Difficulties with handwriting

One of the most common reasons kids and teens are referred to an occupational therapist is because of difficulties with handwriting. 

Referrals for handwriting difficulties can range from problems with legibility that are affecting a teacher’s ability to read and accurately mark a student’s work, difficulty with speed and the amount a student can write within a timed period and/or difficulties with pencil grasp and pencil control.

Dysgraphia is chronic, persistent, affects function and is a significant long-term problem for children and adolescents.

Dysgraphia persists despite treatment and affects the child or adolescent’s ability to perform on an equal level to their peers despite their knowledge and understanding of a subject, which can result in poor outcomes for the child or adolescent.

Dysgraphia is a disorder of writing ability, which covers writing at any level including letter illegibility, slow rate of writing, difficulty spelling and problems with syntax and composition of writing.

Dysgraphia is a learning disorder where the individual’s writing skills are below the level expected for their age and cognitive level (Chung & Patel, 2015).

Some of the signs of Dysgraphia include:

  • May hate writing
  • Stares at the blank paper
  • Letters missing in words
  • Some letters are backward when writing
  • Does much better when you scribe for them
  • Difficulty reading their writing

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) uses the terminology “an impairment in written expression” under the category of specific learning disorder (SLD), which incorporates language-based dysgraphia signs and symptoms.

This is the term used by psychologists and medical practitioners.

This form of dysgraphia describes persistent handwriting difficulties associated with an impairment in motor coordination as an aspect of Developmental Coordination Disorder (DCD), previously known as Dyspraxia.  

Occupational therapists can assess and treat motor-based dysgraphia; the motor and physical components of handwriting and functional output of writing.

All other categories of dysgraphia should be referred on for suitable assessment, diagnosis and appropriate treatment with a suitably qualified educational and developmental or clinical psychologist.  This includes langugage based dysgraphia or dyslexic dysgraphia.

Motor dysgraphia can commonly occur with neurodevelopmental or other developmental disorders.

Common co-existing conditions include:

  • Developmental Coordination Disorder (DCD)
  • Attention Defecit Hyperactivity Disorder (ADHD)
  • Specific Learning Disorder with impairment in Reading (Dyslexia)
  • Specific Learning Disorder with Impairment in Written Expression (language-based dysgraphia)
  • Specific Learning Disorder with Impairment in Mathematics (Dyscalculia)
  • Autism Spectrum Disorder (ASD)
  • Cerebral palsy
  • Hypermobility Spectrum Disorders 
  • Depression
  • Anxiety
  • Communication Disorders
  • Intellectual disabilities
  • Learning difficulties due to neurological or sensory disorders (for example, paediatric stroke, traumatic brain injuries, hearing impairment or vision impairment)
  • Neurocognitive disorders or neurodegenerative disorders
  • Psychotic disorders (for example, schizophrenia or psychosis)


  • Trying different pencil grips
  • Trying different writing instruments
  • Use of gel crayons or textas instead of coloured pencils (this may reduce fatigue from colouring in as the student does not need to press as hard)
  • Use of a slant board, which can improve wrist positioning
  • Complete test verbally
  • Alternatives to writing assignments e.g. drawings, video, verbal presentation
  • Short stretching breaks for hand fatigue
  • Increased time for test
  • Preferential seating
  • Break writing tasks into smaller steps
  • Word prediction software for writing
  • Sentence starters

Hi, I’m sorry I haven’t updated this bit yet, it’s coming.  Thanks for your patience!  Pia 

Who can help?