Deciphering Handwriting Difficulties in Exceptional Needs Individuals

By Laura A. Ryan, OT, OTR, OTD

IN THE EARLY GRADES, CHILDREN “LEARN TO WRITE.” AS CHILDREN ADVANCE IN SCHOOL, EFFECTIVE HANDWRITING IS ESSENTIAL IN NOT ONLY DEMONSTRATING WHAT THEY KNOW BUT ALSO TO INTEGRATE NEW CONCEPTS, ESPECIALLY AS THEY BECOME MORE COMPLEX OR ABSTRACT. IN THE SECONDARY YEARS, ONE COULD ARGUE THAT CHILDREN ARE NOW “WRITING TO LEARN.”

However, many systems need to be in place for a child to be able to perform handwriting tasks, and thus learn in an effective manner. Here we will break down the following graphic for a better understanding of the intricacies of handwriting.

Ocular (eye) control and visual perception

Ocular control is the ability to move the eyes in the head through a full range of motion and in a controlled manner. Similar to the muscles in our arms and legs, there are muscles that surround the eyes that need to be strong, coordinated, and have good stamina to support the eyes as they move through their myriad of visual jobs each day. These visual skills include tracking: moving the eyes through ranges of motion including side to side, up and down, diagonally, and in a circle. Visual skills also include scanning convoluted lines, alternating the focus on a near/far target, and coordinating the eyes to make tiny, precise, but irregular jumps such as when stringing letters to make a word. Ocular control is dependent, in part, on a strong vestibular system to counterbalance the movement of the head while stabilizing the eyes as they focus on an object (Dragoi, 2020).

Visual perception is how the brain interprets visual input and makes sense of that information. Visual perceptual skills include coordinating the eyes and the hands, seeing changes in depth (which is essential when navigating stairs), and the manipulation of visual information for learning things such as geometric concepts. Accurate perception of what is seen is dependent on strong ocular control (Dragoi, 2020). Optometrists.org offers activity recommendations to promote strong ocular control that also contributes to strong proximal control and stability. These activities include robust physical activities such as climbing trees, riding a tricycle, and playing catch (2023).

The sensory system (sensory processing)

Contrary to popular belief, there are eight senses, not five. In addition to the more commonly known “fab five” (seeing, hearing, tasting, feeling, and smelling), there are the senses of proprioception, the understanding of where your body is in space; vestibular, the sense of movement; and interoception, the understanding of soft tissue feelings such as experiencing your tummy rumble and knowing that means you’re hungry.

The senses of proprioception, vestibular, and touch are important for understanding where your body is in space and stabilizing your body during movement such as walking, shifts in body position like leaning forward, and feeling the environment like understanding the difference between soft ground versus hard ground under your feet. Parham and Mallioux (2020) concluded that strong vestibular sensory input is essential for identifying the movement of the head and body in space, which is necessary for postural and ocular control, coordinating both sides of the body, bringing both sides of the body smoothly to the middle, and effective muscle tone. These skills are essential for the body to move and balance.

Thinking about the next systems, it is helpful to think of a person like a tree with many branches that extend far from the trunk, waving gracefully in the wind and providing a stable perch for birds. Much like a tree, one’s core needs to be strong to provide a stable base of support for the arms to extend. Particularly, a strong core allows for the arms to extend to their full length and the hands to work fluidly while suspended in the air. If the core is not strong, then ultimately, the hands and all the important jobs they do are impacted. The next three systems are important to give the body the stability it needs to perform fine motor tasks.

Proximal control and stability

The term “proximal” indicates the center of the body while the term “distal” indicates the distant parts such as the arms and legs. Proximal can also describe a direction of the body. For example, the elbow is more proximal than the wrist because the elbow is closer to the center.

For this article, we will consider the trunk of the body—the upper back and neck—as being proximal parts that are contributing to stability. The trunk includes the abdominal muscles in the front and the back muscles at the back, as well as the lateral muscles at the side of the trunk. The abdominal and back muscles must act in synchrony to keep the body-centered front to back, and the lateral muscles must work to keep the body centered between left and right. The upper back must be strong to support the neck, which in turn supports the very top-heavy head.

It is important to note eye control is, in part, influenced by the stability of the head on the spine, which is stabilized by the upper back and neck muscles. Considering the role of the vestibular system in the sensory processing system, you can understand why neck and head control are important in stabilizing the eyes and allowing for balanced movement.

Foundational fine motor skills

We have now established that the sensory system and ocular system are crucial in giving the body information from its surroundings to keep itself centered and coordinate the eyes at the middle, which will allow the hands to work together. The proximal muscles are strong and give the body stability to move out from its base of support to use the distal portions of the body. At the upper end, the hands are the most distal portion of the body. It is somewhat ironic that the most distal part of the body is asked to do the most intricate work!

If these systems are not working in synchrony, the hands cannot explore, interact with, or control their environment and fine motor developmental milestones may be impacted. Typically, the progression of fine motor movement moves from the pinkie side of the hand to the thumb side. Difficulty balancing when using the hand in free air could lead to decreased development of the tiny muscles in the hand responsible for dexterity and a lag in moving an object from the pinkie to the thumb because the child is leaning on their hand for stability.

In school and at home, many teachers and parents may notice the child having difficulty sitting straight in their chair or keeping their balance when their arms are not resting on the tabletop. Aside from difficulty using the hands without supporting their arms, other indications this is difficult for the child could include the child wrapping their legs around the chair to provide heavy pressure to the joints of the body thereby assisting the sensory system in identifying where the body is in space or to provide a wider base of support and more stability to the trunk.

Handwriting mechanics

Handwriting is an incredibly intricate and systems-related task. In the section above, we alluded to the milestones that must be in place to allow the hand to move through the patterns necessary for handwriting. However, handwriting is the result of all the systems above working in fluid unison. Seo (2018) writes, “Before beginning the act of handwriting, children need to develop readiness skills for forming letters, such as the comprehensive abilities of various sensorimotor systems, the development of large and small muscles, visual perception, fine motor skills, and in-hand manipulation skills.” Layered onto these systems is the cognitive aspect of handwriting, where the child is either learning a new skill (such as learning to form the letters or distinguishing between ‘b’ and ‘d’) or learning a new academic concept.

Our bodies are an amazing network of interrelated jobs; all working together to produce the movement we see and take for granted. Understanding the role of each system in the result interaction with our world helps us understand why a child may be having difficulty in mastering a milestone such as writing their name or indicating their level of understanding on a written test!

References

Deshmukh, M & Palekar, T. J. (2020). Effect of cervical muscle strengthening and ocular muscle training among students with smartphone adversity. Journal of Dental Research and Review (6), s65-s68. https:// www.researchgate.net/publication/351127914_Effect_of_Cervical_ Muscle_Strengthening_and_Ocular_Muscle_Training_among_students_with_smartphone_adversity

Dragoi, V. (2020). Ocular Motor Control in Neuroscience Online (Chapter 8). University of Texas Health. https://nba.uth.tmc.edu/neuroscience/m/s3/chapter08.html

Sao, Sang-Min (2018). The effect of fine motor skills on handwriting on handwriting legibility on preschool children. The Journal of Physical Therapy Science, 30 (20), 324-327. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5851374/

This is Part 1 of a 2-part series. The second article will more thoroughly outline the fine motor developmental process and the complexity of handwriting, including pencil grip.

Laura A. Ryan, OT, OTR, OTD, is an occupational therapist who grew up on a large horse farm in Massachusetts. She has been practicing for 30-plus years and has been using hippotherapy as a treatment tool since 2001. She enjoys seeing the happiness and progress each person has achieved through the therapeutic impact of the horse. Laura has also developed a program for breast cancer rehabilitation using therapeutic input from the horse.

Email: hooves4healingot@gmail.com

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Tosha Rollins is a Licensed Professional Counselor in South Carolina, and the owner of Rollins Counseling, LLC. In 2018 she started the Autism in Action Podcast to help families connect with autism resources, services, and support. Tosha also enjoys serving the community as an autism advocate and has served as a volunteer for the Champion Autism Network and has worked with Lead with Love Training Company as a Safety Plan Coordinator Tosha is a public speaker & published author Her newest book is Autismology: An Autism Dictionary was published in 2022 by Future Horizons, Inc She loves adventures, traveling, nature, and spending time with her family When she is not working, she is spending quality time with her family and planning her next adventure Tosha is married with four children, two of whom are now autistic adults.

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