Is there a correlation between fine motor delay and speech delay?

By Stephanie Sigal, M.A. CCC-SLP

NYC Pediatric Speech Language Pathologist

In my speech therapy practice, I often find that children with articulation delay or disorders often have difficulty with fine motor skills.

Speech is the finest, fine motor skill we have.  Think about the intricacies required for saying the multisyllabic word “buttercup”.  To say this word, your lips come together for /b/.  Next, the tip of your tongue touches the area just behind your top front teeth for /t/.  Then, the back of your tongue spreads out for /r/, and immediately moves upwards for /k/.  Finally, your lips come back together for /p/.  The muscles of the mouth (jaw, lips and tongue) have to perform very specific movements so a word is produced with appropriate speech clarity.  Using words in sentences and conversation requires rapid and precise muscle movements.

The jaw, lips and tongue work most optimally when they have a strong and stable trunk to support them.  A child should sit upright with his or her feet supported, and the ankles, knees, hips and chin at right angles for optimal respiration, phonation, resonation and articulation.  When a child sits on the floor in a “W” shaped position, the knees are bent with one foot on each side of the child’s tushy, not allowing for an upright posture.  Children should be encouraged to sit on the floor with their legs straight out in front of them or in a criss-cross / Tailor-sit position.

Many children make predictable developmental sound substitutions as they are learning to talk.  Articulation errors may involve substituting one sound for another (“tar” for car), omitting a sound in a word (“boo” for blue), or distorting a sound.  Guidelines as to when individual speech sounds should appear can be found here.

A speech therapist can be helpful in improving your child’s speech clarity.  It is important for the therapist to understand why your child is having difficulty saying speech sounds.  For example, is the jaw unstable?  Does he or she not achieve adequate lip closure?  Does the tongue have a poor range of motion?  When oral motor therapy is used in conjunction with traditional articulation techniques (practicing individual speech sounds), excellent results are often achieved.

Thumbsucking, pacifier use, bottles and sippy cups should be avoided past age one for appropriate speech clarity, as long as nutrition is not compromised.  The non-dissociated movement that occurs while suckling does not allow for the muscles of the jaw, lips and tongue to work independently.  Suckling may lead to tongue thrusting.

The jaw, lips and tongue have precise fine motor jobs.  Encouraging good speech habits can help the muscles of your child’s mouth work more efficiently.

Stephanie Sigal M.A. CCC-SLP is a speech therapist practicing in children’s homes on the Upper East Side of Manhattan.  Stephanie specializes in improving children’s articulation and language skills.  She additionally prepares NYC children for kindergarten.  To learn more about Stephanie and her speech therapy practice, please visit her website or you may contact her at or 646-295-4473.


Is Cursive Writing Relevant in the 21st Century?

When we think of cursive writing, many of us think of an antiquated penmanship that our grandparents once used. This is true, however, cursive writing continues to be taught in most elementary schools across the country and for good reason. Below are the top reasons why cursive writing still holds value in our ever changing, fast growing world of technology.

  • Cursive allows students to be faster and more efficient with their writing (as opposed to printing) so they can enhance their note taking and test taking skills.
  • Cursive boosts confidence – Children who enjoy writing will write often, leading to better language arts skills overall.
  • High schoolers benefit from it on the SAT – The College Board found that students who wrote in cursive scored slightly higher than those who printed, on the handwritten section that they just added to the SAT a few years ago.
  • Jobs require it – A recent search revealed some job descriptions require legible handwriting.
  • Email and typing is not always appropriate- we use cursive all the time- writing notes, letters, lists. We need to be able to read our writing & others need to as well.
  • Today’s cursive style is easier to read and write- the cursive taught today is not like the old school cursive that older generations were once taught. The Handwriting Without Tears program focuses on a simple style that eliminates the fancy curly cues, loops and other difficult aspects that cursive once included. It’s much easier to learn and faster to write.

Compiled and condensed from Handwriting Without Tears

What is Pediatric Occupational Therapy?

Occupational Therapy is a health profession focused on maximizing an individual’s ability to function in his/her daily life. An Occupational Therapist addresses difficulties arising from cognitive impairment, physical injury, psychosocial dysfunction, developmental or learning disabilities. Many people associate the word occupation with “work”. Therefore, it is usually surprising to hear that Occupational Therapists often treat children. A child’s “work” is comprised of play, self-care skills, learning, school performance and social interactions. Most of these skills fall within the following areas:

  • Fine motor skills (ex: stringing beads, grasp on a crayon/eating utensils, manipulation of clothing fasteners)
  • Visual motor skills (ex: tracing lines, completing puzzles, imitating shapes via drawing, copying block designs)
  • Sensory processing skills
  • Self help skills (grooming and dressing)
  • Handwriting (grapho-motor skills)
  • Environmental adaptations (organizing and adapting home/classroom to meet each child’s specific needs)
  • Play and socialization
  • Neuromuscular development (muscle strength and endurance)

As therapists, we tap into a child’s interests to provide challenging therapeutic activities aimed at improving areas of weakness. We specialize in creating opportunities for children to master developmental tasks and achieve independence in home, school and within their communities. Therapy sessions look like “play”, which is exactly what the children who are participating think they are doing. Occupational Therapists are trained extensively in psychology, human physiology and development. Therapists often continue training beyond college to become certified in specific areas of treatment including, but not limited to, Sensory Integration (SIPT certified), Handwriting and Listening Therapy.

What is Sensory Integration?

Sensory integration is the automatic process in which our brain registers sensory information from our five senses, as well as our internal senses of body position and movement. The brain reacts to this information with an appropriate adaptive response. For example, when we go outside on a sunny day, we either squint or put on sunglasses. The stimulus in this example is the sun and our eyes are the “sense” which detects the stimulus. Our brain processes this information by organizing and planning a response. This is the way typical sensory integration operates.

Most of the time, we do not think about our responses to various stimuli because our brains produce quick responses. Think about your commute to work. For those of us who take the subway in the morning, our bodies already have an “internal map” of where to go once underground; therefore it’s familiar and automatic.

Think about a trip to an amusement park. Typically, we know the amount and intensity of movement our bodies can handle before we may get motion sickness. Our brain registers this information and tells our body that we have had enough movement from roller coasters or that we can and want to go on more rides.

Imagine you are sitting in a boring lecture. Some of us can coast through this without a problem. Others need stimulation to keep our attention on task and will use compensatory strategies such as chewing gum, drinking water or biting a pen to help us do so.

A child with Sensory Processing Disorder (SPD) has sensory systems that are not functioning optimally. These children do not have the ability to make the types of connections such as the ones discussed above. They have difficulty interpreting one or more of their senses. The senses we are referring to include our basic five senses; vision, hearing, touch, taste, and smell. There are two more senses that may be unfamiliar to you. These senses include our vestibular sense (our sense of gravity and movement which is stimulated by change in head position) and our proprioceptive sense (tells us where our body position is in space). The vestibular and proprioceptive senses coupled with the tactile sense (sense of touch) are often referred to as the power systems, as these three systems are the most essential in early development.

Does my child need Sensory Integration Therapy?

Here are some signs of Sensory Processing Disorder (SPD):

  1. Afraid of movement or constantly moving too much
  2. Overly sensitive or under-reactive to touch, smells, tastes, textures, temperatures in food, sights or sounds
  3. Easily distracted
  4. Poor eye contact
  5. An activity level that is too high or too low
  6. Impulsive; lacking in self control, poor safety awareness
  7. Inability to unwind or self calm
  8. Social and/or emotional problems, frequent tantrums
  9. Physical clumsiness, poor balance
  10. Difficulty making transitions from one situation to another
  11. Delays in speech and language development
  12. Delays in motor skills and difficulty planning new movements

What is Visual Perception?

Visual perception is the process in which our brains take in and interpret visual information from the environment. Visual perception consists of seven components:

  • Visual Discrimination is the ability to look at objects and pictures and know if they are alike and different. This skill is important when matching, categorizing and reading.
  • Visual Memory is the ability to remember something that has been seen. This skill is important in comprehension.
  • Visual Spatial Relations refers to the ability to be able to understand one’s position to other people and objects within the environment while orienting to one’s own body in space.
  • Form Constancy is the ability to recognize objects regardless of their size, color or orientation. For example, a child able to recognize the correct puzzle piece even if it is upside down and backwards.
  • Visual Sequential Memory is the ability to remember objects or forms in the correct order, such as when spelling and remembering patterns.
  • Visual Figure-Ground is the ability to locate objects or figures without getting distracted by a busy background. This is important when looking for a pencil in a full backpack or finding your spot on the blackboard or page in a book.
  • Visual Closure refers to the ability to visualize a whole object when presented with incomplete information or part of a picture. For example, perceiving a picture of a dog, when it’s partially covered by a tree.

Activities requiring visual perceptual skills include:

  • Sorting games
  • Memory games
  • Puzzles
  • Building with blocks from a model or a picture
  • Finding objects in a busy background; eg: Where’s Waldo books
  • Bingo
  • Picture sequencing
  • What’s missing exercise worksheets
  • Matching games such as dominoes
  • Tic tac toe

What are Fine Motor Skills?

Fine motor skills involve dexterity of the small muscles in the hands and fingers for concise and coordinated movements. Occupational therapists (OTS) help children develop and strengthen their fine motor skills. OTs are trained in selecting the right challenge fine motor activities based on a child’s specific needs.

Examples of tasks requiring fine motor skills include:

  • Stringing beads
  • Building with small blocks
  • Connecting legos
  • Turning a key inside a lock
  • Tying shoelaces
  • Fastening buttons and snaps
  • Screwing/unscrewing a nut and bolt
  • Drawing, painting, coloring
  • Writing tasks
  • Assembling puzzles
  • Zipping and unzipping
  • Using scissors
  • Arts and crafts activities
  • Rolling playdoh into small balls
  • Peeling stickers
  • Picking up objects using small tweezers

What are Visual Motor Skills?

Visual motor skills involve the hands and the eyes simultaneously working together to perform a task. An occupational therapist can help develop a child’s visual motor skills by using appropriately challenging eye/hand coordination activities.

Examples of activities requiring visual motor skills (eye/hand coordination) include:

  • Forming shapes and letters
  • Tracing
  • Cutting out lines and shapes
  • Connecting dots
  • Stringing beads
  • Catching a ball
  • Etch a sketch
  • Throwing a bean bag/ball at a target
  • Completing mazes
  • Stencils

What are Self-Care Skills?

Self-care skills, also known as self-help skills are the daily tasks in a child’s life (eg: eating, dressing, grooming).

Self-care skills include:

  • Washing hands
  • Brushing teeth
  • Eating with utensils
  • Making the bed
  • Getting dressed
  • Brushing hair
  • Tying shoes
  • Button clothing

Parents and caregivers often help their children with self-care skills; however, it is important to encourage children to become as independent as possible within these areas. Self-care tasks and experiences give children the foundation for many school related skills including organization, planning, sequencing and independence.