DO occupational therapists DO handwriting?
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A guest post from regular contributor Katherine Collmer.
Now therein lies the question! What exactly DO we do with handwriting? When I was a new pediatric occupational therapist, I found that question to be both disturbing and intriguing. It disturbed me on two levels. First, that I didn’t really know if we did? Second, why didn’t I know if we did? I found it intriguing on a very different level, however, as I connected to my “teacher self.” Previously on the Katherine Collmer Reality TV Show, I was a teacher. One thing to be said about teachers is “once a teacher, always a teacher.” You simply cannot remove the seed once it is planted. As my teacher-side conferred with my OT-side, we began to digest all the information about handwriting that we had – little that there was. I was a middle-high school teacher; hence, I didn’t have an educational background in handwriting instruction. I also had not been exposed to any true semblance of handwriting training in my occupational therapy program (awesome though it was) to give me any insight into my role in children’s handwriting. My education background, however, kicked in and decided to find the answers. There weren’t many! At the time, I was working in a remote area that prohibited me from traveling to courses or training. Online courses were a vision of the future. My mentor gave me a short course on a handwriting program designed for use by teachers and parents. But, somehow, I felt that I was not sufficiently armed for helping children with handwriting PROBLEMS using only that. As a teacher, I knew that the program could work at the classroom level. But as an OT, I recognized that I had to go beyond that. I had witnessed the struggles and despair of children who could not “do handwriting.” If they were going to “get handwriting,” they would have done so right along with their peers. But they didn’t. And they wanted to desperately.
The strongest force in my drive to find answers was a seventh-grade student I will call Kevin. He had been receiving OT services for about as long as he could remember and he had come to the conclusion that all he wanted now was to learn to write his name in cursive. His ticket to OT was a learning disability but he had no physical impairments to stand in his way toward cursive success. At the beginning of each and every session, he would go directly to the chalkboard and connect his “broken” manuscript letters (as he called them) together to form his cursive name. He loved his creation. But, he knew that it was not a true representation of cursive nor an indication that he was learned in the skill. We worked and worked on it and, well, in the end, he thanked me for trying. Now, at the moment that he said, “I’ll just use the computer,” and resigned himself to never writing in cursive, his struggles and despair pocketed themselves in my OT bag and never left.
As I searched for answers from other occupational therapists, I heard a recurring theme: “We don’t DO handwriting.” It took me a few years, and a few more Kevin’s, before I came to the conclusion that, “No, we don’t DO handwriting; we FIX handwriting.” And that is what I am here to talk about today. ARE we fixing handwriting? If not, then WHY NOT?
Recently, I put this question out on the internet: “In your occupational therapy program, how much training did you receive on handwriting assessment and remediation?” I didn’t get many responses; but from those who were gracious enough to do so, their answers were disturbing yet predictable. None. Yes, there was a chapter in a pediatric textbook about handwriting grasping patterns and perhaps an outline of the underlying skills. But they’d received no in-depth training for helping children who suffer from handwriting difficulties. No tools for the tool box. This is particularly sad since Stephens and Pratt determined in 1989 that (although) “The teacher is primarily responsible for handwriting instruction. The therapist’s role is to determine underlying postural, motor, sensory integrative, or perceptual deficits that might interfere with the development of legible handwriting.” Although they stated that we would “determine” them, I’m sure they also meant we would remediate them. And another sad point is that the modern school curriculum has moved away from providing formal training for teachers to provide handwriting skills and we are finding more and more students who cannot “do handwriting.” The therapists who responded to my question had struggled to find answers on their own as well. So what do we DO?
The majority children of the who have joined me at my clinic for help with handwriting did not receive OT services. Those who did were receiving help in a clinic setting for other disabilities but not with their handwriting needs. They ranged in age from 5 to 12 years old. The parents whose children did not receive services in any setting reported that they had numerous discussions with the teachers over the years about their childrens’ handwriting struggles, but the answers were primarily the same: “He needs more practice. He needs to slow down. I don’t know what else to do.” The answers never came in the form of “I feel he needs occupational therapy.” Parents who attempted on their own to obtain OT services for their child were met with answers that turned them away: “He doesn’t qualify for services. His assessment scores don’t warrant services. I don’t do handwriting.” Why can’t he qualify for services when it is quite apparent that his handwriting is being affected by skill deficits – and that those deficits are affecting his educational success? Where is the disconnect?
Perhaps the disconnect comes from an insufficient awareness about handwriting SKILLS in general. Handwriting is a complex skill comprised of cognitive, visual, and physical skills that must work together to produce a very precise movement. The American Occupational Therapy Association (AOTA) describes it as “a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture.” Handwriting struggles result from a problem with one or more of the steps in that process – with the links that connect the chain. Sian Eckersley reminds us in his blog on Occupational Therapy For Children that “Occupational Therapy is process-oriented, whilst education is product-oriented.” The links in that chain – that complex process – belong to OT. We are the professionals trained to inspect those links, find the rusted or broken spots, and spend the time gluing, soldering, or adapting them to meet the students’ handwriting needs. We own Handwriting Mastery!
In a 2010 New York Times Article, “Watch How You Hold That Crayon,” it was revealed that “occupational therapists have taken their place next to academic tutors, psychologists, private coaches and personal trainers — the army that often stands behind academically successful students.” Occupational therapists had expanded their roles from “working with children at hospitals or schools for the blind or deaf…(to include) promoting fitness and enhancing kids’ performance in school.” The article pointed out that parents were seeking private-pay OT help for their children’s handwriting skills. They were the driving force behind finding a “fix” for their children’s handwriting struggles. They paid out-of-pocket for the services and were delighted with the results. The parents. Why weren’t the schools identifying students who would benefit from OT services for handwriting?
The key for obtaining any services is all about what is covered and what is not. Handwriting is not. Not by insurance or any other service-related payer. But, handwriting skills ARE. Fine-motor deficits, visual-motor deficits, visual-perceptual deficits, finger and hand strength deficits, cognitive deficits. They are ALL covered. Handwriting isn’t the real issue. The links in the handwriting chain ARE. Children who come to school with deficits in that chain deserve occupational therapy. Whatever educational area the deficits affect, reading, handwriting, or math, they deserve OT.
My question to all of my readers – therapists, parents, teachers, everyone – is this: “Are we doing enough to help children IN SCHOOL to master handwriting skills? To the therapists, “Are we doing enough to FIX handwriting skills so that children can DO handwriting?”
For all of the Kevin’s in this world, please think about this. And, please, share your answers.
(1) Stephens, L. and Pratt, P. (1989) School work tasks and vocational readiness. In P. Pratt, & A. Allen, (Eds.), Occupational therapy for children. (2nd ed.).Toronto: C.V. Mosby.
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who owns and operates a clinic that specializes in the assessment and remediation of handwriting skills. She can be contacted via her website, www.handwritingwithkatherine.com.
