Handwriting difficulties, low muscle tone, joint hypermobility and DCD

Common difficulties children have with handwriting 

adapted grip 1 (1).jpgA pencil grip that does not allow effective finger movement and places undue stress on hypermobile joints. 

Children with joint hypermobility (often diagnosed as low muscle tone) need to use an adapted thumb wrap grip. 

Poor control of shoulder movements for drawing long lines and moving the hand across the page when writing. 

Difficulty sitting erect ease and comfort when engaging in drawing and handwriting tasks. 

Poor basic graphic abilities for creating straight and curved lines. These abilities should be acquired before the child starts to learn to print. A child with good basic graphic abilities is able to pre-plan movements for forming lines without continuous visual guidance. 

Avoidance of tasks that are difficult and require attention and persistence.  
Learning a new motor skill requires dedicated practice, with attention to getting it right and being able to learn from one's mistakes. 

Poor handwriting teaching practices, which emphasize tracing letters, over reliance on visual feedback and emphasis on correct letter sizing before child has learned the basic movement patterns for 

Good teaching of handwriting includes: dedicated practice with attention to outcomes and learning from feedback which allows the child to develop effective motor plans for letters, with minimal need for monitoring and better control over the shape, size, positioning and spacing of letters. 

Why do some children fail to develop good drawing and handwriting abilities?

Avoidance and lack of persistence 

Many children with joint hypermobility (low muscle tone), DCD and autism also have difficulties with attention and emotion regulation, tend to avoid tasks which they find difficult, are highly sensitive to errors and lack the persistence needed to learn the basic graphic skills that should be in place before the child starts to learn to print letters. 

This means that the child has not learned to pre-plan the basic strokes used in forming the letters, and as a result still uses visual monitoring for the formation of letters. This tendency to visually guide pencil movements is exacerbated by the common use of tracing over pre-printed letters as a way of teaching children to write letters. 

HWG Solution:  Use a stroke based approach to teaching letter formation

Joint hypermobility, pencil grip, shoulder action and posture

Children with joint hypermobility often adapt their grip to accommodate the increased flexibility in their hand joints. The adaptation may be functional and allow for small movements of the fingers needed for writing. However, the child will often adopt a grip that is very fixed and does not allow for finger movements. The child then uses wrist movements for moving the pencil on the paper which is both ineffective and tiring. 

A child with joint hypermobility may also have some tightness in the shoulder muscles that affects the ability to move the hand across the page for handwriting or for drawing long lines. 

The child may also have tightness in the hip muscles and weakness in the back muscles which makes sitting erect for working at a table tiring and uncomfortable. 

HWG Solutions: What is an effective grip?        
Difficulties children have with shoulder control for drawing and handwriting    
Training sitting posture and fitness                       

Developmental coordination disorder (DCD) affects the way children learn

Children with DCD have difficulties with learning from experience: they often require help with understanding the task, paying attention to important aspects of the task, learning from their mistakes. 

This means that they often have not acquired the basic graphic abilities needed for learning to print letters, which for the most part are learned through experience with drawing, rather than formal instruction. 

Task based training has been shown to improve handwriting abilities in children with DCD. 

Poor handwriting in autism is related to poor fine motor coordination and hand strength

The difficulties children with autism experience with handwriting are related to poor control of finger movements, as well as hand muscle strength. In particular their handwriting shows poor formation of letters. A recent study found that on the whole letter size and spacing was less affected than letter shape. 

Another recent study investigated the link between grip and pinch strength and legibility, with poorer performance on strength tests being associated with legibility.  It may be that the grip strength was associated with joint hypermobility, but unfortunately this study did not test for hypermobility. 

handwriting logo.jpeg_1.jpgHandwriting Gym Online Handbook 
A comprehensive program of activities for improving drawing and handwriting 

With detailed instructions on how to teach for better learning.  

Problems with control of movement and posture

A pencil grip that does not allow small finger movements for manipulating the pencil

WE grip 1 (1).jpgAn effective grip can be defined as one where the shaft of the pencil is stabilised between the thumb and forefinger in a way that allows small bending and straightening movements of the fingers to be used to move the tip of the pencil on the paper. 

Children with joint hypermobility (low muscle tone)  will often adapt their pencil grip to accommodate the extra flexibility in the finger joints. Usually the child grips the shaft of the pencil between the thumb and the side of the forefinger (often referred to as a thumb wrap grip).

This grip allows the child to hold the pencil securely without placing stress on hypermobile thumb and finger joints. 

The adapted thumb wrap grip is fine as long as the child is still able to use small finger movements to manipulate the end of the pencil. 

A problem arises when the child grips the pencil very tightly or extends the fingers so that small bending and straightening movements of the fingers are not possible. 

grip 8.jpg    Hypermobile hand grip.jpg

More about an adapted  pencil grip and finger movement  Including instructions for assessing and training a more effective grip and finger movement for handwriting


A tendency to use wrist rather than finger movement for drawing small shapes and printing letters.

A child will often compensate for poor finger movements by using small wrist movements to draw small shapes and when writing. R  5y 9m vertical line 5.jpg

As a result the control of the small strokes needed for drawing small shapes and handwriting is poor. 

Suggestion:  Take a video of your child drawing a row of small circles. Do this close up and film both from the front and the side. Take a look at the clip (play it back slow motion if you can) and take note of the movements that are used to move the pen.

Complains that the hand and arm gets tired when drawing and  writing

Or may not want to draw or write because it is "boring".

Children are usually quite specific about where they experience discomfort when drawing and writing: either in the arm near the shoulder or in the forearm. Sometimes, but less often, the hand itself gets tired. 

Discomfort is usually related to muscle weakness and tightness in the shoulders along with ineffective movement patterns of the shoulder, a very tight grip, and holding the wrist in a flexed position. . 

Children who hold their wrist in a flexed position when writing are particularly inclined to experience discomfort in the forearm. This is because they overuse the forearm muscles that flex the wrist. These muscles work in the shortened position which is also the weakest position for muscles to contract. 

Try the following: Grip a pencil tightly, flex (bend) the wrist and then do small back and forth movements of the wrist, keeping the wrist flexed. You will quickly notice some discomfort in the forearm muscles. 

Poor control of shoulder movements with associated weakness and tightness of some muscles

(Children with joint hypermobility often have tightness in some muscles despite the increased joint flexibility.)

A child with good shoulder control for drawing and handwriting holds the arm close to the body with the wrist straight and the end of the pen pointing backwards past the shoulder. 5 y 9m shoulder position for drawing.jpg

A child with poor shoulder control  holds the arm out sideways, often with the wrist flexed. The hand tends to lie above the writing line. This position is awkward and tiring.DR arm away from body 2.jpg

The child may also have tightness and weakness in some of the shoulder muscles which adds to the problem. 

Observe your child: drawing long lines down and across the page, as well as drawing radiating lines.

Is the arm held close to the body? Does he/she stay sitting erect, keeping the trunk steady? Can he/she draw diagonal lines in all direction keeping the trunk steady. Or does she twist the trunk to change direction?

More informationShoulder control for drawing and handwriting 

Finds sitting erect for drawing and writing tasks tiring

Tends to slump, move about in chair. Sitting upright requires effort, may be uncomfortable and requires attention.T sitting slumped.jpg

Poor sitting posture and stamina is usually due to a combination of  weakness in the back and neck muscles, tightness in the hip and neck muscles and poor control of postural stability. 

Solution: Each of these issues can be addressed by an exercise program to improve muscle strength and flexibility along with training for trunk and head stability.

More information: My child can't sit up straight and fidgets a lot at school. What is the reason?

Pencil control for  drawing straight and curved  lines 

By the age of 5-6 young children who have good drawing skills have learned to preplan their drawing movements, so that they are able to draw long straight and curved lines with a fluent action.   The movement proceeds without the need for visual feedback except for determining the end of the movement accurately.  

The are also able pre-plan the drawing of  small familiar shapes and letters.  At this age the child's control of size still needs work. 

R-6y-sun-rays-1.jpg    Roan 5y 9m hoase that turned into a mandala_1.jpg

More information: Understanding how the brain control drawing and handwriting

Difficulties children have with motor control

Children with poor drawing skills have not learned to preplan their movements and tend to draw lines and write letters using a series of short lines using ongoing visual monitoring of their actions. 

This may happen for several reasons:

  • A child  may have  avoided drawing tasks and simply has not put in the hours of training needed for developing the motor control.  Children with joint hypermobility may avoid drawing because it is tiring, requires time and effort. 
  • Children who tend to use short strokes and visual monitoring when drawing and writing need opportunities to develop the basic motor control strategies for preplanning their movements before they can be expected to write fluently and legibly. 
  • Children with DCD and autism need additional structured and guided practice time to acquire the basic graphic skills. 

More information: Motor control and learning for drawing and handwriting 

Knowing the motor plans for forming and spacing letters  

Learning to write letters is all about learning the motor plan for each letter

Once the motor plan is well established,  recalling the letter (or even a sequence of letters) is directly translated into a sequence of strokes with minimal need to pay attention to the process. Letters and words can be written without visual monitoring. Once the forming of letters has become automatic, the child can pay attention to other aspects of producing written text, such as spelling and composing a sentence. 

Children who have difficulties with the speed and fluency of handwriting often pause before writing some letters.  This pause allows time for thinking about the shape of the letter and planning th movements needed to form the letter. The motor plan has to be constructed on line. This makes writing slow and also requires attention.  

More information: Teaching handwriting - getting it right from the start

Sizing and spacing of letters and words

The size and spacing of letters  depends on the translation of the motor plan into a sequence of muscle actions which control the exact movement of the pencil on the paper. 

For some children this aspect of printing letters is difficult and may need special attention and guided practice. This is particularly a problem for children with DCD and autism 

More information: Teaching handwriting - a stroke based approach

More about common difficulties with handwriting: Speed, fluency, spacing, sizing


handwriting logo.jpeg_1.jpgHandwriting Gym On-line Handbook 

All the information you need

  • To understand why your child is having difficulties 
  • To assess and train basic graphic skills 
  • To improve posture, shoulder control, grip and finger movements for handwriting 
  • For teaching and improving fluent letter and word writing using a stroke based approach