Dysgraphiais commonly understood as a disorder of handwriting. However it is more than that. It impacts self-cares such as learning to tie shoes, buttoning, zipping, and includes all in hand manipulative task such as eating, etc.
It is not an issue that can be resolved by “tutoring”. It will not self-resolve with age and maturity. It is brain-based and is simply stated the translation of a correct cognitive image into a purposeful and correct motor response.
In other words, what you “see” in your mind is what you produce in with your hands.
Although this often first becomes evident in school when the child cannot write legibly there were probably earlier signs that went un-noticed because the child was young (and the thought was “they will outgrow this”).
Without Occupational Therapy treatment children do not “outgrow” Dysgraphia. The visual sensory perceptual motor skills involved in remediating Dysgraphia are outlined below. Getting these skills to work in harmony with each other is the art and science of occupational therapy intervention.
Perceptual Sensory Motor Factors Impacting Dysgraphia
Small muscle strength(this is not related to or about exercise or strengthening).
- Fatigues easily /switches to sedentary tasks
- Ability to sustain a grip/demonstrate resistance and co-contraction.
- Isolation of individual finger movements
- This includes visual tracking and the ability to follow an object, as it is moving.
- Visual pursuits inclusive of copy skills should be consistent and not require a lot of verbal cueing.
- Visual memory should be automatic
- The ability to competently hold a pencil/paint brush
- Make smooth connected strokes
- Use a functional pincer grasp (for writing)
- Ability to sustain a stable hold on the object in the hand (utensil, toothbrush, pencil, etc.)
Perceptual Discrimination—There are 7 realms of perception: (note this is processing not acuity)
- Discrimination: (discerning one object from another)
- Form Constancy: (recognition of form in various sizes)
- Visual Memory:(retention of a visual form)
- Visual Spatial Relationships: (different orientations)
- Visual Sequential memory: (specific items in order)
- Figure-Ground: (overlay discrimination)
- Visual Closure:(part-whole; visual completion)
It is very important to treat the processing beforeintroducing handwriting. Being mindful that handwriting, because it is so blatantly visible is often packaged with a lot of (negative) emotionality.
Start with making the hands “happy”, fun game postures and a lot of gross motor. Creating something functional and fun is often the secret of getting the child engaged particularly if you are working with a 4thgrader and up. Make the initial activities from start to finish no more than 30 minutes. For kids with attention issues, you may want to break this up into 10-minute segments depending upon the child’s task tolerance.
Handwriting is rarely a ‘stand alone’ issue. The factors that impact handwriting were developmentally in place before the child was required to write or draw. Asking parents to remember their elementary child, as a toddler can be very helpful to the OTR in addressing associated concerns. (some questions might be:)
- Did they like to draw?
- Were they able to sit and play with manipulative toys? At the dinner table?
- Did they demonstrate impatience if they had to do something again? (Puzzles, etc.)
- Did things drop out of their hands easily?
- Did they like using scissors?
Using color codes helps with spatial visualization. TheHandwriting on the Wall® Program inclusive of the WIN® Workbook(go to YourTherapySource.com for sample pages) uses colors instead of directional instructions. It is easier for the child to hear, ‘make a red line’ than to process ‘slant up to the dotted line and come back to the solid line’ and/or similar instructions that are used in more traditional handwriting programs.
The WIN® Write Incredibly Now® systemteaches 3 shapes for manuscript and 4 for cursive. When the child can automatically make these shapes with their eyes closed then letters are introduced in groups (not one at a time).
Utilizing games, crafts and multi-media engagement the shapes are presented not as letters but as ‘hand warm ups’. This reduces performance related stress as well as a fear of failure often experienced in previous attempts to learn handwriting.
Early and current behavioral information is important
Using a task/motor checklist that both the parent fills out before the first OT session and that the OTR fills out after the first session can help the parent see things that perhaps were precursors to current issues and might have been ‘excused’ as “Jonny just being Jonny”.
Handwriting is not something that gets “fixed”
As Dr. Keith Berry states, “…because it is so visible, (as opposed to spoken language) poor handwriting often serves as a self-fulfilling prophesy of inadequacy …negatively impacting self-esteem …and is a factor in school drop-outs….”.
Handwriting is a symphony of skills that when left to flounder become triggers for child to reject learning altogether. There is also some research that suggests that Dysgraphia impacts attention and motivation for learning new skills.
This is often difficult for parents to understand because perhaps written skills came almost automatically for them. This is not an issue of just trying harder. Children need to learn motor muscle fluency abilities. Fluency is what we use daily when we look into the refrigerator and without looking at the pad and pencil in our hands, we write ‘milk, cheese, etc.’.
What we did was see the object, see the word, see the letters and see the letters as they were evolving…and we did this automatically because our brains were able to recruit all these neurological, physical, and cognitive skills.
However for children with Dysgraphia, these skills do notcome automatically and that is where Occupational Therapy through the application of evidenced based graded sensory motor -guided engagement creates motor automaticity. Once basic schemes within required skills are secure, the child can easily progress to writing and other fluid motor abilities.
To get a copy of the personal behaviors checklist please contact Susan Orloff OTR/L FAOTA through this website.