive and hands-on. Children check the boxes as the task is being completed. This ensures the completion of each step, as the boxes are checked as one moves down the list. This is very helpful for students who need assistance with sequencing the steps to a task or get lost trying to figure out where to start. It also provides immediate positive reinforcement that progress is being made with a nice visual to display it. I love to scratch items off my to-do-list! It makes me feel very productive and accomplished. Whether it be my chore list, my grocery list, or my Christmas gift list, the feeling is always the same and it is always good. Children need to feel accomplished as well, and checklists are a great visual motivator.

How to Fix...The Disorganized Desk: Laminate For Durability and Dry Erase Marker Use

Lamination makes it possible to use the desk organization system as many times as needed without worrying about making copies. I also recommend using thick paper, like the index cards in the picture above. The end result is a durable tool that should last several months.

How to Fix...The Disorganized Desk: Add a Key Ring

I like to create a flippable booklet by placing a hole in the corner using a paper hole punch. Then use a key ring to secure the pages. I love those little adhesive plastic hooks that can be purchased almost anywhere. Attach the hook to the side of the desk and hang the booklet there.

If you are concerned that it will get lost, you can also tape the cards to the desktop.

How to Fix...The Disorganized Desk: Hang or Place Desk Booklet on Desk

Build Independence

Teach your student how to use the booklet. Gradually pull away and let the student follow the steps on their own. Perform desk checks weekly or as often as needed to reinforce how to use the organization system correctly. Eventually, the level of assistance will decrease and your student will become more independent with keeping the contents of their desk organized.

Happy Organizing! I hope you will find this post helpful. Please comment if this system has worked for you and your students or if you have a strategy of your own that you’d like to share.

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

The Frugal OT Series…Reading Highlighters

Dollar Tree Find of the Month

Introducing my February Find of the Month: Reading Highlighters or as I like to call them…visual scanning aides.

For just one dollar you get 10 of this wonderful tool that helps with so many things.  These strips come in two different color transparencies, yellow and blue, and lots of cute borders options that the child can choose from. 

The Frugal OT Dollar Tree Pick of the Month:  Reading Highlighters
Reading Highlighters from Dollar Tree

Let me count the ways these reading strips can benefit a child…

  1. Helps children who have difficulty with visual tracking (eye movement that enables the eyes to aim their focus on the line without losing place). 
  2. Helps to prevent skipping words, sentences, and lines altogether.
  3. Helps to increase focus/concentration by providing more visual input; this is good for children who have difficulty attending to visual information on a page or are overwhelmed by too much visual information presented on a page.
  4. Provides tactile input for children who need to have something in their hand or need to touch something.
  5. Increases the level of engagement in the reading task as the child must move the reading strip along the lines of text as they read.
  6. Serves as a bookmark which is a great reminder for kiddos to use their reading strip consistently.

How to Use Reading Highlighters:

Using these strips is very simple. Simply place the transparent portion of the strip over the line of text that is being read; much like using your finger to keep place along a line of text. Move the reading highlighter over each line of text as it is being read.

So if you know a child who has needs fitting any or all of the descriptions above, try these visual tracking aides! Leave a comment if this tool has helped your little one, or share successful tips you like to use.

Disclaimer: 

The Fun Strokes blog is designed for educational and informational use only for teachers, therapists, and parents. It is not intended as medical advice or therapeutic treatment that would be provided in an individualized treatment plan. If you suspect a child has delays, please consult an occupational therapist.

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