Supporting Challenges in Written Output – Part 1: The Big Picture

When an individual has a disability that makes it challenging for him to produce written output, oftentimes the solution offered involves high-tech strategies, most commonly through the use of apps on an iPad or on a computer.  I think that what  many of those of us in OT – and those in the fields of health care and special ed – tend to think about doing when we are presented with a situation in which a person has trouble writing is to look for what we think is the most efficient fix for that problem; we so often let our thinking leap ahead to an end-justifies-the-means type of view.

What I have learned over the years, though, is that rather than jumping right in with a tactic aimed at completing a project, sometimes it is more better to look a little deeper into what the objective is for having the individual complete the task at hand.  In other words, what is the point in having the person do whatever is being required of him or her?  Is completion of the work necessary for that person to convey knowledge or thoughts, is it to communicate something in particular, or is it to try to improve the legibility and/or speed of the work?  Gaining clarity on the point of the assignment is essential to recommending a solid strategy with regards to assistive technology and, in many cases, to the successful participation in such a task.

As any OT with experience in pediatrics can attest, there are many benefits for a client to practicing and performing pencil-paper activities, including encouraging the development of hand and upper-limb muscles, eye-hand coordination skills, and visual perception.  If we always go with a plan of action that skips over attempts to grow these skills, we may be missing an opportunity to provide intervention that will support growth in areas that will facilitate participation and independence in many other life skills.


Many years ago, I was a member of a team of school staff members working with a child with special needs who was having difficulty keeping up with the written work required in a kindergarten classroom.  The teacher brought up a particular worksheet that she said was very challenging for the student; the directions for completing the worksheet read, “Color and cut out the pictures at the top of the page.  Glue the pictures that begin with the B sound in the boxes at the bottom of the page.”  The teacher reported that the child took at least three times as long as the other students to complete the assignment and that her coloring and gluing were very messy, although she did glue the right pictures into the boxes as directed.

When the teacher was done talking, I asked her what the point of the assignment was.  “To complete the worksheet,” she answered.

On what are you recording data?” I asked her. “What are you trying to see if the students can do through the use of this activity?” 

I want to see if they know which of the pictures begin with words that start with a certain sound,” she said.

Is there any other way you could determine that for this student other than with that exact set of directions?” I inquired.

Sure!” the teacher said. “She can just draw a line from a picture to a box at the bottom … or she can circle the pictures at the top that start with that sound, and that way she will finish much more quickly.” 

That’s a good example of an output accommodation – a change in the way an assignment is to be done that still gives the teacher the information she is looking for from the student.  That type of adjustment works when the point of the task is outcome-related

When the point of the task is skill-related, though – if the teacher in this example had reported that she wanted the student to complete the worksheet to improve her coloring or cutting skills or to refine the skills needed to perform those tasks – what might have been called for instead of changing the way the work was to be done is to change the tools with which the task was to be done.  In that case, some support from Assistive Technology may need to come into play in the form of having the student use different materials and/or strategies for using those materials in order to improve her skill level.


In the next few posts, I will share at least 25 ways that the production of written work can be supported through the use of various materials and strategies; the choice of which to consider recommending for use by a person with challenges in that skill should be made based on the individual needs of that person, the task with which support is needed, and the availability and feasibility of using specific materials and/of other types of adaptations.  

Stay tuned for more! 



2 thoughts on “Supporting Challenges in Written Output – Part 1: The Big Picture

  1. Thanks for this article. As a therapist new to the school setting this was very informative. I am looking forward to your next post

  2. As a parent of a child with JIA that affects her hands, I am following this with great interest. I’ve also sent this information to my spouse, who is a Special Educator and is always seeking ways to help his students.

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