I was recently at a friend's house for a get-together. As usual all the Dads were crowded around the table talking about the Cowboys' chances of making it through one more playoff game (sorry to bring up that painful topic), and the moms were hanging around the playroom while the kids climbed all over each other. Finally a friend-of-a-friend approached me and told me about her first-grader who has been assigned a tutor by her school to work on his handwriting. Apparently the tutoring sessions have not been working well to improve his handwriting, and has actually led to some behavioral meltdowns that were previously not characteristic for this child. "Do I need something more than a tutor?" she asked me. Tough question, especially for a casual Saturday afternoon. But a very important question for sure. How do you know if a tutor is enough?

Handwriting is one of the most common reasons for referrals to Occupational Therapy (OT) for elementary students who do not have other prevailing diagnoses. The ability to produce legible handwriting is surprisingly complicated. Sometimes, practice makes perfect and a tutor, or just increased practice at home, is the perfect solution. Sometimes, though, poor handwriting is really the most noticeable symptom of a deeper underlying issue. In this latter situation, an OT evaluation can uncover those issues and put a plan in place that will address the foundational skills that need to be solid in order for good handwriting to emerge.

In the case of my friend's son, it turns out his handwriting problems have to do with visual perceptual skills. He was having trouble keeping all his letters consistently sized and spaced and this led to a very messy result. During the OT evaluation, it came to light that he had had an operation as a toddler to correct a muscle in one of his eyes. It was a success; his eyes looked normal from then on and he stopped complaining that his head hurt. What wasn't obvious, though, was that when it came to more subtle visual perception. his brain was still struggling to get caught up. After beginning his life with his eyes not working quite right with one another, he needed a boost in developing mature visual perception, or the brain's understanding of what it sees and how it uses that information. In his tutoring sessions, he was being asked to practice something he was not able to do for deeper reasons and this was leading to frustration and behavior challenges. He is enrolled in OT sessions now and is showing improvement already.

Tutors play a very important role in academic development. And not every child needs OT, or any other type of therapy. But if your child is working with a tutor and its not really working, consider taking a closer look at what might be happening further under the surface. Pediatric therapists are experts in evaluating functional problems, identifying the possible causes, and designing treatment plans that work! Let us know if we can help a child in your life.

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