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Occupational Therapy


Monkey Mouths Handwriting


Is your child struggling with handwriting? Do they avoid writing activities at all costs? Is their work coming home from school because it is not complete? Handwriting difficulty is one of the most common reasons for a referral to an occupational therapist at Monkey Mouths. Our occupational therapists not only look at the quality of handwriting but also all the factors that may contribute to poor handwriting.

Monkey Mouths Handwriting
Monkey Mouths Handwriting


In the evaluation process occupational therapists at Monkey Mouths look at the following:

Upper Body/Hand Strength/Reflex Integration

Often children who have poor handwriting will also have weakness in their core muscles and/or the small muscles in the hand. Decreased strength and/or primitive reflexes can affect a child’s ability to maintain an upright sitting posture while seated at a table and how they grasp a crayon or pencil.

Sensory Processing

Does your child complete writing tasks independently or does he/she need frequent cues? Are they able to complete writing assignments in the time allotted? Do they use appropriate force to produce legible strokes?

Fine Motor Skills

Is your child using an age-appropriate grasp on a crayon or pencil? In typical development, children will transition through different grasp patterns on a writing implement. As strength develops in the muscles of the hand, the grasp patterns become more mature. Below are expected milestones:

Palmar supinate grasp (fisted grasp)

2-3 yrs
Digital pronate grasp (held with all fingers with hand in a thumb down position)

Static tripod grasp (held with thumb, index and middle fingers – movement comes from larger joints)

Dynamic tripod grasp (held with thumb opposite index and middle finger resting under – movement comes from within the hand)

Visual Perceptual/Visual Motor Skills

Can your child track from the left to right side of the page? Are they able to copy from the board without losing focus? Can they copy simple lines, designs, and shapes? We first develop pre-writing skills which involve imitating, tracing, copying and spontaneous drawing of lines, designs, and shapes. Pre-writing skills are critical to the development of writing skills. Typical milestones are:

Spontaneous scribble

Imitates a vertical stroke

Imitates a horizontal stroke

Copies a circle, imitates a cross

Copies a cross

Copies a square

Copies a triangle

Copies a diamond

8 Components of writing

To assess a child’s handwriting abilities, our occupational therapists at Monkey Mouths will use clinical observations including looking at a child’s posture, grasp patterns and quality of print. We also use standardized testing which provides greater detail of handwriting strengths and weaknesses. The Print Tool is a standardized assessment developed with the Handwriting Without Tears program. This tool assesses eight components of handwriting which are described below:

Memory: Remembering how to write letters or numbers from memory without a model present

Orientation: Writing letters/numbers without reversals

Placement: Position of written letters/numbers in relation to the line

Size: Size of letters/numbers decreases as children progress through each grade level due to improved fine motor control

Start: All letters/numbers should start at the top with a common error observed of starting from the bottom

Sequence: Printing parts of letters/numbers in the correct sequence

Control: Legibility of letters/numbers

Spacing: Between letters in a word and between words

Results of standardized testing is compared to expectations for children in the same age range to determine the need for intervention. If a child is noted to have delayed handwriting skills, Occupational Therapy would be recommended.


In treatment, our occupational therapists at Monkey Mouths will address handwriting skills and additional skills that may contribute to poor handwriting. 

At Monkey Mouths, we use a multisensory handwriting program called Handwriting Without Tears. The idea behind it is that if you use multiple senses to learn you will have better mastery. Research supports the use of this tool to improve handwriting skills. It is used throughout the country by Occupational Therapists. It has also been adopted by many states as their statewide program in public schools.

Instead of working on handwriting skills solely based on repetition and practice, HWT provides opportunities to learn how to form letters and numbers by building them with materials such as wood sticks and playdoh. Actual writing practice occurs using chalkboards and workbooks designed specifically for the HWT program. There are a variety of workbooks available to meet the child’s developmental level starting with learning control with coloring and tracing lines, designs, shapes, letters, and numbers and progressing to using pencils to trace and/or copy letters, numbers, and sentences. The teaching order of letters is based on the similarity in the way they are formed and are grouped accordingly to make it easier to learn.

Handwriting without tears

All HWT materials and workbooks are designed using information learned in research. For example, due to the high incidence of children starting letters from the bottom, all materials/workbooks have a smiley face or dot at the top as a reminder to start at the top. It was also uncovered in research that when children copy letters in standard school worksheets with only one model provided, their handwriting samples get progressively worse as they are looking at their last attempt. The HWT workbooks have models for each attempt when copying which allows the quality of print to get better rather than worse.

HWT is a versatile program as it can be used with children of all ages and developmental levels meeting children where they are at. Workbooks are available to work on in print, cursive, and other languages.

The most important part is it is called Handwriting Without Tears for a reason. Children enjoy learning to write using multiple sensory experiences which results in better engagement and mastery of skills.

Monkey Mouths Handwriting

If you have concerns regarding your child’s handwriting skills, please contact Monkey Mouths to schedule an evaluation with an Occupational Therapist.