Monday, October 28, 2013

Hand writing

Jordan and I saw a writing therapist. She conducted new assessments, gave initial observations and opinions, and is now in the process of writing up a report and a treatment plan. I've interviewed many over the phone, so I knew something about what to expect, but I was still amazed by the specifics.

Imagine drawing three overlapping circles, each the size of a quarter. How many hand movements is that? For most of us, three: one for each circle. And all the movement is in the index finger and thumb. For Jordan she stopped counting at 22 separate hand movements. Whoa. The reason is that his pencil grip is almost entirely rigid, so where we move our fingers he moves his wrist, his whole arm (curling and twisting to get into position), his entire BODY (leaving his seat), or rotates the paper itself. She looked at him, looked at me, and said: "What he's doing is exhausting." She asked him to sit straight and keep his paper still while he drew, and he immediately said, "This is so hard! How does anybody do this?!"

Whenever there are issues with reading and writing it is important to be really sure what is going on with a kid's vision, so she quizzed me about his glasses and his history of possible amblyopia. She said, "Which is his good eye? Oh - never mind. I can tell." It turns out that when he writes, he turns his body and cocks his head to favor his good eye, putting the paper in the center of the good eye's field of view. Thus his depth perception is poor, which impacts writing, since for accurate writing a pencil point has to contact a plane of paper just so. He also lets his glasses slide down his nose and looks over the top of them, in which case he is necessarily using only the good eye. 

At home I took some photos and a little movie of him drawing for fun at his desk. You can see the body positioning, the head tilt, the pencil grip that doesn't involve his fingers really at all, and the way he moves his paper around to give his hand access to the different parts of the drawing. On his own, he uses that sketching motion that he is using here, with repeated short hand movements: the motion for those comes from the wrist, not the fingers. In the writing therapist's session, she asked him to just draw solid lines, and he started moving his whole arm and body around.





This is huge news! This means that Jordan has a significant physical impairment with writing. Every time he sits down to write anything he's like whoever that artist was who lost the use of his hands and just tied the brush on to paint. The basic theory is that the way he writes now is so taxing, it takes all his working memory and physical stamina to do it, leaving hardly any for things like spelling and sentence formation, much less essay organization. Not only can he not do these things in the moment, he has probably not benefited much from the schooling he has gotten in these things, because he was just not able to do them when they were taught. In therapy the goal is for him to learn writing that is fast, easy, and beautiful, and that will free up a wealth of resources.

The first part of the therapy will be a complete overhaul of his pencil grip, which will also overhaul his handwriting. But you don't start this with the pencil grip; that's just impossible and insanely frustrating for the kid (can you imagine being asked to do that yourself? wouldn't work). First his hands need to be strengthened in the ways that will actually enable him to hold a pencil well -- and specific hand weaknesses may be part of why he developed his grip in the first place. That will take some weeks. During that time she will also be working on assessing, and then addressing, all the other components of writing that we need to know more about: his phoneme discrimination, what he knows about how to spell all the different phonemes, and so on. When the new pencil grip starts, it will be used only with her and only with drawing, not letters. Gradually as both the mental ingredients of writing (like spelling) and the physical aspects (like grip) become more confident, they can be brought together. There may be things like special pens and special paper that help him do what he's trying to do. Those will eventually be brought to school, but school is the last place that the changes get enacted. It's the most high-stakes and the least supportive, so the kid only brings their new techniques to school when they totally own them. When they can say, "This is my stuff. This is how I use it." and need no teacher support (in fact they will probably be educating the teacher), then they take it to school. The whole process will probably take 4-5 months.

I am so excited! Because now someone actually understands (some of) what is going on for him! We have now been through years of having no idea what his trouble is, or even if he really has any trouble beyond just being stubborn or spacey or something else. Years of teachers recognizing that he is not succeeding, but beyond that really just shrugging, having no idea how to help him improve. And now this person in one hour has figured out so much. Now I can really see him as having a writing disability -- possibly a temporary one? or maybe there are things he will never do fluently. Either way, as far as I'm concerned he has the writing equivalent of a broken leg. He needs therapy to get better. He has a therapist who knows exactly what is going on and what to do about it. Maybe he will get all the way better and maybe not; maybe (probably!) he has other obstacles too, which we will find out more about as we go forward. But now we understand one of the major impediments that he has been dealing with. It is a something that can get better. We have the resources to make that happen. And while he is getting better, he needs accommodations, because he literally cannot do the things that kids without a broken leg can do.

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