Letter Reversals

Letter reversals and phonetic awareness

Letter Reversals…they are a major cause for handwriting concern by most parent’s standards. Here we are covering information about writing letters backwards and what is normal for letter reversals in development. We also have some great tips for addressing common letter reversal struggles and even reversal activities that can help with visual perception handwriting struggles. Read on!

Letter b and d reversals: These specific strategies cover letter b and d reversals.

Letter p and q reversals: You’ll find more specific letter reversal information in this post on reversing letter p and q.

Also check out these activities to work on backwards letters.

Writing Letters in Reverse

Do letter reversals mean dyslexia? Not exactly! Dyslexia means problems learning to read, spell, and write. However, there is much more to reversals than what meets the eye, and should be assessed before jumping straight to the conclusion of dyslexia.

Letter reversals such as switching b and d or writing letters and numbers backwards can be a result of various things. Here is information on letter reversals.

Letter Reversals Normal Development

Reversals are age appropriate up until 7-8 years of age!

That’s right! Letter reversals are normal up to a certain age range. And when kids write letters backwards it is actually typical development in handwriting skills. Working on letter reversals in occupational therapy (and other visual perceptual areas) can be a common occurrence for school-based OTs…but just because kids are writing letters backwards, it doesn’t mean there is a true problem indicating a need for intervention.

It takes our brains that long to integrate all the skills needed to form a letter correctly and automatically during written expression. Skills needed range from phonetic awareness, ability to imitate pre-writing strokes, automation of letter formation, and higher level cognitive skills for multi-tasking.

Some kiddo’s develop these skills faster than others. Some kiddo’s struggle with these skills and may receive support services such as occupational therapy or pull out services with their school’s reading specialist before age 7.

Services provided before age 7 are typically preventative and because the child has shown struggles in the foundation skills needed for reading and writing, such as phonemic awareness, challenges with pre-writing strokes and shape formation (visual motor integration), poor fine motor skills, dominance concerns or underlying vision concerns.

What is a letter reversal

The term Letter reversals refers to several things related to reversing letters in reading or writing:

  • Writing a specific letter backwards, when they replace a letter with another such as forming a letter b as a d or a letter p as a letter q
  • Writing a letter upside down or flipped, such as forming a u as an n
  • Reading a letter backwards, as when kids replace a d with a b
  • Writing letters backwards as when kids write letters h, n, s, z, etc. in a mirror image
  • Transposing letters or switching the order of letters when writing
  • Reversing or writing numbers backwards

Common Letter and Number Reversals

So, knowing that it is quite common developmentally, to reverse letters and numbers up until age 7 or 8, it can also help to know which letters are commonly reversed in writing.

Letter Reversals List

These letters and numbers are often times transposed for one another:

  • b and d
  • n and u
  • w and m
  • s and z
  • 3 and E
  • 2 and 5
  • s and 5

It’s easy to see why the letters and numbers listed above are often reversed. They all contain similar pencil strokes. For children that are just learning to write, spatial integration can be still developing. Kids are getting the muscle memory in place can replace one letter or number for another.

These letters are often written backwards:

  • b
  • c
  • d
  • e
  • f
  • h
  • j
  • k
  • p
  • q
  • r
  • s
  • u
  • z

Each of these letters has a starting point at the top and pencil strokes that then go into a different direction. Children that are still developing handwriting skills are establishing the motor plan for direction changes with the pencil. The can sometimes “guess” the correct direction which results in letters being written backwards.

Numbers that are commonly written backwards include:

  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 9

Each of these numbers also have a direction change which could easily be confused.

In many cases, working on letter and number formation so the muscle memory is established with fix reversal issues. Using multisensory formation activities helps to establish that motor plan.

Letter reversals can be related to phonetic awareness difficulties.
There can be a connection between letter reversal problems and phonetic awareness delays.

Phonetic Awareness and Letter Reversals

The current theory among the educational community is that reversals start with phonemic awareness. If a child is lacking phonemic awareness, they may struggle with letter identification and spelling needed for fluent written expression. Similar struggles may also be seen with numbers, resulting in a negative impact on math skills.

In my clinical experience, I have found that children with high rates of ear infections and PE tubes (ear tubes) struggle with sound awareness. If the kiddo is unable to hear the sound of the letter clearly and consistently, it leads to poor sound awareness.

I have also found that children with difficulties with attention and auditory filtering often pair the wrong letter sound with wrong letter. This is important to note in sessions as it may require remediation by a speech therapist or reading specialist if available. Here is more information and activities for auditory processing.

While phonetics play a large role in reversals, many other foundational skills may influence whether a child will struggle with reversals or not.

Letter reversals and a connection to hand dominance
There may be a connection between letter reversals and hand dominance.

Hand Dominance and Letter Reversals

Hand dominance is typically fully developed by five years of age. Right at the same time most children are learning and mastering the formation of letters and numbers. It also coincides with the start of kindergarten, or formal education where children who are struggling may be noticed for the first time. Writing with both hands can be a common struggle and an indicator of hand dominance challenges.

Children with handedness issues, whether it’s mixed dominance or delayed development of dominance, are more likely to struggle with left versus right tasks.

This plays into reversal concerns as many of these children cannot consistently discriminate left from right, leading to b’s and d’s, p’s and q’s being flipped. Often times, they are unable to recognize that they have made the mistake as their brain is registering the letter as they meant it to be.

VIsual processing plays a big part in letter reversals. Here's what you need to know.
Visual processing plays a big part in letter reversals. Here’s what you need to know…

Letter Reversals and Visual Processing

Vision is can be one of the biggest challenges facing children who struggle with reversals. Chances are, they have had an underlying vision concern that goes unaddressed or unrecognized during the critical learning period of letters and their sounds.

You will find much more information on visual perception in our free visual perception lab series.

(Children in the U.S. typically begin to learn letters and sounds between 3 and 4 years of age when they enter preschool programs. Curriculums now expect children to know their letters, sounds and how to write them upon entering kindergarten.)

Due to their vision deficit, the child may not consistently see the same image of the letter each time, or may not see the letter that is being taught due to “wandering” eyes or poor abilities to focus on the letter. The kiddo now has a poor foundation from which to build on, due to difficulties with recalling from their visual memory what the letter looks like, and pairing it with the correct sound.

To add to vision deficits, vision is not just what we see, or how the eye’s work together. It is also a motor task of taking information in with the eyes and reproducing an image, or in this case, letters on paper. This skill is known as visual motor integration and also plays a role in reversals.

Here are free visual perception worksheets that can address a variety of visual skills.

Visual Motor Integration and Letter Reversals

Visual motor integration allows us to write, draw and paint freely. To do all of these things, we go through a set development of producing pre-writing strokes and basic shapes in imitation to freely producing them from our memories and eventually becoming automatic. Here is more information and activities related to visual motor skills.

Most children learn to imitate these strokes and shapes at a young age from top to bottom and left to right. However, some children do not learn it this way or their brains are not “wired” to follow this pattern of development.

Children who deviate from this pattern may have difficulties with reversals as they struggle to learn and integrate letter stroke combinations in the correct order. When this happens, they struggle to write fluently and reversals may begin to appear.

Signs of poor visual motor integration skills that could lead to reversals include:

  • Segmental Drawing—drawing a shape one stroke at a time instead of integrated
  • Bottom to top orientation when drawing
  • Right to left orientation when drawing
  • Difficulties crossing the midline during drawing tasks
  • Rotation of the paper to adjust for angle execution
  • Failed attempts to imitate basic shapes after the child has stated what the shape is
Reversing letters can be related to an executive function difficulty.
Writing letters in reverse can be a trouble with executive functioning skills.

Executive Functioning and Letter Reversals

Executive functioning skills refer to our higher level thinking that includes attention, multi-tasking and memory, among many other skills. Writing requires all of these skills to be working at their best. If a child is struggling with any of these skills, they may demonstrate reversals and poor overall handwriting.

Reversals and poor handwriting may be the result of the child being unable to recall the strokes of the letter, the sequence of the strokes, what the letter looks like, where to start the letter, how big to make the letter, what each letter sound is, how to spell a word and complete their thought.

Oh, and lets add in that they have to remember how to hold their pencil correctly. For a kiddo who is struggling, this is a CHALLENGE.

There are so many more things that go into writing that may lead to reversals then what I have listed, but are too many to list out. 

The main concept of executive functioning is that if the child cannot make it all work together, from fine motor to phonemic awareness to visual motor, they are more likely to struggle with reversals in their work.

Try these letter reversal interventions to help kids who reverse letters and numbers.
Try these letter reversal strategies…

Letter Reversal INterventions

It is important to recognize that reversals may be the sign of underlying deficits with foundational skills and should be addressed when they are noticed. The sooner that these underlying deficits are addressed the better off the kiddo will be. Once a child has had a long enough time period to practice incorrectly, it will be that much harder to break the “bad habits” and correct the reversals.

You will find many letter reversal interventions in this blog post.

  1. This resource on letter b and d reversals is a helpful read on how specifically to work on these commonly reversed letters. You’ll find multi-sensory writing strategies to address b-d letter reversals.

2. Try “building” letters to establish the motor plan needed to create muscle memory. Use different colors to help children see the ways that the pencil moves when writing letters and numbers. This letter construction activity explains more about this process. This letter building strategy, paired with other forms of multi-sensory handwriting and teaching letters in groups based on the ways the pencil moves can make a big impact.

Addressing some of the other co-existing issues discussed in this article can be a start.

3. Address the motor planning in handwriting necessary for letter and number formation. Strategies that develop motor planning skills utilizing multi-sensory approaches can help with letter reversal. When kids learn and practice letters with visual, auditory, and kinesthetic sensory channels at the same time, the weaker channel may be reinforced (Berninger, 2000).

Multi-sensory letter reversal strategies include:

4. Work on visual perception with toys and games, and activities to address specific visual perceptual skills or visual motor skills.

5. Use cursive writing in some cases. Here are creative ways to teach cursive and our entire cursive writing series.

6. Gain a better understanding of visual processing and all of the “pieces” of the vision puzzle that play into letter reversal and other concerns by joining thousands of other therapists, teachers, and professionals in the Visual Processing Lab.

7. Use this Vision Screening Tool to identify and address specific vision concerns such as letter reversals.

8. Try some of these activities to address visual motor integration and eye-hand coordination.

Have concerns? Talk to your child’s teacher or occupational therapist to address your concerns.

Work on letter reversals and get a better understanding of vision, visual perception, and visual motor skills in the visual processing lab.
Work on letter reversals and get a better understanding of vision, visual perception, and visual motor skills in the visual processing lab.

Contributor: Kaylee is a pediatric occupational therapist with a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. Kaylee has been working with children with special needs for 8 years, and practicing occupational therapy for 4 years, primarily in a private clinic, but has home health experience as well. Kaylee has a passion for working with the areas of feeding, visual development, and motor integration.

Snowflake Activities

snowflake activities

Who doesn’t love snowflake activities? Here, you will find all of the snowflake activities we have shared on the OT Toolbox, linked in one place. When working on creating a classroom or therapy session using a snowflake theme, you can pop right to this post and find everything snowflake related. From snowflake games and crafts, to sensory motor activities, and fine motor fun. You’ll find gross and visual motor activities too! Simply add any of these ideas to a winter snowflake treatment plan, and you’ve got interventions and fun for the whole season, with winter occupational therapy plans! 

Whether it is a wintery day or just chilly outside, add these snowflake lesson plans. Learners of all ages will be able to get out some energy, while developing important skills. 

Snowflake activities for occupational therapy during winter months.

Snowflake Activities

If you are looking for a fun snowflake game, or maybe some snowflake art, these skill-based wintery ideas from the OT Toolbox will have you covered! 

Marbled Milk Paper Towel Snowflakes | By creating these snowflakes, there is a little science and art involved (check out STEM learning) while learners swirl a toothpick around in the food coloring and milk. Children will work on light touch as they swirl the toothpick, and pick up/drape the snowflakes to dry. This is a fun craft that is beautiful to display! 

Winter Snowflake Stamp Art | Make winter snowflakes using pipe cleaners (chenille stems) creating art that is wintery, beautiful, and unique! Stamp art promotes fine motor skills as learners work on a functional grasp, separation of the two sides of the hand, arch development, and an open web space. A creative winter painting idea that has a sensory component, too! 

Craft Pom Pom Snowflake Line Awareness Craft | This snowflake activity is a great one for preschoolers or novice learners, as it promotes a variety of grasp patterns when manipulating the pom-pom balls. It is a fun craft that uses pom-poms placed on the outline of a snowflake to create a colorful design that can be hung at home, or given to family/friends. The learner works on placing the pom-poms directly on the line, they are working on line awareness, which is important for drawing and handwriting. 

Snowflake Party | Have a fun snowflake party with children while creating several snowflakes using a variety of materials, working on a variety of skills. A few of these ideas include snowflake sensory play, snowflake art and crafts, and snowflake snack food. Check out the post to see what we did at our party. It was FUN!

DIY Snowflake Stampers | Use different foam stickers to create these fun stampers for art projects. 

Kindergarten Sight Words with Winter Tic Tac Toe | The adult can either make the tic tac toe board, or work with the learner and make it together.  Either way, when using the board, the learner will be working on visual perceptual skills that are needed for forming and writing letters. 

Gross Motor Snowflake Activities

Snowflake balance beams, catching snowflakes, and throwing or dancing with snowflakes are great gross motor snowflake activities to add to occupational therapy sessions during the winter months. Try these wintery activities:

Snowflake Balance Winter Gross Motor Indoor Play Therapy Idea | Learners will benefit from the vestibular input this activity provides as they play. The use of balance beams challenges the vestibular system. Work on balance and motor planning while using their visual skills to scan the balance beam, tracking the snowflake line they need to walk along. 

Super Simple Snowflake Frisbee Indoor Play  | This basic activity creation uses paper/Styrofoam plates, tape, and a paper snowflake. This activity provides vestibular input as learners perform slight head movements as they throw the frisbee to their partner. Frisbee also promotes upper extremity coordination to grasp/hold/release the frisbee, flex/extend their wrists, cross midline, and use good postural control. 

Proprioception Winter Activity Throwing Snowflakes | Are you working on scissor skills? If so, try this paper snowflake activity that goes along well with this winter theme. You can make them the typical way with copy or cardstock paper, or try using cupcake liners instead! This helps to boost hand strength, and provide proprioceptive input with the end reward of a pretty, colorful snowflake! 

This collection of snowflake themed activities will provide enough activities for your classroom, therapy sessions, or at-home programming to use all season long. They provide a range of skill development with a bunch of craftiness all your learners will enjoy! 

more great Winter resources!

Add our Winter Fine Motor Kit from the OT Toolbox to your wintery treatment plan to help learners develop their fine motor strength and endurance, grasp, and dexterity skills while engaging in these easy, no-prep activities. Just print and go! 

Check out the OT Toolbox Snowman Therapy Activity Kit to your cold weather lesson planning to help children work on core strengthening, motor planning, hand skills, visual motor skills while also getting some sensory input too! Just download, print, and go!

Regina Allen

Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

*The term, “learner” is used throughout this post for consistency, however this information is relevant for students, patients, clients, children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.