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Writers Block in Elementary Aged Children from an OTs Perspective - January 2008

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Writer's Block in Elementary Aged Children from an OT's Perspective

By: Toni M. Schulken, MS, OTR/L

Writing is 50% of literacy, and occupational therapists are well aware of the many kids who struggle with writing. Most of the school-based referrals we receive are for poor handwriting and fine motor skills. Many of these children also have difficulty with idea generation and then getting their thoughts onto the paper in an organized manner. In other words, they have difficulty with planning, sequencing and then executing a plan for a written assignment. What else does that sound like? You're right, PRAXIS, or motor planning! Praxis is the ability to plan, sequence and execute a novel multi-step task. As occupational therapists, we look at the ease and fluidity in which a child can execute a motor pattern to determine whether or not a child has Dyspraxia. Therefore, the ability to move their muscles (overall large muscle groups, fine motor movements and ocular movements) with fluidity is directly related to a child's writing fluency. In addition, the ability to plan, or in this case visualize and come up with ideas, must also be present. The combination and simultaneous production of idea generation, sequencing, smooth visual tracking across a page and dynamic finger movements are necessary for success with writing tasks. It's a wonder any of us can coordinate all of that and end up with pieces of written work!

Given the pre-requisites necessary for beginning writing skills, this area of writing, or more correctly praxis and fluency, is fully within the realm of occupational therapy and should be addressed by an occupational therapist at school or in the clinic. This article will provide you with informal screening tools to determine if praxis and fluency are the barriers to learning. It will then give you numerous treatment ideas to take back to your students and implement immediately. At Pathways for Learning, we have been using these techniques for years with much success!

Suggested items to include in your screenings besides the typical fine motor, perceptual motor, sensory processing, etc. when you get a referral for difficulty with written expression:

  1. Can the child follow a 2-4 part gross motor pattern for 4 cycles, given 2 demonstrations (i.e., jump, clap, hands on floor)? No verbal cues are given. Kindergarten (2-3 part patterns), 1st-2nd grade (3 part patterns), 3rd grade and up (3 and 4 part patterns). The child should be able to follow the pattern for 4 cycles with good sequencing and a steady rhythm.
  2. Can the child follow a 2-4 part clapping pattern for 30-60 seconds while maintaining proper sequence and a steady rhythm (i.e., clap, hands on lap, hands on shoulders)? No verbal cues are given. Child is sitting on floor in a cross-legged position. Kindergarten (2-3 part pattern for 30 seconds), 1st- 2nd grades (3 part patterns for 45 seconds), 3rd grade and up (3 and 4 part patterns for 60 seconds).
  3. Rapid alternating forearm movements (diadochokinesis): have child sit in cross legged position on floor and alternate palms down and palms up while tapping knees with both hands. Children should be able to maintain this rhythm and pattern of extension and flexion for: Kindergarten (30 seconds), 1st-2nd grades (45 seconds), 3rd grade and up (60 seconds).
  4. If you have been trained to do so, it is a good idea to check oculomotor skills such as midline convergence, binocular pursuits and saccades, monocular pursuits and visual fixation. If not, seek out the training from a behavioral optometrist near you so you can better identify those children who could benefit from a functional vision examination.
  5. Idea generation by grade:

    Kindergarten: dictate an ending to three sentences (answer should make sense and have one detail); dictate items in 2-3 given categories (i.e., things at the beach, animals, colors), should be able to give at least 5 in each category; dictate how many things they could do with a blanket (should be able to give 3- 5); have child tell a story about a picture (child should have 1-2 ideas which addresses the picture and makes sense with using a variety of vocabulary).

    1st grade: same as kindergarten but written instead of dictated. Printing should be left to right in orientation, letters should be clear and legible, lines should be generally followed, and there still may be a variety in spacing.

    2nd grade: write a logical ending to three sentences, write synonyms for three different words (i.e., big, small, angry, pretty, happy), the student should be able to list at least 5 total; write as many things as they could do with a sponge (should be able to give at least 5); write about school or other familiar setting, and write a story about a picture (letters should be well formed, alignment/spacing/letter size should be proper with little variety; writing should address the topic with detail and at least two different types of sentence structure, may still have some errors in grammar and punctuation, spelling is still phonetic with the exception of common sight words).

    3rd grade: same as above, but add imaginary idea generation (i.e., how would the world be different if it was dark all the time) and informative idea generation (i.e., write about the type of weather you enjoy the most and explain why).

    4th and 5th grade: same as above but write the beginning (instead of the end) to three sentences (i.e., and then I was scared, then she understood what he was talking about); add homonyms for 5 words (i.e., other words that mean the same thing as square, the shape, you always follow the rules/stay inside the box, a tool for drawing right angles) -student should be able to come up with at least 8 words total, add a persuasive writing sample (i.e., Write your opinion on silent lunch as a punishment? Write your opinion on whether 4th graders should keep a daily reading log. Give reasons for the opinion and try to convince the reader of your point of view.)


By now you have narrowed down if the student you are working with has difficulties in the area of praxis and fluency related to written expression. What next? There are a variety of treatment tools that can be utilized. It is recommended that the child participate in the activity with you and then practice the activities at home 3-5 times per week for optimal improvement and functional carryover. Depending on what you find in the screening, you will be able to pick and choose which activities will best suit each individual child. As you will see, it is not suggested that you work directly on an organized end product, such as the informative and persuasive writing in the above samples. Those writing samples were obtained for before and after assessment and to understand how the underlying skill set is affecting the child functionally. If everything looks good up to this point, it is more appropriate for the teacher or parent to seek out a tutor to work with the child on written expression.

The following activities are just a sample of the many activities we use, but should be a great start for you and your students:

Verbal Idea Generation (relaxed setting: swinging, lying in pillows with lights dimmed)
  1. Word association. Either the therapist or the student begins by saying a single word, the next person says another word related to the word the other just said, they continue to alternate. A word may not be repeated and must be associated with the previous word (i.e., Correct, green, slime, sticky, marshmallow, smores. Incorrect, green, slime, green apple, in this instance the student continued on their own train of thought rather than associating the word to "slime").
  2. Guided visual imagery stories. This activity is done with eyes closed with the instruction to try to "see" the scene. The therapist will start with a place such as, "You are in the middle of a green meadow and there are two ways you can travel. You may walk up the stairs or crawl through the small tunnel. Which way would you like to go?" The child will answer. Descriptive questions are asked along the way such as "What is the weather like in the meadow? What do you see? Does the tunnel have a smell? What does the ground feel like?" The therapist can model when necessary using rich detail and varied vocabulary.
  3. Categorical idea generation. Pick a category and see how many items the student can come up with. The therapist and student may alternate and words may not be repeated (i.e., farm animals, girl's names, food you eat for a snack).
  4. What can this be? This is an especially good activity for children to begin thinking outside the box and developing their creativity. The question posed to the child is "Name as many things possible you could DO with a _______?" For example, if a "stick" is placed in the blank, answers might be: draw in the dirt, use it as a walking stick, build a raft, tie a string to it and use it as a fishing pole. Generic answers are not acceptable such as throw it, step on it, break it, etc. The child would be asked to elaborate (i.e. break it to make firewood).
  5. 1-4 words used in a sentence. Given 1-4 words which can either be stated to increase auditory memory, or written for easy referral. The child uses the words in a sentence. Begin with a noun, add a verb, add an adjective, and finally add an adverb (i.e., boy, ran, tall, quickly). The relation between the words can become less associated as the children get older and/or more skilled (i.e., girl, gallop, sweet, happily).
  6. Progressive story. This activity works well in a group or with just a child and therapist. One person starts a story. The story then alternates back and forth, or around a circle for a group. The story will change and take many turns. The therapist will guide the students with ideas to stay on the topic the previous person began. Therefore, the children are working on transitions if they choose to change the direction. The therapist will provide introductory sentences and conclusion statements. As the child or children become more skilled, the therapist will pick a child to begin the story, or "set the stage," and to conclude the story, or "wrap it up."


Motor Fluency
  1. Jump rope:Focusing on a steady rhythm, have the child jump rope while reciting a familiar sequence (one with each jump) such as the alphabet, months of the year or days of the week. Once this is mastered, move to saying items in a category with each jump such as animals, food, colors, etc. See how many they can do without losing their rhythm. Grade it by having the child recite the item every other jump. (This activity is the beginning of thinking and moving at the same time, just as they have to do when they think and write at the same time).
  2. Jumping side to side over a line:

    1. Jumping on the beat to a metronome set on 54 beats per minute (there is a free online metronome at http://www.metronomeonline.com)
    2. Jumping with rote idea generation (abc's, months, days)
    3. Jumping with categorical idea generation
  3. Magic code: practice 2-4 part gross motor patterns as outlined in screening
  4. Clapping patterns: practice 2-4 part clapping patterns as outlined in screening

    1. Practice to beat of metronome set on 54 beats per minute (try to keep up the rhythm for as long as you can)
    2. Practice with rote idea generation
    3. Practice with word association (alternate with therapist playing word association, whatever word comes to mind, such as red, apple, tree, leaf, fall, summer, hot, hot dog, etc.), This is a great activity for getting the flow going for brainstorming
    4. Practice with categorical thought flow



Ocular Fluency (speed and accuracy)
  1. Circle the vowel: Find a passage of appropriate reading level for the child with whom you are working. Have the child start at the top and move left-to-right across the page circling each "a" in the passage. Next time, have them circle the "e"s on a copy of the same passage. Continue with the rest of the vowels. The child is not allowed to circle the vowels out of order. If skipped, keep the missed letter un-circled. Count how many were missed and try to beat the score each time.
  2. Reading directions of arrows: Make a sheet with 10 rows of 10 arrows (randomly pointed up, down, right and left). Have the child "read" the page by calling out the direction of each arrow. Try this to the beat of a metronome set at 54 beats per minute. This is the first step in using the eyes fluidly across a page while thinking. Grade the activity up or down by adding more or less arrows on the page and adjusting the size of the arrows.
  3. Saccades: Have a sheet with 10 rows of 10 numbers and letters. Have the child read the 1st and 10th, then the 2nd and 9th, then the 3rd and 8th for each line. If the child gets good at this, try it to the beat of a metronome at 54 beats per minute.
    [Image: Jan-08-1.jpg]

    The child would read: A, R, 5, 9, Y, B, K, P, J, U, G, B, etc.
    Grade the activity up or down by adding more or less numbers/letters on the page and adjusting the font size.
  4. Trap the ball/catch the ball: You'll need a small bouncy ball and a plastic cone or plastic cup. Start on the floor and roll the ball to the child making sure you vary where the ball is received (midline, across midline, etc.). Have the child hold the cone or cup in his/her dominant hand and trap the ball. To make it more difficult and add in the ability to switch visual focus from far to near quickly, do the same activity on a long tabletop and have the child have the cup facing upwards and catch the ball as it rolls off the table.

Writing Fluency (speed and accuracy): the activities involving the alphabet are only presented when the child has mastered proper letter formation.
  1. Make small circles in a counterclockwise direction within varying sizes of graph paper boxes, cue the child to relax their fingers and try to move them freely (no white fingernails from pressing too hard). Also, encourage the child to use fingers only with active thumb. Using the Grotto GripĀ® will help train the muscles necessary to accomplish this task successfully for those children who do not demonstrate a dynamic tripod grasp pattern. (this same activity can be done with small "x"s or diagonal lines in the boxes.
  2. Writing the alphabet:

    1. Write the alphabet with proper formation, letter size and spacing using RediSpaceĀ® Transitional Notebook paper (1st-3rd grade) and regular notebook paper (4th -5th grade). This should be timed with errors in formation circled. Goal: 30 seconds, 26 seconds for 4th and 5th.
    2. Same as above but add in spacing while being timed and still paying attention to proper formation, alignment and size. For example, the child will be instructed to write ab cd ef gh....or abc def ghi jkl....


Written Idea Generation and beginning webs: These activities are completed once the child is able to write the alphabet with fluency. When working on the webs, remind the child to write the same size and neatness they used doing the writing fluency activities. You may want to provide one or two model letters to get them started.
  1. All items from verbal idea generation above can now be down in a written format.
  2. Word Association Web: start with a word in the middle, come up with four related words, and come up with three words related to each of the four related words just generated.

    [Image: Jan-08-2.jpg]
  3. Character Web: Write the name of a person (friend, family, character from a book) in the middle circle. Write things to describe the person in the ovals. See if someone can guess who you are describing just from your descriptors. These can also be turned into sentences.

    [Image: Jan-08-3.jpg]
  4. Compare/Contrast Web: Write two objects/animals/food items, etc. in the two ovals. Write three ways in which they are similar in the three middle rectangles. Write three ways in which each is different from the other in the outside rounded rectangles.

    [Image: Jan-08-4.jpg]
  5. Simile Web: Have the child fill in the web and then write sentences. Start with the first noun. Next, fill in the adjectives and then write a noun related to the adjective. Finally, write the beginning, try to vary the words used here. Now write a sentence!

    [Image: Jan-08-5.jpg]

    1. The cat is fluffy like a cotton ball.
    2. My hair is stringy like spaghetti.



It is so exciting when the writing fluency and idea generation kicks in and the child gets into the flow of writing for the first time, or when the parent comes in with writing samples in just weeks after you've begun working with their child ecstatic with the improvement in their writing and the child's overall improved attitude and confidence when writing. I am more than willing to answer any questions or help problem solve a difficult situation. I'd also love to hear any feedback from therapists that implement the above ideas. The best way to reach me is by email at [email protected]. For more handwriting tips visit http://www.pathwaysforlearning.com

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Special Thanks to Toni Schulken for providing an article for this issue's Therapy Corner.

Toni M. Schulken, OTR/L, inventor of the Grotto Grip, RediSpace Transitional Notebook Paper and Writing Fundamentals by Mead, in stores Spring 2008.

Please support our contributing authors and visit Pathways for Learning

She can also be reached by email at: [email protected].

Tags: January 2008 Newsletter OT School Based OT Childhood Apraxia of Speech Article