THE

HANDWRITING
BOOK

The Functional Skills for Kids Pediatric Therapist Team:

Colleen Beck OTR/L
Cindy Chuan OT
Tonya Cooley OTR/L
Lauren Drobnjak PT
Heather Greutman COTA/L
Claire Heffron OTR/L
Christie Kiley OTR/L
Anna Meadows OT
Margaret Rice PT
Jaime Spencer OTR/L
COPYRIGHT INFORMATION

Copyright © 2017 by the Functional Skills for Kids authors: Colleen Beck, Cindy Chuan,
Tonya Cooley, Lauren Drobnjak, Heather Greutman, Claire Heffron, Christie Kiley, Anna
Meadows, Margaret Rice, Jaime Spencer

Once purchased, this book may be printed, in part or whole, for personal use only. Except
where permission is specifically noted, no part of this publication may be reproduced or
transmitted for public use, in any form or by any means, electronic or mechanical, including
photocopy, recording, or any information storage and retrieval system, without written
permission from the copyright owner(s).

Information and ideas presented in this publication are for informational purposes only.
They are not and should not be interpreted or misconstrued as medical advice or therapy
recommendations. This publication does not replace an individualized treatment plan
developed as the result of professional assessment, clinical observation, and collaboration
between therapist, parent/guardian and child. If you have concerns about a child in your
life, that child’s parent/legal guardian should communicate those concerns with the child’s
primary medical provider or teacher. The appropriate parties can then determine whether
further referral, consultation, or evaluation is recommended.

Please provide appropriate supervision when applying any information or completing any
activities from this publication. Appropriate and reasonable caution should be used when
implementing any ideas or activities from this publication, particularly if there is any risk of
injury (e.g., falling, crashing, etc.), choking (e.g., small parts, etc.), drowning (e.g., water
play), or allergic/adverse reaction (e.g., materials, ingredients, etc.). The authors disclaim
any liability for any damage, mishap, injury, etc. that may occur from engaging in any
activities or ideas from or inspired by this publication.
 TABLE OF CONTENT
TABLE OF CONTENTS

Chapter 1: Developmental Progression of Pencil Grasp and

Handwriting Strokes

Chapter 2: Gross Motor Skills and Handwriting

Chapter 3: Fine Motor Skills and Handwriting

Chapter 4: Sensory Considerations in Handwriting

Chapter 5: Visual Perceptual Skills and Handwriting

Chapter 6: Tips for Size, Spacing, and Alignment in Written Work

Chapter 7: Engaging the Reluctant Writer

Chapter 8: Combining Handwriting and Play

Chapter 9: Activities to Practice Handwriting Skills at Home (The

Handwriting Home Exercise Program)

References

Additional Resources on the Web

INTRODUCTION
As technology becomes more popular and accessible in society, the importance of
formal handwriting instruction is often disregarded. High­stakes testing and increased
curriculum demands may cause educational administrators to overlook handwriting in
order to spend time on subjects such as mathematics or literacy.

Handwriting is a complicated motor skill that requires dexterity, strength, motor

planning, and visual perceptual skills. Other developmental prerequisites such as hand
dominance, grasping skills, postural control and letter recognition also play an important
role in how a child learns to write.

Research has shown that the act of handwriting is directly tied to academic
achievement. When children struggle to write letters and words, it takes away from the
content of their writing. These children often include less detail, rush through
handwritten assignments and show avoidant behaviors (Graham & Weintraub, 1996).

Handwriting continues to be the primary mode of communication for students and

teachers. Children need to be able to write in journals, take notes, fill in worksheets,
and complete many standardized tests that are presented to them. A Handwriting
Without Tears survey found that children ages kindergarten to fifth grade spend
between 24 and 58 percent of their time in the classroom writing on paper (Handwriting
Without Tears, 2015).

As pediatric occupational and physical therapists, the authors of the Functional Skills
for Kids team can attest firsthand to the importance of handwriting. Children who
struggle with handwriting often have underlying difficulties with gross or fine motor
coordination, visual perception, sensory processing and attention or behavior.
Assessing and overcoming these difficulties to provide our students with the
foundational skills needed for handwriting helps to prepare the child for a successful
academic career.

Our goal in creating this book is to produce an effective, easy­to­use resource for any
parent, educator, or therapist. As each component of handwriting is explained, we’ve
included modifications, adaptations, ideas for activities, and strategies to implement
with children of all ages. Each chapter includes helpful therapist tips to make
handwriting practice more engaging and fun.
The Handwriting Book is part of a 12­book series written by the Functional Skills for
Kids team of pediatric occupational and physical therapists. Parents, teachers,
therapists, and anyone looking for information about all the tasks a child routinely
completes will find this series to be a wonderful resource they will reach for again and
again. You'll see each functional skill broken down into developmental level, fine motor
considerations, gross motor considerations, sensory considerations, visual perceptual
considerations, accommodations and modifications, creative ways to work on problem
areas, and more.
CHAPTER 1:
DEVELOPMENTAL PROGRESSION OF
PENCIL GRASP AND HANDWRITING STROKES

Pediatric occupational therapists often receive questions from concerned parents and
teachers about whether a child is on track with their handwriting development.
Understanding the developmental progression of handwriting skills can help parents
and teachers keep developmental milestones in mind when tracking a child’s
handwriting development.
 DEVELOPMENTAL PROGRESSION OF PENCIL GRASP

Pencil grasp is usually the most obvious fine motor marker of how a child’s handwriting
development is coming along, and it’s a common concern among parents. Though
handwriting development begins to take place well before a child ever picks up a pencil,
these are the milestones to keep in mind when looking at how your child is holding their
crayon, marker, or pencil.

1 TO 1.5 YEARS – PALMAR SUPINATE

The crayon is held in the palm (“palmar”) with the thumb on top in a slight forearm­up
(“supinated”) position. This is considered a “primitive” grasp and typically accompanies the
“scribbling” stage. Scribbling movements are initiated by the shoulder and elbow, which
involve larger muscle groups and a relatively low level of precision.

2 TO 3 YEARS – DIGITAL PRONATE

The child transitions to holding the crayon with the whole hand while the index finger
(“digit”) points to the tip and the forearm rotates to point down toward the paper
(“pronated”). This is considered a “transitional” grasp and is typically present when little
ones are learning to make lines and circles. Coloring and early drawing movements still
come from the larger muscle groups and typically involve large strokes, however, there
may be a higher level of control over the tool compared to the Palmar Supinate grasp.

3.5 TO 4 YEARS – STATIC TRIPOD

The child can now hold the crayon with the thumb and index finger while resting it on the
knuckle of the middle finger. This means there are a total of three fingers controlling the
tool (“tri” = “three”). Movements during coloring and drawing are initiated from the larger
joints of the arm such as the shoulder and elbow, while the fingers remain “static” and the
hand moves as one unit. This grasp is typically present around the same age that kids are
becoming “pre­writers” and learning to make shapes such as a cross and square. When
the Static Tripod is first developing, you may see the wrist flexed (bent forward) and
“floating” above the writing surface, whether the child is working on paper flat on a table or
coloring on a vertical chalkboard. However, as kids become more comfortable and
confident in this position, they are then usually able to transition to resting their forearm on
the table as they color or draw. Research has found that nearly 50% of three­year­olds are
already able to use a tripod grasp, and grasp maturity at this age tends to be higher for
girls than for boys (Yakimishyn & Magill­Evans, 2002). Regardless of when it occurs, the
shift from Digital Pronate to Static Tripod is significant, as it signifies the transition from
"toddler" grasp to "big kid" grasp.
 DEVELOPMENTAL PROGRESSION OF PENCIL GRASP
(CONTINUED)
The “Static Quadrupod" grasp is similar to the Static Tripod, but there is one extra finger
pinching the pencil. Three fingers pinch and one supports the tool, for a total of four
(“quad” = “four”). This Static Quadrupod grasp is considered to be just as functional and
age­appropriate as its Static Tripod counterpart.

4.5 TO 5 YEARS – DYNAMIC TRIPOD

The child continues with the same grasp pattern of pinching with thumb and index finger
while resting the crayon on the knuckle of the middle finger. However, the pinky and ring
fingers can now tuck themselves securely into the palm to stabilize the arch of the hand
and the middle finger. The wrist is consistently positioned in slight extension, and the
forearm and pinky­side of the hand (the “ulnar” side) are comfortably stabilized on the
table. This means that movements are now able to be initiated from the first three fingers
and wrist while making vertical and horizontal strokes, rather than from the elbow and
shoulder.

This “dynamic” grasp allows for more precision and detail during tasks such as coloring
within the lines or within smaller spaces, drawing with more detail, and tracing or writing
letters with more precision. It is around this age that children demonstrate an emerging
ability to form diagonal strokes when coloring and/or drawing shapes. Once kids can
consistently utilize a Dynamic Tripod grasp, it means they are one step closer to being
ready for formal writing instruction!

A similar grasp kids may use at this age use is the “Dynamic Quadrupod” grasp. One extra
finger is used for pinching and controlling the pencil (for a total of three pinching fingers
and one stabilizing finger), and it is considered to be as effective and age­appropriate as
the Dynamic Tripod.
OTHER GRASP PATTERNS

Sometimes a child's grasp patterns may not match any of these descriptions, and it is
common for pre­writers to experiment with a variety of grasps as their hands and pre­
writing abilities develop. It is also common for young kids to demonstrate different grasps
on different types of tools, based on whether they are fat, skinny, long, short, or even how
they are positioned in front of them.

THERAPIST TIP:
Hold a small toy or eraser in the palm (under pinky, ring, and middle fingers)
while coloring or writing with a pencil. This encourages separation of the two
sides of the hand and a more mature pencil grasp.
 DEVELOPMENTAL PROGRESSION OF PRE-WRITING STROKES

Children tend to follow a fairly predictable pattern of development when it comes to drawing
various shapes and lines, known as “pre­writing strokes”. While pre­writing strokes are often
thought of as the lines and shapes needed for learning how to write letters and numbers, they
also prepare kids for being able to draw, which is another great indicator of pre­writing
development.

Though pre­writing is typically an area of early childhood development that is less familiar to
parents and teachers when compared to pencil grasp development, it is just as (if not more)
important for preparing children to learn how to write. Kids’ writing and reading skills often
develop alongside one another, and kids who are able to produce pre­writing strokes will
often have an easier time learning how to write letters and numbers.

PRE-WRITING TERMINOLOGY

In pre­writing development, there is a difference between “imitating” and “copying.”

“Imitation” means the child first watches a demonstration of the shape being formed, and
then they immediately try to do what they just saw. “Copying” means the child is simply
shown a picture or a model of the shape, and then tries to reproduce it on his own.
Developmentally speaking, kids typically learn how to imitate drawing shapes before they
learn how to copy them. Once they’ve learned how to copy those shapes, they can then
begin to form a visual memory of them and draw them without a visual model. As with all
developmental milestones, keep in mind that there is a wide range of “average” and
children’s acquisition of these milestones can be influenced by their level of interest and
attention.

1 TO 2 YEARS
Scribbling
Imitating vertical lines, horizontal lines, circular scribbles

­Imitating cross
2 TO 3vertical
YEARS 2 TO 3 YEARS
­Copying line, horizontal line, circle

Imitating a cross shape

Copying vertical line, horizontal line, circle
1 TO 2 YEARS
3 TO 4 YEARS

Drawing circle without a model

4 TO 5 YEARS

Imitating square
Copying cross, square, right and left diagonal lines, X shape, some letters and
numbers
May be able to write own name
Drawing a recognizable face with eyes, nose, mouth
Drawing a basic stick figure with 2­4 body parts
Coloring inside a circle and filling it at least halfway

5 TO 6 YEARS

Copying triangle
THERAPIST
Printing own name TIP
Copying most capital and lowercase letters
Drawing a person with at least 6 body part
CHAPTER 2:
GROSS MOTOR SKILLS AND HANDWRITING

The gross motor skills involved in handwriting mainly refer to the postural control required
for writing. Efficient control of the larger muscle groups in the neck, shoulders, and trunk is
necessary to help children maintain stability. This allows the fingers and hands to move with
greater precision and control during handwriting tasks.

As children develop, control and stability begins at the trunk, progressing to the elbow, wrist
and finally the hand. With normal development, gross motor skills lay the foundation for fine
motor skills. For example, a baby will first learn to swat, then reach, grasp, and finally
manipulate a toy.

Children need to develop the proximal muscles (closer to the center of the body) of the trunk
and shoulder girdle in order to efficiently use the distal muscles (further from the center of
the body) in the fingers and hands. These proximal muscles develop in children with gross
motor activities such as reaching, playing in tummy time, rolling, getting up on all fours,
crawling, standing, and walking.

Children also must develop the ability to plan and execute gross motor skill actions. With
handwriting tasks, this motor planning requires muscle groups to work together with the
proper force, timing and actions to produce an acceptable outcome (i.e., legible
handwriting). For example, in order to write with a pencil, the brain has to plan and execute
gross motor actions.

Starting with the pectoral muscles, the trapezius and the rhomboid muscles coactivate with
the proper force and timing to stabilize the shoulder and allow the fingers and hand to move
the pencil along the paper efficiently. Research shows that children with poor motor planning
skills exhibit poor handwriting legibility compared to their peers (Tseng & Murray, 1994).

Gross motor skills also play a role in eye­hand coordination. Eye­hand coordination requires
the visual system to coordinate the information received through the eyes to control, guide,
and direct the hands in accomplishing a given task. This requires gross motor movements
such as reaching and grading the control of the arm.
THE EFFECTS OF GROSS MOTOR DEFICITS ON HANDWRITING

Gross motor challenges can contribute to children’s handwriting being overly slow,
more effortful and harder to read. Proximal muscles function as a stabilizer during
handwriting tasks. Children with low postural muscle tone may have difficulty sustaining
contractions in the proximal musculature. When the proximal muscles stabilize
correctly, the decreased variability in the distal muscles has been shown to be
associated with a faster handwriting speed (Naider­Steinhart & Katz­Leurer, 2007).

‘Red flags’ to look for which may suggest that gross motor challenges are impacting a
child’s handwriting include:
Poor posture during writing tasks: ‘Slumping’; leaning to the side; rocking back in the
chair; resting head on hand, forearm or even the desk; neck bent forward with face
close to the paper; legs crossed, swinging or wrapped around the chair legs.
Movement during writing/drawing coming from the shoulder, arm, elbow, wrist (rather
than fingers).
Pain or tiredness: complaints of muscle soreness (weakness or inefficient muscle
use), or fatigue (poor writing endurance).
Excessive or insufficient pencil pressure: pushing too hard or not hard enough.
Challenges in the areas of visual motor integration (eye­hand coordination), body
awareness, sensory processing or motor planning may also be impacting a child’s
gross motor skill development and therefore, handwriting ability. You’ll find more
information around these topics in the chapters to follow.

GROSS MOTOR ACTIVITIES TO SUPPORT HANDWRITING

The best gross motor activities to support handwriting development are those that
improve postural control and strength in the proximal muscles. Here are some
examples:
Hanging activities ­ Practice monkey bars, chin ups, pull ups, or swing from tree
limbs to increase strength in the shoulder girdle muscles.
Climbing activities ­ Climb ladders and ropes on the playground.
Pushing and pulling activities ­ Pull a heavy wagon or push a child on a swing.
TheseTHERAPIST
pushing and pullingTIP:
motions help the shoulder learn to coactivate to produce
the right amount of force and stability.

THERAPIST TIP:
“Monkeying” around on overhead bars can help build muscle
strength and shoulder stability.
 GROSS MOTOR ACTIVITIES TO SUPPORT HANDWRITING (CONTINUED)

Gross motor activities can also be used to support children’s motor planning skills.
Here are some examples:

Sky writing ­ Have children “air write” the letters using their entire arm, describing
each step as they go.
Obstacle courses ­ Handwriting requires the ability to formulate a motor plan to
complete multiple steps just like completing an obstacle course. Include activities
from the list above. For example, have children crawl to a scooter board, lay on their
tummy, pull themselves along a line, and wheelbarrow walk to the finish line.
Body Letter Formation ­ Children can practice making their bodies into letters to
improve the imprint on the brain of how the letter is formed.
Coordination activities ­ Jumping jacks, jumping rope, hand clapping games, etc. all
require extensive motor planning and coordination skills.Ball skills are great for
developing the eye­hand coordination needed for handwriting. Throwing, catching,
and shooting balls all teach the brain to practice guiding the hands toward the
proper direction and location.

GROSS MOTOR MODIFICATIONS FOR HANDWRITING

First and foremost, children should be properly positioned for handwriting:

The feet should have a stable base of support.
Hips, knees and ankles should be bent at 90 degrees.
Desk should be 1­2” higher than bent elbows.

If children fatigue while writing, try having them change positions. Perhaps having them
lie tummy­down on the floor or using a slant board may help them complete the writing
assignment. Or you may need to break writing assignments into smaller chunks to
prevent proximal muscle fatigue.

It can be helpful to take frequent breaks to stretch the muscles in the shoulder, neck, and
back. The best suggestion is to sometimes put down the pencils, take a break from
routine handwriting practice, and get children moving!

THERAPIST TIP:
Take writing to a new level and try a new position! Tape paper to
the wall at eye level to incorporate upper extremity strengthening
and allow kids to move while they work.
CHAPTER 3:
FINE MOTOR SKILLS AND HANDWRITING

It is incredible how many fine motor skills are called upon when handwriting!

Fine motor skills are some of the most important skills required for handwriting
efficiency. They utilize all of the small muscles in the hand and fingers, that work
together in a very complex, coordinated manner during writing activities.

The larger muscles in the hand help to stabilize the pinky (ulnar) side of the hand so that
the tiny muscles of the fingers can make the small movements that are used for efficient
writing. These small movements of writing are generally seen developmentally by
around 5 years of age.

However, in order to develop the fine motor movements in your hand, children need to
have well established stability and strength in their body, shoulder, arm, wrist, and hand.
If children don’t have the strength and stability in the rest of their body, using their hands
is much harder. As we have seen in the previous chapter, the development of those
gross motor skills starts early in life, such as through weight bearing activities such as
crawling, and hand use including grasping and squeezing.

Fine motor skills also rely on visual perceptual, sensory processing, motor planning and
attention abilities. This chapter breaks down the fine motor skills involved in handwriting,
and offers suggestions for how children can be supported to really target each of these
important skills individually.
 FINE MOTOR PREREQUISITES FOR HANDWRITING

Efficient handwriting requires many fine motor skills: Core postural strength and stability,
shoulder and upper arm stability, bilateral hand skills, wrist stability and extension, hand
strength, development of the palmer arches, thumb opposition, separation of the two sides
of the hand, and in­hand manipulation.

CORE POSTURAL STRENGTH AND STABILITY

A strong core allows children to assume and maintain a stable sitting posture at the desk for
writing tasks. This supports all other fine motor skills.

SHOULDER AND UPPER ARM STABILITY

When the muscles around the shoulder joint are strong, the arm and elbow can be held in
a functional position, allowing the hand to get on with the business of holding and moving
the pencil.

BILATERAL HAND SKILLS

The ability to use both hands together with each hand doing a different task” TO
“cooperatively during a task. In handwriting, the non­dominant hand acts as a ‘stabilizer’
(keeping the paper steady) while the dominant hand grasps and manipulates the pencil.

WRIST STABILITY AND EXTENSION

It is easiest to use your fingers when your wrist is slightly extended (bent back), and your
hand is resting comfortably on the table. This is a key factor in moving from a static to a
dynamic grasping pattern; that is, moving the pencil with the fingers rather than wrist
movements.

HAND STRENGTH

When the muscles in the hand are strong, they are best able to achieve and maintain an
efficient, functional grasp for longer. If there is weakness, alternative (less efficient) grasps,
fatigue and hand soreness may follow.
 FINE MOTOR PREREQUISITES FOR HANDWRITING
(CONTINUED)

DEVELOPMENT OF THE PALMAR ARCHES

The arches of the hand are the inside of your hand, where your hand bends and wrinkles.
These arches give the hand its mobility and the ability to function on different planes. In
handwriting, palmar arches are particularly important in grasping the pencil in a functional
way, preventing fatigue and soreness in the small muscles of the hand.

THUMB OPPOSITION

The pad of muscles at the base of your thumb are responsible for moving it in multiple
directions. The ability to touch the tip of the thumb to each fingertip and the opposite side
of the palm of the hand allows the writer to lie the pencil down in the (open) webspace a
little, and coordinate the small muscles of the hand during writing tasks.

SEPARATION OF TWO SIDES OF THE HAND

This is the ability to move the pinky side of your hand separately from the thumb side of
your hand. In writing, you are able to use the most refined movements of your thumb,
index, and middle fingers while the pinky side of your hand is stabilized.

IN-HAND MANIPULATION

This is the ability to move items around in the hand using precise finger movements. In­
hand manipulation includes: ‘translation’, ‘rotation’, and ‘shift’. Dynamic, finger­driven
writing is made possible with well established in­hand manipulation skills.

THERAPIST TIP:
Use small pencils and broken crayons to facilitate a proper grasp
and discourage extra fingers on the writing utensil.
 FINE MOTOR ACTIVITIES FOR HANDWRITING
It is helpful to work on the underlying motor movements needed for a functional pencil grasp
and precision of pencil strokes. These activities can really refine the small muscles in the hand
and fingers in order to get them working separately rather than as a group.

When children have fine motor skill delays, they may have difficulty with establishing an efficient
grasp pattern on writing utensils and with maintaining an efficient grasp over time. Children with
specific skill difficulties can be supported through these activity ideas:

Core postural strength and stability

­Fit ball games
­Yoga
­'Superman’ pose (Lying on tummy, lifting outreached arms and legs off the ground)
­Curled up like a ball pose (Lying on back, holding tucked up knees close to chest and lifting head up
off the ground)
­Sit ups
­One­legged balances
­'Wobbly’ stepping stone games (eg. cushions or air discs)
THERAPIST TIP
­Lying on tummy, resting on elbows
­4­Point kneeling balances (Hands and knees ­ lifting and holding outstretched arms and legs one at a
time, then opposite arms/legs)

Shoulder and upper arm stability

­Crawling (Over uneven surfaces are even better!)
­Animal walks (e.g. Bear walking (hands and feet), frog jumping (placing hands forward on ground then
jumping forward), puppy dog walking (hands and knees), snake crawling (on tummy and elbows)
­Hanging (e.g. Monkey bars, trapeze)
­Wheelbarrow walks
­Working on vertical surfaces (e.g. Paper, black/whiteboards, reversed contact/sticky paper, magnets,
stickers, stamps, paint)
­Painting the fence with water
­Car/window washing

Bilateral hand skills

­Drawing on loose paper held on the wall by the non dominant hand
­Lacing beads/shapes
­Threading buttons, pasta, cut up straws
­Play dough ­ rolling, cutting out shapes
­Tearing paper
­Scruching paper
­Pulling cotton balls apart
­Lego/Duplo ­ Construction pieces that stick together
­Cooking (e.g. Holding bowl with one hand and stirring with the other)

Wrist stability and extension

­Vertical surface play (Window, mirror, wall, fence)
­Sloped surfaces (Slanted desks)
­Drumming with sticks or hands, bending wrists up (extension) and down (flexion)
 FINE MOTOR ACTIVITIES FOR HANDWRITING (CONTINUED)

Hand Strength
­Weighted balls ­ holding, passing/careful throwing or rolling and catching
­Hand grips
­Squeeze/stress balls
­Squeezing water out of a big (car) sponge
­Theraputty
­Elastic band push ups (Elastics around fingers, and moving finger tips together and apart)
­Tug­of­war
­Snap beads/connectors
­Playing with clothes pegs

Development of the palmar arches

­Cup both hands together and shake a dice inside
­Pull theraputty/resistive putty apart with finger tips
­Place pegs, matchsticks, coins, pipe cleaners into play dough or theraputty
THERAPIST TIP
­Use a tennis ball head (“Munchy Ball”) and beads or bugs

Thumb opposition
­Use tweezers to pick up small objects
‘­Connect Four’ ­ counter games, where children drag counters to the edge of the table with the
index finger tip, and pick them up with the pad of the thumb tip
­Flick games’ ­ pom poms, ping pong balls, cotton balls, scrunched up paper
­Threading small beads
­Sorting/playing cards and card games
­Hole punchers which can be held in one hand

Separation of two sides of the hand

­Finger snapping
­Finger puppets
­Hand/finger action songs
­Spray bottles
­Spinning tops

In­hand manipulation
­Pick up multiple coins with only one hand at a time and ‘squirrel’ them into the palm. Then move
the coins back to their fingertips one at a time to place them into a piggy bank.
­Hide and dig small items out of therapy putty or silly putty
­Place a small item (e.g. eraser) in the finger tips and turn it around
THERAPIST TIP:
­Holding a long pencil or chop stick with a tripod grasp (thumb, index and middle fingers), move
from the bottom to the top and back down again, only moving those fingers
­Twirl a long pencil or chop stick like a marching baton, or a circus performer between the fingers of
one hand only
­Holding a pencil with the thumb underneath and the index and middle fingers on top, rotate the
pencil to and fro (alternating straightening and bending two fingers and thumb)
 FINE MOTOR MODIFICATIONS FOR HANDWRITING

The following modifications are frequently suggested by therapists to encourage

students to both compensate for fine motor difficulties and develop fine motor abilities for
more functional, efficient handwriting habits.
Use of a pencil grip ­ There are many different styles available. Your local occupational
therapist can provide advice and assess/prescribe for specific situations. Cost effective
solutions are also available, such as ‘Blu tac’ wrapped around the pencil and
shaped/molded appropriately.
Holding a pom pom or cotton ball under the 4th and 5th (‘Pinky’) fingers
Triangle shaped pencils
Groove pencils (with small holes/cut outs along the length of the pencil)
Thicker pencils
Shorter pencils
A built up handle may be necessary for a child with significant weakness.
Use of visual cues on pencils for finger placement, such as a texta mark or sticker.
Visual checklists or photos/diagrams (laminated) can be a great help on students’ desks
as a reminder of good pencil grasp
Sloped/angled writing boards (or large lever arch folders stuck to the table, with ‘bulldog
clips’ to hold paper)
The modified/adapted tripod grasp uses the least amount of muscle of any grip position,
so it is good for those who fatigue easily.
CHAPTER 4: SENSORY CONSIDERATIONS IN
HANDWRITING

Pick up a pencil. Hold it correctly. Write a letter. Copy a word. Fill in a worksheet. Write
down the day's homework assignment in the correct space with a noisy classroom
while the teacher chats to someone at the door. The open windows alert you of another
class playing on a playground. Bouncing balls, laughing students, a buzzing pencil
sharpener, bright sunshine, and that homework assignment that needs to be written
legibly so you and your parents can read it an hour from now.

One of a child's occupations is to perform educational activities like handwriting.

Holding a pencil, forming letters, writing on lines, and copying from a chalkboard is a
multi­sensory occupation of childhood.

Handwriting depends on accuracy and legibility. Letters must be formed correctly with
appropriate pencil pressure, on the lines, with attention to details.

To complete these skills, handwriting and sensory processing are naturally associated.
All components of handwriting requires a child to integrate information through their
senses. This allows them to produce quality written work with good accuracy and
legibility.

In a classroom environment, students are constantly bombarded with sensory

information. They receive sensory information from their eyes, ears, skin, muscles, and
joints. Then, their brain has to organize the information, select the important parts, and
disregard the rest.

When a child’s sensory systems are functioning appropriately, they are able to manage
a simple task like writing. However, if there is a deficit in sensory integration, an activity
such as drawing or writing could be very challenging.
 SENSORY PROCESSING AND HANDWRITING

Sensory processing, also known as sensory integration, requires the body's central
nervous system to effectively register sensory information, filter the parts that are not
necessary, organize and interpret what to do with that information, and modulate the
attention level of the nervous system. When a child’s body is unable to perform the
steps of this process, it can lead to distractibility and disorganization. There are eight
sensory systems in our bodies:

Tactile System (touch)

Vestibular System
Proprioceptive System
Olfactory System
Visual System
Auditory System
Gustatory System
Interoceptive System

Sensory integration occurs as the brain processes the sensations from these systems
and integrates it into something meaningful, organized, and useful (Ayres, 1979).

HANDWRITING AND THE SENSORY SYSTEMS

The proprioceptive, vestibular, and touch senses are primary influences on the integration
of our senses. This happens from infancy as a baby is swaddled, carried in a flexed
position, and swung in their mother's arms. If these sensory systems are poorly
functioning, a child will have trouble developing in all areas. Integration of the vestibular
and proprioceptive systems gives the child control over eye movements at infancy. The
integration of these systems allows the baby to develop appropriate postural reactions and
a good foundation of movement.

If the proprioceptive, vestibular, and touch sensory systems are not functioning adequately,
the child will have a poor reaction to his environment. The child may have difficulty
THERAPIST TIP:
focusing on tasks and may feel insecure in his environment. These problems can lead to
poor body awareness. These problems can lead to a poor body perception.

A child with proprioception dysfunction may seek out sensory feedback from his
environment. You might see them bumping into desks, stomping their feet on the ground
or kicking their neighbors chair. They might rub their hands on the desk, bite their pencils,
or write with heavy pencil pressure. Students seeking proprioceptive input often crack their
knuckles and chew on their shirts.
An inefficient grading of movement might result in students holding their pencils too
tightly, writing so heavily that the pencil point breaks, or producing messy work with
large erasure holes.

A child with vestibular dysfunction may present as a hyperactive or hypersensitive

child. Some students might have an intolerance for movement and will seem willful and
uncooperative, while demanding physical support. Gravitational insecurity is another
symptom of vestibular dysfunction. Kids with gravitational insecurity might be fearful of
movements that are out of their control, such as when a teacher pushes in their
chair. The hyposensitive student will have an increased tolerance for movement. These
kids need to keep moving in order to function. They might fidget, wiggle, and bounce in
their seat. You may see these students jumping up and down in their chair, sitting on
their feet and swaying, hanging upside down at their desk, and falling out of their seat.

Children with vestibular, tactile, and proprioception difficulties will typically have trouble
with eye­hand coordination. Writing on lines and coloring between lines is difficult.
There may also usually be difficulties with depth perception. In order for a child to
develop visual perception, they need adequately integrated vestibular and
proprioception systems.

AUDITORY AND TACTILE DYSFUNCTION AND HANDWRITING

The child with auditory processing concerns will seem unaware of where sounds are
coming from. When a teacher directs the class to write down items or copy specific
information, these directions are lost. They are unable to pay attention to one voice or
sound without being distracted by other sounds in the classroom. They may even be
distressed by the sounds of pencils making marks as they or other students write. They
have difficulty attending, understanding, and remembering verbal directions related to
letter formation in words and sentences. These kids might have difficulty putting their
thoughts onto paper and trouble revising or correcting what they have written. Students
with poor auditory processing often have a weak vocabulary. They struggle to structure
their words and sentences, which may cause them to lose focus on the letter formation
and line placement.

The child with tactile dysfunction may be either hypersensitive or hyposensitive to touch.
A studentTHERAPIST TIP:
who has tactile defensiveness (hypersensitivity) may over­react to light touch.
The student might become fearful or irritable if a teacher leans too close or brushes up
against them during handwriting instruction. These kids can become overly focused on
neatness in handwriting and their desk space. They might need to brush off every eraser
bit or clear their paper and desk of every stray mark. The child with under­
responsiveness to touch (hyposensitivity) might seem unaware of pencil pressure. They
may write with very heavy or dark pressure on their pencil. These children often fail to
realize that they’ve dropped their pencil or they have pencil smears all over their palms.
MOTOR PLANNING AND HANDWRITING

When their body understands sensations from the skin, muscles, and joints, a child is able
to feel and know what their body is doing without looking at it. If a child’s body isn’t able to
process this information, it can lead to difficulty coordinating the two sides of the body as
they perform different tasks. The child might have trouble holding his paper with one hand
while writing with his dominant hand. The child will need to think through his actions, rather
than having them occur naturally and automatically.

For most students, forming letters and numbers properly becomes automatic with practice.
Children with a poor motor plan must think out the way a letter is made. Motor planning is
the sensory process that allows us to complete and adapt to an unfamiliar task (like a
worksheet), using what we already know. The key to motor planning is a body perception
that can accommodate to tactile, proprioceptive, and vestibular information.

A child’s attention span is also dependent on their sensory processing system. If the
sensory information is not registered, filtered, organized, selected, and discarded
appropriately, the child will not be able to focus his attention on an activity like handwriting.

THERAPIST TIP:
 POOR SENSORY PROCESSING AND HANDWRITING DIFFICULTIES

Children with difficulties modulating sensory input face a big challenge in the classroom.
The school environment is overstimulating. Asking a child with sensory integration
difficulties to filter out irrelevant sensory input while attending to academic work is very
difficult. Problems in handwriting might include (but not be limited to):

Handwriting Issues Related to Poor Registration:

The child may be unaware that he drops his pencil
Shows a weak grasp
Difficulty maintaining an effective writing posture
Tires easily in writing tasks
Does not notice details (misses letters when copying words or sentences)
Desk and writing area are disorganized and sloppy
Avoids smells (pencil or paper) in the classroom
Easily distracted during writing tasks
Difficulty paying attention to a writing task
Cannot work silently
Visually distracted by other children, noises, and scents
Difficulty focusing on one section of a board or one part of a worksheet

Handwriting Issues Related to Sensory Seeking:

Seeks movements by moving the chair, wiggling in the seat, bouncing legs and arms
Distracts other students with movements
Overly excited after recess and is difficult to settle down
Always touching the desk or parts of the chair during writing tasks
Craves scents or tastes: chews the pencil for its taste, smells the paper or pencil shavings
chews the pencil, eraser, or clothing
Bites hair/shirt/nails when writing
Writes with heavy pencil pressure

Handwriting Issues Related to Sensory Avoiding:

Difficulty with changes in the routine of writing (new paper or type of worksheets)
Low frustration level with errors in letter formation
Anxiety (wants to make letters and numbers correctly the first time)
THERAPIST TIP:
Stubborn in handwriting concerns
Avoids touching pencil shavings, the wooden part of the pencil tip, or the eraser
Avoids erasing mistakes
 SENSORY STRATEGIES AND MODIFICATIONS FOR HANDWRITING
PROBLEMS
Many times, sensory integration activities can help with handwriting problems. Children
who demonstrate proprioceptive issues may benefit from heavy work activities in the
classroom. Children with vestibular processing difficulties may demonstrate improved
handwriting performance if they participate in active movement (such as dancing or yoga)
prior to handwriting activities.

Typically, the sensory systems and sensory integration is developed by the time a child
enters school. The ability to concentrate while managing sensory input is very much
needed for the classroom that is multi­sensory.

Many problems seen with handwriting are the end product of an inefficient and irregular
processing system. Heavy pencil pressure, sloppy letter formation, inconsistent sizing,
and poor attention may all be attributed to poor sensory integration.

A sensory integrative approach to teaching handwriting can be successful for the child with
sensory processing concerns. Occupational Therapists can analyze sensory processing
skills during the performance of handwriting (and other school­day tasks). An OT uses
formal evaluations, screening tools, standardized tests, observation of classroom
behaviors, parent/teacher checklists, and observation of classroom behaviors and play
activities to identify handwriting issues related to sensory processing.

HEAVY WORK SENSORY ACTIVITIES TO HELP WITH HANDWRITING

Take down, put up, and push chairs to correct places in the room
Erase the chalkboard
Wash desks/dry erase board
Sharpen pencils with a manual pencil sharpener
Chewy food breaks (fruit leather, licorice)
Crunchy food breaks (vegetables, popcorn, pretzels, dry cereal)
Cut materials from oak­tag or heavy paper
Carry books with both hands, hugging the books to their chest
Weigh down the student's chair by taping weights to the chair legs
THERAPIST
Pad the feet of the chair toTIP:
add extra resistance
Climb playground equipment
Carry books and supplies to other classrooms
Provide hand fidget toys and squeeze toys
Brain Breaks
Wall push­ups
Chair push­ups
Animal walk breaks
OTHER SENSORY STRATEGIES TO HELP WITH HANDWRITING PROBLEMS

Try a variety of pencil grips

Wrap the tip of the pencil in clay and tell the child that if the clay is misshaped, then he
is pressing too hard on the pencil
Try various proprioception in handwriting modifications
Tilt the child's writing surface to a slightly inclined position using a 3 ring binder. This
positioning provides improved wrist positioning and will decrease the force the child
presses through his wrist.
Try writing with carbon paper under the paper to show the child that he needs to press
harder or lighter through the pencil
Copy written work from a his desk instead of from the chalkboard or overhead
Write with a grease pencilto provide more resistance and feedback
Remove distractions from the classroom and seat the child away from windows and
doors
Provide the child with written and verbal instructions
Provide a quiet space in the classroom
Provide movement breaks

THERAPIST TIP:
THERAPIST TIP:
Start the day with “heavy work” to help with attention, arousal and
organization!
CHAPTER 5: VISUAL PERCEPTUAL SKILLS
AND HANDWRITING

Handwriting is a complex skill. It involves the ability to form letters with consistent letter
size, proportions and spacing, so that others can read words and sentences. This is
called visual­motor integration. Producing legible handwriting requires complex visual
perceptual skills as well as an integration of motor skills with these visual perceptual
skills. A deficiency in visual­motor integration may be evident when observing poor
quality handwriting (Volman, van Schendel, & Jongmans, 2006).
 WHAT IS VISUAL PERCEPTION?

Visual perception is the process where the brain extracts and organizes information, giving
meaning to what we see. Visual­motor integration is the degree to which visual perception
and finger­hand movements are well coordinated (Beery & Beery, 2010). There are many
components of visual processing which work together to assign meaning to what we see.
Eye­hand coordination, figure ground, visual discrimination, form constancy, visual
memory, and visual sequential memory are a few of these components.

EYE- HAND COORDINATION AND PRE-WRITING SKILLS

Eye­hand coordination is the ability to coordinate eye movement with hand movements.
This includes the ability the ability to process visual information to guide hand function.
When children are learning to control a pencil for handwriting, they will rely on visual
information as they look at their hand and what the pencil is producing.

The ability to copy a vertical line, circle, horizontal line, right diagonal line, square, left
diagonal line and a diagonal cross (X shape) have been recognized by therapists as an
indication of a child’s readiness to integrate visual­motor skills to begin handwriting
instruction. Beery & Beery (2010) recommend that formal pencil­paper instruction is
postponed until a child can easily execute an oblique cross as it requires crossing the mid­
line, which is the source of many reversal problems. They also suggest that formal
instruction of letters, words and sentences are still required, regardless of a child’s visual­
motor integration skills.

Typically children are encouraged to control their pencils and practice eye­hand
coordination by tracing various lines, shapes, and letters. These activities may include a
variety of line types: bold or faded dotted lines, bold or faded unbroken lines, or dashed
lines to trace on. Children may also be provided with paths, roads or outlines to draw
between to produce lines, shapes or letters. Therapists may support children with eye­
hand difficulties by highlighting the path to be drawn or emphasizing the boundary line
(e.g., with a raised surface).
THERAPIST TIP:
THERAPIST TIP:
Eye­hand coordination with fine and gross motor tasks may also be encouraged prior to
handwriting instruction. Therapists or teachers often emphasize large movements before
moving to small movements. Children may be encouraged to develop eye­hand
coordination with larger tools before using small tools for more accurate control (eg. crayon
rock before ordinary crayon).
 VISUAL DISCRIMINATION

Visual discrimination is the ability to classify objects or shapes based on visual information
such as color, form, pattern, size or position. In handwriting, children need to be aware of
common characteristics as well as subtle differences which distinguish letters and words.
Children need to identify letters as well as the sequential order of letters to recognize words for
reading, writing and spelling. Difficulties with visual discrimination may be seen with letter
reversals or lack of attention to detail in letter formation.

For example, when writing “n”, if the initial line is drawn too long, it appears as “h”. If the up
and over section is too short, it appears as “r”. When writing “a”, if the line is produced too
long below the circle, it appears as “q”. If the line is produced too long above the circle, it
appears as “d”. If the line is too long above and below the circle, it is unrecognizable. If the line
is too long, placed to the left, and below of the circle, it appears as “p”. And if it is placed to the
left and above the circle, it appears as “b”.

Visual discrimination in handwriting may also be seen with confusions with the use of lower
and upper case letters. First, children need to be able to identify both lowercase and capital
letters. Then, they need to use them appropriately (e.g., capital letters used at the beginning
of a sentence.)

Children with visual discrimination difficulties may require additional strategies to classify
letters into lowercase or capital. Providing a multi­sensory approach to learning (eg. use of
pipe­cleaners, play dough, rice, shaving foam, etc) may assist with kinesthetic learning and
muscle memory.

THERAPIST
THERAPISTTIP:
TIP:
THERAPIST TIP:
Have kids practice writing and tracing letters and words in a
tray filled with a layer of dry rice or beans. Place colorful
paper underneath to make the letters stand out as the child
forms them with his finger.
 POSITION IN SPACE

Position in space (or spatial relationships) involves the ability to process information
about oneself in relation to their environment. It may involve the ability to understand
directional language concepts such as up/down, next to, left/right, over/under, etc. In
handwriting, difficulties with spatial relationships may also affect letter formation as
children have difficulty relating the position of lines in relation to other parts of a
letter. Children may have difficulty understanding how or where to place their letters on
the line. Children may also demonstrate difficulty with writing on a line or spacing
appropriately between letters or words. They may have difficulty starting at the margin
and maintaining their writing on the left side of the page.

Children with difficulties with spatial relationships require a range of intervention

strategies. Strategies mayVISUAL CLOSURE
include using gross motor and postural control activities to
encourage body awareness. Shape positioning activities such as Tangrams and felt
shapes can help children learn concepts such as next to, on top, or under. Children
may also benefit from copying block or bead patterns before attempting to copy patterns
on paper.

Further strategies may include use of specialty writing paper (eg. colored lines), grid
paper, highlighting the writing line, placing a ruler on the writing line and the use of a
“spacer” between words.
 FIGURE GROUND

Figure­ground is the ability to see an object or form when presented in a complex

background. In handwriting, this is needed when copying information from a source (eg.
the whiteboard) and keeping track of where you are up to. Children with figure ground
difficulties may lose their place in the middle of sentence after they look up to the board.
They may struggle to find their place when looking at a busy page with a lot of visual
information. They may also miss important information or segments of a letter or word
when writing.

Extra visual cues may help children with figure­ground difficulties. Highlighting the
writing line, using squares for children to write in, or blocking out extra information on
the page can be helpful. They may also benefit from scanning exercises.

VISUAL CLOSURE
Visual closure is the ability to process visual information when the object or word is
partially hidden. In handwriting, this may affect letter formation and spelling words.
Visual closure in letter formation is closely related to visual discrimination. Children may
also demonstrate incomplete letter formation which affects handwriting legibility and
neatness. The activities recommended in the visual discrimination section are also
relevant for children with visual closure difficulties.

FORM CONSTANCY

Form constancy is the ability to identify an object, shape, letter, number, symbol when it
is presented in a different way (e.g., larger, smaller, rotated, italics, bold, different font,
sideways, upside down, different color). In handwriting, children with visual closure
difficulties may have difficulty “closing” up their letters. They may not realize when their
letters don’t look correct. For example they may see the visual closure examples
above and may consider the forms to be constant (form constancy) and are unable to
identify the discriminating features (visual discrimination). Children who have difficulty
with form constancy may also have difficulty transitioning from printing to cursive writing.

Children who experience with difficulty with form constancy may benefit from consistent
use of the same writing font in the classroom. It is helpful to present information at the
same orientation that it is expected to be reproduced (eg. flat on the table when writing
at the table or vertical when writing on a whiteboard). Teaching letters and words using
a multi­sensory approach can help children to become more aware of the properties of
shapes and letters needed for handwriting.
 VISUAL MEMORY
Visual memory is the ability to remember and recall objects, shapes, symbols or
movements in short term memory. This may affect a child’s ability to recognize and
name shapes, letters and words. They may have difficulty remembering what these
“look like” without a visual prompt. For example, a child may be able to copy the letters
of the alphabet when it is on a desk strip. However, without the visual cue (the letter
strip), they would be unable to recall what the letters look like in order to produce them.
When copying, they may forget all the letters in a word. This forces them to “look up” in
order to copy each letter, even if a word is familiar.

Children with visual memory difficulties benefit from playing memory card games and
chunking small amounts of information at a time for writing (eg. word on a flash cards
rather than a whole sheet). They may require visual aids for longer than other students
(eg. use of desk strips of the alphabet). These children also benefit from multi­sensory
learning activities. Incorporating verbal cues with motor movements (eg. tracing in
shaving cream while using the verbal cues for letter formation). Try creating a letter with
a skipping rope and then writing it on a whiteboard or drawing it with a finger on the
someone’s back.
VISUAL SEQUENTIAL MEMORY
Visual sequential memory is the ability to remember and recall a sequence of objects,
shapes, symbols or movements in a particular order. In handwriting, children with poor
visual sequential memory may demonstrate frequent letter reversals. They may have
difficulty remembering the correct order to write the different parts of the letter for proper
letter formation. For example, they may draw the “hump” of the n before adding the line
on the left. This may also affect a child’s ability to write words with similar letters (eg. on,
no, one). When writing a sentence, they may struggle to write the words in the correct
order.

Children with visual sequential memory difficulties benefit from pairing verbal cues with
motor skills. To write a word, have the child read the letters out loud before writing them.
To write sentences, have the child read phrases aloud and then write them. This
auditory cue can be very helpful for children with visual memory deficits. As the verbal
cues are said aloud, the child internalizes this habit. Next, they start to “say it in their
heads” as they write. Simple sequential memory games using physical props such as
beads or blocks may precede games using letters, numbers and words. These may be
presented in increasingly large numbers as skills develop.

Occupational Therapists use a variety of assessment tools to identify visual perceptual

and visual­motor integration difficulties. If your child is experiencing difficulties with
these aspects of handwriting contact a registered Occupational Therapist for a
comprehensive assessment.
CHAPTER 6: TIPS FOR SIZE, SPACING, AND
ALIGNMENT IN WRITTEN WORK

One of the most common reasons for occupational therapy referrals in the primary
school setting is messy handwriting. Often, kids don’t have exposure to or have never
mastered the fundamental pre­writing skills they need to develop handwriting skills like
sizing, formation and construction, alignment, and spacing.
 HANDWRITING DEVELOPMENT RELATED TO SPATIAL AND
SIZE AWARENESS
Handwriting is an extremely complicated skill. We have to have a mental picture or memory
of what each letter looks like and then develop a motor plan to create that letter as it looks in
our memory. The development of higher level handwriting skills (letter formation, letter size,
spacing, alignment, and more) all begins with being able to copy simple shapes. Children
who are able to copy basic prewriting shapes are able to copy significantly more letters than
those who cannot.

LETTER FORMATION AND CONSTRUCTION

Once children are able to copy pre­writing shapes and lines (horizontal lines, circles,
vertical lines, intersecting lines, and diagonal lines) around the ages of 3 to 4 years old, it’s
time to move on to letter formation and construction. Sometime during the kindergarten
year (between the ages of 5 and 6), kids are ready to learn how to accurately form and
construct the letters of the alphabet.

Research shows that kids acquire straight­line and circular uppercase letters first, then
other uppercase letters, then lowercase letters, numbers, and words (in that order). By the
end of first grade, they no longer demonstrate letter reversals in their writing.

In Occupational Therapy, we differentiate between letter formation (how the letters look)
and letter construction (how the child produces each letter). Efficient construction typically
leads to better legibility and speed.

LETTER SIZING, ALIGNMENT, AND SPACING

After kids have developed accurate letter formation and construction, they need to be able
to keep their writing within the designated space and to size them properly. They need to
learn how to properly size their letters. During the earliest exposure to handwriting
activities, preschoolers and kindergarteners may practice by writing huge letters that take
up the whole page. As kids move through kindergarten (ages 5 to 6), they begin to hone
this skill. They learn how to use the lines on the page to guide the size of their writing.
Then, kids move on to learn formation and construction of lowercase letters. It adds
another dimension to letter sizing as they learn about tall, short, and tail letters.

Correct letter sizing closely relates to alignment, or consistent use of the bottom
handwriting line as the “home base” or baseline for each letter. This skill also emerges as
kids move from kindergarten into first grade (ages 6­7). As kids become stronger, more
confident readers, they begin to have a better sense of where one word ends and the next
word begins. This should coincide with the ability to leave appropriate spacing between
their words when writing.
HANDWRITING DEVELOPMENT RELATED TO SPATIAL AND SIZE
AWARENESS

WRITING SPEED

Kids achieve speed and fluency with printing and become more automatic in their writing
by the end of second grade (ages 8­9). They are able to keep up with note­taking in the
classroom and can complete longer writing assignments (e.g. paragraphs, journals) at an
appropriate pace.

PROBLEMS WITH HANDWRITING DEVELOPMENT

Handwriting development can be impacted by many factors, including:

Attention to task
Pencil grasp
Posture and core strength
Fine motor coordination
Visual perceptual skills
Visual motor integration
Hand dominance
Midline crossing
Sensory processing problems
Learning disabilities

When there is a problem in one or more of these areas, children may demonstrate letter
reversals beyond the ages of 6­7. They may not be able to keep up with their peers during
writing assignments. They may not leave any spaces between their words as they write (or
they may leave too much space). They may write with “rollercoaster letters” – the baseline
of their letters and words seems to go up and down within the writing lines, like the hills of
a roller coaster. Or, they may cover the entire page with huge, giant letters.

Whatever the issue is, there are many strategies and activities for addressing handwriting
skills that can help kids compensate for difficulties or help them develop the skills they are
lacking.

THERAPIST TIP:
If a child or student is having trouble with reversing letters or
numbers, try multi­sensory strategies to practice formation: Make
Highlight
letters withwriting lines using
play dough, write different
them with colored markers
wet chalk, and to give
write kidsina a
them
visual
thin reference
layer of "goop"point for wheremixed
(cornstarch to start and
with stop their letters.
water).
 HOW TO HELP:
TRICKS AND TIPS FOR HANDWRITING DEVELOPMENT

LETTER FORMATION

Try letter formation apps like iWriteWords and Little Writer.

Make “starting points” for each letter using a crayon, marker, or small sticker.
Use consistent terminology. Some of the terms from the Handwriting Without Tears
program work nicely– big line, little line, big curve, little curve, and slide (diagonal line) for
the strokes of each letter.
Use a hands­on approach. Allow children to build letters using Wikki Stix, wooden
pieces, or play dough. Have kids trace letters cut out of sandpaper or other textured craft
paper. Or trace over learning materials with puffy paint or a hot glue gun to make them
more touch­friendly!

ALIGNMENT

Teach kids the concepts of the top, middle, and bottom with movement games. Then,
work on generalizing these concepts onto the handwriting paper, by identifying the top,
middle, and bottom writing lines.
Using a highlighter, trace the baseline of the student's letters on his written work,
following along the bottom of each one. It might look like the hills of a roller coaster or
the baseline might fall down below the bottom line. Talk about how it looks and how
writing is easier to read if the baseline is smooth and flat. Then, highlight the bottom
handwriting line on his blank paper before he writes to show him where his baseline
should be.
Try handwriting paper with raised lines or sticking Wikki Stix to the baseline of the
handwriting paper to give kids a tactile cue to bump into with their pencils.

SIZING

Provide a visual and tactile cue by cutting a long rectangular “window” (the same width
as the writing lines on the page) out of a strip of cardboard and placing it where the child
should write. The window provides a boundary for the child to bump into with his pencil
as he writes and a clear visual boundary.
Handwriting paper with raised lines – Another great tactile cue for kids who tend to
make their letters too big.
Draw boxes for individual letters and gradually move to larger boxes to contain words
and then sentences. Worksheets with big, blank spaces are difficult for kids who
struggle with sizing and spatial awareness.
 TRICKS AND TIPS FOR HANDWRITING DEVELOPMENT
(CONTINUED)

SPACING

Teach the child to place something down in between each word as he is writing. Try
craft sticks, pennies, small toys or manipulatives – or even the child’s finger.
Make your own Space Man spacing tool or teach the student to use his finger as a
spacing tool.
Draw smiley faces or place small stickers in each space to see how many “points” they
can get (1 point for each smiley face).
Read their writing out loud to them. If they’ve forgotten to leave spaces between words,
read it just as it’s written so it sounds jumbled and doesn’t make any sense. It’s a
lighthearted way to bring the child’s attention to the fact that his writing won’t make
sense without any spaces!

SPEED AND FLUENCY

Have kids compete against themselves to beat their time on writing or copying a
passage. Tell them not to worry about mistakes or erasing when they're working on
speed – just see if they can get it done as quickly and legibly as possible. Then go back
and edit.
Copy written work from a model. They can sit with a teacher or other adult to generate
their own ideas and speak their sentences aloud for the adult to write and then copy the
passage from the model.
Try a fill­in­the­blank format for journals and note taking in the classroom. Preparing a
fill­in­the­blank writing prompt doesn’t take long and often helps kids keep up with
written tasks.
Try cursive. Moving kids away from printing to learn cursive (even at a young age) can
sometimes help improve writing speed and fluency.
Try a visual timer on the child’s desk to help keep her focused and on task.

THERAPIST TIP:
For kids who struggle with handwriting speed and fluency, try
introducing cursive writing. Introducing a new writing style like
this can also help kids break less efficient writing habits and
patterns.
CHAPTER 7: ENGAGING THE RELUCTANT
WRITER

There are many aspects to handwriting, including core postural strength and control,
upper arm stability, bilateral coordination, visual perception (and visual motor
integration), pencil grasp and manipulation, letter/number formation, placement and
spacing. Sensory processing plays a big role too in the development of handwriting
skills, as does overall literacy, and the ability to generate ideas.

Motivation and Behavior are huge components for the reluctant writer.

It could be that the task expectations are actually too difficult in the first place, requiring
an adjustment in the demands. It could be that they are experiencing some difficulties
remaining (sensory) regulated, at the “just right” level of alertness to focus throughout
writing tasks. A pediatric Occupational Therapist can work with children, families and
teachers for specific assessments and recommendations as required here.

We must also remember though, that sometimes we simply don’t have the luxury of
choosing whether we want to do a task or not. Sometimes, there are some things we just
have to do. So, whilst there are certainly many creative and active ways to build
handwriting skills and confidence without even picking up a pen, at the end of the day,
handwriting is about putting pen/pencil to paper. With the right support, even these
students can become efficient, competent, willing writers!

The following tips aim to reassure, re­frame and re­energise your efforts to boost your
child’s handwriting abilities, and highlight many of the key points raised throughout this
handwriting support book. You might not believe this approach to improving attention
and behavior in regard to handwriting, but read on. It’s exciting and effective.
 WHY WON'T MY CHILD WRITE?

RELUCTANT WRITERS MAY:

Refuse to write
Procrastinate when it comes to writing tasks
Not even want to attempt a writing task or do part of the required work
Give up quickly
Complain that they ‘hate’ writing
Worry that they are too slow
Display low self­esteem, saying that they are no good at writing or that their work is
messy (e.g. “I can’t write neatly”, or “the teacher says they can’t read what I write
anyway”)
Insist they don’t care about writing and that it’s not important
Report hand/wrist pain or fatigue (e.g. “I can’t write any more, my hand hurts” or “I’m
too tired to finish this writing”)
Have an emotional meltdown, becoming distressed, upset, or angry at a parent/teacher
request to attempt or follow through with a handwriting task

However, it could be that they are simply unmotivated to write in the first place! It is
unlikely that children who refuse to write do so with the intent to misbehave or be
naughty or malicious. Most children want to please and generally do their best. When
they want to write, and enjoy writing, they happily practice the skills without it becoming a
chore. Many children though, would rather be running, jumping, playing sport, singing,
dancing, getting messy, or going wild in their own imaginative play scenarios, than sitting
at a table...writing.
 TEN TIPS TO ENGAGE THE RELUCTANT WRITER

1. KEEP CALM AND DON’T WORRY

Children develop different skills in their own way, and in their own time. Embrace their journey
and celebrate their achievements with them. The less pressure and stress imposed by adults
around writing, the less anxiety will be felt by children. The less anxious children are about
writing, the more relaxed, ready and willing to write they’ll be!

2. AVOID CALLING IT HANDWRITING PRACTICE

Children don’t need to be aware of the many skills they are working on while they play.
That’s only interesting to us adults! In fact, there’s no need to even pick up a pencil in
order to develop underlying (pre­writing) skills to make handwriting easier and more
efficient. Play dough (with or without ‘tools’), Lego/construction blocks, cooking, using
tongs/tweezers/pegs, beading, threading, lacing, weaving, ‘vertical surface’ play, as well as
climbing, hanging/swinging by hands, crawling and core strengthening activities are all
excellent in preparing children for handwriting.

3. PLAY GAMES

Play games with require and element of writing to provide a more palatable way of
practicing handwriting skills. Some good ideas include Hopscotch, Hangman, Tic­Tac­Toe,
“Celebrity Heads”, etc. Refer to Chapter 8 for more ways to incorporate play into
handwriting.

4. FOLLOW THE CHILD’S LEAD

This might sound obvious. It is obvious to children, and that is why it works! Go with
whatever their interests are at the moment, and the ways they most love to play. If they
love sports, how about keeping score too? Try pirate treasure maps, cooking recipes,
scavenger hunt lists, Minecraft stories, painting/drawing with captions, or comic
strips. Intersperse the writing with plenty of their favorite activity – that’s where they’ll be
most energetic and positive. Keep the writing minimal. Quality over quantity!

5. PRIORITIZE – DON’T WORK ON EVERYTHING AT ONCE

Perhaps name writing might be an early goal, or getting an idea down, letter formation or
holding a pencil well. Provide examples, tracing opportunities or other support, in order to
ease the effort of working on everything at once.
 TIPS TO ENGAGE THE RELUCTANT WRITER
(CONTINUED)

6. ENSURE SENSORY BREAKS BEFORE AND DURING WRITING TASKS

Each child will have their own ways of ‘recharging their batteries’. Try some quiet time.
Movement can be a motivator. Try a trampoline bounce, a bike ride, or a dance to a
favorite song. A snack on something crunchy like carrot sticks or crackers can be a
great burst of alerting, proprioceptive, sensory input

7. GIVE PLENTY OF FUN CHOICES

Creative ideas include a variety of paper type, color, size, shape, and texture.
Kids enjoy trying different writing implements such as chalk, paint, shaving cream, water
squirters, glue and glitter, magic erase boards, “fancy” pens, crayons of different shapes
and size. Explore handwriting practice in various locations by writing on concrete, a fence,
blackboards, whiteboards, the wall, a window, dirt, sand, rice, pasta, or flour.
 TIPS TO ENGAGE THE RELUCTANT WRITER
(CONTINUED)

8. ENCOURAGE SELF-CORRECTION

This gives ownership over one’s work which is an instant motivator.

9. PROVIDE OPPORTUNITIES FOR “INCIDENTAL” WRITING

Have the child help with checklists, shopping lists (common words), Santa letters, lunch
bag labeling, birthday/special occasion gift cards, etc.

10. DEVELOP WRITING SKILLS WHILE PLAYING WITH A FRIEND

Collaborative posters, murals, stories, or letters to a pen pal are great ways to encourage
writing. Social interactive writing (or drawing) provides wonderful learning and practice
opportunities. Playing with friends is THAT powerful!

CASE EXAMPLE:

Alex, 8 years old, 2nd grade

Alex had been attending OT sessions to improve his writing skills for some months.
However, he was onto his parents. He knew they wanted him to work on his pencil grasp
and how he wrote his letters. He also knew his writing was usually “messy” and sometimes
his teacher (and parents) found it difficult to read. So, as far as he was concerned, when
he walked into the OT room it was “shop closed”; there was no way he was going to
partake in any writing activity. In fact, if he so much as saw paper and pencils on the table,
he’d need a good deal of encouragement to even enter the room at all. He was anxious
and self­conscious about writing and besides, would much rather be moving around being
active and creating some wild imaginative story to play out.

After many sessions without even picking up a pencil, playing actively, remaining sensory
regulated, consolidating some prewriting skills (especially in­hand manipulation), and
incidental writing – in the course of whatever play idea he came up with (such as drawing a
plan on theTHERAPIST TIP:
whiteboard for a fort he wanted to build and making a list of obstacle
Use small
challenges to check pencils
off once and broken
completed)… crayons
he surprised us to
all,facilitate a proper
himself included, grasp
in his last
session for theand
yeardiscourage
– writing a full TWOfingers
extra page letter to Santa!
on the It was
writing a list of 11 items,
utensil.
above and beyond what was expected of him. (And trust me, some of those video games
have long names and details!) This was serious, meaningful, business to him. He wasn’t
going to leave anything out! I had to coax him out of the room when time was up!
 CASE EXAMPLE (CONTINUED)

He was calm and regulated, attending to his writing well, having swung a bit on the trapeze
swing and jumped and crashed off the trampoline onto landing mat at the start of the
session (and during many previous sessions). His posture was upright and functional,
having engaged in so many balance and strengthening games. He had great upper arm
control and a functional (extended) wrist position, perhaps from the many games we’d
played on vertical surfaces. He was grasping the pencil well, (with the help of a little ‘blu
tac’ pencil grip), and was beginning to move his fingers more than his hand (as in a more
dynamic tripod grasp). And most importantly, he wanted to be there. He was therefore
more accepting of my corrections/suggestions to remember a ‘finger space’ between the
words, and to write the ‘tails of letters’ below the line, so that Santa would be able to read
his list easily.

THERAPIST TIP:
Use small pencils and broken crayons to facilitate a proper grasp
and discourage extra fingers on the writing utensil.
CHAPTER 8: COMBINING HANDWRITING AND
PLAY

Throughout the school day, children are expected to use handwriting to communicate
their thoughts, express their ideas, and answer questions. The importance of
handwriting in the school curriculum has diminished in recent years. Some
administrators and teachers feel that technology is a priority and handwriting is
becoming less important. That is not true. The education field is trendy, and right now
handwriting is not a popular topic. That does not mean it isn’t important. Handwriting IS
an important functional skill and it always will be! That said, there are fewer
opportunities to work on handwriting skills at school. Parents and teachers can try to
work on handwriting by combining it with other subjects or by emphasizing neat
handwriting during homework time.

That said, there are fewer opportunities to work on handwriting skills at school. Parents
and teachers can try to work on handwriting by combining it with other subjects or by
emphasizing neat handwriting during homework time. Combining handwriting and play
is a fantastic way to incorporate more handwriting practice into a student’s daily life
while keeping it fun!
 DEVELOPING A SOLID FOUNDATION IN HANDWRITING

Handwriting should be taught with formal instruction. Formal instruction means that a
teacher teaches the children the name of a letter, what sound it makes, and models
HOW to write the letter. A good solid handwriting program incorporates multi­sensory
methods to help all children (visual learners, kinesthetic learners, etc.) gain the
awareness of the lesson.

However, once children have been taught how to write the letter, they need to practice.
Practice makes perfect, they say! Sometimes handwriting practice can be perceived as
boring, but combining handwriting and play is a great way to keep it fun! As this chapter
will prove, kids of all ages can have a blast developing their handwriting skills (often
without even realizing it) across both home and school settings.

INCORPORATING HANDWRITING GOALS INTO PLAYTIME

Classic games lend themselves to ‘sneaky’ handwriting practice. Simply change the
directions of the game to include writing. All time favorites include:
Hangman
Tic­Tac­Toe
Bingo
Scrabble
Scattergories
Boggle
Taboo
Balderdash
Upwards
Banagrams
Pairs in Pears
THERAPIST
Apples to Apple
TIP:

THERAPIST TIP:
Adapt games like Hangman, Boggle and Scrabble to include
handwriting. Combining handwriting and play can help motivate a
reluctant writer!
 HOW TO COMBINE HANDWRITING AND PLAY

Class instruction that includes Handwriting and Play is always fun. Tic­Tac­Toe is the perfect
game for combining Handwriting and Play to work on letter formation. Simply set up a page
with tic tac toe boards and write the letters that you want the kids to practice at the top. For
example, if the kids need to practice the letters a and d, they play with those letters instead of x
and o. Simple, but genius! Be sure to offer a visual explanation to the student on the paper or
chalkboard. An example of the proper letter formation or other handwriting mechanics such as
letter size is necessary to encourage carryover of the areas being addressed. This is just so
the kids know that they need to write the letter properly. It’s not a free for all!

Old fashioned Hangman starts by writing the entire alphabet. Teachers can choose lowercase
or capital, print or cursive. This is a great way to get the whole class writing. Parents can
practice with a quick game after dinner or when you are stuck in a waiting room. Everyone is
always tempted to pull out their phone during a few minutes of downtime, but it can be fun to
combine handwriting and play. Plus, nothing beats one on one conversation and connecting
with your kid.

Word Scrambles are also an easy go­to handwriting game. Simply write a short phrase on the
board, “Happy Valentine’s Day!” or “It’s cold out!” Children need to scramble the letters up to
make as many words they as they can using the letters in the phrase. This is similar to Boggle
in that it gets children listing words and word families, which is also a great review.

HANDWRITING IN THE CLASSROOM

Teachers are encouraged to create a “handwriting center” when the class breaks into groups.
It is important to consider the level of the children when choosing how to incorporate
handwriting and play. If the children need to work on sizing or spacing, independent work like
the word scramble or a board game is fine. See the advice below for how to adapt for different
GROSS
ages.MOTOR MODIFICATIONS FOR HANDWRITING

However, if children need to practice letter formation (how to write each letter properly),
independent work is probably not a good idea. As stated earlier, children really need to be
taught how to write the letters. Handwriting is not automatic, so handing out a worksheet or
assigning a Journal topic where children are expected to write letters that they haven’t
mastered is not best practice. Playing a game that involves handwriting but doesn’t teach the
letters isn’t a great idea for this handwriting goal. If you do something incorrectly over and over,
THAT becomes automatic. So why would we set our kids up to learn something incorrectly?
We wouldn’t.

So, with that said, there is a problem. How do we let the kids play a Handwriting Game if they
aren’t being supervised or if they haven’t learned the letter yet? It’s tricky, but it can be done!
HANDWRITING PROBLEMS AND YOUNG CHILDREN:

1. Break the activity down into one tiny skill. Rather than working on all lowercase letters,
work on two or three. Break the letters into groups by letter formation – this way the kids
are learning ONE specific skill (how to write diagonal letters like v and w).
(Before you present an independent play activity that requires the physical act of writing,
you should ask yourself, “Is this a reinforcement activity? Have the children already
mastered how to write this letter?” If the answer is no, put it away. We don’t want the kids
to practice the letters incorrectly.)

2. If some of the children have mastered the letter and others have not set up a buddy
system. The Handwriting Without Tears Program incorporates a “write it and check it” into
their handwriting pages. The kids can do this with their buddy, as long as the group has
mostly mastered the letter. Make sure the kids know to check for how the letter is being
written, NOT what it looks like.

3. If they haven’t learned how to WRITE the letter, let them do other activities with the
letter. For example, circling all of the “lowercase b’s” on a page with lots of letters. The
children aren’t physically writing, but they are seeing the letter over and over, recognizing
what it looks like, and separating it from other letters. Plus, it’s fun! The visual memory of
the letter really important.

4. Don’t be afraid to combine technology with writing! If your class has tablets or Ipads, set
the kids up on a handwriting app! The tablet won’t let them write the letters incorrectly, so
you don’t have to worry! Use games on the smartboard that emphasize visual memory or
grouping the letters, too. The kids are having fun, but you are still combining Handwriting
and Play.
HANDWRITING PROBLEMS AND OLDER CHILDREN:

Older children have often developed poor handwriting habits. Many handwriting “games”
can be used to address handwriting legibility, sizing, spacing, and on­line orientation.
Additionally, they can be used to work on rhyming, spelling, and word families.

1) Make sure the kids know that they are working on handwriting while they play. Often
kids get caught up in the “play” part and they forget to focus on handwriting, too! Have the
kids submit their papers to you after the activity. Make sure you check them, make
corrections and hand them back. If the children see that handwriting matters to you, it will
matter to them.

2) Use graph paper or Redispace paper to work on spacing or sizing for any handwriting
game. Try raised lined paper to work on sizing and on­line orientation. As mentioned
before, Scattergories, Boggle, and Hangman are all fun games that incorporate
handwriting.

3) Use the opportunity to incorporate script if your student needs to improve in this area.

THERAPIST TIP:
Make sure that have set up “guided access” in the settings of the tablet
so that children can’t exit the app. This will ensure that the child
remains logged into the desired app for the correct amount of time.
CHAPTER 9: ACTIVITIES TO PRACTICE
HANDWRITING SKILLS AT HOME (THE
HANDWRITING HOME EXERCISE PROGRAM)

If your child is attending therapy services to work on any type of functional skills, the
best thing you can do as a parent to help carry over those skills is to follow through at
home. While getting help from a professional has many benefits, you will not see the
best results unless you help your child continue those skills in a home environment.
 HANDWRITING PRACTICE AT HOME

There are three things to keep in mind regarding practicing handwriting.

1. Handwriting warm up exercises are a great way to get the arms and hands ready
to practice handwriting. Not only do they warm the muscle groups they also help
facilitate gross motor and fine motor strengthening of the arms, hands, and fingers.

2. Use every day activities to practice handwriting. Maybe you need to make out the
grocery list? Or you need to write down an important note to remember later. Dictate
this information to your child and ask them to help you out by writing it down for you.

Some children may enjoy keeping a journal or writing to a friend, classmate or pen­pal,
whether they use words, draw pictures, or a combination of both.

3. Don’t make it all about paper and pencils. There are a lot of ways to practice the
basics of handwriting skills without using paper or pencil, especially if you have a
reluctant writer on your hands. Sensory and fine motor activities that focus on using a
pincer grasp on objects are a great way to involve handwriting skills in a non­
conventional way.

PRACTICE HANDWRITING AT HOME IN PLAYFUL WAYS:

Sensory writing bags

Using sand, cornmeal, salt, or other fine sensory mediums and then using a paint brush
or fingers to write in
Using WikkiStix to form letters
Play dough and play dough letter mats
Writing in shaving cream or whipped cream (if you have a child who likes to taste
things)
Using clothespins, tongs, or bubble tongs to transfer items
Squeezing a glue bottle, hole punch, stapler, or turkey baster for activities

THERAPIST TIP:
Try to recreate the same handwriting experience at home as what the
child is familiar with at school or in OT. Use the same adaptive paper,
pencil grip, etc.
RESOURCES FOR ADAPTIVE HANDWRITING EQUIPMENT AND
MATERIALS:
Suppliers ­ USA
­Fun and Function
­Therapy Shoppe
­The Pencil Grip, Inc.

Suppliers ­ Australia
­Sensabilities
­Sensory Tools
­The Therapy Store
­Everyday Kids

Resources from the web:

­Sign­in Ideas to Support Handwriting ­ Kids Play Space
­Handwriting Heros
­Free Positioning Poster for Handwriting ­ Your Therapy Source
­The Importance of Positioning in the Classroom ­ Ms. Jaime OT
­Tips for Addressing Proprioception in Handwriting and Pressing Too Hard When
Writing ­ Sugar Aunts
­Handwriting Warm Up Exercises ­ Growing Hands on Kids
­Research Review: Handwriting Without Tears K to 5 Review
­Information on Letter Formation and Construction ­ The Inspired Treehouse
­40 Fun Play Dough Mats for Preschoolers ­ Mama OT
­Pencil Grasp Reference Sheet ­ Your Kids OT
­Pros and Cons of Pencil Grips ­ Therapy Fun Zone

THERAPIST TIP:
REFERENCES:

Amundson, S. (2005). Prewriting and handwriting skills. In J. Case­Smith (Ed.),

Occupational therapy for children (5th ed.). St Louis: Elsevier, Inc.

Ayres, A.J. (1979). Sensory integration and the child. Los Angeles: Western Psychological
Services.

Beery, K. E., Buktenica, N. A., & Beery, N. A. (2010). The Beery­Buktenica developmental
test of visual­motor integration: Administration, scoring, and teaching manual (6th ed.).
Minneapolis, MN: NSC Pearson.

Bundy, A., Lane, S., & Murray, E. (2002). Sensory Integration Theory and Practice. F. A.
Davis Company.

Centers for Disease Control and Prevention. (2014, March 27). Important Milestones: Your
Child at Four Years. Retrieved
from http://www.cdc.gov/ncbddd/actearly/milestones/milestones­4yr.html

Centers for Disease Control and Prevention. (2014, March 27). Important Milestones: Your
Child at Five Years. Retrieved from
http://www.cdc.gov/ncbddd/actearly/milestones/milestones­5yr.html

Exner, C. (2005). Development of hand skills. In J. Case­Smith (Ed.), Occupational therapy

for children (5th ed.). St Louis: Elsevier, Inc.

Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and

intervention. Developmental Medicine & Child Neurology, 49(4), 312­317.

Graham, S., & Weintraub, N. (1996). A review of handwriting research: Progress and
prospects from 1980 to 1994. Educational Psychology Review, 8(1), 7­87.
doi:10.1007/bf01761831

Kaiser, M.THERAPIST
L., Albaret, J. M., TIP:
& Doudin, P. A. (2009). Relationship between visual­motor
integration, eye­hand coordination, and quality of handwriting. Journal of Occupational
Therapy, Schools, & Early Intervention, 2(2), 87­95.

Naider­Steinhart, S., & Katz­Leurer, M. (2007). Analysis of proximal and distal muscle
activity during handwriting tasks. American Journal of Occupational Therapy, 61(4), 392­
398.
REFERENCES (CONTINUED):

Peper, C. E., & Carson, R. G. (1999). Bimanual coordination between isometric

contractions and rhythmic movements: an asymmetric coupling. Experimental brain
research, 129(3), 417­432.

Research Review: Handwriting Without Tears K to 5 [Review]. (2015). 1­9.

https://www.hwtears.com/files/HWT%20Research%20Review.pdf

Smith, B. (2011). From Rattles to Writing: A parent’s guide to hand skills. Framingham:
Therapro, Inc.

Tan­Lin, A. S. C. (1981). An investigation into the developmental course of

preschool/kindergarten aged children's handwriting behavior (Doctoral dissertation,
Southern Illinois University at Carbondale).

Tseng, M. H., & Murray, E. A. (1994). Differences in perceptual­motor measures in children

with good and poor handwriting. OTJR: Occupation, Participation and Health, 14(1), 19­36.

​Volman, M. J. M., van Schendel, B. M., & Jongmans, M. J. (2006). Handwriting difficulties
in primary school children: A search for underlying mechanisms. American Journal of
Occupational Therapy, 60(4), 451­460.

Weil, M. J., & Amundson, S. J. C. (1994). Relationship between visuomotor and

handwriting skills of children in kindergarten. American Journal of Occupational Therapy,
48(11), 982­988.

Yakimishyn, J. E., & Magill­Evans, J. (2002). Comparisons among tools, surface

orientation, and pencil grasp for children 23 months of age. American Journal of
Occupational Therapy, 56, 564–572

THERAPIST TIP:
THE FUNCTIONAL SKILLS FOR KIDS THERAPY TEAM

COLLEEN BECK, OTR/L

Colleen has been an Occupational Therapist since 2000, but
currently is a stay­at­home mom to four sweet kids. Colleen created
and authored the Sugar Aunts blog. As we all know, timing and life's
needs change. The site for creative play ideas morphed into a
resource for developmental activities for parents, teachers, and
therapists and is re­branding to The OT Toolbox. Colleen graduated
from the University of Pittsburgh and has worked as a school­based
OT, in outpatient pediatrics and acute, LTC, home care, early
intervention, and in hand therapy.

CINDY CHUAN, OT
Cindy graduated from the University of Sydney with a Bachelor of
Applied Science (Occupational Therapy) in 1998. She is a
registered Occupational Therapist based in Sydney, Australia.
Cindy, who blogs at Your Kids OT, has worked as a senior OT in
the public sector (disability and community health) and more
recently in the private sector. She has had experience working with
children all of all ages and a wide range of difficulties (including
children with global developmental delays, cerebral palsy, autism
spectrum disorder, ADHD and specific learning difficulties). She
loves finding ways to encourage a child's development in their
natural environments. Cindy also enjoys working creatively with
children to see them reach their potential.

TONYA COOLEY, OTR/L

Tonya is a pediatric Occupational Therapist and mother of two
children. At Therapy Fun Zone, she blogs about fun activities that
help develop skills. Tonya loves creative activities, and believes that
the work involved in development should involve play and fun. As a
therapist, Tonya is always creating new things to use in therapy or
adapting objects. She enjoys sharing her projects and solutions.
Tonya started her career in the skilled nursing field and then moved
on to pediatrics. As a pediatric therapist, she has worked in a clinic
setting, inpatient rehab and acute, ICU, early intervention, and in a
school district.
THE FUNCTIONAL SKILLS FOR KIDS THERAPY TEAM

HEATHER GRUETMAN, COTA/L

Heather is a Certified Occupational Therapy Assistant turned
therapy and homeschool mom blogger. Her blog, Growing Hands­
On Kids, is a place to share her passion for homeschooling, child
development, and raising her children in a Christian home.
Heather’s journey of encouraging independence started when she
was working in the school system as an Occupational Therapy
Assistant. She loved working with the kids and finding fun ways to
work towards their goals. When she had her own children, she
found a love of the Montessori education method or model and
realized it fit in very well with her background in Occupational
Therapy (OT). She currently uses both models to set up activities
for her two children.
CLAIRE HEFFRON, OTR/L & LAUREN DROBNJAK, PT
Claire and Lauren are practicing pediatric Occupational
and Physical therapists who blog at The Inspired Treehouse. Claire
holds a Master of Science in Occupational Therapy from The
University of North Carolina and has been practicing in public and
specialized school­based settings for over 10 years. Lauren
graduated from Youngstown State University’s Physical Therapy
program and has been practicing for 17 years in both clinical and
school­based settings. Together, they use outcome­ and evidence­
based techniques to evaluate and treat children with a wide range of
diagnoses and developmental delays. The also share a passion for
promoting healthy development for all children by providing
information, activities for kids, and resources on their website.

CHRISTIE KILEY, OTR/L

Christie is a California­based mom and Occupational Therapist. She
is also the mastermind behind the blog, Mama OT. Christie
graduated from the University of Southern California (USC)
Occupational Therapy program in 2011 and has experience working
with children in early intervention (0­3 years), school­based, and
clinic­based therapy. Early in her career, she found herself in the
unique position of learning how to be both a mama and an OT
simultaneously, and she found that each role taught her to do a
better job in the other. Her mission with Mama OT is to encourage,
educate, and empower those who care for children by sharing
helpful insights and fun, practical ideas
THE FUNCTIONAL SKILLS FOR KIDS THERAPY TEAM

ANNA MEADOWS, OT
Anna is a Melbourne­based paediatric Occupational Therapist, who
currently works in a busy, private practice clinic. She is a
presenter/workshop facilitator, consulting at early childhood centres,
kindergartens, and schools. Anna is a play advocate and is
passionate about child development. Her blog, Kids Play Space,
holds the philosophy that children’s independence in everyday
activities can be supported in many small, meaningful ways every
day, that children’s primary occupation is play, and through play,
children’s learning is the deepest and most valuable.

MARGARET RICE, PT
Margaret is the owner of Your Therapy Source Inc, an online
resource for pediatric occupational and physical therapists. She
graduated from Columbia University with her Masters in Physical
Therapy in 1992 and has years of experience as a pediatric physical
therapist in urban school districts and early intervention. She has
authored many activity and form books for school­based therapists
including titles such as Therapeutic Activities for Home and School,
Play Move Develop, Modifications and Interventions for School and
more. She is also the mother of 6 children.

JAIME SPENCER, OTR/L

Jaime, from Miss Jaime, OT, has a Bachelor’s degree in
Occupational Therapy from Utica College and a Master’s Degree in
Special Education from Adelphi University. She has been a Long
Island pediatric OT for sixteen years and currently works in a public
school setting with students Kindergarten to 5th grade. She also has
ten years' experience working in a sensory gym with preschool­
aged children, has experience with middle school kids and has
worked with adults. She recently finished coursework in Assistive
Technology at California State University Northridge.