Autism Spectrum Disorders and Handwriting

Handwriting is arguably one of the most difficult fine-motor skills a young child is required to learn. Not every child is developmentally ready at ages five or six to sit in a chair without sliding down and pay attention in a roomful of squirmy bodies that might be too close, too loud, and too overwhelming, especially for a child on the autism spectrum. Teachers frequently refer kindergarteners and first-graders for occupational therapy evaluations because they struggle with handwriting, but sometimes the best strategy is simply to give children the time they need to mature.

*A vision evaluation should be performed to rule out visual issues that may impact reading and writing.  Click here for information about functional vision. 

What are Prewriting Skills?

It may be helpful for parents to understand the foundational skills, or prewriting skills,  that  children should attain before being taught how to form letters and numbers.

Prewriting skills include abilities to

  • sit with good postural control-not sliding out of the chair or resting the head on one hand
  • effectively control a writing tool, such as a crayon, marker, paintbrush, or pencil
  • understand concepts of directionality, size, and length, such as up and down, big and small, and tall and short. All are needed in order to form the letter H with two long vertical lines connected by one short horizontal line.
  • differentiate similar shapes, such as diagonal lines slanting toward the left versus toward the right.
  • discriminate right and left on shapes in order to identify and form letters such as d and b.
  • follow a sequence of pictures or words on a page from left to right and top to bottom (in Western cultures).
  • form lines and shapes that make up letters. The vertical + and diagonal X crosses are the basis of letters formed with a combination of vertical and slanted lines, such as V, N or Y.

The following video provides strategies to  form lines:

Autism Spectrum Disorder Challenges

Children with Autism Spectrum Disorder (ASD) may miss out on important developmental experiences that prepare them for writing. Because of their sensory, motor, and executive functioning challenges they may currently or previously have avoided when they were younger, experiences of

Children who lack proficiency in pre-writing skills may be referred for an OT evaluation to determine what aspect of writing is difficult and what strategies may help them. One of these children might be Gary, a hypothetical child with ASD described in my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills. Gary has a learning disability as well as challenges with sensory processing, functional vision, and executive functioning.

Let's Meet Gary:

Seven-year-old Gary is able to read out loud but reverses words (saying "nam" instead of "man").  He is able to copy words if given a model on the same piece of paper. But if he has to look back and forth between the board and paper; he makes many errors. Gary struggles to grasp the pencil in a way that allows him to see the lines he is forming. His letters are legible but are all the same size, and there are no spaces between words. His hands are weak and he has low muscle tone. Gary has learned that he can control the pencil better if he uses "the death grip". He holds the pencil so tightly that his knuckles turn white an his hand begins to ache after writing only a few words. When Gary's teacher asks him to do more, he runs away.......

Older students with ASD may have multiple challenges. First, it is difficult to write when struggling to attend' sit with good posture; stabilize the paper; and control the pencil to form letters and words with good sizing, spacing, and legibility. Second, these students often have difficulties generating ideas to put on paper. Authors Cheryl Boucher and Kathy Oehler remind us that "even simple writing tasks require skills in areas that are often very difficult for individuals with ASD: language, organization, sensory regulation and motor control (Boucher and Oehler).

Sensory-based strategies may motivate young children to engage in Pre-writing activities that build foundational skills. 

Let's add Sensory Fun to Writing!

Five-year-old Keisha prefers to run around, but she is willing to work when sitting on a vibrating cushion. Her teacher provides the cushion only during prewriting time. That makes this practice "special." Keisha has learned to associate "writing time" with various special sensory treats, individualized to her preferences and needs..... such as

  • aromas, incense, or scented markers
  • a motorized pen that makes squiggly lines
  • music that is played in the room or through headphones
  • a weighted or squeeze vest

The child shown in the above photo sits on a Senseez vibrating cushion. Her weight activates the powerful motors.

Keisha also enjoyed ripping off the long  and short Velcro strips designed to form  the train tracks shown below.  Fitting the short red vertical pieces between the horizontal, yellow strips teaches about the spatial relationships required to fit letters between horizontal writing lines. In addition,  ripping the Velcro off the board provides the resistive, proprioceptive, sensory stimulation that help children to become self-regulated.

Strategies that Promote Forming Shapes, Letters and Numbers

Start Big!

Children may best learn how to form letters by copying the instructor's large arm movements to form giant circles and later letters in the air. This helps their muscles learn how the strokes feel and the correct sequence of movements. Next practice forming large circles on a board. As motor control develops introduce forming large circles between lines on the board and then smaller ones on paper.

Children first have to learn to form letters proficiently before being expected to orient them on a writing line, with appropriate sizing and spacing between letters and words. Thus, children benefit from lots of free practice forming large letters on large, unlined surfaces.

Tracing over the super large, sideways 8 with the right hand, left hand and both hands together help children to  develop motor control. Notice how tracing over the sideways 8 demands crossing midline.

Children who are ready to learn letter formation may form letters inside the giant sideways 8.  Note that the letters b, h ,m and p are formed with clockwise circles while moving in the clockwise direction on the 8. The letters q, c, s and f are formed using counterclockwise circles while moving in the counter clockwise direction on the sideways 8. Again, offer these tasks on a large vertical board before attempting with paper and pencil.

Use a Multisensory Approach

Gary's teacher preferred to use a multisensory approach to enhance learning. Gary did many tasks that engaged his tactile, proprioceptive, and visual senses such as

  • completing lacing boards in the shapes of letters and numbers
  • rolling clay snakes that he shaped into letters and numbers
  • forming letters and numbers with pipe cleaners
  • sorting shapes, letters, words, or numbers written on cards or objects. This activity enables chidlren to work on visual discrimination and manipulation skills at the same time. 

Gary had difficulty discriminating the diagonal lines that made up letters such as V, W, Y and X. His occupational therapist made a matching game using the cards shown below.

Vertical Surfaces and Angled Paper  

Children may have better visual attention for materials positioned directly in front of their face, rather than on a table. The same is true when writing: encourage children to color or write on a whiteboard, chalkboard, large easel, or paper taped to a wall. A slant board is also beneficial, vertical or angled writing surfaces place the wrist in the optimal position to control a pencil. You can buy a slant board or make one by clipping paper to a large empty binder. The binder shown above has been covered with adhesive shelf paper, and a clip has been attached to secure the paper. The following video demonstrates how to make a simple angled surface out of a cardboard box.

Grasping the Writing Tool

Although children can write using various pencil grasps, the tripod grasp is considered the most efficient for motor control and comfort. This grasp got its name because the middle finger, index finger, and the thumb look like a tripod stand.

Some children may write more comfortably using a large-sized pencil or attaching a grip to a thin pencil. This creates a larger surface to grasp. A tennis ball may be used to adapt an even larger gripping surface!

Another adaptation is to simply wrap a rubber band around a pencil about an inch above the point. Some pencils and pencil grips have indentations that indicate finger placement used in the tripod grasp. The following video demonstrates some fun strategies to promote the tripod grasp.

Selecting Paper 

There are many different types of lined paper designed to help children form letters correctly. They usually have a solid base line, or writing line. 

Using lined paper can be quite challenging since children have to follow the rules of making letters fit in the correct spaces. However, using paper with bold, color codes, raised and/or broken lines such as shown above, help to clarify where to fit letters. For example, the half-space letters e, c, i, and n fit between the base line and the broken line above it. Uppercase letters and lowercase ascender letters such as R, H, k, or t extend above the broken line. Descender letters such as y and g dip below the base line. Graph paper or drawing boxes as shown below may be used to delineate letter size relationships.

Gary found the following Velcro activity helpful. It involves writing letters on plastic using dry erase markers. Wiping them clean provided a great sensory activity, too. The following video demonstrates how this activity teaches the spatial relationships between small and large letters and how they fit on writing lines.

Apps to the Rescue!

Some children who resist writing with a tool may be motivated to use the index finger or stylus on an Ipad. Some Apps teach how to form lines and shapes in the  top to bottom, left to right directionality used to form letters and numbers. Many parents of children on the autism spectrum discover how motivating electronic devices are because they are multi-sensory with frequent reinforcement such as fun music after completing a maze.

Spacing Tools

A spacing tool can be as simple as an index finger or a wooden craft stick. The child places the stick or his finger on the paper at the end of a word to create a space before writing the next word. Cute commercially available spacing tools are sold in sizes to match the type of paper being used. You can also use graph paper to teach spacing. The child simply leaves an empty box between each word.

For some children writing by hand will never be practical. Writing may be too slow, too frustrating, and illegible. These children are lucky to live in the digital age of computer and tablet app options. A team of parents, teachers, and therapists should discuss the best option for each individual child.

Related Blog Posts (developing the tripod grasp)

Other Related Resources

Doreit S. Bialer and Lucy Jane Miller. No Longer a Secret: Unique Common Sense Strategies for Children with Sensory or Motor Challenges (Arlington, TX: Future Horizons, 2011).

Lois Hickman and Rebecca E. Hutchins, Eyegames: Easy and Fun Visual Exercises (Arlington TX; Sensory World, 2011)

Lois Jean Brady, Apps for Autism (Arlington, TX: Future Horizons, 2015)

Cheryl Boucher and Kathy Oehler, K., I Hate to Write! (Lenexa, KS; AAPC, 2013)



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