WriteWays NO-TECH LOW-TECH HIGH-TECHTools for Teaching Students With Handwriting Difficulty By: Jeane Zobel-Lachiusa Margaret E. Pierce Occupational therapists can choose from a growing number of tools for helping children with dysgraphia improve their written expression. Dysgraphia (difficulty with handwriting) is a learning disability that affects how easily children acquire written language and how well they use written language to express their thoughts.1Despite the increasing use of computers in school and for everyday tasks, developing handwriting competency continues to be essential for success in school.2 Children spend 30% to 60% of their school day performing handwriting and other fine motor tasks3; therefore, children with poor written expression are at a distinct disadvantage for a majority of their school day. Handwriting is necessary to successfully complete assignments, homework, and tests, including high-stakes tests for achieving in high school and getting into college.4 Additionally, legible handwriting is important in our society for communication tasks such as writing letters, taking phone messages, completing application forms, and writing checks.2 School professionals have witnessed first hand how inefficient or messy handwriting contributes to feelings of frustration and failure in children with handwriting difficulty. The handwriting of children with dysgraphia often does not adequately reflect their knowledge and cognitive ability. For example, an in-class essay from a sixth-grade student with dysgraphia might be short, with simple vocabulary and few descriptive details. Frequent erasures or words crossed out may make it difficult to read. The draft would not accurately reflect the student¶s actual ability. Very often, the written products of students with dysgraphia contrast starkly with their verbal descriptions, which contain age-appropriate vocabulary and extensive details (for example, see Figures 1 and 2). . less time is spent on developing the requisite sensory and motor foundation skills necessary for legible handwriting.6 This number may be on the rise. Duell proposed three distinct diagnostic subtypes of developmental dysgraphia (disorder of written expression).8 Clearly. .7 School-based occupational therapy practitioners identify and support students with handwriting difficulty. Recognizing Handwriting Difficulty The first step in helping students with handwriting difficulty is to identify and recognize the problem. each with a unique profile of symptoms and corresponding assessment suggestions. I¶ve seen a dramatic increase in the number of kids who don¶t have the strength in their hands to wield scissors or do arts and crafts projects. which remains among the most common reasons for occupational therapy referrals.It is estimated that between 10% and 20% of school-age children have problems with handwriting. which in turn prepares them for writing. As schools increasingly push academics down into kindergarten and preschool.9 When an occupational therapist or teacher suspects that a student¶s handwriting difficulties are disrupting his or her model of Dysgraphic subtypes (summarized in Figure 3) and corresponding assessments may be a helpful first step in identifying which dysgraphic subtype best describes the student¶s profile. But in the last 5 years. This is expressed well by a quote from an elementary school principal in a recent New York Times interview: Almost all our kids come into kindergarten able to recite their letters and their numbers. fine motor delay and resultant difficulty with handwriting are important deficit areas for occupational therapy practitioners and teachers to be aware of and to address. Some can even read. . Students with motor dysgraphia can be distinguished by looking at their oral spelling (which will be good). They may have difficulty forming letters correctly. drawing. opening and closing containers) are preserved. and fine motor skills. spacing. and there may be frequent size. . Students with dyslexic dysgraphia can be distinguished by looking at their oral spelling (which will be poor). and their finger tapping (which will be abnormally slow). However. They are focusing so much on spelling. spatial perception. and they are skillful readers and spellers. composing text can be a slow and laborious process. and motor skills compare with those of children at the same developmental stage.Duell¶s model describes students with dyslexic dysgraphia as having difficulties with reading and spelling that result in poor handwriting. These students display illegible handwriting in both spontaneous written text and copied text. drawing (which will be poor). For these students. students with motor dysgraphia exhibit slow and uncoordinated fine motor movements. due to the onerous demands of language formulation and spelling. a range of formal measures can be included inmthe multidisciplinary evaluation that will target spelling. which interferes with letter formation and drawing. and finger tapping (which will be normal).10 Students with motor dysgraphia exhibit poor handwriting stemming from ³motor clumsiness´.9 For students who are being evaluated for special education.g. Some of these assessment options are presented in Figure 4. However. therapists and teachers should focus on how the child¶s spelling. grammar rules. and formulating their thoughts into words that they do not pay attention to the mechanics of writing. These students can usually copy written text accurately. fine motor tasks that do not draw on spatial perception (e.9. and their drafts often contain many spelling and grammatical errors. or alignment errors that interfere with legibility. Whether formal or informal measures are used. with relatively well-formed letters and words. The third subtype of dysgraphia is due to a deficit in understanding space. There are also myriad informal measures that target these skills and can be used with general education students or students with disabilities who are not due for a reevaluation. which result in written work that is illegible or slowly produced. and their finger tapping (touching thumb to each finger without looking.9 These students are usually verbally adept. Students with spatial dysgraphia can be distinguished by examining performance on oral spelling (which will be normal). which will be normal). These students typically have good motor control but lack the language skills to write fluently and legibly. their handwriting breaks down when composing text. Students with spatial dysgraphia have been found to have deficits in spatial perception. their drawing (which will be messy). However. their drawing (which will be normal). Some examples include providing increased time for written tasks (e.g. For older students. These options could benefit all students who are identified with any of the three subtypes of dysgraphia.Supporting Handwriting Development After a student¶s dysgraphic profile has been identified.. writing sentences with 10 spelling words rather than 20). occupational therapists are in a better position to select and recommend instructional supports and strategies that are matched to the student¶s needs.11 ³No-tech´ strategies do not require specialized equipment. An additional no-tech option to try for students with motor dysgraphia is adjusting body position. ³High-tech´ strategies involve specialized materials and typically require ordering and training to use. A useful way to categorize handwriting supports and strategies is to consider the level of technology involved. supports. providing an extra class period to complete an in-class essay) and decreasing length of written assignments (e. These students would benefit from optimal body position in a wellfitting supported on the floor or an appropriately sized foot rest. The optimal body position rule of thumb is for hips and knees to be angled at 90° with forearms resting on the desk and shoulders in a neutral position (see Figure 5). Another no-tech option is arranging a peer to act as a notetaker. maintain. For example. the teacher might provide a hard copy of the lecture notes prior to the class for the student to follow along with and take supplemental notes on.11 No-tech options include tools. and techniques that can increase. . ³Lowtech´ strategies involve materials that are easily found in most schools and classrooms.g.. no-tech strategies can ease the burden of taking notes during teacher presentations or class discussions. or improve the functional capabilities of a child with dysgraphia without the use of equipment. and green is the top line or where to start). Students enjoy decorating their own stick and can use Velcro to attach the stick to their desk when not in use. The lines on the graph paper encourage the student to write an vindividual number inside each space. or improve the functional capabilities of a child with dysgraphia using commonly available materials. the teacher can provide highlighted lines that are the same width as the word to be written. Low-tech options useful for some students with dyslexic dysgraphia include electronic aids such as a handheld. maintain. Highlighting the bottom writing line with a colored highlighter may help some students with spatial dysgraphia pay better attention to it.Low-tech options can increase. This provides a visual boundary. . electronic dictionary or a tape recorder to tape lectures and/or record assignments. thus improving letter alignment. paper with broken midline (visual cue to size lower-case letters). Other low-tech options benefiting students experiencing spatial dysgraphia include paper options such as graph paper for completing math problems. with spaces in between. Popsicle stick spacers are a standard low-tech option to try as an alternative to using a finger as a spacer. Paper options for children with spatial or motor dysgraphia include raised-lined paper (bought or made with glue so the lines can be felt). Additionally. These paper options may assist a child by providing a visual and/or kinesthetic boundary or cue that helps to size letters more evenly and prevent letters from ³floating´ above or ³sinking´ below the lines. which is useful for writing smaller and lining numbers up evenly. and/or paper with colored lines (red is the bottom line or where to stop. If spacing between words is an issue for a student during copying tasks. doublelined paper (Handwriting Without Tears materials). Another low-tech option is to provide alternate writing tools or pencil grips. active mobility of the fingers. allowing for the finger mobility necessary for writing. including a text reader (READ:Outloud). With Dragon Naturally Speaking. thesaurus. which provides a wealth of up-to-date information related to assistive technology through its resource directory. the speech needs to be clear and loud enough to detect. magazine. flexible font size. talking word processor (WRITE:Outloud). the finger flexor muscles and tendons are shortened. high-tech options have expanded to include computer software programs such as Solo 6 and Dragon Naturally Speaking. which ³help position the digits for efficient distal manipulation of writing tools´. from Facebook status updates to e-mail messages to word-processed documents. However. language-related errors will appear unless the text is edited. It easily fits into students¶ backpacks and can used at their desks in class.12 Similarly. The general principle underlying high-tech assistive technology tools is that they allow the student to record written language while minimizing the physical demands of writing (motor dysgraphia). Dragon Naturally Speaking 11 (produced by Nuance Communication) is another software package to assist with written output. although the software ³learns´ to read the child¶s speech. positioning paper on an angled surface (such as an empty three-ring binder) promotes wrist extension that provides a biomechanical advantage for optimal finger mobility. There are many organizations available to help teachers and practitioners stay current with assistive technology developments. graphic organizer (DRAFT:Builder). because the software writes exactly what the student dictates.com).12 When a student¶s wrist is flexed. Anything a student writes on the computer. such as a Neo 2 (formerly AlphaSmart. which prevents full. custom dictionary. Additionally. produced by Renaissance Learning). Additionally. This is sometimes difficult. especially with younger children. the student speaks into a microphone and watches the spoken words instantly appear in documents. can be done using Dragon Naturally Speaking. Each of these Solo 6 accommodations can be purchased and used separately or ³bundled´ together as the Solo 6 Literacy Suite (produced by Don Johnston). some of the high-tech tools provide the needed support for improved writing useful for students identified with spatial or dyslexic dysgraphia. Additionally. and annual international conference. Solo 6 is a literacy suite of popular assistive technology accommodations. and word prediction (CO:Writer). including Closing the Gap (www. or improve the functional capabilities of a child with any of the three types of dysgraphia through the use of specially designed tools. . Dragon is speech recognition software in which the computer program transcribes what the writer dictates. Students with dyslexic dysgraphia may also find these technologies useful because the software correctly spells their spoken text. Positioning the wrist with approximately 30° of extension provides an optimal balance of finger and wrist flexors and extensors. maintain. and specialized software options. High-tech options increase. A commonly used high-tech tool involves using a laptop or a portable keyboard to write.closingthegap. The portable keyboard option is successful for many students because of its ease of use. the Neo 2 provides a spell checker. More recently. This voice recognition software can help students who experience slow or difficult written output secondary to motor coordination difficulties. and high-tech instructional supports. This is especially true for students with deficits in handwriting. Students with different subtype of dysgraphia will benefit from different no-tech. These options are presented in Table 1 . among whom the underlying vulnerabilities can be so varied. low-tech.Selecting the Proper Tools The art of good teaching lies partly in selecting the most appropriate instructional support for each student. .As with any intervention. therapists and teachers should monitor student progress. The authors have found an observation tool like the one presented in Table 2 to be an effective way to gather this data. & Zobel-Lachiusa. special educators. Henderson & C. length.interdys. 2011. Halstead±Reitan Neuropsychological Test Battery.. American Journal of Occupational Therapy.. St. 10. (1995). S. Learning Disabilities Research & Practice. (2006). 3. Predicting occupational performance: Handwriting versus keyboarding. (2000). 16(2). & Cermak. MO: Mosby.to 11-year-old children. International Dyslexia Association.html 8. In A. 898±903. American Journal of Occupational Therapy. Graham. The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6. (2006). Tyre. Handwriting development. Weiss.). R.. & Larsen. American Journal of Occupational Therapy. 19(1). 58. Reitan. References 1. 461±471. K. 11. fluency. As always. Principles and practices of teaching handwriting.. low-tech. occupational therapy practitioners. 5. Pehoski (Eds. L. (2001). McHale. Wechsler Individual Achievement Test (3rd ed. from http://www. San Antonio. & Majnermer. 16±27. 49. S.pdf 2. & Weintraub. Retrieved February 9. Handwriting instruction in elementary schools.. 46. L.In documenting progress. 60. S. Wechsler. and intervention. 4. TX: Pearson. K. 2011. (1993).. & Moser. . (2010. Cope. Watch how you hold that crayon. Benbow. S6±S8. Journal of Child Neurology. 74±84. Harris. or complexity of composed text? y Has there been a change in the neatness or fluency of the child¶s writing when copying text? Final Thoughts The difficulties associated with dysgraphia present barriers and prevent some students from reaching their potential and experiencing academic success.org/ewebedit pro5/upload/dysgraphia. Developmental Medicine & Child Neurology. and high-tech interventions that should be matched carefully to the student¶s subtype of dysgraphia.com/2010/02/25/ fashion/25Therapy. Just the facts: Dysgraphia. P. M. competency. K. The field of occupational therapy has developed a range of notech. (2007). 193±201. C. 12. Denton. (1992). A. 9. P. Deuel. Louis. Marlboro.. (2006). Asher. practitioners might consider the following questions. 6. F. K. Katz. February 10).nytimes. 60. N. 7. Retrieved February 9. MA. 319±342). A. Cultivating connections: A harvest of skills and knowledge. from http://www. November 1). Feder.). J.. 312±317. Prevention and intervention of writing difficulties for students with learning disabilities. Fine motor activities in elementary school: Preliminary findings and provisional implications for children with fine motor problems.. Developmental dysgraphia and motor skills disorders. R. Preminger. D. and classroom teachers are encouraged to track the progress of their students with dysgraphia carefully to determine specific responses to these interventions. American Journal of Occupational Therapy. P. D. R. Hand function in the child: Foundations for remediation (pp. 13. Workshop presentation at the Massachusetts Association of Occupational Therapy State Conference. (2004). Tucson. (2001. y Do I see any changes in the child¶s attitude about and interest in writing tasks? y How would I characterize the child¶s satisfaction with the tool? y Has there been a change in the neatness. (2011). AZ: Reitan Neuropsychology Laboratory/Press. and spelling instruction (4th ed. 18.). (1988). TX: Pearson. N. (1999). TX: Pearson. & Moats. & Beery. (1999). Beery. vocabulary.). (2011). & Johnston. 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