Essential Components of Handwriting

components of handwriting

In this blog post, we’re covering the components of handwriting in a list with tools and resources to cover each element. Click on each link to find all of the information you are looking for.  Be sure to check them all out for a complete understanding of developmental and physiological components to handwriting, creative activities to improve your child’s writing skills, and everything you need to know!

components of handwriting

Components of Handwriting

The components of handwriting can be broken down into categories: motor, visual perceptual, executive functioning, and sensory. Each of the building blocks of writing can contribute to handwriting problems when there is a delay in development or issues with building the underlying skills upon the other skill components.

Motor Skills Components- Motor components of handwriting refer to the physical act of writing, which includes the movements made by the hand, arm, and fingers to form letters and words.

This involves range of motion, hand strength, hand-eye coordination, pencil control, and fine motor skills.

Some of the motor components of handwriting include:

  1. Form: The shape and structure of individual letters and words. Read about letter formation.
  2. Size: The overall size of the letters and the spacing between them. Read about size awareness.
  3. Slant: The angle at which the letters are written. This is more applicable to the cursive form. Read about slant in cursive writing.
  4. Pressure: The amount of force used to write each letter. Read about pencil pressure.
  5. Speed: The rate at which the writer produces the handwriting. Read about writing speed.
  6. Writing Posture: The ability to assume and maintain upright sitting posture when writing, using core strength and stability. Read about writing posture.
  7. Rhythm: How smoothly and fluidly the writing flows across the page. Read about writing rhythm.
  8. Pencil grasp: This is a large area of handwriting. Refer to our resources on functional pencil grasp and development of pencil grasp for more information.

Fine Motor Elements- The fine motor skills can be further sub-categorized into a list:

Visual Perception- Visual Perceptual components involve the visual, motor, and cognitive processes that go into recognizing and interpreting written text.

This includes the visual and spatial aspects of handwriting, such as:

  1. Legibility: How easy the writing is to read and understand.
  2. Alignment: How well the letters and words are placed on the page. Read about margin alignment.
  3. Discrimination of letters: knowing the difference between upper and lower case letters and making the connection between different forms of a letter. read about visual discrimination.
  4. Spacing: How evenly spaced the letters and words are from one another. Read about spatial awareness.

Legibility- A related handwriting component is legibility. This is the ability to read written work, and the ability for others to read the written material. Many of these areas refer to the combination of visual and motor elements, or visual motor skills. Legibility refers to several aspects of handwriting:

  1. Writing speed
  2. Carryover of handwriting skills
  3. Copying material from a near point or distant point
  4. Consistency: How similar the handwriting is from letter to letter, word to word, and page to page.

Sensory Components- The sensory aspect of handwriting relates to several areas:

  1. Pencil pressure
  2. Body awareness
  3. Position in space (or proprioception)
  4. Self-regulation
  5. Sensory needs

Executive functioning components- Finally, a critical piece of the handwriting puzzle is executive functioning skills. We can break handwriting and executive functioning skills down into sub-areas:

  1. Working memory
  2. Impulse control
  3. Attention
  4. Organization
  5. Flexible thinking
  6. Planning and prioritization

I’m sharing each of the Handwriting posts here so you can easily find each topic.  If bad handwriting is an issue, check out the fundamental ingredients to handwriting!

From fine motor skills to gross motor skills, and sensory considerations to posture: This is a complete guide to Handwriting for Kids from pediatric Occupational and Physical Therapists.  

Everything you need to know about handwriting. Fine and gross motor considerations, sensory concerns, developmental progression, creative activities, posture, and more, from pediatric Occupational and Physical Therapist bloggers.

Everything you need to know about handwriting. Fine and gross motor considerations, sensory concerns, developmental progression, creative activities, posture, and more, from pediatric Occupational and Physical Therapist bloggers.
More Handwriting ideas you will love: 

Activities for Handwriting Elements:

You’ll find many resources here on The OT Toolbox to support skill development impacting the elements of handwriting that make a difference in overall legibility. Here are some of our favorites:

For a comprehensive resource that breaks down each component of writing, grab a copy of The Handwriting Book:

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.

Types of Eye Specialists

types of eye specialists

In this blog post, we’re covering information on types of eye specialists. As occupational therapy providers, many times we work with clients or patients on activities of daily living or IADLS that are challenged by vision needs. Knowing about different types of vision specialists is important because we can better understand what support a the individual could benefit. Here, let’s dive into vision specialties.

types of eye specialists

If you have been researching types of eye specialists or read my post on Behavioral Optometrists, you may feel overwhelmed by all of the information out there! 

In order to make this clearer, the OT Toolbox has a PDF on the Different Types of Vision Specialists.  This is one of the resources included in our Visual Processing Bundle.

This post will (hopefully) shed some light on the differences between these professions, especially if caregivers are asking  you for advice, or you are in the position to make recommendations after screenings*

Types of Eye Specialists

There are four different types of vision specialties highlighted on the Types of Vision Doctors/Eye Specialists chart found in the Visual Processing Bundle:

  • Optometrists
  • Ophthalmologists
  • Behavioral/Developmental Optometrists
  • Vision Therapists

The chart gives a general overview of the different roles of the four types of vision specialists:


  • This doctor is responsible for checking visual acuity
  • They can prescribe glasses and contact lenses
  • Can not perform surgery and are not medical doctors
  • They can monitor conditions like glaucoma, dry eye, and diabetes related vision problems
  • For routine primary care, people often select an optometrist first


The Opthalmologist does more in depth vision care than the optometrist. 

  • They perform extensive eye exams, including dilation of the eyes
  • They are medical doctors
  • Medical eye care — for conditions like glaucoma, iritis, and chemical burns
  • Surgical eye care — for trauma, crossed eyes, cataracts, glaucoma, and other problems
  • Diagnosis and treatment of eye conditions related to other diseases, like diabetes or arthritis
  • Plastic surgery — to raise droopy eyelids or smooth out wrinkles

According to the American Academy for Pediatric Ophthalmology and Strabismus, there are certain conditions that warrant a visit to the Ophthalmologist:

  • Bulging of one or both eyes;
  • Dark curtain or veil that blocks your vision;
  • Decreased vision, even if temporary;
  • Diabetes mellitus;
  • Distorted vision;
  • Double vision;
  • Excess tearing;
  • Eyelid abnormalities;
  • Family history of eye disease;
  • Halos (colored circles around lights);
  • High blood pressure;
  • HIV or AIDS;
  • Injury to the eye;
  • Loss of peripheral (side) vision;
  • Misaligned eyes;
  • New floaters (black “strings” or specks in the vision) and/or flashes of light;
  • Pain in the eye;
  • Thyroid disease-related eye problems (Graves’ disease);
  • Unusual red eye.


  • Opticians aren’t eye doctors and can’t give eye exams. They get a 1- or 2-year degree, certificate, or diploma. 
  • They fill the prescription your eye doctor gives you. 
  • Check lens prescriptions
  • Provide, adjust, and repair glasses, frames, and contact lenses
  • Take facial measurements
  • Help decide which type of lenses and frames will work best
  • Order and check products, including contacts and eyeglass lenses


  • A behavioral optometrist uses a wide array of exams to study your vision. 
  • Many of the tests require you to answer verbally because they’re related to how you interpret your vision.   
  • Because of the connection between the brain and the eyes, behavioral optometrists do measure your sight, but also your brain’s response to what you see.  
  • Behavioral optometry acknowledges the brain’s connection to vision, and the impacts on behavior that poor vision can  have.  
  • They are concerned with how your eyes and visual system function, and are interested in how your behavior affects vision or how your vision influences your behavior.  
  • The behavioral optometrist, also known as a  developmental optometrist, treats functional vision problems, including difficulties with binocular vision, eye movements and depth perception, as well as visual deficits following brain injuries. 


“Vision therapy” is a term used by optometrists. 

  • Optometrists define vision therapy as an attempt to develop or improve visual skills and abilities; improve visual comfort, ease, and visual efficiency; and change visual processing or interpretation of visual information. 
  • Vision therapy is often prescribed and used by optometrists or behavioral optometrists 
  • Many ophthalmologists advise their patients that there is no benefit to vision therapy – there is a lot of controversy surrounding the efficacy of vision therapy, however many therapists have seen success in practice.
  • They work closely with the developmental or behavioral optometrist
  • An optometric vision therapy program consists of supervised in-office and at home reinforcement exercises performed over weeks to months. 
  • In addition to exercises, lenses (“training glasses”), prisms, filters, patches, electronic targets, or balance boards may be used.
  • Performs eye exercises with the goal of improving fundamental visual skills
  • Works to change how a patient processes or interprets visual information
  • Addresses visual problems such as lazy eye, crossed eyes, double vision, and convergence insufficiency
  • According to AAPOS: Behavioral vision therapy is considered to be scientifically unproven
  • American Academy for Pediatric Ophthalmology and Strabismus states there is no evidence that vision therapy delays the progression or leads to correction of myopia.  They also discount the use of “training glasses”.

Vision Therapists generally address the following issues:

Oculomotor problems: Problems with eye tracking skills, including fixation, pursuits, and saccades. Fixation refers to the ability to continue looking at a stationary target. Pursuits refer to the ability to continue looking at a moving target. Saccades refer to the ability to smoothly change fixation quickly and accurately from one target to another. For example, saccades are especially important in the act of reading.

Accommodative problems: Problems relating to the focusing system of the eye. Accommodative problems include difficulties focusing accurately during close work and difficulties switching focus from distance to near efficiently.

Vergence problems: Problems with eye teaming abilities and visual convergence. An example of this is convergence insufficiency, which is when the eyes do not work well together. Convergence insufficiency is one of the most common problems that can be treated with vision therapy

There are three categories of vision therapy:

Orthoptic vision therapy” so called by optometrists are a series of exercises usually weekly over several months performed in the optometric office. Orthoptic eye exercises (orthoptics), as used by pediatric ophthalmologists and orthoptists, are eye exercises to improve binocular function and are taught in the office and carried out at home. ”Orthoptics” is a well-established profession performed by “Orthoptists” who work within the sub-specialty of ophthalmology. Orthoptists evaluate and measure eye deviations, manage amblyopia treatment and treat small intermittent symptomatic eye deviations.

Behavioral/perceptual vision therapy – eye exercises to improve visual processing and visual perception

Vision therapy for prevention or correction of myopia (nearsightedness)

Final Thought on Vision Specialties

While much of this can be confusing, the hope is that this post with the accompanying chart defines the skills and differences between each specialist.

While some professionals do not agree with vision therapy because of lack of clinical evidence, much of what WE do as occupational therapists could be considered alternative medicine with unproven results.  This holds true for chiropractors as well. We know through practice and clinical observation that what we do works, just as vision therapy can work for certain students.

Use your best clinical judgment to determine the best treatment and course of action for each of your clients.

*NOTE: Not all therapists are allowed to make recommendations or referrals.  Occupational therapists do not make diagnoses, therefore we must be very cautious making referrals or labeling a condition.  School based therapists are generally forbidden to make outside referrals due to liability reasons. When caregivers specifically ask for a recommendation, it is acceptable in many cases to provide a list of providers you trust.  Know your district and state laws when making referrals to other types of providers.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

visual processing bundle

The Visual Processing Bundle includes digital products to target underlying visual processing skills so you can help students with classroom tasks like copying written work, letter reversals, and messy handwriting in fun and engaging ways!

  • Over 235 pages of workbooks, worksheets, e-books, handouts, activity cards, tracking tools
  • Classroom accommodation ideas
  • Checklists
  • Multi-level visual-motor integration workbooks
  • Pencil control worksheets
  • Classroom and therapy activities
  • Activity cards
  • Specific and open-ended activity cards
  • Visual tracking guide

The Visual Processing Bundle is a collection of 17 digital products. Get your copy today!