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May 16, 2018

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"The Pen Would Not Obey Him!" Anxiety and handwriting in students with high functioning autism.


The quote above from Uta Frith, a German developmental psychologist , struck me. In the time I have worked with high functioning students with autism, I found the academic task most avoided and angst provoking was handwriting. I recall student after student being referred to the special education schools I worked in as being “anxious” or even “afraid” of writing. I have seen my fair share of behavioral incidents revolving around teachers attempts to address what seems to be a counterintuitive problem because of the student's high IQ. One student would refuse to enter the classroom, any classroom, because it would inevitably involve picking up a pencil to write something. We would plead with the student to just give it a chance because we were certain the caring professionals and unique environment would soothe the child’s anxiety. The high functioning student with autism has the IQ, so why not the skill? They would get the concepts easily. There’s nothing to be afraid of or anxious about. Typically, our private discussions would turn toward the behavior of escape. "He's learned that he can escape doing the work because nobody has has held the line with him." This rarely turned out to be the case. 


Even though rapid gains in technology have revolutionized the way we think and teach, for many of us there is still an intuitive sense of the importance of handwriting. Indeed, much of the research notes that handwriting activates the brain in unique ways and is a vital part of language development, acquisition of social skills, comprehension and the organization of an individual’s thoughts. It has also been an indicator of future academic success. In school, the handwriting basics (spelling, punctuation, grammar, organizing) are taught in the elementary grades so that students can later engage in reading and core comprehension. If skills are not learned at this stage, or are learned and then, for a range of reasons, the student can no longer access the skills, the prognosis is not good. To exacerbate this, a recent study showed that lengthy portions of the school day are spent writing and, yet, the time spent teaching handwriting has decreased.  Unfortunately, the odds are stacked against high functioning ASD students.


Anxiety is Real

For all students, writing involves correction and feedback which, by definition, requires flexibility. In school, where significant portions of the day involve writing, student experience fatigue which compromises attention and focus.


Let’s add to this the impairments experienced by many students with autism. These include fine and gross motor function deficits, difficulty sensing themselves in space, hypervigilance, and an inability to perceive letter shapes.


If you add this all up, the need for flexibility to engage in the task over long and tiring portions of the day, with impairments to various functions required to engage in the task, you have the perfect equation for anxiety. Add again, the evidence indicating that students with high functioning autism have higher anxiety levels to begin with. Anxiety, then, impacts emotion, social and self-control skills, further compromising the child’s ability to cope.


Because anxiety can be considered an internal (private) operation, not easily defined by observable behavior, we often experience the “soda can effect.” A soda can that has been shaken appears on the outside to be just like every other can. But when you open it, it explodes.


By the time we experience the behavioral outcomes built into the writing task, we might see what appears to be an inexplicable set of behaviors that leaves even the best behavior analyst confounded. Thus, even creating an appropriate behavior plan can be elusive.



Giving students the means to identify their own anxiety should be a central focus. This can be done through a range of services with professionals in counseling, speech, and occupational therapy  that emphasize recognizing arousal states. Methods and tools like Zones of Regulation (teaching students to consider the intensity of their feelings) and teacher narration of possible symptoms, “I can see that your fists are clenched,” have been proven successful. In time, students will learn to identify the emotion they’re feeling, which is the first step in learning to regulate it.


Ensure that potential anxiety around writing is considered. Even though you may not be able to see it, sudden changes in behavior and ongoing outbursts can indicate that anxiety is at work. Provide behavior support plans that consider anxiety and the coping strategies necessary to reduce or prevent anxiety.


Utilize the services of the occupational therapist to support the student with handwriting targeting motor skills and coping strategies as well as to provide the teacher with tools for instruction.


Build appropriate coping breaks into the daily routine. Most students benefit from breaks that will allow them the chance to recharge. Students with anxiety should be allowed breaks that meet their specific needs. This might be to take space in a quiet place or in a place where they can exercise. In order to make sure students are not avoiding or escaping the task, implement systems that limit coping strategies and durations to those that have been identified by the team in a specific plan. Utilize a chart that aligns difficulty with certain tasks to agree upon coping strategies that can be used during that task.


Teach writing utilizing all modalities: seeing, hearing, speaking, doing


Use technology to expand on the skills needed to complete writing. There is research that indicates if you can create computerized, multi-level lessons that teach handwriting, spelling and sentence construction using all modalities, you can more effectively deliver instruction that positively impacts student with challenges in writing.


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1. Iman M. M. Muwafaq Al-Ghabra. (2015). Handwriting: A Matter of Affairs English Language Teaching. Vol. 8, No. 10; 2015 Published by Canadian Center of Science and Education : Received: August 25, 2015   Accepted: September 24, 2015   Online Published: September 25, 2015


2. ChristinaT. Fuentes, BS, Stewart H. Mostofsky, MD,  Amy J. Bastian, PhD. (2009). Children with autism show specific handwriting impairments. Neurology73 November10,2009 1537


3. University of Haifa. (2016, June 1). Children with high-functioning autism spectrum disorder show unique handwriting patterns: Integrative education system should consider this factor, say experts. ScienceDaily. Retrieved August 2, 2017 from


​4. Jessica Minahan and Nancy Rappaport. Anxiety in students: A hidden culprit in behavior issues. Kappan, December 2012/January 2013


5. Virginia W. Berninger, William Nagy, Steve Tanimoto, Rob Thompson, and Robert D. Abbott. (2014). Computer Instruction in Handwriting, Spelling, and Composing for Students with Specific Learning Disabilities in Grades 4 to 9. Comput Educ. 2015 February 1; 81: 154–168. doi:10.1016/j.compedu.2014.10.005


6. Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., Mccracken, J. T., … Scahill, L. (2013). Exploring the manifestations of anxiety in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(10), 2341–2352. 











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