What is Visual Attention?

Visual attention

Visual attention is a hot topic when it comes to learning! There’s more than meets the eye when it comes to being visually attentive, however. Attention to visual information is an area of visual processing that is more than just focusing on a task or leaning activity. Attention and awareness of visual information is a skill necessary for noticing details, adjusting to patterns, reading, and so much more of the giant visual processing umbrella.

Be sure to read our resource on near point copying as visual attention plays a role in copying written work.

Visual attention

Visual Attention

Read on to discover what is visual attention and how this visual skill impacts so much of what we do.

Visual attention is a visual processing skill that allows us to notice and focus on details. Some aspects of visual attention occur automatically and immediately, and others require integration of other visual processing aspects such as visual perceptual work, focused vision, retained attention, visual mindfulness, and more.


What is visual attention?

First, it’s important to recognize where visual attention lies in the visual processing umbrella. Visual processing is an aspect that includes the cognitive components, once visual information is received through oculomotor skills and visual acuity.

Attention of visual information is an area of obtaining visual information and communicating that information with the brain. This collection of information requires several eye mobility skills including: voluntary eye movements, visual fixation, smooth pursuits (or visual tracking) and visual scanning.

Additionally, visual perceptual skills are included in the visual processing skill. These skills allow us to discriminate details and fill in “missing pieces” such as partially obscured portions of the form and to use the “mind’s eye” to visualize those aspects.

About Visual Processing…

For more information on visual processing and the aspects that are a part of visual skills (oculomotor skills, visual perception, visual motor integration, etc.) join us in a free 3-day email series, the Visual Processing Lab, as we discuss each aspect of visual processing with a fun, chemo or bio lab theme!

As a related component, the visual input from a picture story sequence can support needs of individuals to work on visual attention.

Visual Attention includes:

1.) Alertness- Defined as “the quality of being alert”, alertness is that watchful and attentive manner of being ready and responsive to visual information. Visual alertness requires focused vision and keenness to a specific object or area in the visual field.

2.) Selective Attention- The ability of noticing and processing specific information while disregarding other, less relevant information describes selective attention. This ability to discern visual information is needed for attending visually to information.

3.) Surrounding Attention- This aspect of attention refers to the surroundings and position in space. An awareness of our body position and the environment happening around us, including distance impacts attention at large.

4.) Mindful Alertness- The ability to be mindful and aware of visual input with a concentrated effort allows attention needed for participating in a visual task. The continuous alertness in a focused state allows us to attend with intention.

5.) Shared Attention- This aspect of visual attention allows us to shift focus between visual input. This can involve filtering of unnecessary information.

What is visual attention? It's a visual processing skill that allows us to read and maintain our place on a line of words. Visual attention allows us to copy written work and notice details. It allows us to recognize faces and letters or words. Visual attention is an important visual skill that many kids struggle with.Learn more here, as well as other information on visual processing.


Visual Attention and Preattentive Features

If visual memory and attention is depiction of and focusing on specific qualities of a form, then pre-attentive features are basic features of visual information that are automatically noticed by the eyes. These features are easily pulled out of a background or group in a visual display.

Pre-attentive features include:

  • Color
  • Orientation
  • Curvature
  • Size
  • Motion
  • Depth Cues
  • Vernier
  • Lustre
  • Aspects of Shape

Visual Attention and Occupational Therapy

Occupational therapy providers address functional skills in their clients. They help to support every day tasks. Visual attention is one of the underlying components that are required in the visual system and plays a key role in supporting visual processing for performance of everyday activities.

There are several types of visual problems:

1. Visual efficiency- This includes eye movements, eye alignment, and eye focusing. These three abilities relate to functional performance. 

Consider these questions related to the attentional mechanisms surrounding visual efficiency:

  • Can you be a good reader if you lose your place constantly while reading, because of poor eye movements?
  • Can you be a good reader if you are seeing double? Wouldn’t you express visual inattention as a result of double vision?
  • Can you be a good reader and learner if the words are moving in and out of focus and as a result you have headaches and eye strain? Wouldn’t these hardships signal the eyes to close one to shutdown, thus losing visual attention to the stimulus of the reading task?
  • Wouldn’t visual efficiency problems impact your ability to think with reasoning and impact comprehension as a result?

Looking at these questions, it’s easy to see the attentional effects that visual efficiency has on maintaining attention to visual stimuli. 

2. Visual Perception- Visual perceptual skills impact academic performance, and visual attention is one of these. These skills work together to allow for functional vision! Visual perception and attention skills enable the cognitive processes.

  • Visual attention
  • Visual memory (which requires attention)
  • Visual discrimination (which visual attention is a key component in order to discriminate between details)
  • Visual closure (in which visual attention is a skill that impacts the mind’s eye in closing a visual image)
  • Spatial attention in written work

3. Visual motor integration- The components of visual motor integration includes the  integrates the perceptual awareness with the motor output, and attentional skills are a main role. Consider:

  • Automaticity of movement
  • Rhythm and timing
  • Body knowledge and control
  • Laterality and directionality
  • Reaction time, which is related to the visual attention on a stimulus
  • Filtering out irrelevant information

All of these areas listed above impact everyday life! 

Visual Attention Tests

There are screening tools that can look at visual attention. These allow the examiner to determine both a focus of attention as well as efficiency and accuracy components. Attention tests won’t give the full picture when used in isolation, but they should be considered as contributing evidence of visual attention challenges. 

Some visual attention tests include:

  1. Basic vision screening- Follow a tongue depressor with a sticker at one end with the eyes, or follow the end of a pen with the eyes. The visual attention screening tool can be used to examine how the eye moves to follow a stimulus across various fields of vision. Another screening task is to ask the participant to scan between tow stimuli held at different sides of their field of vision. Both are also a way to see the attentional capacity to follow a moving target. Included in this screening is a look at pursuits (eye tracking) and saccades (eye scanning). You’ll find more information in our blog posts on visual tracking and visual scanning.
  2. Test of Visual Perceptual Skills (TVPS-4)
  3. Beery-Buktenica Developmental Test of Visual Motor Integration, or the Beery VMI
  4. Non-standardized screenings using Parquetry blocks (tangrams), block copying tests, and directionality tasks
  5. Copying materials from a near point and far point

Automaticity in Vision Attention

Automaticity refers to the ability to perform routine activities effortlessly and automatically, or without conscious thought. Every motor task that we do throughout the day required conscious through and effort when it was first learned. 

Once we’ve done a task for long enough, it becomes routine and automatic. We can then do other tasks at the same time. You see this when driving a car, for example. When the task of driving become so routine and ingrained that it is automatic, we can do other things at the same time: think about our day, remember a thought, carry on a conversation, change the radio station, etc.

Driving is an extremely complex task that moves to a conscious routine over time!

However, the issue is that we have a sort of blindness when we do other things even during an automatic task. Have you ever driven home from work, only to not recall the drive because you were thinking about other things?

We as humans also challenge ourselves, often unsafely, by thinking we can do other things while performing an automatic task. Think: texting while driving. The results from this is unfortunate.

What is at play with automaticity is the visual attention skill that moves from a conscious effort to an unconscious effort.

Similarly, this ability is present when we read or write. 

A proficient reader is able to automatically recognize, recall, and reproduce, or write, letters and numbers without conscious effort to identify each letter and number form. 

This attention to detail has become ingrained and automatic. 

When we see challenges with reading proficiency, comprehension, speed, and overall the student who is struggling academically, the automaticity may be missing. The visual scene is incomplete without the automatic integration of visual attention.

Visual Attention Activities

Visual challenges with spatial skills, omitting materials in reading or writing, and other functional considerations can mean working on visual attention can help. Attention tasks like the ones below can support this skill.

The goal for using these visual attention activities is to have comfortable, efficient, and accurate vision at various distances through the function of play and learning. We want to see eye alignment, eye focusing, and eye movements, all operating at an automatic and reflexive level, or without conscious effort.

  • Tangram activities
  • Laterality or directionality activities
  • Letter tracking in word searches
  • Brock string 
  • Bead stringing sequences
  • Directional jumps
  • Mazes
  • Code deciphering activities
  • Dots game
  • Sorting items (beads, buttons, etc.)
  • Hidden pictures activities
  • I Spy
  • What’s missing activities
  • Spot it game
  • Sequencing activities

For the individual with cognitive impairments such as following a stroke or other impairment in which visual inattention is present, some strategies can include:

  • Eye patching
  • Dynamic stimuli (flashing lights)
  • Activities to activate orientation and overall attention
  • Verbal cueing
  • Auditory cuing (bell, finger tapping, snapping, etc.)
  • Tactile cuing to engage the participant to look at the unattended side
  • Mirror therapy

Using an adaptive approach to visual inattention is important to foster functional participation, independence, and safety. These strategies can include:

  • Compensation strategies
  • Incorporate the patient’s awareness 
  • Place necessary items within the patient’s field of vision

How to work on Visual Attention

For more information and specific activities that can address visual attententiveness in fun and meaningful ways, grab the Visual Processing Bundle. In it, you will find 17 digital products, e-books, workbooks, and guides to addressing various aspects of visual processing. The bundle is valued at over $97 dollars for these products, and includes over 235 pages of tools, activities, resources, information, and strategies to address visual processing needs.

For one week, the visual processing bundle is on sale at $29.99. Grab the Visual Processing Bundle HERE.


Wolfe J. Visual attention. In: De Valois KK, editor. Seeing. 2nd ed. San Diego, CA:
Academic Press; 2000. p. 335-386.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Handwriting Assessment: Occupational Therapy

occupational therapy handwriting assessment

Occupational therapy handwriting assessments analyze the components of handwriting to discover what may be leading to sloppy or illegible handwriting. One way that occupational therapy practitioners work with students in school based OT is by conducting handwriting assessments in occupational therapy. Here, we are covering areas that an OT looks at in an occupational therapy handwriting assessment.

Occupational therapy practitioners tend to get a bad rap in the schools because they are the go-to service for supporting handwriting needs. While we aren’t “handwriting teachers”, we do know a lot about the intricacies of underlying skills that impact legibility! Identifying those specific needs all starts with the handwriting eval!

To get started, you’ll want to begin with the occupational therapy eval request, and then we can go from there…

handwriting assessment occupational therapy

Handwriting Assessment Occupational Therapy

When it comes to analyzing handwriting, there is no escaping handwriting if you are a pediatric OT.  Handwriting evaluations and interventions is a main task of school-based occupational therapists. It’s no wonder when you consider that handwriting is one of the primary tasks that school-aged children engage in, and is one of the most prominent reasons for an OT referral in the school and outpatient settings.

Today we’re talking handwriting analysis and clinical observations related to assessing handwriting.

Check out our informative video on handwriting evaluations in the classroom environment:

Seems like handwriting should be pretty easy right? The challenge in teaching kids to use legible handwriting is often the limited exposure we receive prior to entering the field, and ensuring that we are providing a skilled service and not tutoring.

Handwriting analysis of writing samples is an important part of a handwriting evaluation. These underlying skills are essential clinical observations in handwriting assessment.

Handwriting Clinical Observations

In a handwriting assessment occupational therapy providers look at specific areas. These are the skilled components that are necessary for figuring out what’s going on.

When I was in school, we briefly touched on fundamentals of handwriting, and the Handwriting without Tears program. I later had some great exposure to handwriting during my Level 2 fieldwork in a school setting, but still felt unprepared to really dive into what prohibited kid’s from learning to write, and to then decipher those findings. For information on Handwriting Without Tears letter order, we have a comprehensive explanation on that aspect of this program.

Since practicing on my own, I have developed a set of clinical observations that are relevant to the handwriting process as it relates to OT and what they meant in terms of function. Check out the list of clinical observations below.

Working on handwriting and pencil grasp? Be sure to join the Pencil Grasp Challenge…a FREE five day challenge loaded with information, strategies, and resources related to a functional pencil grasp.

Below are strategies to use in analyzing handwriting. These are clinical observations that can impact the legibility of written work.

Fine Motor Skills in an Occupational Therapy Handwriting Eval

One major component to handwriting is fine motor skills, and this motor aspect is assessed in the handwriting assessment occupational therapy practitioners conduct.

Fine motor skills play a HUGE role in a child’s ability to participate in writing activities. From grasp patterns, to which hand they use, to endurance and in-hand manipulation skills—there’s a lot to make sure you are checking off during your observations and evaluations.

Let’s break down the components that are assessed in a handwriting evaluation. OT’s typically look at:

We’ve broken these skills down into categories below.

  • Pencil Grip/Grasp pattern
  • Dynamic finger movements
  • Finger mobility
  • Joint positioning and joint integrity
  • Hand and wrist mobility
  • Posture
  • Segmental Drawing
  • Hand dominance
  • Visual motor skills (segmental line skills)
  • Letter formation
  • Sizing, spacing, line use
  • Sequence and strokes of pencil lines
  • Uppercase and lowercase letter usage
  • Fluidity of handwriting

Pencil Grip

This one seems like an obvious one, but there have been many times that I have sat down to write an evaluation and realized that I didn’t note anything about the grip pattern.  Yikes! The major points of clinical observations of pencil grips to keep in mind are that you watch for dynamic finger movement, hyperextension of joints and overall functionality.

Here are some important things that therapists wish parents and teachers knew about pencil grasp.

Grasp pattern in a handwriting Assessment Occupational Therapy

When an occupational therapist conducts an OT handwriting assessment, they look at the grasp pattern the student is using when writing. The occupational therapist asks themselves what does this look like while the child is writing? Is it a dynamic tripod? Static tripod? Or some form of primitive grasp pattern like a fingertip pattern or a gross grasp? 

Make sure that you watch throughout the evaluation to see if they have any regression to a primitive pattern or switch how they hold the writing utensil frequently. 

If you notice grasp pattern regressions, fidgeting or switching of grasp positions frequently, it’s a sign of fatigue related to poor muscle endurance and strength. It may also be an indicator that there is poor separation of the two sides of the hand, under development of the arches of the hand, and finger to thumb opposition, and even potentially poor web space development. 

Bonus Tip! Watch for consistency of skills. If you notice that a skill is consistent, even if it’s an immature pattern, you can determine what is due to poor muscle strength and fatigue (inconsistent patterns) versus an established pattern or compensatory pattern (consistent patterns) that’s going to be difficult to change. 

Dynamic Finger Movements and Pencil Grip

Dynamic finger movement is a big key to preventing fatigue. If the hand or wrist move as a unit, fatigue and endurance significantly increase. Dynamic movements also allow for more control of the utensil within a given space.

 Once dynamic movements have developed, it is exponentially easier for the kiddo to color or write in small spaces, form multi-step lower case letters and produce smaller sized letters and numbers.  

Occupational Therapists Look at Finger Mobility in a Handwriting Eval

Similar to wrist and hand mobility, you will also want to assess finger movements and joint isolation. 

Mature patterns will allow for the thumb, index and ring fingers to move in synchronized flexion/extension patterns to great dynamic movements. If you don’t see this, or notice that the child uses their whole hand to form letters, this is another inefficient pattern that you’ll want to address in your treatment. 

If you’re not sure that this is an issue, have the child walk their fingers up and down a pencil to evaluate their in-hand manipulation skill focusing on shift. 

Whether you are assessing an 8th grader or a preschooler, fine motor components are addressed across the continuum to promoting independent and successful handwriting experiences. Working from this list of skills you can develop these skills further and take the stress out of handwriting!

Functionality of Pencil Grip

Current evidence-based practice in occupational therapy indicates that there are several functional pencil grip patterns outside of the standard tripod grasp pattern that we all identify as “the best” or “most functional” grip pattern. Other patterns include static and dynamic variations of tripod and quadropod grips.

However, I really encourage you to just take a minute to see if the child is functional with their current grip pattern. Trying to change the pattern they are functional with is not always the best option for addressing handwriting.

If they are able to control the utensil for accurate execution of strokes, are able to remain in the given boundary and are not showing signs of poor endurance or fatigue—then they are functional and other components of handwriting should be addressed.

Hyper-Extended Fingers and Pencil Grip

When a child hyper-extends a joint when holding a writing utensil, the grip typically appears “tight” or “too hard”. Hyperextension can lead to damage in the joint itself, along with uncomfortable feelings to the fingers, increased levels of fatigue, poor overall endurance, and hinder dynamic movement. 

Children with poor overall joint stability or poor strength often exhibit this pattern of pencil grips. The “tight” or “too hard” grip that leads to hyperextension is a compensatory strategy to increase motor control and dexterity within the task. Due to the variety of pencil grips that children display, it is important to assess the functionality of the grip before attempting to change it.

Analyzing Joint Integrity in an OT Handwriting Evaluation

Joint integrity of the joints of the fingers, hand, and wrist when holding a pencil is an important component of pencil grasp that needs to be assessed and documented during a handwriting assessment by the occupational therapist.

Joint integrity is super important because a child that has a grasp pattern that is too tight or too loose can have compromised joints. 

A grasp pattern that is too tight puts undue stress on the joints, ligaments and muscles which will lead to poor endurance, and hand cramps. And even potentially repetitive stress injuries. 

On the opposite end, a grasp pattern that is too loose or where the child has hyper extended joints, they will experience similar pain and concerns. They are more likely to have joint pain due to the bone on bone of hyper extension patterns. 

Both patterns are inefficient and will need to be addressed to help the child be successful with handwriting.

Analyzing Wrist and Hand Mobility

Related to the above factors is a more proximal look at the motor component. Occupational therapists will assess the wrist and hand mobility in a handwriting eval because the stability of the joint proximal to the arches and fingers offer the support to provide distal mobility and dexterity.

In this category, we want to look at how the wrist and hand move both as a unit, but also separately. Ideally, the hand and wrist should move independently of one another when writing with the wrist being stable and the hand moving.

If you see that the child is moving their hand and wrist as a unit with stabilization coming through the forearm, that is an inefficient movement pattern that you will want to work on addressing. This pattern is inefficient because it requires more energy from large muscle groups instead of utilizing them for stability.

Posture and handwriting

I want to touch on posture’s impact on handwriting quickly because you can learn some interesting things about a child’s handwriting this way.

If they are slouched over or use their hand to hold their head up, poor core and upper body strength may be the culprit. This will greatly impact their fine motor skills. Without a strong foundation, dexterity skills will not develop.

It’s also important to note if the hand that is holding the child’s head up is covering one eye consistently. This may indicate that there is an underlying vision issue that needs to be addressed. Children typically cover the eye that is making them see double or causing blurred vision.

This is not only an issue from a vision standpoint, but also because you now don’t know what the child is seeing for letters or strokes. Once the vision concern is addressed, the child may have to “relearn” the letters and strokes which can appear as a regression of skills.

Similar concerns are also noted when the child is consistently adjusting their head position in location to the paper.

Hand Dominance

Dominance plays a large role in handwriting and if a child does not display a dominant side, or has mixed dominance, delays in handwriting can occur.

Lack of dominance can prevent adequate levels of motor practice of strokes and letters from being completed. This can then lead to sloppy or illegible writing, along with confusion on the sequence of strokes to form letters. Children who display these motor patterns typically have delayed automation of handwriting, may have a higher incidence in reversals and struggle with getting their thoughts onto paper.

These three simple tips on hand dominance, laterality, and functional activities are a resource in establishing this essential skill.

When looking at hand dominance, you want to look and see if they are consistent with the use of one hand, or if they are trying to switch hands. If you observe challenges with consistency, this may indicate poor muscle strength and endurance. 

Visual Motor Skills

Visual motor integration is a major piece of the handwriting assessment that occupational therapists analyze. Visual motor skills enable us to write using specific aspects that highly contribute to overall handwriting legibility:

Each of these components plays a different role in overall handwriting legibility. In general, writing that has poor sizing, spacing, and letter formation will have challenges with letter formation. However, when some of the components are addressed (spacing between words and baseline use), legibility increases greatly allowing for functional handwriting. In most cases, functional and legible writing is possible even with mixed case use and inconsistencies with letter size. Think about your average medical doctor, whose scripts are written in mixed case and mixed size. Many adults work with these handwriting inaccuracies and the written output is legible and functional.

However, in the teaching moment of working on these skills, legible handwriting for children and students has a different version of functional, so that for the child, addressing letter size along with line use and spacing supports legible written output.

The handwriting occupational therapy assessment then needs to take all of these contributing factors into consideration in order to create an individualized plan of care to support legible written work.

Segmental Drawing

Segmental drawing is when a child “draws” or writes a letter using singular strokes with clear, and abrupt stops between the strokes. This is time consuming, and requires a high level of active thought for the child. Essentially, it’s very non-functional and needs to be addressed.

Segmental drawing not only provides a picture about the child’s writing skills, it also provides insight to the therapist on how they process information. Children who typically utilize segmental drawing are only able to process small or shorter pieces of information at one time. For example, they may need directions given in short bursts or in simple statements to be successful.

Sequence of Strokes and Handwriting

Building on segmental drawing is the sequence in which strokes are completed. Letters in our culture flow from top to bottom, and left to right. A child who is demonstrating a bottom to top orientation or sequence of strokes, when writing may have a significantly harder time learning to form letters correctly and fluidly. Their brains may be “wired” naturally to move in this pattern, or they may be compensating for a visual motor impairment such as spatial relations deficits.

uppercase/lowercase letters Assessment

The case a child chooses to write in, or the combination of case they use provides information on letters that they may be unable to recall, are unsure of their direction (reversal prevention/compensatory strategy), or are unable to execute. By analyzing the use of upper case and lower case letters you can determine where the break down in skill is.

Fluidity and Handwriting

Finally, as all of these observations come together, the final piece is fluidity.  This looks at a few different things including the child’s speed of writing, whether they talk to themselves or watch their hand when they write, and if they demonstrate any motor overflow.

The amount of time that a child takes to write can be an indication of poor memory recall and lack of automation of the writing process. The longer the task takes, the more difficulties the child is having retrieving the information from their memory and utilizing it effectively.

Children who are struggling with writing often talk themselves through the process—from where to start to the verbal cues taught to them. This external processing further indicates poor processing speeds. This can also be seen in the form of oral motor overflow. This is when a child’s mouth moves in odd patterns, they stick their tongue out or some combination of jaw and tongue movement.

Along with motor overflow and outward verbal processing, a child may watch her hand when writing. By watching her hand, the child ensures that the stroke she recalled from her memory is indeed correct and that she is able to execute it. This pattern further hinders the automation of handwriting and indicates challenges with processing and memory recall. When writing requires this much active thought for just the formation of the letters, spelling, sizing, spacing, and thought completion often go by the way side.

Use these handwriting analysis strategies to analyze pencil grasp and writing components during handwriting evaluations.

Final Thoughts

Handwriting is such a large part of being a kid, and being a pediatric OT, that it deserves more attention than it often gets. There are so many foundational skills that go into handwriting, and many places for the skills to become a challenge for a kiddo.

Hopefully everyone from seasoned OT’s to brand new grad’s found this post helpful and learned something new in handwriting analysis and clinical observations needed to assess handwriting.

The Handwriting Book is a comprehensive resource created by experienced pediatric OTs and PTs.

The Handwriting Book covers everything you need to know about handwriting, guided by development and focused on function. This digital resource is is the ultimate resource for tips, strategies, suggestions, and information to support handwriting development in kids.

The Handwriting Book breaks down the functional skill of handwriting into developmental areas. These include developmental progression of pre-writing strokes, fine motor skills, gross motor development, sensory considerations, and visual perceptual skills. Each section includes strategies and tips to improve these underlying areas.

  • Strategies to address letter and number formation and reversals
  • Ideas for combining handwriting and play
  • Activities to practice handwriting skills at home
  • Tips and strategies for the reluctant writer
  • Tips to improve pencil grip
  • Tips for sizing, spacing, and alignment with overall improved legibility

Click here to grab your copy of The Handwriting Book today.