Thriving School Psych Thriving Students

Visual-Motor Integration (Psychoeducational Part IV)

So far, this series has addressed the following components of a Psychoeducational assessment:

1) Background History
2) Testing Observations
3) Intelligence/Cognition

In this post, the psychological process of “Visual-Motor Integration” will be addressed. Loosely defined, visual-motor integration is eye-hand coordination, and is required for tasks such as writing and copying material, handwriting/cursive, pencil-paper tasks, copying from the board, and drawing. As the name suggests, the student can have difficulties with the visual aspect, the motor aspect, or integrating/coordinating the two together. Often students with such deficits can have even more difficulties when the task is timed (sometimes, this will be called “Processing Speed” on intelligence tests, but that can be a general term as one can slowly process auditory information too.)

Students with visual motor integration difficulties are often impaired in their ability to keep up with written work. It would be like using your non-dominant hand to write. You can do it, but it is mentally taxing. If you want to simulate this, go ahead and write left-handed all day (if you’re a righty). Also, get someone to hover over you and ask if you’re done yet and encourage you to hurry up because everyone else is moving on. Let me know how that goes!*

I am reminded of a student I worked with who was 13 at the time, and “refused” to do any written work. Upon testing him, he had a severe visual-motor integration deficit, despite above average intelligence. He couldn’t even copy a triangle, let alone take notes from the board with speed and accuracy. I can see why he refused to work. It’s better to look bad than dumb when you are 13.

I was presenting the results of this student’s testing to the parent, school staff, and an outside therapist (the student had some emotional difficulties related to his poor achievement as well) and as I like to do, I showed them the picture of the triangle he was supposed to copy and then what he produced. His triangle was like a rectangle with one side missing, so the triangle would never connect if he continued the lines. The therapist gasped and said, “Oh my, it’s so phallic! Look what he drew. He took the triangle and made it phallic. Very disturbing.” And she went on and on with a psychoanalytic interpretation.

What was actually disturbing was that she missed the entire point. He had visual-motor integration issues and was trying to copy the triangle picture that the test developers made up. She will have to take up the obscene triangle stimulus with PsychCorp. In my head, I imagined them saying to her, “Lady, sometimes a triangle is just a triangle.”

*Most teachers, once they find out the student has a visual-motor integration deficit, will accommodate such that the student gets more time to complete written work, or the task demand is reduced for quality, not quantity. Teaching computer skills is also a good compensatory bypass strategy.

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Comments on Visual-Motor Integration (Psychoeducational Part IV)

  1. Anonymous says:

    Thank you so much for this: sometimes a triangle is just a triangle!

    Sometimes a child with a visual-motor processing deficit hides under his desk because he is tired of being humiliated in front of his class when he is at the blackboard. Sometimes a child talks to himself because a parent has told him that self-talk is a good strategy when you’re having trouble at school. Sometimes a child who wears camouflage pants to school is just following the latest fashion trend, and is not “obsessed with war”.

    Sometimes, just sometimes, adults over-analyse things. Sometimes adults are wrong. Imagine that!

  2. Anonymous says:

    Thank you very much for this insightful article. I am a special education teacher. My son, who is very intelligent, is in second grade. He had some problems last year with copying from the board and actually finishing the sork. This school year, we found that he was failing timed math fact tests. He could tell me the answers very quickly, but was unable to get more than 50% finished on the test. I had him tested at an outside agency because I thought that the whole problem was his handwriting (very messy and slow). It was found that he has above average visual perceptual skills, average motor skills and below average visual motor integration skills. We are going to therapy once per week to help. However, his teacher is not implementing the accommodations that have been recommended. I know that since he does not have an actual “learning disability” as defined by Alabama, she does not need to follow these recommendations, but I would think that she would. My question is: Should I choose my son’s teacher for next year to ensure someone who would accommodate him, or should I let it to chance (again) and have him just deal with what life has handed to him?

    Thank you!

  3. Without knowing all the details of how things work in Alabama, I would say that you should try to find a teacher who is psychologically-minded for next year. Any time a teacher understands kids and learning differences, the kids benefit. You are doing the right thing by addressing the issue on your own in therapy.

    That being said, if things get worse for your son and he is really struggling, I think you should also look into whether or not your son may qualify for a Section 504 of the Rehabilitation Act Plan (a federal civil rights law). It is sometimes used when kids don’t meet criteria under IDEA, but still have a disabling condition that limits a major life function (in this case, learning). It functions, in many ways, like an IEP, in that it is a written plan of action to make sure your son has equal access to the curriculum and details accommodations that may be appropriate.

    Best of luck to you–R

  4. Anonymous says:

    We just had the evaulation meeting for my 1st grade son. We had asked for the evaluation as his handwriting is very messy (to the point of being illegible) and trying to get him to do any kind of written work at home is a constant battle. He did get OT in kindergarten, but they don't do it in 1st grade or higher without the IEP. At school he'll do the bare minimum for written work and will add more details if the teacher prompts, but tries to get it over with as soon as possible. There's a huge focus on the kids being authors, but he'll just write one sentence on each page of his books because writing is so tough for him. He scored poor/below average on VMI. My son is excelling in reading and math, so it's tough to argue that there is an educational impact since he's not failing. Luckily for him, his teacher, the OT and the SPED teacher all agreed that his VMI problems are impacting his ability to do the work that needs to be done — we were told he was "borderline" to get services at school as he does do so well in the academic subjects. He'll be getting two 30 minute OT sessions per 6-day rotation starting next fall. We're so glad we finally got through the evaluation process, but wish that this year hadn't been wasted. Teachers aren't supposed to tell parents they can request an evaluation, but the OT he worked with last year told me what I needed to do to get the evaluation, etc.

  5. Rebecca says:

    It's unfortunate the way the process is set up, isn't it? Let's wait until he fails enough to be in need of an IEP! So frustrating.

    I'm glad he's getting the help he needs though. You are right that there are so many expectations on kids to be writers at a younger and younger age.

  6. Vika says:

    Thanks for the insightful article! I wish all school psychologists would read it.

    My son, age 15 and a high school freshman, is "2E"–GT and AD/HD–and has struggled with handwriting and "art" all his life. The last testing we had done, three years ago, showed visual-motor search and visual-motor speed in the 2nd and 9th percentiles, though other motor-reduced scores were average or better, except horizontal tracking (21st percentile). The geometry teacher called this morning to tell me that DS's behavior has deteriorated over the past few weeks. Turns out they've been doing "constructions" (using a compass) and not only has his behavior in class been uncharacteristically off-task, but he hasn't turned in a single construction. F, F, F. I strongly suspect that this is avoidance related to his visual-motor difficulties but don't know how to explain this to the geometry teacher or what to do. He has a 504 for executive function issues, but the school psych who presided over the case conference (2 years ago, in middle school) pretty much dismissed the visual processing report, saying that the low scores were caused by distractibility!


  7. Stephanie says:

    I am so glad your post came up in a web search I was doing! I plan to share this with my daughter's teachers next year when I meet with them to discuss her VMI issues. This paragraph really struck me:

    "Students with visual motor integration difficulties are often impaired in their ability to keep up with written work. It would be like using your non-dominant hand to write. You can do it, but it is mentally taxing. If you want to simulate this, go ahead and write left-handed all day (if you’re a righty). Also, get someone to hover over you and ask if you’re done yet and encourage you to hurry up because everyone else is moving on. Let me know how that goes!"

    That must be what she goes through every day. I need to print that and tape it to my desk to read every day.

  8. Anonymous says:

    I have been working an an OT in a school setting for the past 25 years. All the responses that I have read ring true to what I deal with daily. Yes, significant deficits in visual motor integration will not only impact ones ability to complete written tasks but also any other school related tasks such as math (i.e. lining up numbers in columns for accurate calculation; draw geometric shapes) and art (i.e. drawing skills in general, draw maps for geography, etc.). Once I feel like I have been able to help my students develop functional writing skills, along with functional keyboarding skills and explore various strategies/accommodations to be implemented in the students curriculum to help by-pass these weaknesses, I will then recommend discharge from an IEP to a 504 accommodation plan. Interesting reading tonight.

    1. Hi.What is your specialty?'Would love to find an OT to work with my son around my area

  9. Anonymous says:

    I am so glad to have found your blog! My 6 year old son has similar issues, although undiagnosed. This is because the school only wants to suspend him for his behavior rather than test him. This blog is helping me compile a list of areas that he needs to be tested in.

  10. UK mother says:

    We live in the UK and there are variable levels of understanding about specific learning difficulties within school staff members and between schools. Unfortunately, my son was diagnosed only at age 12 with VMI as it is very mild while his other cognitive abilities are very high, so this was masked and treated as poor handwriting and not trying hard enough. It was when he was put in the lowest group for science after some written tests that I had him tested. Now it is a year later and the school still has not moved him up to a higher group although he has performed well in science since being given 25% extra time as was agreed after a long battle with the special needs department. He cannot do the statutory exams in science from the level he is being taught at the moment so you can imagine that we are distressed for him. He is in the top group for his other subjects and has had high predictions for all subjects following cognitive testing at school and privately. My advice to families is to test your child as early as possible and keep up communications with school staff throughout the child's education because they tend to forget that he or she has a different need.

  11. Anonymous says:

    My son just got tested at the eye dr, and was in the 99th % for scanning, but 9th % for visual motor speed. He is getting glasses, but I suspect that is not all he will need. What exercises/therapies help this? What kind of 504 accommodations do kids get? (An IEP is not going to do me much good because we are in a private school). Any advice would be appreciated.

  12. Anonymous says:

    Our 11 year old son really struggles with visual motor and visual integration. He has been seeing a school OT since kindergarten (she is not helpful and very "reactive" i.e. she waits until he has failed a math quiz and I ask her why he wasn't helped with the protractor before the test) and outside OT on Sundays. He also has social issues that I believe are directly related to his frustration in the classroom. He was made fun of because his artwork looked different and teased generally – this has turned him into a very defensive and unhappy kid. I have seen a really happy 1st grader turn into a sullen 6th grader. He is now in therapy ….I am up at 2:30 a.m. trying to figure out what more we can do to help.

  13. Anonymous says:

    Thank you very much for this article — the analogy you make to writing with the non-dominant hand is exactly what my son's therapist told me today. I would be very interested in any further thoughts you have on managing visual-motor integration impairment in an above average student. In a nutshell my son has exceptionally poor and slow handwriting, plus organizational challenges, which is where many months of testing began, but has well above average performance in many areas, e.g. maths (joint highest score worldwide on a recent International Schools Assessment, maths competition team for school etc.); is seen as a top performer in science and humanities (very knowledgeable/creative); a creative thinker in English; represents his school in several sports including skiing, badminton,football, track and field etc. I would very much appreciate your advice in managing this dichotomy. Currently we are working on typing skills plus an evaluation which will allow him to use a computer in his IB (high school exams) plus therapies to address the VMI issues. Any suggestions you have would be welcome.

  14. Anonymous says:

    Thank you so much! I'm going back through my 19 year olds IEP… I too have struggled my entire life with special needs. Even though you learn to adjust, work harder and do what you need to do to get things done it isn't easy. Some people don't realize how exhausting it can be to have to work harder than others all the time. It can take an emotional toll on a person. Thank you so much for your article!

  15. Anonymous says:

    If a student has difficulty with Visual Motor Integration, would it fall under the Sped eligibility category of Specific Learning Disability?

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