This is one of the most down-to-earth comments regarding handwriting. One thought I would add, although it is not under OT control, is that when handwriting is properly taught at the earliest possible age, it becomes an automatic motor skill. Unfortunately, even when well taught in the formative years, the popular forms of cursive are introduced with all of their directional changes. Thus children are taught one small motor skill for two to three years, followed by as little as one year for another, and all supposedly for the purpose of writing by hand.
Many times it is a problem with attention, particularly if they can write well when they try and all their attention in on the task. Once their attention is taken by other aspects of the writing assignment, their handwriting goes down the tubes. I don't really think they are being lazy, just overloaded. The best course is to work on making writing a better habit so they don't need to pay much attention - this takes lots of practice and commitment on the child's part (good luck!). Also, there is lots of brain research to show that people process and plan language based tasks in different parts of the brain than non-language tasks. Lots of kids can draw beautifully but write terribly. Handwriting is very much a language task, not just a fine motor task. That's also probably why some kids will do everything with one hand, but write with the other.
But how do you determine from any writing evaluation whether there is a motor or visual problem as opposed to a handwriting problem?
I start primarily with a classroom observation and, if warranted, use the Erhardt to do further assessment. One of the strengths of OT is the ability to observe people engaged in typical tasks and identify problems in successfully completing the task. Every person who has poor handwriting does not need OT intervention. ... Task analysis allows us to look at the process, Clinical reasoning is the key.
Nice thoughts. I also find the 1 minute each eval of near point copy, far point copy, dictation, free composition, and eyes closed letter writing (abc's...) worth a lot of info, even if it is not standardized. It helps me to look at the standardized info with a possible analysis scenario in mind. example the children who stand out & do well on the free composition seem to have technical issues with their eyes that are slowing them down in other tasks, and I would do an eye screen with them. If the children are actually slowest in the free comp., I begin to question if it is a processing language, expressive ability and organization issue. These children might benefit from a 'visualizing and verbalizing/TV in the head' approach which I might also work with if there is a general organizational/motor planning issue present as well. Far point difficulty indicates... and so on.
The Beery sub test results are also quite useful to me to statistically back up these thoughts. And if the Benbow observation comes out as showing good in-hand movements on all fronts, then motor involvement is less likely. There's a lot of info out there.
