When Handwriting Issues Need Occupational Therapy

How school-based OTs can assess and address handwriting problems

By Jennifer Larson, contributor

how school based OTs help students with handwritingRemember sitting at a classroom desk and painstakingly practicing your letters on a sheet of lined paper? 

That’s a less frequent occurrence in today’s elementary school classrooms. Teachers are under pressure to introduce more and more material to children at younger ages, and handwriting instruction tends to slip further and further down the “to do” list. 

And many teachers don’t have any formal training in how to teach handwriting skills, according to Jan Olsen, OTR, founder of Handwriting Without Tears.

If a student struggles with handwriting skills, school-based occupational therapists can often help.

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Why handwriting struggles are a concern

With or without the proper instruction, some students may struggle to form all of their letters correctly. Their handwriting may be labored or uneven. It may be difficult to read. They may even have trouble completing some assignments. Such early struggles can impact a child’s self-confidence and success in other areas.

Handwriting is a frequent concern of parents and teachers, according to Jessica Lynn Hatfield, MS, OTR/L, public media manager for the Kentucky Occupational Therapy Association (KOTA).

“Occasionally, in the school setting, we get a referral for just handwriting,” she said. “But then we identify during the evaluation that the student is having difficulty with more than just handwriting.” 

There are two handwriting-related situations that occupational therapists tend to encounter. The challenge is for the therapist to determine which one affects their client. 

Handwriting problems related to other issues

The first situation an OT might encounter is a child who has some underlying issues that are negatively affecting his or her handwriting. According to the American Occupational Therapy Association, “a child’s inability to master good handwriting skills could indicate a more serious problem such as development or learning disabilities.” 

The problems could range from issues with hand development, strength, manual dexterity, visual motor control and visual perceptual skills to a number of other problems, said Hatfield. 

“Once the underlying challenges are identified, we address those skills,” she said. “If they have decreased hand strength, we’ll choose a fun intervention to build up strength. If they have a retained reflex, we’ll do a ‘game’ that integrates the reflex so they can look from board to their paper without losing their place each time.”

And the interventions, which are tailored to each child, often do resemble play. That’s purposeful, Hatfield added. 

“This is because children learn best when activities are contextualized in play. Additional strategies will not be as effective without building up the foundational skill,” she said. 

Occupational therapists can also work with the parents of children who have underlying conditions by providing strategies they can use to reinforce the therapy at home. For example, an OT might suggest parents encourage their children to participate in sports or activities that improve their skills, and practice certain tasks that use their hands and fingers. 

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Handwriting skills that need refinement

The second situation that an occupational therapist might encounter is a child who is just struggling with handwriting skills. In these cases, the child may not have received solid instruction in learning to write or practicing the correct skills, which can be addressed with help from an OT with experience in a program like Handwriting Without Tears

Olsen recommends that occupational therapists keep the big picture in mind when a child sits down for an evaluation. Consider what might be happening in that child’s life at home and at school—and that the child may be receiving little to no handwriting instruction or assistance. 

“If a child is struggling with handwriting, you need to look at more than the child,” she said. “Any complete evaluation must consider the quality of instruction and the quality of materials that the child is using.” 

That’s where additional training in handwriting may come in handy for occupational therapists who work with school children. Olsen’s program helps OTs learn to use a special assessment tool that can identify which specific area is giving a child trouble and recommends strategies to resolve that particular problem. Handwriting curriculums are also available for teachers to use in the classroom.

Even 10-15 minutes of daily handwriting practice can be so helpful for children, said Olsen. 

“It really supports so much of their other school achievement,” she said.

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