Snowball Alphabet Worksheet pdf

snowball alphabet letter formation worksheet

Today, we have a fun handwriting resource for you. Grab your mittens because this snowball alphabet worksheet PDF is a free download that builds many skill areas. It may look like a snowball themed tracing worksheet, but this snowball letters PDF builds many skill areas. Let’s take a look at various ways to incorporate Winter Snowball letters into therapy and the classroom or home!

This snowball alphabet worksheet PDF is a free download that can be used to work on letter formation, handwriting skills, and more.

Snowball Letters

The OT Toolbox is continuing with its winter theme this month by offering another wonderful free printable.  If you have to live/vacation/endure somewhere with snow, you might as well make the best of it.  Everyone loves making snowballs.  That is why they have snow making machines pumping out fake snow here in the south, so we don’t miss out on all of the fun.  I have to say it is kind of strange sledding and throwing snowballs while wearing a short sleeved shirt.  

Before we get to the snowball letters activities, check out these snowball sensory ideas. Use real snow brought indoors (or use the items outside!). Kids will LOVE to use these snowball tools with our fake snow recipe. Plus, when kids are involved in making the fake snow, there are more therapy goals to address like executive functioning, bilateral control, and even tactile defensiveness.

Snowball Maker- The beauty of making snowballs?  It has evolved!  No longer do you need to have cold wet mittens while scooping up layers and layers of snow.  They have a tool for that! This (amazon affiliate link) snowball scooper is perfect for creating the perfect snowball.

Before you scoff and say you would rather do it the old fashioned way, you need to check this thing out!  I made the most perfect fake balls of snow with this contraption.  Now all I need is a launcher like they make for tennis balls, and some better aim.  Are you intrigued by this wonderful tool? 

Snowball Mold Set– Wait, there is more!  Kind of makes me want to have a snow day to try all of this cool stuff out.  You no longer have to roll snowmen, create handmade blocks for igloos, or scoop the snow with your hands.  Tired of circle snowballs?  They have a solution for that!  This snow mold set comes with penguin and heart shapes.  Need to be more efficient when creating these fluffy white bundles of fun?  They have a tool that will make FIVE snowballs at once!  They have just ramped being out in the snow to a whole new level.

Now that we have filled your shopping cart with such wonderful things to do in the snow, what about the days when your learners have to be in school, or it is too awful to stay outside all day?  A winter skills treatment or lesson plan is just what you need.

Snowball Alphabet PDF

The OT toolbox is showcasing winter activities and PDF sheets all month long. Today’s cute design is an alphabet letter worksheet full of winter snowballs to practice letter formation.

As always I love the versatility of each of these pdf activities and printables.  This design comes with two different ways to change the activity for different skill levels.  Tracing inside snowballs or working on letter formation with blank winter snowballs.

Use this snowball alphabet worksheet PDF along with our recent Winter Clothes Number Tracing worksheet for tons of skill areas.

When working with any learners, it is important to be able to adapt or grade your activity for multiple learning levels.  What does it mean to grade an activity?  To make it easier or harder for your whole caseload of learners or adapt the task for a specific learner.  Suppose you get started with the blank snowballs and realize your learner has no clue what the letters look like.  You would grade this down to either tracing, or copying letters from a model.  You could grade it further down to matching letters or identifying them.  You can grade up to writing lowercase and uppercase letters in the winter snowballs.

Snowball Letter Tracing Sheet

Since the first page is a tracing task, let’s talk about tracing. I am not a fan of tracing unless it is used correctly, or the objective is understood. 

  • Tracing is not going to teach number/letter formation if the learner does not know what those figures are.  To a learner who does not know these symbols, they will be tracing lines, not numbers or letters
  • Know your audience. If your learner does not know the letters or numbers, use the activity as a fine motor task to develop dexterity
  • Kinesthetic awareness.  This long word means to learn by doing.  Theoretically if a person writes the number 5 enough times, the body will start to recognize this pattern and commit it to memory.  This only works if the learner understands what is being traced
  • Tracing for dexterity. This is the type of tracing I like best.  Tracing for dexterity works on staying on the lines, fine motor control, building hand muscles, scanning and so much more.

What else does tracing and writing alphabet letters work on?

  • Handwriting – this is obvious as you are building letter formation
  • Fine motor control – holding a pencil, developing intrinsic muscle control to improve written expression, dexterity to stay on the lines on the tracing section
  • Letter formation – correctly forming the letters top to bottom
  • Letter sizing – correctly fitting the letters into the size boxes
  • Copying – copying letters from a model if you have graded it to include one
  • Working memory – remembering what letters have already been written, and what comes next. See if your learner can recall the next letter without going back to letter A each time
  • Sequencing – will your learner do the letters in order?  Will they go in a haphazard pattern all over the page?  
  • Bilateral coordination – remembering to use their “helper hand” to hold the paper while writing.  Using one hand for a dominant hand instead of switching back and forth is encouraged once a child is in grade school or demonstrates a significant strength in one or the other.
  • Strength – core strength, shoulder and wrist stability, head control, balance, and hand strength are all needed for upright sitting posture and writing tasks.
  • Executive function skills – attention, frustration tolerance, task completion and initiation, self regulation, working independently

To learn more about executive function, type this into the search bar on the OT Toolbox to see dozens of posts on this topic.  Here is a general post on executive function by Colleen Beck, owner of the OT Toolbox:

snowball letters, Winter Letter SNowballs- snowball letters, alphabet worksheets pdf, snowball alphabet worksheet


There are many other ways to adapt or grade the snowball alphabet sheet:

  • Laminate the page for using markers and wipes. This can be useful for reusability, as well as the enjoyment markers bring.
  • Place craft pom poms or mini erasers on the letters.
  • Cut out the snowballs and use them to match letters.
  • Use the snowballs for letter BINGO. Call out letters and ask kids to find the letter in the alphabet.
  • Call out a letter and have a student place a mini eraser or marker on the letter. Then they can form the letter onto paper or onto the blank snowballs.
  • Different colored paper may make it more or less challenging for your learner
  • Enlarging the font may be necessary to beginning handwriting students who need bigger space to write.
  • Create another page with all of the alphabet letters for copying or reference
  • Have students cut out letters from another page and glue to the snowballs – this adds a cutting and gluing element
  • Velcro the back of the snowballs, after laminating and cutting it, to create a matching game
  • Make changes to the type of writing utensil, paper used, or level of difficulty
  • Have students write on a slant board, lying prone on the floor with the page in front to build shoulder stability, or supine with the page taped under the table
  • Project this page onto a smart board for students to come to the board and write in big letters.
  • More or less prompting may be needed to grade e activity to make it easier or harder
  • Make this part of a larger lesson plan including gross motor, sensory, social, executive function, or other fine motor skills

How to document this activity:

  • First determine what goals and skills you are addressing. Are you looking strictly at letter formation, tracing, and alphabet recall?  Or something else entirely such as executive function and behavior?
  • Focus your observations on the skills you are addressing.  It is alright to address one or ten skills at once, just be sure to watch for those skills during the activity.  This can take practice to watch everything all at once. Newer clinicians often videotape sessions to go back and review clinical observations they may have missed.
  • Use data to back up your documentation. Avoid or limit phrases such as min assist, fair, good, some, many, etc.  They are vague and do not contain the numbers and data critical to proficient documentation.  Instead use percentages, number of trials, number of errors, exact sizing, how many letters were written incorrectly, number of reversals, number of prompts, minutes of attention.  You get the idea.
  • This type of documentation may feel foreign at first if this is not what you are used to, however insurance and governing agencies are becoming more strict on accurate documentation.

In addition to this great winter snowballs alphabet PDF worksheet, the OT Toolbox has entire winter themed lesson plans available as well as a Snowman Lesson Plan Kit that covers all aspects of therapy sessions.

These winter printables, including this Snowball Alphabet Worksheet will be highlighted all month long to help create amazing therapy sessions.  I have to say I am kind of excited about the snowball making contraption for those of you who live in the frozen north.  


Want to grab a copy of this Snowball Alphabet Worksheet PDF for your therapy toolbox? Enter your email address into the form below and the PDF will be delivered to your inbox. OT Toolbox Member’s Club members can access this writing practice sheet along with many others with one click to download, inside the dashboard.


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    I’d rather throw sand than snowballs any day!

    Victoria Wood, OTR/L

    Victoria Wood

    Victoria Wood, OTR/L 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.

    Snowman Therapy Activity Kit

    Click here to read more about the Snowman Therapy Kit and to grab your copy while it’s on sale.

    Snow globe Alphabet Puzzle Cards

    snow globe printable for letter matching

    Here, you can access a set of free snow globe alphabet puzzle cards. These upper and lower case puzzle cards use printable snow globe puzzles for matching upper and lowercase letters. It’s a fun winter therapy activity that develops many skill areas. Let’s take a look!

    This free snow globe printable is a hands-on, multisensory strategy to teach upper and lowercase letter matching. Use the snow globe letter match task in many ways in occupational therapy.

    Snow Globe Letter Match

    Get ready to have some Snow Globe Letter Fun with these snow globe printables.

    Winter is upon us.  For many, this is a wonderful time full of sledding, ice skating, hot cocoa, bonfires, icicles, and snow.  If you live in the cold areas of the globe, winter can be magical.  I am a summer type myself, so winter and cold are not my favorite words.  If I could live in the Bahamas year-round, I would.   Unfortunately, being a popsicle saleswoman does not pay enough.

    However, for those who love winter, the cold, and outdoor sports, this is your time! I grew up skating on frozen ponds listening for the crack sound before darting off the ice. We survived the blizzard of 1977 with snow piles as high as the roof.

    For me I can get my winter fix on just one blustery day, or by staring into a snow globe! 

    Snow globe Activity

    Creating a fun winter treatment plan is a good way to pass those long blustery days stuck inside. This week center a lesson around snow globes.  You can research snow globes, talk about collectors, go broad and discuss winter, then start your activity session on snow globes.

    Add this free snow globe breath awareness strategy as a deep breathing or self-regulation tool. Kids will love this whole snow globe theme!

    Then, print off the snow globe printable at the bottom of this blog post and use it to work on letter identification, visual discrimination, and handwriting skills, and letter formation.

    Snow Globe Facts

    Writing this blog post led to finding a few fun facts about snow globes. Use these in your therapy sessions, classroom, or home to work on handwriting skills.

    1. Snow globes are a glimpse of winter one can view from the comfort of the beach.  Collectors have shelves lined with snow globes they have gathered from around the world.

    2. If you want to bring back a globe from vacation, you will have to pack it in a checked bag.  No liquids over a couple of ounces in a carry-on bag.  I wonder how many awesome snow globes are sitting at security every day after being confiscated from lovely travelers.

    3. The Queen of Snow Globes has an entire website dedicated to snow globes.

    4. Andy Zito holds the world record collection of globes and domes, a whopping 11,500!

    5. You can read about the history of snow globes. The first known snow globe was reportedly created from an idea to make a brighter surgical instrument.

    Snow Globe Letter match

    If you are looking for printables and snow globe ideas, The OT Toolbox has you covered!  A good place to get started is the Snow Globe Printable Upper- and Lower-Case PDF Printable Puzzle Cards.

    This is a cute set of snowglobe worksheets that include the entire alphabet. It uses a winter theme to address goals related to matching upper- and lower-case letters.  Use this as a jumping off point to work on letter recognition, matching letters, and scanning goals. 

    There are many ways to use this activity, but the most efficient would be to color in these cards, then laminate them. 

    •  Make this activity easier for learners by coordinating colors on sides that go together, or more challenging by leaving them blank. 
    •  If leaving them uncolored, how about printing them on fun colored paper to help with the less motivated learners?
    • During the entire first week, have all of your learners color a page, then laminate the whole bunch.  Now each student will have had a hand in this reusable activity, that can be repurposed each year.
    • Enlarge these pages to make a great floor puzzle!
    • Project these pages onto a smart board for an interactive game dragging the pieces around the board. I am not a huge fan of technology; however, I like to provide these options for people who are.

    The term “jumping off” was used above in reference to this worksheet.  This does not need to be the complete lesson on snow globes OR handwriting. There is a continuum to learning anything.  For handwriting it might start with recognizing letters, move to matching letters or matching upper- and lower-case letters, progress to copying letters, then finally to writing them from memory.

    Start where your learner is currently functioning, then move forward. Often it is wise to start at one stage earlier than the current level, so the learner can have a sense of mastery, before moving onto a more difficult challenge.

    Have you ever noticed how many of your older learners gravitate toward “baby toys” or easy puzzles? This is because they have mastered them, and that sense of accomplishment, no matter how small, bolsters their spirit. Avoid getting stuck at this stage, but allow it at times, especially for your more reluctant learners.

    The OT Toolbox can fill your treatment plan with great ideas, not just worksheets. Look at this post on winter fun activities. Adding our snow globe puzzle cards to a winter theme would be a great way to incorporate various skill areas.

    In previous posts such as the Winter Fun Clothes Number Trace Worksheet, several goals were outlined beyond the most obvious.  Check out that post to get an idea of the goals that can be addressed using just one work page such as this Snow Globe Upper- and Lower-Case Letter Matching PDF.

    Free Snow globe Printable

    Want to add this snow globe letter match to your therapy toolbox? Enter your email address below to access a PDF for matching upper and lowercase letters. This alphabet puzzle card set is also available in The OT Toolbox Member’s Club so members can access it there without entering your email address.

    Snow Globe Uppercase and Lowercase Letter Match

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      Enjoy your winter season full of sledding, ice skating, snowball fights, and building snowmen, while I just stare into my snow globe, lounging by the beach.  Just kidding, I do not actually live in the Bahamas yet, but I will be spending one glorious week in the Caribbean getting away from old man winter!

      Stay warm folks!

      Victoria Wood, OTR/L

      Victoria Wood

      Victoria Wood, OTR/L 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.

      *The term, “learner” is used throughout this post for readability, however this information is relevant for students, patients, clients, children of all ages, etc. The term “they” is used instead of he/she to be inclusive.

      Winter Number Tracing Worksheet

      winter clothes number tracing worksheet

      When it comes to managing the long winter with activities, this winter number tracing worksheet has you covered. Use the winter clothes worksheet to talk with kids about winter clothing AND work on number formation. It’s a winter clothing printable that you’ll want to add to your therapy toolbox!

      This free winter number tracing worksheet is a winter clothes activity for kids that helps with motor planning of number formation using a winter clothing printable.

      Free Winter Number Tracing Worksheet

      This winter clothing number tracing worksheet is similar to our recent Christmas lights number tracing printable.

      Winter means different things for different people depending on their climate. Winter in the southern United States means adding a sweatshirt, possibly a hat at the bus stop early in the morning.  In the northern states winter is a different story.  Up north, winter starts in mid- September and seems to last until May.  I have northern roots but am a southern girl by heart. 

      Winter months in cold areas of the world mean bundling up and adding clothes.  Mittens, hats, coats, snow pants, boots, gloves, earmuffs, thick socks, long johns, and lots of layers are the customary daily garb.  Imagine trying to put this on and off a toddler each time you head out!  As soon as you get your child decked out in all these layers, they usually announce the need to go to the toilet!  It never fails.

      Since bundling up is a daily chore in the frozen north, why not add it to your treatment plan? The Warm Winter Clothes Number Trace Worksheet is a cute printable to build essential skills while using meaningful, relevant content.

      Tracing Numbers Worksheets

      Let’s talk tracing so you can use it to the maximum benefit and its intended purpose. 

      I am not a fan of tracing unless it is used correctly, or the objective is understood. Here is information on the benefits of tracing

      • Tracing is not going to teach number/letter formation if the learner does not know what those figures are.  To a learner who does not know these symbols, they will be tracing lines, not numbers or letters
      • Know your audience. If your learner does not know the letters or numbers, use the activity as a fine motor task to develop dexterity
      • Kinesthetic awareness.  This long word means to learn by doing.  Theoretically if a person writes the number 5 enough times, the body will start to recognize this pattern and commit it to memory.  This only works if the learner understands what is being traced. Using our sandpaper writing trick is one great way to incorporate kinesthetic awareness into number tracing and number formation.
      • Tracing for dexterity. This is the type of tracing I like best.  Tracing for dexterity works on staying on the lines, fine motor control, building hand muscles, scanning and a whole host of other important skills as defined below

      Winter Clothes Worksheet

      While worksheets are not a favorite among occupational therapists, there are ways to support skill areas by using worksheets to meet the needs of kids. When we address the underlying skill areas to support function, printables like this winter clothes worksheet can address a variety of areas.

      What does this winter number tracing worksheet work on besides tracing?

      1.  Kinesthetic awareness – This means learning by doing.
      2.  Hand strength and dexterity – staying on the lines builds hand muscles and develops muscle control. Check out the In Hand Manipulation Printable Worksheet to incorporate developing the intrinsic hand muscles.
      3. Visual motor skills –Combining what is seen visually and what is written motorically.  This takes coordination to be able to translate information from visual input to motor output. Coloring, drawing, counting, cutting, and tracing are some visual motor skills.
      4.  Visual Perception – Developing figure ground to see where one item start and finishes, scanning to find all answers, and visual closure to understand that dotted lines will create something.
      5. Strength – Core strength needed for sitting, shoulder/elbow/wrist stability, finger strength, and head control all play their role in writing.
      6. Bilateral Coordination – Be sure your learner uses their helper hand for stabilizing the paper while using their dominant hand for writing.
      7. Counting/Learning Numbers – Count the items to understand number concepts in addition to tracing them.
      8. Social/Executive Function – Following directions, turn taking, task completion, orienting to details, neatness, multi-tasking, attending to task, and impulse control can be addressed using this Warm Winter Clothing Printable PDF.

      When using a task such as this number tracing worksheet, therapists can utilize and focus on all the above skills or just one or two.  There are times when I am working more on executive function than fine motor skills but will use this task with more of my focus on these executive function skills.  My note might not say much about their number formation, counting skills, or neatness, but how well they were able to attend to the task, complete the task, follow directions, and control their impulses.

      Winter Clothing Printable

      There are so many ways to use this winter clothing printable to work on number tracing, and more.

      How do I incorporate or modify this task for the needs of all my learners?

      Lots of ways!  As always, this sheet can be laminated for reusability or marker use, printed on different colored paper for readability, enlarged or made smaller, made simpler or more complex. Try having learners color the shapes and write the numbers independently on the back to add more visual motor tasks to this winter clothes worksheet.

      This covers one day of winter, what about the other 240?

      Glad you asked!  The OT Toolbox is stuffed with activities, blog posts and work pages to fill those winter days. The Winter Fine Motor Kit full of handouts and PDF files provides several visual motor tasks to be used throughout the winter season.

      Plus, in The OT Toolbox Members Club, you’ll find winter clothing printables and resources to address a variety of needs.

      In addition to these handouts, you can also read this article on Winter Fine Motor Activities for more great ideas and suggestions:

      Winter is a very long season. Especially if you are not a fan of the cold weather (author raises hand).  Adding fun activities and games can take some of the monotony and sting out of the long cold days. 

      Brrrrrr, bundle up!


      Want to access this printable number tracing worksheet? Enter your email address into the form below. You can also find this winter clothing printable in The OT Toolbox Member’s Club.

      Winter Clothing Number Tracing Worksheet

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        Victoria Wood

        Victoria Wood, OTR/L 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.

        Watch for more winter clothes worksheets and winter printables coming to this space.

        Hanukkah Word Scramble

        We’ve been sharing a lot of holiday printable activities lately, and this Hanukkah word scramble is one more! Winter holiday season is upon us!  Whether you celebrate Hanukkah, Christmas, Kwanzaa,  Winter Solstice, or something else entirely, this is a joyous time for many. It should not matter what you celebrate, learning the history, traditions, and meaning of these events should be at the center of the lessons. Kids can unscramble the Haunukkah words and work on visual perceptual skills and handwriting.

        This free Hanukkah word scramble is a Hanukkah activity sheet for the holidays.

        Hanukkah Word Scramble

        In order to be interesting and motivating to young learners, fun worksheets can be incorporated into lesson plans.  These not only provide a relevant lesson plan during the holiday season, but can incorporate many important goals and objectives in one single task.  This is most important, as therapy sessions are often limited or short, as well as the attention span of young learners.  Therapy sessions in school can be as short as 15 minutes, just enough time for a warm up activity and a fun worksheet such as the Hanukkah activity sheet with scrambled words.

        This Hanukkah activity sheet which involves matching Hanukkah words, is an excellent idea!

        Let’s explore the many different goals and skills that can be addressed using the Hanukkah word match:

        1.  Letter formation – the worksheet has lines for correct letter formation
        2. Sizing and spacing of letters to fit in the provided boxes
        3.  Copying from a model
        4.  Decoding to use strategies to determine how many letters in each word and the size of the corresponding boxes
        5. Bilateral coordination using one hand to write and the other to hold the paper
        6.  Visual perception – being able to visualize the words once they are scrambled
        7. Social skills – working on frustration tolerance, attention to details, and following  directions
        8. Fine motor skills – building hand muscles through writing

        Ways to adapt and change this activity:

        •  Laminate this page to use wipe off markers as a different medium as well as reusability. Note: some children love wipe off sheets, while others become upset that they can not take their work with them.
        •  Put this activity on the smart board to make it a group task or invite students to come to the board and write.
        •  Make space to draw the items on the page to work on visual motor skills.
        • Work in pairs or in a small group to address problem solving, turn taking, and negotiation skills.

        Many times, it seems Hanukkah takes a back seat to Christmas based on the number of participants or popularity. This special traditional celebration can be incorporated into an inclusive lesson plan that includes many holidays, or as a stand-alone unit for learners celebrating Hanukkah.  This is a great opportunity for anyone to learn about different cultures and traditions no matter what is celebrated.

        What is Hanukkah?

        Check out this article about what Hanukkah is. This is a great tool to add to your lesson plan about holidays.

        Holidays like Hanukkah can be exciting and fun to incorporate into treatment sessions. Be mindful that too much of a good thing is not so good after all.  Scatter fun holiday activities into regular tasks to help students modulate their arousal level and stay on task during these busy times.  Holidays can be a lot of fun but can also cause stress for many.  There are added responsibilities, money woes, social stressors, increased expectations, and changes in schedules that can set adults and children off of their routine.

        Turn your holiday stress into a teachable moment

        One article outlines how to turn your holiday stress into a teachable moment. Don’t let stress get the best of you and turn a great time into a mess.

        More Holiday Activity Sheets

        The time leading up to the holidays between Thanksgiving and these winter celebrations can last two to three weeks.  In order to feel well prepared for this season, having several activities planned ahead of time will ease stressful planning or running out of meaningful activities.  The OT Toolbox offers the Winter Fine Motor Kit full of handouts and PDF files providing several visual motor tasks to be used throughout the winter season.

        In addition to these handouts, you can also read this article on Winter Fine Motor Activities for more great ideas and suggestions:

        For me, the most difficult part of therapy sessions is trying to plan them and come up with novel ideas that are going to be appealing to all my different levels of learners.  Once I have several sessions planned for the week, the time flies by and sessions go much smoother.  I am able to adapt each task to meet the needs of most of my different learners.  Take this opportunity to streamline your sessions by downloading activities and ideas from the OT Toolbox today.

        Free Hanukkah Word Scramble Activity Sheet

        FREE Hanukkah Word Scramble Activity Sheet

          We respect your privacy. Unsubscribe at anytime.

          Happy Holidays!

          Victoria Wood, OTR/L

          Victoria Wood

          Victoria Wood, OTR/L 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.

          *The term, “learner” is used throughout this post for readability, however this information is relevant for students, patients, clients, children of all ages, etc. The term “they” is used instead of he/she to be inclusive.

          P and Q Reversals

          Letter p and q reversal tips and tricks

          In this article, we’re discussing p and q reversals. Writing letters backwards can mean a letter p is mistaken for letter q, and in functional reading and writing, letter reversals can mean errors and lower confidence in kids. Let’s take a look at some strategies occupational therapy professionals use to work on letter p and q confusion.

          Tricks for p and q reversals and tips to fix these commonly reversed letters.

          Letter P and Q Reversals

          I’m going to start by saying there really is no magical cure for children who reverse or invert their letters. I wish there were as that would ease a lot of the frustration a child must endure and alleviate the extra effort a child must exert to get to the end game of reading and writing letters and numbers accurately.

          However, there are a few tips and tricks that might help a child as they go through the learning process whether you are addressing this issue in the classroom, in therapy sessions, or during at-home learning.

          We’ve talked about Results with Multi-Sensory Strategies for B and D Reversals, let’s now talk about other frequent letter reversals that are common for children – letters ‘p’ and ‘q’. These letters look just as similar to one another like ‘b’ and ‘d’, which really makes it confusing for kids.

          Mind your P’s and Q’s

          Take a look at this image that gives a nice visual perspective of what b, d, p, and q might look like to a kiddo as a chair is still a chair. Working through this confusion can be tricky, but there are a few good tips and strategies that might help lessen the frustration and thus build a simple learning avenue as children work through and master the formation of these two letters.

          Understanding Left and Right Directionality

          First of all, we must begin by ensuring the child understands left and right directionality on their own bodies and has progressed to analyzing objects, symbols, letters and numbers. You should also check to see if they can identify the left and right sides of the paper as a precursor to emphasizing letter directionality. 

          Teach Letters in groups

          Next, teach letters in identified groups so as to make the teaching of the letter forms easier and more simplistic thus making it less difficult for a child to reverse or invert letters. Letter order and multi-sensory teaching of letter formations is focused on in the Learning without Tears™ curriculum and First Strokes™ curriculum, both of which were developed by an occupational therapist.

          In the Learning without Tears curriculum, the letter ‘p’ is a diver letter and the letter ‘q’ is a “magic c” letter therefore they are taught at different times. 

          hand dominance and letter reversal

          Next, look at the child’s hand dominance patterning. Hand dominance can play a part in letter reversals in written expression.

          Do they have a solid left- or right-hand dominance? If not, here are a few hand dominance activities that might help.

          Do they demonstrate a cross or mixed dominance? If so, this could serve as an issue when learning letter formation strokes. Check to see if this is the case with the children you see. 

          Cues for P & Q reversal

          Lastly, look at how you are verbally and physically guiding that child to form letters based on their hand dominance. If you are right-handed and they are left-handed, you need to be keen to knowing how to describe the letter formation patterns that are relevant to their hand dominance.

          Why? If a child is left-handed and forming the letter ‘p’, they will stroke downward from top to bottom (if they were taught correctly), frog jump to the top, and then push their pencil outward to the right followed by curving around and pulling back inward to the downward stroke.

          If a child is right-handed and forming the same letter, they will stroke downward from top to bottom, frog jump to the top, and then push their pencil outward to the right and then curve around pushing their pencil inward to the downward stroke. 

          How to Fix P and Q Reversals

          Now three quick reminders for teaching remediation:

          • Address only one letter at a time and ensure the child has a full understanding of that letter before moving to the next letter. 
          • When using visual aids, consider the hand dominance of a child whether it be in actual hands-on learning or how you are verbally describing the formation. Also, consider this when you explain how to identify and recognize the letters.
          • Be understanding to the way a child might need to form a letter to recall the correct formation patterning as some left-handed children must form the letters more segmentally to keep on track, but they can still keep the same pace as their right-handed peers. 

          Multisensory Activities for P and Q reversals

          Here is a list of fun tips for teaching the difference between targeted letters of ‘p’ and ‘q’ that might help some of the kiddos you know. If one tip or strategy doesn’t work, that’s o.k., try another. Multi-sensory strategies can always aid a child in learning letter and number formations and will further encourage the use of visual memory and kinesthetic or muscle memory. 

          1. Create glitter glue or pipe cleaner stick ‘p’ and ‘q’ letters on index cards to finger trace with eyes open and then upgrade to doing so with eyes closed. 
          2. Create ‘p’ and ‘q’ rubbing plates with the use of dried bottle glue letters on index cards.
          3. Create large ‘p’ and ‘q’ letters on the floor using painter’s or masking tape and have the child walk or pull themselves on a scooter board to go over the lines. Bump up this skill to include walking or driving on the lines with their eyes closed thus working on kinesthetic memory.
          4. Create sandpaper ‘p’ and ‘q’ letters on index cards to finger trace.
          5. Have child draw the letters in the air with whole arm movements and a pointer finger while verbalizing the stroke patterning otherwise known as air writing. Do this with eyes open and closed. Shift to doing so with elbow resting on table-top and using their wrist and pointer finger to form the letters in the air. 
          6. Have child form letters on foam sheets in a repetitive fashion to further build motor memory. 
          7. Have child form the letter ‘p’ with pipe cleaner pieces and the letter ‘q’ with q-tips as the name of these materials begin with ‘p’ and ‘q’.
          Help kids with p and q reversals with q-tips and pipe cleaners
          1. Place letter models underneath screen or plastic canvas material for the child to trace over with their finger. Upgrade to have the child form letters on these materials with their eyes closed. 
          2. Use letter play dough mats to form the letters and then use a golf tee or small pieces of straw to make dots (holes) on the letter lines to correctly form the letters.
          3. With the lights dimmed or turned off, have the child either trace over a large ‘p’ or ‘q’ wall letter using a flashlight or a laser light. An alternative would be to have the child roll a ball on the tape letter using correct formation. Try the use of a weighted ball to provide more muscle input while forming the letters. 
          4. Write the letters ‘p’ and ‘q’ on 8 ½” x 11” paper, then have the child use ink stamps to stamp trace over the lines.
          5. Make the letters using craft sticks and play dough curved lines to create the letters using different colors to represent to the different letter lines. 
          Correct p and q reversals with play dough and popsicle sticks
          1. Form letters in a sand tray, shaving cream tray, sprinkles tray, finger paint tray, or rice tray. 
          2. Draw letters on the back of the child’s hand while their eyes are closed or on their backs and have the child guess the letter that was formed.
          3. With straight lines drawn on paper, have the child place a circular dot sticker on the side of the line that represents the letter you call out such as b, d, p, or q. An alternative would be to have the child draw the curve on the side of the line for the letter being called out.
          4. Play tic-tac-toe with the ‘p’ or ‘q’ letter that they are working on learning. 
          5. Create small straight lines on paper using pretzel sticks and have the child place a circular food item such as M & M’s, Skittles, Froot Loops, or Cheerios to create the letter they are working on or that you call out. To check their own work, they compare a correctly formed letter model and compare to the ones that they created. If they are right, they get to eat the food items they placed to form the letter accurately.

          Visual Cues for Fixing P and Q Reversals

          Visual strategies can assist a child with the learning process if using visual means is an avenue that provides a good outcome for the child. Some children learn best with this system, while others use it more as a supplement to support their learning.

          In this list you will find a variety of ideas using the visual system and have access to a few free visuals that might trigger the ‘just right’ clue a child needs to identify and form the letter they need. They are created with the adult and the child in mind as they include wall posters and quick reference cards that are small enough to post on a desk-top or in a notebook. 

          These activities could be separated into letter p activities and Letter q activities as well. Use them in isolation when working on individual letter formation.

          1. Thumbs-down images to self as a ‘p’ and ‘q’ visual depiction.
          2. Palms to self with fingers pointing down and thumbs pointing outward with the space between the thumb and the fingers serving as ‘p’ and ‘q’ representation.
          3. Form circles with the fingers (such as looking through binoculars) with forearms pointing down and inward toward torso providing a visual representation of ‘p’ and ‘q’. 
          4. Create a mask that looks like eyeglasses which is made using paper letters of ‘p’ and ‘q’. 
          5. A bed image with the letters ‘p’ and ‘q’ being the bed frame in two ways: 1) being legs of the bed and 2) use of the words ‘peace’ and ‘quiet’ because the story goes, “With sleep comes peace and quiet”.
          6. Picture of a prince and queen facing each other with emphasis placed on the heads being the curved lines and the bodies serving as the straight lines and then the train of the queen’s dress could further represent a tail on the letter ‘q’, if desired. 
          7. Simple visual and verbalization that ‘p’ sees or looks at ‘q’. 
          8. Use different colors to form the letters such as a green straight line and a red curved line for ‘p’ and then different colors for ‘q’ such as a blue straight line and a yellow curved line. The different colors can be more easily recalled by some child rather than using the same colors for each letter. On the other hand, some children can do well with the same colors being used. It may take some exploration on your behalf as the instructor. 

          As you review and explore all of the multi-sensory strategies and visual supports in this post to give a child what they may need to master ‘p’ and ‘q’ letter formation, take the time to also consider the basic elements that might be impacting letter reversals as these are important foundational factors to fully understand and consider.

          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!

          Instant Results With Multi Sensory Strategies For B And D Reversals

          b and d reversals

          A common challenge for many children is letter b and d reversals. When kids first learn to write, is is very common for them to reverse letter b and d. Here, we are talking specific multisensory strategies to address reversal of these tricky letters.

          Letter b and d reversals and multisensory strategies for teaching letter reversals.

          b and d reversals

          Letter b-d reversals are very common among children. We see these letters interchanged in reading, in writing, in isolation, and in words or sentences that contain both letters. But why are the letters b and d reversed so often?

          Oh, those dreaded letter reversals and the need to change them, what to do, what to do, what to do.

          Why are b and d reversals so common?

          These two letters are the most commonly reversed letters, and it can even be a normal part of development.

          It’s important to know that it is common for young children such as preschoolers and kindergartens to reverse some letters.  However, by age seven and at the latest age 8, children should be infrequently or not reversing letters at all. If they are doing it frequently and with little success despite remediation, you should consider testing to determine if there are other issues that need to be addressed first. 

          If b and d letter reversal is an issue for a student consistently above the age of 8, a visual processing problem, or dyspraxia, dysgraphia or dyslexia may be present, impacting letter confusion in written work or reading.

          How to Correct b and d letter reversals

          Let’s go over various ways to help young learners by correcting letter b and letter d reversals. 

          Children need to always be taught HOW to form letters, not given worksheets to trace and left to figure it out on their own as this just leads to them piecing letters together with no instruction in proper sequence or stroke direction.  

          This is a PROBLEM! 

          Lowercase b is formed from the top down with a vertical line. Then the round part of the letter is formed. Kids typically get that process. 

          But then, lowercase d is introduced. Sometimes, children also form letter d from the top, down, by starting at the top of the line. They make the vertical line down because that motor plan is established. Then, they need to add the curved portion of lower case d and they have confusion about which way to go. That’s when you see a letter reversal. 

          Part of the issue with common letter reversals like the b/d issue is that the motor plan for each letter isn’t established fully. This occurs in young children as they begin writing and learning correct letter formation. 

          Another issue is that letters are not formed correctly (starting letter d at the top rather than forming the “c” part of the letter first. You can get a better understanding of letter formation in our blog post on how to teach letters and the order of letter formation.

          Children need to be TAUGHT from the beginning how to form each letter with the correct start point, sequence, and stroke directionality. Repeated errors in formation only further reinforce reversals and leads to more difficulty with repairing them down the road.  Don’t allow repeated formation errors, but do seek to work toward good habits in formation.  

          Multi-sensory strategies for b and d  Reversals

          But if you need ideas to assist a child in repairing learned reversal behaviors, take a look at this varied list of ideas and pick what you think will work best for your children. 

          Some intervention strategies will work better for one child while other strategies will work better for another, so always use the one that works best for each child.

          Choose a multi-sensory activity and work on letter recognition as well as formation using visual cues, verbal cues (auditory cues), and kinesthetic input to practice lower case b and lower case d in isolation as well as together.

          • Ensure a child first has solid left and right discrimination on themselves, others, and in space. Incorporate visual spatial relations with movement. Understand that spatial awareness impacts handwriting in many ways. Letter reversals are just one aspect.
          • Teach letters in groups. For example, teach the letter that have similar stroke patterns.  Take a look at how the Learning without Tears™ program does this. For example, they call the first group the “magic ‘c’ letters” this includes: ‘c’, ‘a’, ‘d’, ‘g’, ‘o’, and ‘q’. They all begin with a letter ‘c’ stroke. Then they have a group called the “diver letters” and this group includes: ‘b’, ‘h’, ‘r’, ‘n’, ‘m’, and ‘p’. They all begin with a line down and then swim up and over strokes. Using this approach coupled with the visuals provided helps a child to build a better mental image of some commonly reversed letters. 
          • Connect a frequently reversed letter to another letter of the alphabet that is similarly formed and that the child never reverses, like letter c. Lower case c can be connected to lower case d in formation.
          • Use your finger and form the letter on a child’s back. Have the child guess what letter it is. Follow with having the child air write the letter. End with the child writing the letter on paper. You can place a textured material under the paper such as sandpaper, plastic canvas, window screen material, etc.
          • Create textured letter cards for letter d and letter b. Have child finger trace over the letter forming with correct sequence and directionality. Have them try to do so with their eyes closed and then their eyes open. This builds the motor plan and muscle memory of each letter for the child. 
          • Use the Handwriting without Tears materials to include a small chalkboard with boundaries and have child begin forming letters under the smiley face located in the top left corner. 
          • Mark all of the p’s and b’s red to show that the loop is formed on right (both red and right start with the letter ‘r’) and then mark all of the q’s and d’s green to show that the loop is formed on the left. 
          • Develop consistent use of left and right direction using a variety of media and intervention activities. 
          • Have child first trace a really large letter on the board, form the letter independently, write the letter with eyes closed, and write the letter with eyes open. This increases interest and provides increased feedback. 
          • If a child reverses multiple letters such as: b/d, m/w, p/q, u/n then be sure to address one discrimination at a time. Be sure one set is solid before moving to the next. Note: Be sure to over-teach one letter in each set before addressing the next letter in the set.
          • Use multisensory materials to teach letter formations such as play dough, shaving cream, wikki sticks, puffy paint, hair gel, glitter glue, rice, sand, and yarn.  Be sure the child associates letter forms with the actual letter name so as they form the letter have them state the letter name. 

          Cognitive Cues to addressing b and d reversals

          Use cognitive cues to help a child distinguish letters such as:

          1. The lowercase letter ‘b’ is formed like the uppercase letter ‘B’, but without the top loop.
          2. The lowercase letter ‘d’ is formed with the lowercase letter ‘c’ first and the lowercase letter ‘c’ comes before the letter ‘d’ in the alphabet.
          3. The lowercase letter ‘d’ is formed with the lowercase letter ‘c’ and then add a line to form the letter ‘d’.
          4. The uppercase letter ‘E’ faces the number 3. 
          5. For letters ‘a’, ‘d’, ‘g’, and ‘q’ and the number 9, cue the child to use “c up down” as the method to form these letters and this number. 
          6. Use the b e d image. Show children how the b starts the word bed and d ends the word bed. This can be a positioning imagery that helps with adding a visual to correct reversals.
          7. Use the imagery of lowercase d having a diaper and lowercase b as a ball and bat. This can be confusing for some children as the images can be reversed, but for other children, these images can be motivating. After all diapers can be funny for some kids. Other kids are motivated by the sport of baseball. In this case, it’s about using what motivates the child.
          8. For the number 3, cue the child to use “around the tree, around the tree”.
          9. Consider ‘b’ and ‘d’ eyeglasses formed with fingers (like o.k. signs with final three fingers closed and standing up straight) or draw a ‘b’ and ‘d’ headboard and footboard of a bed as a fun visual cue. This is the order they come in the alphabet as well, ‘b’ before ‘d’. 
          10. Consider using a thumbs down sign on both hands to refer to the letters ‘p’ and ‘q’ as this is how they come in the alphabet, ‘p’ before ‘q’.

          Struggling readers may revers b and d when reading. And, studies have shown that children who made more errors in the letter writing task went on to become poorer readers.

          In this case, continue to work on the multisensory strategies listed above, but also use some of these tips during reading tasks:

          • Show the student how to make a letter b with their left hand by pointing their index finger up and making the round part of the letter with their closed fist. They can then use their right hand to make a lowercase letter d by pointing their pointer finger up and making the round part of the letter d with their closed fist. Then, when reading, show the reader how to use their left hand to point to letter b and to use their right hand to point to the lower case letter d’s. They can do this throughout the reading passage.
          • Encourage the reader to correct sounds when they read a letter incorrectly. Go back and re-read the word and feel the positioning of their lips and tongue as they say the word with the correct letter. Ask them to repeat the sound of letter b and the sound of letter d. This auditory practice will help to instill writing the letters correctly. It’s all about repetition and practice.

          How to correct b and d reversals

          If a child is still reversing letters after the age of 8, or continues to reverse letters no matter the visuals or tricks that you’ve tried, try some of these strategies listed below to correct letter confusion: 

          Offering visual cues can help!

          • Provide a model of frequently reversed letters on the desktop for the child to reference in the classroom.
          • Provide an index card with straight line down the middle and then write the letters on the card based on where the straight line is positioned within the letter. 

          For example:

            b d p q

          • Provide visual cue cards for the desktop that has pictures of fun reminders such as hands for a pair of eyeglasses or a bed for the letters ‘b’ and ‘d’ or a thumbs down sign with both hands for the letters ‘p’ and ‘q’. 

          Take your time to teach the formation of letters and numbers as well as using a multi-sensory approach when teaching the letters. It will always pay off in the end for the child!  

          letter reversal strategies Handout

          Want a free PDF of multi-sensory letter reversal strategies? Enter your email address into the form below to access this printable handout. Use it in your handwriting toolbox to help kids write b & d!

          Letter b and d Reversals Strategies

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            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!

            Letter Reversals

            Letter Reversals…they are a major cause for handwriting concern by most parent’s standards. Do letter reversals mean dyslexia? And dyslexia means problems learning to read 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. 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 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.

            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.

            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 Post by Kaylee Goodrich, OTR: Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all!

            Letter Formation Handout

            Letter formation handout

            This blog post is DAY 1 in our Free Handwriting Handouts series. Here, you’ll find all of the information you need to educate others on letter formation. To access the free printable letter formation handout (and all of the other handwriting handouts in this series), be sure to sign up for the Occupational Therapy Handwriting Handouts where you will receive tons of resources and information related to occupational therapy handwriting interventions and handwriting instruction for helping children write legibly.

            letter formation handout for helping kids with handwriting skills

            You’ll also find many resources and writing strategies related to writing letters accurately and legibly on our letter formation resource page.

            Letter Formation Handout

            Letter formation can be a great challenge for children of all ages. Beginning with pre-writing strokes, preschoolers

            Sometimes, when teaching kids how to make letters, it is helpful to add creative and different methods to the good old fashioned, paper and pencil letter making practice. Here are some creative ways to work on letter formation using the senses:
            Foam Strip Letter Formation
            Letter Formation Resistive Surface
            Sensory Letter Formation

            You can find all of our handwriting posts here.

            Now, let’s move onto the details on letter formation. We’re going to cover a few concepts: tracing letters, letter formation development,

            Tracing Letters

            Tracing has it’s time and place. And like all things (especially chocolate chip cookies in my case), moderation is key.

            Tracing letters is not an ideal format for teaching letter formation and here’s why: When children trace letters, they can become overly focused on the immediate line strokes under their pencil. It’s harder to create a motor plan for the letter in it’s entirety.

            Also, tracing letters can set kids up for establishing a poor motor plan for letter formation. This is especially true if children are given a tracing worksheet with no cues or prompts to start letters at the top and to form letters in proper formation sequence. Often times, you’ll see children start letters at the bottom when tracing, or segmentally, jumping from piece to piece of the letter. This can be a recipe for disaster!

            However, practicing letter tracing can be a good activity, too.

            Tips for Tracing letters

            When the child is tracing the letters over and over again, they become more efficient at planning out and executing the movements needed to make a letter accurately. This activity is great for a new writer because they are given a confined space to practice a letter, visual cues, and verbal prompts.

            To make the most of tracing, be sure to ensure the child is tracing letters correctly. You’ll want to watch for a few things and show the child the correct way to trace if they are forming the letter incorrectly.

            • Make sure they trace starting at the top
            • Make sure the child retraces lines when appropriate
            • Make sure they form the letter in correct sequence (don’t picking their pencil up to trace the last part of the letter first, for example)

            Tracing Letter Strategies

            Some ways to effectively use tracing as a method for working on letter formation:

            1. Write the letter in highlighted lines and ask the child to trace in a different colored marker to get a color-changing effect. This marker rainbow writing activity is one great example.
            2. Use a tracing font that has numbers and arrows so kids know where to start and how to sequence the letter formation. These A-Z letter formation worksheets are a great resource for teaching letter formation of upper case and lower case letters segmentally to establish a motor plan. They are great for sensory handwriting techniques, too.
            3. Use this letter construction method to work on forming letters correctly.

            Letter formation development

            So often, handwriting is impacted by fine motor development and resulting endurance, strength, and therefore pencil grasp. Read here about fine motor skills.

            Try this quick tip to address fine motor skills:

            • Provide tons of opportunities that open up the thumb web space. Many times, children with poor handwriting have their thumb squashed up against the pencil, the pointer finger wrapped around the pencil, or the thumb wrapped or tucked against the pencil.
            • Try to encourage your student or child to open up the space around the pencil. Read more about an open thumb web space and find a lot of creative activities to address this need HERE.
            • Pencil grasp isn’t a make-or-break deal when it comes to letter formation. Read this resource on things an OT wants you to know about pencil grasp and handwriting.

            One final note: While functional handwriting is key, letters need to be formed in a manner that is readable and mostly accurate. By that I mean sometimes we need to follow the “beggars can’t be choosers” mindset. If a child is struggling with composing written work, building sentences, and putting their thoughts on paper, then a functional style of letter formation can be A-OK.

            Need more Handwriting Help? If you landed here and want in on the full Handwriting Handouts series (and access 6 free handwriting resources for legible written work, head to Handwriting Occupational Therapy Tips and Tricks to sign up.

            handwriting handouts

            Colleen Beck, OTR/L is an occupational therapist with 20 years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to