Brainworks® - ADHD and Handwriting: Is There a Connection?
ADHD and Handwriting: Is There a Connection?
by Carla Crutsinger, M.S.
It has been known for decades that individuals with ADHD are more than likely going to have problems with handwriting (dysgraphia). In fact, there are studies that say over 60% will have handwriting difficulties, but in the 29-year history of Brainworks working with ADHD students, we feel that number is low. We feel it is closer to 85%.
When we hear a student complain about written assignments, we have to think about two factors. We ask, "Do you struggle with the physical act of making the pencil move fast enough on the page, or do you struggle with getting your thoughts organized to get the words on paper, or is it both?" Most of the time the answer is "both."
The medical profession of occupational therapy looks at all aspect of the handwriting process, and they see handwriting as a developmental fine motor skill. Sadly, teachers are not trained in the stages of fine motor development, and as a result, have wrongly accused many students of being lazy and having no sense of pride in the neatness of their work. It would be extremely helpful if teachers were made aware of why handwriting is so complex. Occupational therapy sees handwriting not as one skill but as a coordinated effort of 14 abilities that need to work together and smoothly.
14 Abilities Needed for Handwriting
If a student struggles in one or more of the following abilities, he or she could have a handwriting disability (dysgraphia) and dread written assignments:
- Visual focusing: the ability for the eyes to work together
- Mental attention: the ability to screen out distractions
- Organized physical movements: the ability to maintain posture and hold the writing tool
- Receptive language: the ability to perceive abstract concepts and follow verbal directions
- Inner expressive language: the ability to think clearly, organize ideas and concepts, and communicate through writing
- Memory recall: the ability to remember letter formations and the required movements necessary to make each letter and connection.
- Concentration with awareness: the ability to maintain consistent awareness of details and form over a period of time
- Spatial perception: the ability to utilize space.
- Organization: the ability to organize mind, body, and space to produce meaningful responses
- Integration: the ability to unite the mind, body, and space to create meaningful written expression
- Eye-hand coordination: the ability to use the eyes and hand together as a unit.
- Motor planning: the ability to plan and carry out an action
- Tactile input: the ability to feel the pencil in the hand and apply the appropriate pressure to write
- Crossing midline: the movement of the eyes, a hand, or forearm to move across the midsection of the body without moving any other part of the body
Visual Perception and Motor Planning Training
Since handwriting is a developmental process, we must consider the mechanical aspect of writing as the primary cause of the problem. Neat handwriting requires visual perception and motor planning at the same time. Students with visual perception problems may trace a shape, but they do not notice that the triangle looks like a lumpy circle and do not see the difference in their shape and the sample. These same students have trouble making letters a consistent size, and they may not have spacing between words. Also, letters could be of different sizes within words, or there could be a mixture of print and cursive or upper and lower case. In many cases, there could be an inconsistent slant of letters. When the teacher comments on the mistakes, their brains cannot see the problems.
When students with visual perception problems are first learning to write, they need to describe orally what they are thinking as they make their letters. "h is tall; it starts up in the clouds at the top." "j starts at the middle of the line and dives below the water (bottom of the line)." This is done until they can make their letters faster than they can describe what they are writing. The check for this motor memory is to have students write the letters on unlined paper with their eyes closed. By doing so, you are speeding up letter production.
The best way to build confidence and familiarity is to introduce the letters in a developmental sequence. Start with letters with straight lines and angles like H, T, I, F, E. Next introduce letters with circular shapes C, O, P, B, U. The most difficult letters are K, S, Y, X, and A. In the lower case, start with the letters that look the most like the capital ones like o, c, p, t.
There is another interesting pattern about ADHD students that we have discovered at Brainworks. A majority of them have directionality problems that continue longer then their non-ADHD peers. They have to spend extra time thinking about which direction to draw a letter such as d, b, p, q. All those letters are a ball and a stick. The difference is where the ball is in relation to the stick. These students still confuse their left and right directions. They need directionality training that is combined with a metronome. When they can keep the beat of the metronome in their training, directionality is becoming automatic. And that is the goal in handwriting.
For motor planning problems, one has to consider the pencil grasp. Have you noticed how many awkward pencil grasps you see in today's world? There is a reason. Teachers are not trained in all the aspects of teaching handwriting; they are given a book and told to get the students writing paragraphs as soon as possible so they can pass the state exam. No one is taught to look for the child that has weak muscles in the fingers or the thumb that could cause an awkward pencil grasp. These students actually need strengthening exercises before they are ready to tackle writing paragraphs. Also, some students hold the pencil very near the pencil lead. These awkward pencil grasps can cause muscle spasms, and students in pain do not like to write. Instead, they tend to procrastinate on all writing assignments. These students would benefit from using pencil grippers that have a specific place for the thumb, pointing finger, and middle finger. The pencil is to rest on the middle finger, not the ring finger. The thumb is not to curl around the top of the fingers.
Another mechanical factor in handwriting is timing. Being able to cross "t's" and dot "i's" requires that the student hit a target on the paper. Timing is also required for students to take notes while a teacher lectures. The task demands a fast execution of writing numbers, letters, diagrams, and symbols along with spelling words correctly and punctuating the sentence properly. If the student gets stuck having to think of any one of these factors, he often will lose his thoughts to complete the sentence. Thus valuable information in the lecture could be lost in the process.
Some students with visual spatial problems need additional aides to write successfully. Consider using graph paper in math to keep the numbers in columns. Use an index card to mark your place when you have to copy from the book or read. Some students seem to write better if they are allowed to write in colored pencils. Others do better if they write using a slant board to elevate the surface at an angle. Any method to make it easier for the student should be allowed.
The typical ADHD student may have so many ideas in her head that it is difficult to make choices about a sequential thought process that could lead to an organized paper. Grouping and sorting thoughts is complicated when you can also get distracted and forget where your thoughts are taking you. At Brainworks, we have discovered that the ADHD brain works so much better if the thinking process is separated from the writing process at first. Therefore, we try to get students to tape record their thoughts or use a graphic organizer to get ideas on paper before worrying about sentences.
Stimulant medication can make a major difference in the handwriting, especially for students that are in the primary grades. Their writing is more legible and tends to flow better. There are studies comparing gifted ADHD students on and off medication. The differences are extremely pronounced. The unmedicated students could create a well, organized, detailed and descriptive story orally; but when the students were asked to write the same story, they could barely construct a single legible, understandable paragraph. In addition, those same students could appear lifeless with their heads on their desks as they struggled to write. It appeared that the energy had completely been sucked out of them.
If the student's handwriting problem is a major issue, he can appear lazy and defiant. Even the thought of writing seems to rob these students of much of their cognitive capacity resulting in writing that lacks creativity or eloquence. This is why there should be accommodations available to them. Skipping recess should not be an option for students with dysgraphia.
- By 4th or 5th grade, allow students to type their rough drafts and final papers.
- Provide keyboarding lessons for these students.
- Allow more time to complete written tasks.
- Allow students to begin projects early and turn in their work as soon as it is completed.
- Adjust note taking by providing a partial outline so the student can fill in the details under major headings.
- Allow some students to take oral tests.
- Provide a copy of the math problems instead of the student having to copy them.
- Allow the student to use graph paper in math.
- Teach the stages of the writing process (brainstorming, rough draft, editing, and proofreading) and considering giving points for each stage of the process.
- Allow students to use colored paper and colored writing instruments.
- Encourage the use of mechanical pencils.
- Encourage the use of pencil grips or pencils/pens with the grip built into the instrument.
- Instead of writing in complete sentences to answer questions, allow the student to use phrases.
- Reduce the length of written assignments.
- Provide extra guidance on long-term assignments.
- Extra time on tests.
Without teachers and administrators who are willing to think out of the box for these ADHD students, too many of them will see themselves as losers who cannot keep up with the workload.
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