Handwriting is one of the most important tools a child uses to express himself at school. Because a teacher has so many children to work with, she often relies on the child’s written responses to determine a child’s progress, whether it is through workbooks/exercises or through tests and exams. However, for a certain group of children, producing handwriting or expressing themselves through the written word can be challenging.

One of the most common skills an occupation therapist works on is handwriting. There are many aspects of handwriting the occupational therapist may explore/promote, including:

• The way a pencil is held and whether the letters are formed by dynamic finger movements or whole hand movements.
• The form, size, shape and legibility of the letters
• How the letters are placed on a line
• How fast the child is able to produce the handwriting and how quickly the hand tires when writing
• How the work is structured and organised (for example, does the child start on the left, work to the right, leave enough space on each side, organise appropriate paragraphs, structure an essay appropriately, etc)

Some other factors related to a child’s ability to write that the occupational therapist will consider include:

• Attention
• Posture and stability at a desk
• The ability to copy notes from a board
• How successful visual information is integrated with motor skills

There are so many ways that an occupational therapist helps a child build on handwriting. Here are only a few examples:

• Liaise with the teacher, resource teacher and/or special needs assistant to determine what is being done at school and what supports are necessary in the school.
• Consider what tools or materials the child needs to promote their handwriting skills, such as pencil grips, adapted writing surfaces or adapted paper, etc.
• Build on the motor skills necessary for handwriting, including:
• Posture
• Fine motor skills & in-hand manipulation (the ability to manipulate the pencil and other materials in the hand, and to produce small, effective movements with the fingers)
• Eye-hand coordination (the ability to draw/write with precision, such as ensuring the letters stay on the line, the sizes are appropriate, etc).

The occupational therapist is likely to spend only a short time on actual handwriting exercises. Much time and effort will be spent on building on the required skills in a fun way. Movement activities which facilitate posture and muscle tone often form an integral part of the treatment, as do sensory-motor feedback activities which improve the way a child interprets and uses sensory-motor feedback. Depending on the child’s needs, the occupational therapist may also use visual activities, construction activities, and planning and organising techniques to build on handwriting.

It is very important that an occupational therapist work together with the whole team to develop a child’s writing skills. Many other factors can influence a child’s ability to use handwriting effectively, including their understanding of language, their attention, organisational skills and many more. Thus, an occupational therapist who works as an integrated part of a team, including speech and language therapy and psychology is in a better position to address the child’s skills.

Note: For many children with handwriting difficulties, additional handwriting exercises are used to improve these skills. There is very little evidence of the effectiveness of this approach and the disadvantages of such an approach are clear:

• When a child continues to form letters poorly, he is reinforcing his ineffective motor pathways and this only reinforces poor handwriting.
• Children frequently spend more time on homework than other children, usually with a high level of frustration and stress. This has a negative impact on a child’s mental health and often on the relationship between the parent and child.

If your child is spending too much time on homework, please take this seriously. Speak to your teacher, ask for a referral to a psychologist and occupational therapist (and if necessary a speech and language therapist) and ask for homework to be adapted to meet your child’s needs. The occupational therapist can assist in liaising with the teacher in this regard.