Wednesday, September 22, 2010

Why Can't My Child Express Himself in Writing?

Very often, when a child is referred to me for handwriting problems, the parent tells me that the child is very bright and articulate and has lots of ideas, but simply cannot get his thoughts down on paper:  "He will write a sentence or two when the rest of the class has written three or four paragraphs."

In order for a child to be able to write well, the act of writing itself must be completely automatic.  If it isn't,  the child will not be able to compose fluently, even though he has great ideas and can articulate them perfectly.  The cognitive, perceptual, and physical underpinnings {eye/hand coordination, visual acuity for close work, trunk and shoulder stability, fine motor control, attention span, visual memory and discrimination, and knowledge of letter formation} must be firmly in place in order for the child to be able to express himself to the best of his ability in writing.

What does it mean for the child's writing to be an automatic skill?

For those of you who remember what it's like to learn to drive a car, when you were first starting out, it was a stressful, exhausting task.  There were a million details to keep in mind every moment you were behind the wheel.  You had to focus continually on the coordination of your hands and your feet to steer, signal, shift gears, accelerate, and brake.   You had to remember to look in the rearview mirror every few moments and take into account all of the other cars on the road before you could turn, change lanes, or park.  You had to plan how you were going to to respond to traffic, make split second decisions, and remember all of the specific traffic laws.  Holding a conversation or thinking of something other than what you were supposed to be doing while trying to keep track of all of that would have been impossible, because doing it took every ounce of your concentration.

After a few sessions of practice, though, your body took over the details, and braking, shifting, signaling, accelerating, and steering became automatic.  You no longer had to think about it.  Suddenly, without any conscious effort on your part, your body was smoothly coordinating the gas, the brake, the steering wheel,  and the turn signals.  Your eyes began to automatically check the rear view mirrors.   You and the car were one, the car was responding to your commands, and it wasn't terrifying and exhausting anymore.  You didn't have to think about it!

  How did this happen?

 Repetition coupled with conscious thought eventually sent the skills you were practicing down to the lower lobe of your brain, the cerebellum.  This is the part that is responsible for automatic tasks, so when it took over, you didn't have to think about all of those things anymore behind the wheel.  Your conscious brain was freed from having to work at coordinating your body while driving, and then it was easy to have conversations, or to think about other things.

Any physical task we undertake to learn is mastered in the same exact way.  The forefront of our brains, the grey matter, is initially responsible for  coordinating our thoughts with our actions.  The more the task is repeated, the further it is sent to the lower parts, which eventually take over, and the task becomes automatic.  Any impairments in the above mentioned underpinnings {for instance, poor eye hand coordination, delays in visual perception or fine motor planning} will stand as an obstacle in allowing the cerebellum to take over completely.

For a child to whom writing has not become a completely automatic skill, the part of his brain that should be free to think about what he wants to say is caught up in trying to remember how to form the letters or is busy trying to coordinate the work of his hands and eyes.  I see this quite often. I ask the child, "write a capital letter A," and his pencil will hover uncertainly over the paper for a few moments before he begins.    If he can't remember how to write the letters, and must focus his attention on just that part, there's not a whole lot of grey matter available for him to come up with an organized, articulate, cohesive essay.  {Or for that matter, to solve the problems in his math homework. } The activity itself is such an arduous task that order to comply with the adults' demand that he write something, he's going to get the minimum quantity down,  just to get it over with, then breathe a sigh of relief.  He doesn't have the energy or ability as yet to be free to focus on the quality.

  Sometimes poor handwriting is one symptom in a whole constellation of problems. Other times, it's just poor pedagogy {schools are just not doing a good job of teaching handwriting these days} and can be resolved with some extra work on the basics and short, concentrated daily practice sessions.

If your child is doing well in all other aspects of school and life but has bad handwriting, he just may need to learn correct habits of letter formation and do some work on spacing, sizing, and organization to bring him up to speed.  If you suspect that this is the problem, you can try purchasing some Handwriting Without Tears materials, go over how to form the letters correctly, and work on drilling your child until his habits of letter formation are completely automatic.  {If you are putting a disproportional amount of time and effort into it, and it's not getting better, I suggest an evaluation by an OT specializing in sensory integration, and a visit to the neurobehavioral optometrist.  What this suggests is that those underpinnings need some work.}

What if a child is exceptionally resistant to writing?  If a child really has a difficult time of it, it's quite possible that he has a convergence issue with his eyes and can't see what he's doing very well.  He could be struggling just to focus on the paper.  Again, he's using up the part of the brain that should be functioning to formulate and express his thoughts in order to control his eyes and hands.  If the child rests his head on his non dominant hand and turns his head to one side while writing, this is a signal that his eyes are not functioning together properly.  A visit to neurobehavioral optometrist is in order.

Another reason a child won't want to write is a dysfunctional grip.  Many children these days who didn't get enough tummy time as infants, or who spent time in walkers in strollers instead of crawling, didn't develop sufficient shoulder stability or trunk strength to support the fine motor control in their fingers.  They hold their pencils in such a way that their entire hand and arm must be involved in the formation of letters.  This is awkward and often painful, so the child will have quite a limited ability to tolerate the activity.

In my next post, I'll talk about some of the kinds of things I do to help kids practice until they attain fluency.

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