Monica Fortunato, OTR, had been an occupational therapist for more than two decades when she noticed her preschool-aged son was having difficulty holding a pencil. “He had no interest [in writing]. I started taking the Handwriting Without Tears courses with the intention of assisting him, and realized he was not the only one that needed help,” Fortunato says.
For the past five years, Fortunato has worked exclusively on children’s handwriting issues at her Hermosa Beach, Calif., practice. “Parents always tell me, ‘I didn’t know there was anybody like you that would just help with handwriting,’” she says.
While some children with handwriting problems need therapy, many simply need an assessment followed by appropriate instruction and remediation, according to Jan Z. Olsen, OTR. Olsen is the founder of Handwriting Without Tears, which produces a pre-K curriculum and a developmentally based handwriting curriculum for grades kindergarten through five. The company also does more than 500 training sessions a year for OTs, teachers and parents.
“When I started doing workshops in the early ’90s, most of the people at the workshops were occupational therapists, and they were using Handwriting Without Tears with children who had special needs,” Olsen says. “The kids were doing so well that, sometimes, the children with special needs were developing better writing skills than the typical children.”
Vast Need
“Gradually, OTs advocated for the wider use of the curriculum and we became a primary curriculum for children of all abilities,” Olsen says. “The children with special needs might take our curriculum at a slower pace, use more of the multisensory learning materials and get more individual attention. But they will basically be using the same curriculum as the other children and learning to write efficiently and well.”
Casey Halper, OTR, whose New York City OT practice focuses on children’s handwriting, attention and organizational issues, says that teaching handwriting skills goes beyond what most OTs learn in traditional training. “Most OTs address fine motor skills … and they touch on writing, but to have it as a main focus is a little different,” Halper says.
Halper uses her OT training to look at all the forces that might be working against the child who struggles with writing. In a 45-minute session, Halper will integrate handwriting lessons with game playing, awareness exercises and strength building. She might have the child build letters out of clay, write in the sand or use Wikki Stix to trace letters. Halper says she often starts sessions by waking up the muscles in the children’s hands. She uses creative approaches, such as hiding small pieces from a game board in clay, having the children pull apart the clay, find the pieces and put them on the game board.
“It’s really a multisensory approach,” Halper says.
Some of the causes of children’s handwriting challenges, according to Halper, include hand weakness, or that they weren’t taught or didn’t adequately learn to write.
OTs who focus on handwriting issues find many of their patients are normal children. Even some adults need help, according to Olsen. “There are many cases where our materials could be useful for adults, particularly if they have a stroke or a hand injury where they need to change hands,” she says. “I have had adults purchase and use the materials to learn to write again or to learn to write for the first time.”
Individual Focus
Although formal research data backing the efficacy of handwriting remediation is lacking, practitioners say that they see important benefits to honing in on handwriting remediation. Fortunato recalls the boy whose handwriting issues, she figured out, were simply because of his physical size versus the size of conventional desks. “His feet weren’t on the ground, either at home or at school, and the table heights were too high. I told his mother, ‘The table height is too high and the pencils are too long. If we bring everything down to his size, we’ll be successful,’” she says. “I just saw him one time. The mom took that information and adapted it to the area where he was doing his homework then talked to his teachers and they adapted his work area at school.”
The older children who are in second and higher grades might require more attention because they’ve established handwriting habits, according to Fortunato. “I help them work first on their legibility; then, build up their speed with legibility,” she says.
Halper says that her goal with handwriting skill education is to build children’s confidence. That, she says, is an attainable goal with the training. “Parents and teachers report to me that the kids feel better about themselves [after the handwriting sessions] and that they, as students, are improving,” Halper says.
She uses a handwriting assessment tool that helps to measure children’s progress before and after the remediation to confirm the benefit. After they complete the remediation, Halper gives each child a checklist with specific instructions of what to work on.
Halper says most of the referrals to her practice come from teachers. “Teachers are becoming more aware of the role of OTs in expanding children’s writing skills,” Halper says.
These experts encourage OTs to use their skills combined with specific handwriting training. “My best advice would be to take some of the courses that are available and educate yourself,” Fortunato says. “Get the education and take your OT knowledge about motor planning and visual motor integration and apply that to helping kids with handwriting.”
(Source: Today in OT)
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