WRITING-ITIS: A COMMON BUT OFTEN OVERLOOKED PROBLEM EXPERIENCED BY SCHOOL CHILDREN

By Glenda Thorne, Ph.D.

A plethora of information exists in lay and professional literature regarding two problems commonly experienced by school children--attention deficits and dyslexia. However, another common but generally overlooked problem that school children are often troubled by is difficulty with graphomotor skills, which are the fine motor skills involved in handwriting.

Children with graphomotor difficulties are frequently referred to as "lazy", "unmotivated" and/or "oppositional", because they are reluctant to produce written work. Many times, these are the children who dislike school the most. Because they are sometimes able to write legibly if they write slowly enough, they are often accused of writing neatly "if they want to." This statement has moral implications and is untrue. It is not a matter of choice for them.

When required to write, children with dysgraphia (i.e., trouble with writing) frequently engage in numerous avoidance behaviors. They have to go to the bathroom; they need to sharpen their pencil; they need a Kleenex from their back pack. Sometimes they just sit and stare. Even disrupting the class and getting in trouble may be less painful than writing. Work that could be completed in one hour takes three hours, because they put off the painful task of writing.

Breakdowns in graphomotor skills can occur at several levels. The first is with the guidance system that leads to written output. To produce letters and/or words, we must be able to both accurately and quickly recall from visual memory information regarding what the letters or words look like. Additionally, we must be able to recall from memory the correct motor pattern for writing letters and words.

Children who have breakdowns in the graphomotor guidance system often prefer to print rather than to write in cursive because the printed alphabet consists of only 26 separate motor and visual patterns, whereas, when words are written in cursive, the number of motor and visual patters are seemingly endless. Further, they may retrace letters and write illegibly.

A second problem that can occur with graphomotor skills is dyspraxia. Dyspraxia is trouble assigning various muscles or muscle groups to their specific role in the writing task. To effectively hold a pencil or pen and write with it, our fingers must wrap around the instrument and move in a coordinated manner to produce legible written output. The thumb and middle finger are responsible for the mobility of the writing utensil. The index finger is responsible for the stability of the writing instrument. When the muscles in the thumb and fingers do not work together in a coordinated fashion, there are problems with both the mobility and stabilization of the pencil and/or pen.

Children with dyspraxia often have inefficient pencil grasps, or they may frequently change their pencil grip from one that is normal to one that is not. They may have trouble alternating between use of the pencil point and use of the eraser. In fact, this problem may be so severe that when the child needs to use the eraser, he/she actually has to drop the pencil and pick it up at the end where the eraser is, because he/she is unable to coordinate the muscles in the fingers well enough to turn the pencil in the hand. Additionally, they may write slowly. Their written output is often illegible, and handwriting for them is a labor-intensive task.

A third breakdown that can occur in the graphomotor system is finger agnosia. With finger agnosia, the brain does not receive enough information regarding the placement of the fingers in space. For most of us, there is little difference between our signature written with our eyes open or with our eyes closed. This is because the motor units in the fingers inform our brains about where the fingers are in space (i.e., proprioceptive feedback).

When the motor units in the fingers do not perform this task adequately, the child may closely visually monitor the fingers when writing to know where they are in space, thus, holding their heads very closely to the paper. Frequently, the child may lock up the fingers by using a "fist-like" pencil grip. When they use this grip, there is more movement in the hand and lower arm where they motor units are larger and provide the brain with adequate feedback about where the hand is in space. Further, they may press very hard with the pencil/pen when writing, and often break pencil leads. For these children, handwriting may be neat if produced at a very slow pace; however, the speed with which they must write is usually not adequate to keep up with their peers and with classroom demands. They don't like to write and produce a low volume of written work. Writing is also a labor-intensive, dreaded task for these children. Rather than making statements that have moral overtones, we need to adjust the amount of written work that children with handwriting problems are required to produce and give them extended time to complete writing assignments. We should teach them how to type on computers and become comfortable with audio tape recorders. They may need the amount of copying they must do from the board or overhead reduced. For example, at the beginning of the week, their teachers would provide them with a copy of their homework assignments for that week instead of requiring them to copy daily assignments from the board. They may need copies of teachers' or other students' notes. Many of these children who are bright and have good listening skills may benefit more from just listening to class lecture than from trying to both listen and take notes. Frequently their notes are unreadable even by them. And finally, they need humiliation protection--that is, not to have their handwriting put on public display by posting it on bulletin boards or having other students grade or review their papers.

Dr. Thorne is clinical director at the Center for Development and Learning. She specializes in children and adolescents with learning and attentional problems.