In­abil­ity to hold pen­cil prop­erly points to DCD

The Guardian (Charlottetown) - - HEALTH/COMMUNITY - Dr. David Wong Ask Dr. Wong Dr. David Wong is a con­sul­tant pe­di­a­tri­cian in Sum­mer­side and re­cip­i­ent of 2012 Dis­tin­guished Com­mu­nity Pae­di­a­tri­cian Award of Cana­dian Pae­di­atric So­ci­ety. His col­umn is in The Guardian on the last Tues­day of ev­ery month. If

Dear Dr. Wong: Our nineyear­son was di­ag­nosed with ADHD two years ago. His hy­per­ac­tiv­ity and at­ten­tion span have greatly im­proved since he started med­i­ca­tion. How­ever, his hand­writ­ing has not im­proved. He can­not hold a pen­cil prop­erly, his hand­writ­ing is aw­ful and he hates it. He can type into the com­puter, but his teacher won’t al­low him to use it in school. Home­work is a night­mare. He is very bright, but he hates school al­ready. Please give us your ad­vice.

An­swer: Your son likely has a prob­lem big­ger than at­ten­tion deficit hy­per­ac­tiv­ity dis­or­der (ADHD). Chil­dren with ADHD of­ten rush to fin­ish their work quickly. With proper med­i­ca­tion, they can pay bet­ter at­ten­tion and im­prove the qual­ity of their work. Many par­ents and teach­ers can gauge whether medicine is work­ing well by the stu­dents’ school­work and home­work.

Most chil­dren with ADHD have no dif­fi­culty hold­ing the pen­cil in a tri­pod grip, print­ing and writ­ing leg­i­bly, un­less they are rush­ing.

Some chil­dren with ADHD have ad­di­tional learn­ing chal­lenges. One of those is called de­vel­op­men­tal co-or­di­na­tion dis­or­der (DCD). Th­ese chil­dren have dif­fi­culty con­trol­ling and co-or­di­nat­ing the move­ment of their mus­cles, in­clud­ing small mus­cles in the hands.

Our hands have de­vel­oped many more com­plex func­tions as com­pared with other pri­mates. Young ba­bies can grab a toy with their whole hand; over time, they can ex­plore small ob­jects with their fin­gers only. Tod­dlers love to push but­tons, turn­ing light switches on and off.

Soon, they be­gin to grab crayons and scrib­ble with big strokes. With time, they start to hold pen­cils with a tri­pod grip and copy lines, cir­cles and other shapes, fol­lowed by copy­ing let­ters and num­bers. With prac­tice, they be­come more pro­fi­cient in print­ing and writ­ing. Some chil­dren grasp th­ese steps faster than oth­ers; most of them can im­prove with prac­tice. The part of the brain that con­trols this group of small mus­cles in the hands de­vel­ops rapidly over the first few years of life.

Un­for­tu­nately, chil­dren with DCD have more dif­fi­culty co-or­di­nat­ing the move­ment of th­ese mus­cles. Hold­ing the pen­cil with the proper grip and the right amount of strength some­how es­capes them. They may press too hard or too light on the pa­per. They have dif­fi­culty form­ing the shape of let­ters and num­bers prop­erly; it is hard to de­ci­pher what they have writ­ten. As a re­sult, they try to write as lit­tle as pos­si­ble, and they don’t en­joy it.

Some of th­ese chil­dren also have dif­fi­culty ty­ing their shoelaces. For­tu­nately, there are shoes with vel­cro straps. Oth­ers can­not but­ton up their clothes; zip­pers come in handy for them. Some have dif­fi­culty rid­ing a bi­cy­cle or they trip and fall more eas­ily. Phys­io­ther­apy and oc­cu­pa­tional ther­apy can help to train them, with vary­ing de­gree of suc­cess.

Your son can use a com­puter key­board in­stead of writ­ing on pa­per. Hav­ing a tran­scriber to write down the an­swer for him can also help. How­ever, the school needs to un­der­stand that your son has this dis­abil­ity. Some school boards re­quire a for­mal psy­cho­log­i­cal test be­fore al­low­ing adap­tive tech­nol­ogy like a com­puter in the class­room or pro­vid­ing him with a tran­scriber for an exam.

You should con­tact his school to find out what needs to be done to help your son. You may also re­quest a meet­ing be­tween the school and your doc­tor, who can ex­plain your son’s con­di­tion. He needs adap­ta­tion in or­der to suc­ceed in school.

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