What if my child can't use a "normal" pencil grasp? Should I change it?

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Not everyone uses a functional efficient pencil grasp. If you walk into a room full of adults and look at how they hold their pens, you will find a range of "functional grasps". In my last article I explained what makes  a grasp "functional" and "efficient"; read more about this here.

Functional Inefficient Pencil Grasps
Some people are happy to use an inefficient pencil grasp because what they have is comfortable for them and produces legible writing.   We all adjust our pencil grasps according to comfort and pain.  Inefficient pencil grasps develop for a number of reasons.  Sometimes these inefficient grasps develop because of weak hand muscles, low muscle tone or hyper-mobile joints.

Sometimes the writing may be a little messy, however this compromise is accepted because it enables the writer the least amount of pain or the most stability.  Some writers who use an inefficient grasp also make other accommodations. They may write for a short duration with regular breaks or use a modified writing implement.

Typical Modifications of Pencil Grasp
Here are some ways that children and adults hold the pencil to adjust for weak hand muscles, low muscle tone or hyper-mobile joints.

• Pencil rests along the index finger (part or the whole length) rather than into the web space.
• The index finger is hyper-extended.
• Pencil is held between the second and third fingers.
• Thumb is tucked around the pencil.

Movement of the pencil using these grasps may be either static (control coming from wrist, elbow or shoulder) or dynamic (from the fingers).

Joint Hyper-mobility
Children with finger joint hyper-mobility (often called "double-jointed") have difficulty stabilizing their joints to control pencils and other implements. These children are prone to fatigue so consideration should be provided with how much they are expected to write and for how long.  

Joint protection should also be considered (this may depend on the severity of joint hyper-mobility). Joint protection may be achieved through strapping or splinting to provide extra support to their fingers during tasks that require manual dexterity.  A quick trick is to use a hair elastic twisted into a "figure 8" over the joint to provide some extra support (see photo below).

Some children with joint hyper-mobility also benefit from using a modified pencil grasp such as those mentioned previously.  Benbow (2006) describes the grasp held between the second and third fingers as the adapted tripod grasp.  The "Twist n write" pencil (pictured below) provides an alternative way to hold a pencil.

If you suspect that you child has hyper-mobile joints, seek professional medical advice.

Inefficient and not functional Pencil Grasps.
An inefficient pencil grasp moves from functional to not functional when there is an issue with: -

• Legibility (How neat or messy is the handwriting? Can you read it?)
• Pain
• Fatigue
• Unable to write as much as others of the same age
• Unable to write as quickly as others of the same age

When to change a pencil grasp if it is inefficient?
Pencil grasps should be looked at as part of an overall age-appropriate handwriting assessment and remediation.  

Consider working on a more dynamic pencil grasp with children who may be demonstrating one of the following :-

• Child is less than 8 years of age - Benbow (2006) says that any grip once it has been used over time, becomes kinesthetically "locked in" and is difficult to change without motivation.  Once a child is about 8 years of age, their grasp is more difficult to change.
• Child uses many different grasps within a short period of time.
• Child is experiencing pain or fatigue during writing.
• Child can't see their writing due to the position of their wrist and hand during writing.
• Child who is switching hands or using both hands together to hold a pencil during writing.
  
• Child controls the pencil from the wrist, elbow or shoulder.
  
• Child is at risk of "hooking" their wrist during writing.

For some great ideas to work on pencil grasp - check out my "Handwriting and Writing" Landing page.  There will be more practical ideas to come here on the blog!

Where a grasp can not be changed due to a child's age or the issues described previously with low muscle tone and joint hyper-mobility; then consideration should be made with regard to the use of technology such as laptops, ipads and speech to text recognition.  Additional exam support may also be considered for older children such as extra time or the use of a scribe.

Do you or someone you know use an "inefficient" grasp? Is it functional?

Cindy Chuan is a registered Occupational Therapist practising in Sydney Australia.  She has two young children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun.

Cindy is the author of the Occupational Therapy blog Your Kids OT.

Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

References:
* Benbow, M. (2006). Principles and Practices of Teaching Handwriting. In Hand Function in the Child Foundations for Remediation (pp. 319-342). Mosby Elsevier.

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