Have you ever noticed your child flipping his or her letters or numbers? Occasional letter or number reversals can be typical as children learn how to write, but may indicate underlying difficulties if they are still present by age 7. If your child writes letters or numbers upside-down or backwards, this may be an indicator of underlying difficulties with the following skills: 

Left and Right Discrimination 

Children must have the ability to discriminate between left and right in order to appropriately sequence letters and recognize that they are reversed. Many factors contribute to difficulty with left and right discrimination, including delayed hand dominance, difficulty crossing midline, vestibular processing challenges, or a retained Asymmetrical Tonic Neck Reflex. 

Visual Perceptual Skills

Children may struggle with visual memory or sequential memory, which makes it difficult to copy a series of letters or words, as well as remember the details of each letter. Children may have difficulty with form constancy to recognize letters or numbers when they are rotated or written in a different size, or difficulty with visual discrimination to differentiate between letters or numbers. Children may also have difficulty perceiving if a letter or number is reversed, making the ability to identify how to correct reversals difficult. 

Visual Motor Skills

Typical, efficient handwriting involves a top-down and left-to-right motor pattern when copying letters and shapes. If children cannot accurately integrate visual input with motor output, they may demonstrate disorganized letter formation sequencing patterns, which can lead to reversals. 

Vestibular Processing 

The vestibular system is located within the inner ear, and gives us a sense of where our body is in space. It helps our awareness of left and right sides, as well as vertical positioning. It also works closely with our visual system to move our eyes in various directions. If your child has difficulty with visual-vestibular processing, they may have difficulty discriminating letters from each other (i.e. b, d, p, q) while writing and reading. 

Letter reversals may be indicative of underlying difficulties with vestibular and visual processing. If your child presents with significant challenges with letter and number orientation, or is 7 years old or older with occasional reversals, a consultation with an occupational therapist is recommended. Interventions may include play-based activities such as Simon Says (i.e. “touch your right elbow”), handwriting intervention to practice letter formation in various tactile mediums (i.e. shaving cream), games to identify reversals or differentiate letters, mazes, and activities targeting bilateral motor coordination. If reversals are frequently occurring, it is more advantageous to begin addressing these underlying skills through occupational therapy services early on to address foundational skills and set your child up for success.