Graphics and Writing: Supporting the Child in Difficulty
Handwriting is one of the main reasons for consultation in pediatric occupational therapy. This comprehensive guide helps you in the assessment, rehabilitation, and implementation of adaptations for children with graphomotor difficulties.
Handwriting is a complex skill that involves many functions: motor, perceptual, cognitive, and attentional. When a child has difficulty writing legibly or quickly, the impact on their schooling and self-esteem can be significant. The occupational therapist is the specialist in analyzing and rehabilitating the writing gesture, capable of identifying the causes of difficulties and proposing suitable solutions.
🧠 Understanding Writing: A Complex Skill
Handwriting is the culmination of a long developmental process that mobilizes many skills. Understanding this complexity is essential to identify difficulties and propose appropriate rehabilitation.
The Components of Writing
Motor Component
Postural control, hand-eye coordination, finger dissociation, appropriate pressure
Perceptual Component
Visual perception, spatial organization, positioning on the page
Cognitive Component
Letter memorization, gesture planning, sustained attention
The Stages of Graphomotor Development
- 2-3 years: Scribbling, first voluntary strokes, palmar grip
- 3-4 years: Simple geometric shapes (circle, cross), evolution of grip
- 4-5 years: Copying complex shapes, beginning of three-finger grip
- 5-6 years: Formal learning of letters, writing with a model
- 6-7 years: Consolidation of letters, beginning of cursive writing
- 8-10 years: Gradual automation, increase in speed
💡 Automation: Key Objective
The goal of learning to write is automation: the child must be able to write without thinking about the gesture to free up cognitive resources for content. A child whose writing is not automated will be penalized in all learning requiring written production.
⚠️ Graphomotor Difficulties
Writing difficulties can have multiple origins. The occupational therapist carefully analyzes the characteristics of writing to identify the underlying factors and guide the intervention.
Dysgraphia
Dysgraphia is a specific writing disorder characterized by illegible or very slow writing, with excessive cognitive and/or physical cost. It can be isolated or associated with other disorders (TDC, ADHD, dyslexia).
- Clumsy Dysgraphia: Poorly formed, irregular letters, shaky strokes
- Tight Dysgraphia: Excessive pressure, quick fatigue, pain
- Slow Dysgraphia: Careful writing but extremely slow
- Impulsive Dysgraphia: Fast but illegible writing, lack of control
- Spatial Dysgraphia: Organization problems on the page, alignment
Possible Causes of Difficulties
Motor Causes
TDC, hypotonia, tremors, poor pencil grip, deficient coordination
Perceptual Causes
Visuospatial disorders, difficulty with positioning, poor shape perception
Attentional Causes
ADHD, concentration difficulties, impulsivity in gesture
Impact of Writing Difficulties
- Academic: Unfinished homework, penalized grades, excessive fatigue
- Self-esteem: Comparison with peers, feeling of failure, discouragement
- Behavior: Avoidance of writing tasks, opposition, anxiety
- Cognitive: Resources mobilized by the gesture at the expense of content
⚠️ Spotting Warning Signs
Signs to alert: persistent illegible writing, excessive slowness (less than half the expected speed for age), fatigue and pain during writing, avoidance of graphic activities, significant gap between oral and written skills.
🔍 Assessment of Writing
The occupational therapy assessment of writing is meticulous and multidimensional. It analyzes the product (the writing itself) as well as the process (how the child writes).
Standardized Tests
- BHK (Quick Writing Assessment Scale): Evaluates quality (13 criteria) and writing speed, norms from 6 to 11 years
- BHK Adolescents: Adapted version for adolescents
- NEPSY-II Writing Test: Copying sentences with qualitative analysis
- Writing Speed Test: Number of letters per minute according to age
Clinical Observation
Posture
Sitting position, distance to the page, head position, forearm support
Pencil Grip
Type of grip, finger positioning, digital mobility, pressure
Organization
Orientation of the page, holding hand, positioning in graphic space
Writing Analysis Criteria
- Legibility: Are the letters identifiable? Is the text understandable?
- Regularity: Size of letters, spacing, alignment on lines
- Letter Formation: Adherence to shape, direction of strokes, connections
- Speed: Number of letters per minute, comparison to norms
- Quality of Stroke: Pressure, tremors, fluidity of gesture
- Cost: Fatigue, pain, attention required
"Assessment should not be limited to the final product. Observing the child writing is as important as analyzing their writing, as this is where the mechanisms of difficulties are revealed."
— Principles of Graphomotor Assessment
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COCO offers exercises in coordination, visual perception, and attention that support the prerequisites for writing in children aged 5 to 10 years.
Discover COCO →🎯 Prerequisites for Writing
Before working directly on writing, it is essential to ensure that the prerequisites are in place. A child whose foundations are not solid will have a lot of difficulties progressing in writing.
Motor Prerequisites
- Postural Control: Trunk stability allowing mobility of the upper limbs
- Shoulder and Elbow Stability: Stable base for fine hand movements
- Finger Dissociation: Ability to move fingers independently
- Hand-Eye Coordination: Precision of gesture guided by sight
- Crossing the Midline: Ability to work across the entire graphic space
Perceptual and Cognitive Prerequisites
Visual Perception
Discrimination of shapes, shape constancy, spatial relationships
Spatial Organization
Left-right orientation, up-down, positioning on the page
Attention
Sustained concentration, inhibition of distractions
Developing the Prerequisites
- Fine Motor Games: Beads, modeling clay, cutting, gluing
- Preparatory Graphic Activities: Tracing, coloring, mazes
- Construction Games: Legos, puzzles, assembly games
- Tablet Activities: Applications working on coordination and perception
- Sensory Games: Raised letters, tracing in sand, rough letters
💡 Applications as Support
Cognitive stimulation applications like COCO offer exercises in visual perception, coordination, and attention that reinforce the prerequisites for writing in a playful manner. These exercises complement the work done in sessions.
📝 Graphomotor Rehabilitation
The rehabilitation of writing must be tailored to the causes identified during the assessment. It combines working on prerequisites, explicit learning of the gesture, and gradual automation.
Principles of Rehabilitation
- Progressivity: From simple to complex, from large amplitude to reduction
- Repetition: Automation requires many repetitions
- Multimodality: Combine visual, auditory, kinesthetic to reinforce learning
- Immediate Feedback: Real-time correction to avoid anchoring errors
- Motivation: Fun activities, recognition of progress
Working on Posture and Setup
Sitting Position
Feet on the ground, back supported, elbows at 90°, table at the right height
Page Position
Inclined according to laterality, held by the non-dominant hand
Pencil Grip
Dynamic three-finger grip, adapters if necessary
Rehabilitation Methods
- Dumont Method: Learning basic shapes, managing space
- ABC Boom Method: Playful approach, story of letters
- Multisensory Rehabilitation: Rough letters, tracing in different textures
- CO-OP Approach: Cognitive strategies to learn gestures
⚠️ Frequency: Key to Success
Graphomotor rehabilitation requires regular and frequent training. Short but daily exercises are more effective than a long weekly session. Collaboration with parents for home exercises is essential.
🔧 Adaptations and Compensations
When rehabilitation reaches its limits or the disorder is too severe, adaptations and compensations allow the child to function despite their graphomotor difficulties.
Material Adaptations
- Adapted Pencils: Ergonomic pencils, grips, weighted or non-weighted pencils
- Adapted Supports: Inclined board, paper with colored lines, line guides
- Adapted Furniture: Chair and desk at the right height, footrest
- Organizational Aids: Frames, visual markers on the page
Compensation through Computer Tools
Keyboard
Learning to type blind, an alternative to handwriting
Voice Dictation
Voice recognition for severe difficulties
Tablet
Stylus on tablet, digital writing applications
School Accommodations
- Reduction of Written Work: Photocopies of lessons, fill-in-the-blank texts
- Extra Time: Additional time for exams
- Tolerance on Presentation: Do not penalize neatness
- Use of Computer: For long written productions
"Compensation is not an admission of failure but a strategic choice to allow the child to demonstrate their real skills without being penalized by their graphomotor disorder."
— Principles of Supporting DYS
🧰 Tools and Materials
The occupational therapist has a wide range of tools for graphomotor rehabilitation, from traditional materials to digital solutions.
Rehabilitation Materials
- Preparatory Materials: Modeling clay, beads, fine motor games
- Various Writing Tools: Pencils of different sizes, markers, chalks
- Multisensory Supports: Rough letters, sand tray, magic slate
- Notebooks and Guides: Notebooks with adapted lines, progressive rulings
- Grip Aids: Grips, finger guides, ergonomic pencils
Digital Tools
Graphomotor Applications
Tracing letters on tablet, visual and auditory feedback
Preparatory Applications
Exercises in coordination and perception like COCO
Keyboard Learning
Blind typing software (TapTouche, Typing Club)
💡 Balance Paper-Screen
Digital tools are valuable complements but do not replace work on paper. Handwriting remains important for cognitive development. The occupational therapist balances modalities according to the needs and goals of each child.
🤝 School-Family Collaboration
Graphomotor rehabilitation cannot succeed without close collaboration with parents and the school. The occupational therapist plays a coordinating and transmitting role.
Working with Parents
- Information: Explain the child's difficulties and the goals of rehabilitation
- Home Exercises: Provide short and fun exercises for daily life
- Setup: Advise on furniture and materials to use at home
- Support: Assist parents in managing written homework
Collaboration with the School
Report
Provide a clear assessment with concrete recommendations for the class
Exchanges
Meet with the teacher, answer questions, adjust recommendations
ESS Meetings
Participate in educational follow-up teams if PPS
Home Exercise Program
- Frequency: 10-15 minutes per day, 5 days a week
- Variety: Alternate types of exercises to maintain motivation
- Progression: Regularly adjust according to progress
- Recognition: Encourage the child, celebrate successes
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Discover our training →🎯 Conclusion
Graphomotor and writing difficulties are a frequent reason for consultation in pediatric occupational therapy. The occupational therapist provides unique expertise in the fine analysis of the writing gesture and the implementation of tailored solutions.
The intervention combines strengthening prerequisites, rehabilitating the gesture, and, when necessary, implementing compensations to allow the child to function despite their difficulties. Digital tools, whether cognitive stimulation applications like COCO or compensation solutions like the computer, enrich the possibilities for support.
Close collaboration with parents and the school is essential to ensure the coherence of support and allow the child to progress in all their life environments.
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