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Another pencil grip which suggests fine motor dyspraxia is one in which the child holds the pencil very tightly and near the point when writing. Further, students with dyspraxia often change pencil grips and prefer writing in cursive rather than print. They do not like to write and complain that their hand hurts when they write. Writing for them is a labor-intensive task. Fine motor dyspraxia is frequently associated with speech production problems because these children often have difficulty assigning the muscles in the mouth to specific speech sounds (Levine, 1987, 1994).

Impaired Kinesthetic Feedback. Children with impaired kinesthetic feedback often develop a fist-like grip of the writing instrument. With this grip, they extend their thumb over the index and middle finger, limiting the mobility of the fingers. They may also press very hard on the paper with the writing utensil in an attempt to compensate for the lack of kinesthetic feedback. Further, they may look closely at the pencil or pen when writing thus attempting to guide the hand using visual feedback which is a much slower process. This is why children with impaired kinesthetic feedback may produce legible handwriting at a greatly reduced pace. As they progress in school, however, the demands placed on written output are too great and legibility deteriorates. These are the children who are often accused of writing neatly "when they want to". They also often prefer to use mechanical pencils and "scratchy" pens because these provide more friction on the paper when writing. They complain that their hand hurts when writing and they do not like to write. Performance in other fine motor skills may be adequate or good because many fine motor skills do not place such reliance on kinesthetic feedback.

Research has shown that tasks which were designed to improve kinesthetic sensitivity improved handwriting performance more than a task that involved only practice in handwriting (Harris and Livesay, 1991).

Deficits in Visual-Motor Coordination. Children with visual-motor incoordination function much differently than those with impaired kinesthetic feedback because of the different demands of certain motor tasks. Poor visual-motor integration may lead to problems with fine motor tasks that rely heavily on visual feedback. These include threading a needle, drawing, painting, craftwork, building things with blocks, repairing things, playing games such as Nintendo and using a mouse on a computer.

Complete references are available at: http://www.cdl.org/resource-library/articles/graphomotor.php?type=subject&id=45

• DESCRIPTION OF GRAPHOMOTOR SKILLS
• Handwriting is complex perceptual-motor skill that is dependent upon the maturation and integration of a number of cognitive, perceptual and motor skills, and is developed through instruction (Hamstra-Bletz and Blote, 1993; Maeland, 1992). While a plethora of information exists in lay and professional literature about many of the common problems experienced by school age children, difficulty with handwriting is often overlooked and poorly understood. Students with graphomotor problems are frequently called "lazy", "unmotivated" and/or "oppositional" because they are reluctant to produce written work. Many times, these are the children who dislike school the most. Because they are sometimes able to write legibly if they write slowly enough, they are accused of writing neatly "when they want to". This statement has moral implications and is untrue; for children with graphomotor problems, neat handwriting at a reasonable pace is often not a choice.
• When required to write, children with written production problems frequently engage in numerous avoidance behaviors. They have to go to the bathroom; they need to sharpen their pencils; they need a Kleenex from their backpack. Sometimes they just sit and stare. Even disrupting the class and getting in trouble may be less painful for them than writing. Work that could be completed in one hour takes three hours because they put off the dreadful task of writing.

The following paragraphs will attempt to elucidate the various components of handwriting and the characteristics which students display when there are breakdowns in these components. Components of graphomotor or handwriting skills include visual-perceptual skills, orthographic coding, motor planning and execution, kinesthetic feedback and visual-motor coordination.

• Visual-Perceptual Skills. Visual-perceptual skills enable children to visually discriminate among graphic forms and to judge their correctness. Thus, visual-perceptual skills involve the ability or capacity to accurately interpret or give meaning to what is seen. Generally a number of specific skills fall into this category including visual discrimination, or the ability to distinguish one visual pattern from another, and visual closure, or the ability to perceive a whole pattern when shown only parts of that pattern. Adequate visual-perceptual skills are a necessary but not sufficient condition for legible written output.
• Orthographic Coding. A second factor important to the production of legible handwriting is orthographic coding. Berninger and her colleagues (Berninger, Yates, Cartwright, Rutberg, Remy and Abbott, 1992) define orthographic coding as the "ability to represent a printed word in memory and then to access the whole word pattern, a single letter, or letter cluster in that representation" (pg. 260). Thus, orthographic coding refers to the ability to both store in memory and retrieve from memory letters and word patterns. The relationship between poor handwriting and orthographic coding deficits has been empirically established (Berninger et. al., 1992).