There are a number of developmental, cognitive and intellectual aberrations that may present with difficulties in learning capabilities and school performance. Healthcare providers suggest early identification and appropriate management or training can lead to absolutely normal or near normal development in children that does not interfere with personal, social and occupational aspects of life in adulthood.

Improper pencil grip is the leading cause of poor handwriting as a result of impaired motor skills. It has been observed that development of pencil grip and good hand-writing is an automatic reflex that develops during the early years of schooling; however, in some children this reflex is significantly impaired. There are a number of parameters that are used by educators and teachers to determine the hand-writing and pencil grip in school- aged children as young as 9 to 10 years. The parameters like use of appropriate spacing between letters and words, accuracy of letter formation, legibility, letter size uniformity, letter slant, and alignment of words on the sheet are used as important tool in the assessment of improper pencil grip in children.

Research conducted by Carter and Synolds suggested that the majority of the children with handwriting abnormalities develop symptoms of learning disabilities in coming years.

Colleen M. Schneck conducted a research study on 60 school-aged children to assess the handwriting skills in accordance with the pencil grip and identified that the children who presented with poor handwriting also performed poorly at pencil gripping test (drawing tasks) and also manifested symptoms of impaired proprioceptive-kinesthetic awareness (impaired hand preference and perception of pencil and paper and distance of pencil from paper).

Research conducted by Benbow suggests that the position of head and distance of the writing surface from eyes plays a very important role in the development of improper grip. He explained that if the actual cause is not identified at an early age, the chances are high that the developmental disabilities or learning deficits may go unnoticed or misdiagnosed, affecting the entire life of the child. Benbow coined the term somesthetic feedback that is a form of visual compensation as the distance between the eyes and writing surface is very little, leading to fatigued visual input.

Research conducted by Laszlo and Bairstow suggested that children are unable to master their writing skills and proprioceptive-kinesthetic ability (the response of joints to the movements performed by fingers) until at least 6 years of age; but various simple tasks can help in early determination of impaired writing skills. For example an inability to color within boundaries or the inability to build blocks suggests a sluggish proprioceptive-kinesthetic capacity.

Laszlo suggests that assessment of such children in second standard is very helpful in reaching to a diagnosis to establish if the child needs therapy or mere lifestyle modification is enough.

Occupational therapy is helpful in all such children as the trained therapists can identify and diagnose improper pencil grip reflex earlier than the healthcare providers and advise therapies for treatment.

Playing sports in which the palmar aspect of the hand is in upright position helps in improving the proprioception and kinetic stability. This can be achieved by promoting the participation of the child in sports that employ the use of racquet or paddles (table tennis or volleyball). Other helpful activities that help are encouraging children to play with pop bubble wrapper, playing jump-rope, encouraging children to wash cars, or clean tables using sponges (to allow development of palmar reflexes), string games and play-doh activities, yoga and exercises.

Most importantly, in order to ensure proper visual stimulation, occupational therapists also work with teachers and parents to establish the correct posture based on the height, weight and development of the child. Different children grow at different rates and therefore it is very important that the distance from the blackboard, posture of the child in the classroom, and posture of the child on the desk or chair should be observed closely in order to improve coordination, development of reflexes and posture stability. For best results the head and shoulder alignment of 30 degrees is needed, in the beginning, allow child to practice on paper with boxes (or graph paper) to teach proper spacing between the words, and allow the child to practice on writing models, with colored pages for visual stimulation.

Most children experience difficulties in taking notes from the board. This problem can be overcome by sitting closer to the board, decreasing the amount of text copying from the board and modification of assignments. To reduce visual fatigue, take small breaks from writing, perform visual exercises, perform yoga and hand exercises. In order to ensure proper grip, it is very important to know the type of pencil that is best for your grip. Use thin lined markers or mechanical pencils (in front of an occupational therapist so that the finger pattern and grip can be assessed).

It is interesting to see the development in the field of occupational therapy. Previously, pediatric occupational therapists worked only with the children with known history of autism, developmental delays or evident cognitive impairments; however, now pediatric occupational therapists work in schools, with child psychologists and in communities to assess, identify and improve mild to moderate disabilities and learning deficits at an early age in order to devise optimal treatment plans.