In a world with ever-advancing technology — computers, laptops, iPads, etc. — handwriting could easily be pushed aside as a less than-important skill, especially if it proves challenging to a child, as is often the case for children with trisomy 21. However, while technology provides children with opportunities to increase independence and participation by compensating for fine motor delays, there are still times when the ability to write is important.
It provides a child with a sense of independence and autonomy, by signing a piece of artwork, signing a letter or card, or simply writing one’s name at the top of a worksheet at school. I believe handwriting is an important skill that deserves time to develop, improve and master.
While not all children with trisomy 21 will have the same challenges with handwriting, some common traits that may make handwriting difficult include:
- Hypotonia or “low tone,” which results in decreased core and upper extremity strength and therefore decreased stability with positioning and impaired motor control
- Small hand size and short digit size, which negatively impact a child’s ability to grasp or sustain a grasp on a writing utensil
- Visual impairments, which negatively impact the ability to see or process visual information
- Cognitive delays, which make new learning and recall difficult
If your child possesses any of these traits, it is important to break handwriting down to the foundational skills required to participate in the activity and focus on improving those areas. The foundational skills of handwriting include:
- Postural control for proper positioning and distal control
- Fine motor and upper extremity strength for sustaining grasp on a writing utensil and proper letter formation
- Visual perceptual skills for the ability to understand the information your child’s eyes are seeing
These activities will help to improve your child’s skills in each of those three foundational skill areas.
Have your child participate in weight-bearing on his arms and legs. This can be done statically, such as when playing a board game or watching a video, or dynamically, such as crawling over couch cushions, completing an obstacle course or walking like an animal.
You can also have your child participate in unsupported sitting. This can be statically, by sitting on the edge of a chair, couch or bed without any back support to play a game, color or do a craft at a table top, or dynamically, by sitting on a therapy ball or a swing.
These activities will increase the strength of your child’s core, which will make it easier for him to maintain an upright posture when handwriting. This will improve hand and finger control. Your child will also be able to focus on the handwriting task rather than on sitting without losing balance!
Fine motor and upper extremity strength and coordination
Have your child participate in resistive activities, such as playing with Play-Doh, clay or water (squirt bottles, squeeze toys, etc.), baking, doing crafts (tearing/crumpling/cutting paper of different textures), using clothespins to pick up objects or drawing in shaving cream, pudding, oatmeal or whipped cream. These activities will increase arm and finger strength, which will make it easier to demonstrate and sustain an efficient grasp pattern on a writing utensil.
Have your child participate in activities such as stringing beads, completing puzzles, baking, ball activities (vary the size of the ball you use) or crafts (tearing/crumpling/cutting paper). These activities will improve coordination, which will make it easier to properly produce letters with one hand, while stabilizing the paper with the other hand.
Visual perceptual skills
Have your child participate in activities such as matching or sorting by color, shape or size, completing puzzles or hidden pictures, imitating designs with blocks or LEGOs, copying pictures, or going on a treasure hunt (hide familiar objects around the room). These activities will improve his ability to process the visual information, which will make it easier to recognize the difference between letters, understand that capital and lower case letters are different forms of the same letter, put appropriate space between letters and words, recall proper letter formation and spelling, and focus on one word or letter on a busy page.
In addition to working on the foundational skills of handwriting, the following strategies may help decrease the challenge of this task for your child:
- Always make sure your child is sitting in a supportive seat.
- Always have your child’s feet supported on a flat surface (you can use a stool, large text book, phone book, etc.).
- Place a small wedge on your child’s seat to change the position of his/her pelvis and improve upright posture.
- Put the paper your child is using on a vertical surface to increase upright posture.
- Use short writing utensils (break crayons in half) to increase the amount of control your child has on the utensil and to promote an efficient grasp pattern.
Handwriting activities are important for both school-aged children and pre-school children who are working on prewriting skills. It’s never too early to start to improve those foundational skills!
Bruni, M. Fine Motor Skills for Children with Down Syndrome. A guide for parents and professionals. Bethesda, MD: Woodbine House; 2006.
— Katie Casey, MOTR/L, CBIS