ADHD and Handwriting

UWindsor Blog Post by: Thomas A. Duda, M.A.

The diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) often conjures to mind an image of a child who doesn’t pay attention during school, is very talkative, acts without thinking, and appears to be constantly on the move as if powered by a motor. In addition to these cardinal features of ADHD, those with ADHD also tend to present with other differences compared to those without ADHD, including problems with motor control. In particular, the handwriting of those with ADHD is often described as illegible and less organized than those without ADHD. However, looking at what’s written down on paper isn’t the only way to think about handwriting. For example, other kinds of research has identified differences in the handwriting of those with ADHD at the actual movement level. Said another way, there are differences not only in what handwriting looks like, but also in the movements during handwriting. As one example, scientists in Australia found that how forcefully children with ADHD wrote was related to symptoms of hyperactivity and impulsivity. There are several different ways to conduct these kinds of studies, but scientists have most frequently used digitizing tablets (think “iPad”) to study handwriting motor movements.

Child with ADHDResearchers at the University of Windsor have been studying handwriting movements in children and adults with ADHD since about 2011. During this time, several interesting discoveries have been made. For example, parents and educators talk about children with ADHD as having a problem “doing what they know” rather than “knowing what to do.” They also show a lot of variability in performance such that the only thing that is consistent is their inconsistency! They may do really well on one assignment, but on the next one, although similar, do very poorly. They may complete chores satisfactorily sometimes, whereas on other occasions, these chores are completed haphazardly. This variability isn’t limited to these kinds of activities. Compared with adults without ADHD, Windsor researchers found that the handwriting movements of adults with ADHD were significantly more variable on average. Interestingly, this was only the case when learning a new symbol and it didn’t matter if they were on or off their medication for the treatment of ADHD. It was also shown that these adults with ADHD didn’t become as fluent in reproducing the new symbol as quickly as the adults without ADHD. This could mean that it takes more practice for adults with ADHD to become fluent when learning how to write.

Handwriting TabletThe next question might be, why is this important? Good question! First, these findings show that certain characteristics of ADHD (i.e., differences in handwriting motor movements) are not limited to childhood and continue into adulthood. In addition, the observation that adults with ADHD may take more time to become fluent at a motor task could have implications for accommodations. What’s more is that within the greater scope of psychology, researchers are trying to come up with new ways to identify and diagnose different kinds of psychological and neurodevelopmental disorders. Needed are more objective measures of functioning and this type of research can help with developing new methods to do this! Researchers at the University of Windsor are currently investigating if differences in variability and learning how to write that were observed in adults can also be found in children with ADHD, how different “thinking” abilities might be related to developing fluent handwriting in those with and without ADHD, and whether or not an objective measure of handwriting fluency development can successfully identify those who have ADHD.

Thomas A. Duda, M.A.
PhD Candidate
University of Windsor

The Write Stuff: Handwriting Difficulty in Young Learners

Multiple-print-reversals-e1331590434434-300x286The first time I reviewed my son’s grade one assessment binder that came home from school I was overcome with worry.  Flipping through the pages, I noticed that every page had some letter or number reversal.   I got even more concerned as I read his teacher’s notes about the number of reversals he was making.  I had excused his writing because of his young age but now having a seasoned grade one teacher comment was making the gears in my head turn.  As a teacher myself who works with students with learning disabilities, letter reversals in writing is not new to me.   I knew how to help my son; I had all the right tools to help him improve his writing, tools that I regularly use with my students.  What I didn’t know was why these reversals occur and what is typical for younger children and what isn’t.  I dove right into books and articles to learn as much as I could about letter reversals in children.

frustrated writingWhat I learned from my research was that letter reversals in young children were common until about age 8 because generally, children do not develop directionality until that age.  Directionality means up/down, right/left and forward/backward.  Another issue is that some children do not learn to properly form their letters and what helps is to re-teach them how to write.  I also learned that for children who have dyslexia, 8 out of 10 will have an issue with directionality.   Younger children who have Dysgraphia will have trouble with forming letters, maintaining word spacing, and will complain about having sore hands.  These students may also have trouble forming ideas about what to write about.  Their writing may be illegible and may not fall on lines or within the page margins.

It’s a lot of information to take in and in my son’s case I’m not yet sure if the writing troubles are because of his age (he’s in the second grade now) or because there is an underlying issue affecting his handwriting.  As an educator, I know these handwriting issues will not just disappear regardless of the outcome and some work needs to be done.  While I strongly support modification and accommodation to support a student with difficulties I am an advocate for remediation in whatever capacity possible.   It’s the basis of our ABC123 Tutoring Program and it’s what I utilize with my students and my own son.

wetdrytryIn the ABC123 program, I have used the Handwriting Without Tears  program and while researching writing difficulties I came across their iPad app Wet-Dry-Try  and purchased it to try with my son.   He immediately took to the program and was willing to practice printing.  With the program he learned to properly form his letters from top to bottom, something I had tried to do with paper and a pencil, but which only frustrated him.  The app has been a game changer in our home, and my son has been learning how to form his uppercase and lowercase letters and numbers.

With students who have difficulty with writing it’s important to learn what strategies will work best for them.  For my son it was the iPad, for others it may be paper with raised lines or finding the right pen or pencil.  Practicing letter shapes through motor activities such as finger tracing in a tray of sand, or forming individual letters and numbers with play-doh are other methods that help students learn.  It’s also important to ensure that the student is using good writing hygiene, meaning that they are sitting properly, holding the paper down and have a good grip on the pencil since many of these bad habits will be harder to unlearn later on.  With many of my students, their grip is awkward which makes writing with a pencil difficult.   A strategy I learned from an occupational therapist was to have the student ball up a tissue in their hand to grip their pencil (see picture below).  For my son and many of my student’s it’s helped to find a commercial pencil grip that works for them.

kleenex grip

In the end, a wait and see approach is risky and many bad writing habits are difficult to change later on.  If you have a child or student with a writing difficulty, it’s beneficial for them (Dysgraphia or not) to try to remediate these difficulties because it’s likely that they will not improve on their own.  After remediation has been thoroughly examined accommodations such as keyboarding or Assistive Technology can be further explored.  For my son, I am taking it one day at a time and working with him to improve his printing for now.

To read more about Dysgraphia and the warning signs: http://www.ncld.org/types-learning-disabilities/dysgraphia/what-is-dysgraphia