Good day
P.S.!
I'm thrilled
to hear that my appearance on Montel helped plant some seeds in your
son -- as I've written about recently (The Esteem Octopus Parts I
and II) working on self-comfort is an extraordinarily
important step to take, as it leads to a startlingly vast number of
improvements (symptomatically and otherwise) in one's life.
Given
that TS is a disorder involving motor control and movement, it would
seem to make intuitive sense that poor handwriting would be associated
with it wouldn't it? In fact handwriting is indeed a recognized neuropsychological
sign of a possible diagnosis of TS.
Research
consistently suggests that gross and/or fine motor skills are low in
TS'ers. Dr. Peter Como, a neuropsychologist from New York, believes
these skills are between .5 and 1 standard deviation below normal. This
is going to lead to very poor writing skills; something that Cathy Budman
(a New York psychiatrist) recognizes is an issue in TS'ers.
Schultz,
Carter & Scahill reviewed 8 studies in 1999 to find that motor skill
problems in TS may be the factor that contributes towards another problem
also typically seen in TS: poor visual-motor integration. Visual motor
integration is your ability to effectively use sensory feedback (i.e.
what you see) to guide your physical movements. This type of functioning
involves reasoning and judgment as they relate to the processing and
elaboration of complex objects, but also involves the integration of
the senses and the coordination of the eyes, hands, and body. And, of
course, if your hand movements aren't well tuned to BEGIN with, it stands
to reason that your ability to effectively copy what it is you see is
going to be poor whether you are seeing it well, and translating it
to your hand well, or not. The short story is: people with visual motor
integration problems often have problems taking down notes from a chalkboard,
or properly aligning arithmetic questions. TS'ers are again about 1
standard deviation below average in their visual motor integration.
All this
problem in writing and copying is going to lead to more frustration
around the simple mechanics of writing than in the average student.
The concentration (thus energy) it takes to simply hold the pencil and
form the letters is also going to detract from the resources available
to invest in the actual assignment (for example coming up with a creative
story, watching grammar and punctuation, etc.). This increased attention
is going to fluctuate depending on how much on-line energy we have left
that day; this increased attention could also elicit more 'writing tics'
-- after all, to be neat in writing you also need to be thinking about
what would make your writing NOT neat, so you know to avoid those things.
Once you are thinking about those things, our 'leaky brakes' can ironically
lead to the very 'not neat' behaviours we were trying to avoid in the
first place.
No wonder
we hate to write! I avoid it whenever I can these days, preferring to
type. I was actually just saying the other day how much my compositions
have improved since getting a computer -- now I can revise endlessly
and with ease whereas before the thought of rewriting everything was
so horrifying I'd resist it and accept the lower mark.
In terms
of "what will work", the Alpha-Smart is a great idea: you
are on the 'write' track (sorry :). If your son doesn't like the typing
option you could advocate for a scribe for him at school -- for this
option to be available you'd likely want to get a Writing Needs assessment
done by an Occupational Therapist through the school board to 'legitimize'
your concerns. There also exists these days some excellent "speech-to-text"
software such as Dragon NaturallySpeaking so that his computer can,
in effect, work as a scribe for him.
I hope
this helps!
Dr. Dunc.
