The Handwriting Lady

At the AOTA Autism Specialty Conference I attended last week (there will definitely be more about the conference in a later blog), Winnie Dunn, an amazing OT and researcher, said in her keynote address, "Don't let yourselves be pigeonholed. We are more than just the Handwriting Ladies!" (Followed by a comic nod  to the 3 male OTs in attendance). This is very true. In the world of pediatric OT, we are so often linked with handwriting to the point where other related service professionals, teachers, parents (and if we're not careful even us as OTs!!) can forget or never realize in the first place that OTs do so much more than just helping the kids we treat improve their handwriting!

Why is it that pediatric OTs so frequently address handwriting that it has become possible to pigeonhole us as “the Handwriting Ladies”? Why is it that poor handwriting is the most common reason for OT referral in school aged children (and poor pre-writing skills in pre-school children)? I believe it is because of a paradox that is a very real part of school for kids. And that is that handwriting is an essential part of a child’s occupation of being a student (for those non-OTs who may be reading, an "occupation" refers to the things people do in their daily life that are of necessity and/or of meaning to them, for children being a student is one of the primary occupations they engage in).  Children are required to produce written work in basically every school subject, because writing is how they communicate what they know and have learned.  Unfortunately for children with special needs, handwriting is also one of the most complex tasks children are expected to perform. It seems automatic for those without a disability, but handwriting actually encompasses an extraordinary amount of body systems and underlying component skills, and if a child has issues with any one or combination of these skills it will very often manifest as poor handwriting.

[Here’s something that will probably blow the minds of the non-OT readers. Take a deep breath in....ok, readysetgo: In order to write successfully, first one needs to be able to sit in a chair. Just that involves a lot, such as having the core strength and postural control to stay upright in the chair against gravity. Then there are also a lot of visual elements to handwriting. There's visual acuity (being able to see and see clearly), occulomotor skills (such as being able to move one's eyes to visually scan from left to right and top to bottom), visual perception (which includes being able to interpret series of lines and curves as different and distinct letters), and visual-motor integration (which includes being able to write in between the lines). Another key component to handwriting is fine motor skills. One needs to be able to grasp a pencil appropriately, and manipulate it using very small movements. This involves having good control over the very small muscles of the wrist, hand and fingers in addition to strength and endurance of these muscles. Also, there's praxis (motor planning), which is the ability to plan and execute the specific movements required to form each letter consistently and correctly. Then there's other neurological components, such as the ability to sustain attention to task. There’s cognitive components such as memory--one needs to remember which set of lines and curves represent which letter. There's sensory processing components involved, such as being able to feel the pencil in one's hands and judging how much force to use on it, and having the ability to filter out excess sensory stimuli from the environment. And a partridge in a pear tree, lions and tigers and bears oh my!!! This is just to name SOME of the many components and skills involved in handwriting!!!] 

I am an occupational therapist, not a handwriting specialist. However, as OTs, we have the knowledge base to break down the task and determine exactly which components are posing a barrier to the student's success in handwriting, and then determine an appropriate intervention to help that student. The reason why OTs so often address handwriting is not so much the WHAT (the student writes poorly), but the WHY (ie poor fine motor coordination and endurance, poor visual perceptual skills, ect), and most importantly, HOW it is affecting the student’s ability to be successful in school.

Our jobs are to help our clients with any and all things that prevent success in their occupations. Although handwriting is a big part of the childhood occupation of being a student, it is not by any means the only part. As Winnie Dunn said, it is very important to make sure that we are recognized as more than just "the Handwriting Ladies," and I do make sure to do my best to advocate for the many other things we do as pediatric occupational therapists to other professionals and those outside the related service field. However, that being said, I am also excited to be, for 45 minutes every Friday, just that: The Handwriting Lady! On Fridays at the clinic I run a handwriting group for 5, 6 and 7 year olds. I was so happy to see them today, because we did not have group the last two Fridays due to being closed the day after Thanksgiving, and then me being away attending the aforementioned Autism Conference.

The group I run is based on the handwriting program Handwriting Without Tears. I took the course to become trained in the program this summer and I absolutely adore it! It was developed by an occupational therapist, Jan Olsen, and encompasses underlying skills that support handwriting success as well as using techniques that target the way children learn best--through multi-sensory, experiential learning, as backed up by years of research. It's also fun, motivating, and easily adaptable for kids with many different special needs. OTs understand that there is so much more to writing than pencil meets paper, which is why when children have handwriting issues we tend to be the ones called in. The kids in my group came to me with a variety of different challenges and were at varying developmental levels, but they all have shown remarkable success in group so far. This, in my humble and professional opinion, is because I'm using a program that's fun, motivational, developmentally appropriate and multi-sensory, and I can tailor each group's activity to meet the needs of each of the five children in the group. We sing songs, color with crayons, use play doh, write on chalkboards, do activities using our whole bodies, and exercise our fingers all before sitting down and practicing letters with a pencil and paper.

I know the importance of not being pigeonholed as "the Handwriting Lady," but for 45 minutes on Fridays that is exactly what I love to be......just with a very "OT" spin!