Handwriting problems part 3

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Case B. Background information. Molly was born in September 1992 and is now nine years old. Like Mark, Molly is a very bright child. She showed signs of AS from a very early age. In particular, she had obsessions about the colour of her clothing, all of which had to be a special colour on particular days. As time passed, other symptoms emerged and Molly was given a diagnosis of AS at the age of 5. At this time, she was also referred to occupational therapy following concerns about her coordination and her ability to organise herself at home or at school coordination. Although she had difficulty in school from the beginning and has required extra assistance, she has managed to remain in a mainstream school. When tested by an educational psychologist on the Weschler Scales (WISC IIIR) at the age of nine, Molly was reported to be at the 97th percentile on the verbal scales and above the 81st percentile on the performance scales (this means that on verbal ability, for example, her score was equal to or better than 97% of children of the same age). The psychologist noted that she was advanced in her verbal reasoning skills and in social comprehension (a very surprising result given her autistic tendencies). On the practical tasks, in the performance section of the test, she did well when she could talk her way through the task and develop an overall strategy for performance. However, when she had to modify strategies as the task became more complex, she ran into difficulties. At school, Molly's teacher was pleased with her academic progress. She confirmed that she had good long term memory and retained information well. She was described as good at mathematical investigations. The only area of concern was her handwriting. Motor competence. Molly's general motor competence proved quite different from that of Mark. Over the years, she has been tested on several tests, each devoted to different aspects of perceptuo-motor control and development. Yet, on all of these she scored rather well. At the age of five, she was assessed on a test called the SIPT (Ayres, 1989). This is intended to assess the child's visual and kinaesthetic perception, requiring them to complete tasks like finding a particular shape hidden among others or to recognize a shape by touch. It also assesses the ability to perform actions to command (e.g. put one hand on your foot and one hand on your head), to copy designs, and to copy facial movements. Balance is measured in various ways and other gross motor tasks are included. Although Molly had minor difficulties with some of these tasks and her therapist was slightly concerned about some aspects of her perceptuo-motor development, overall her scores fell within the normal range. At the age of 7.5, Molly was tested on the Bruininks-Oseretsky. Unlike Mark, she obtained scores on this test that were considerably above her age level. When required to run at speed, she obtained an age-equivalent score of 8.8. On the tasks involving manual dexterity and upper limb control, her age equivalent score was 9.11. Overall, therefore, on motor tests which did not resemble handwriting, she seemed rather well coordinated. Molly's handwriting. Figures 1 and 3 show examples of Mollys handwriting. Many aspects of her writing were striking, especially the variability exhibited in the free writing tasks shown in figure 3. From the ETCH test, we can see that Molly is uncertain about the formation of a number of letters, although sometimes it would seem that the problem has arisen because she has joined up all the lower case letters of the alphabet in spite of being asked not to. She seems shaky on a few of the capitals, too. In terms of legibility, overall only 53% of her words were legible and 74% of her letters. She was only able to produce between 16 and 25 letters per minute, depending on the task, a speed far below what would be expected of a child her age. In the testing situation, Molly's difficulties reduced her motivation and her cooperation to such an extent that she actually refused to complete some of the tasks on the ETCH. In addition, it was very difficult indeed to get her to produce any free writing for us - so the example shown in figure 3 must speak for itself. See what's new at AOL.com and Make AOL Your Homepage.