Inability to hold pencil properly points to DCD
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.