The Effectiveness of the Size Matters Handwriting Program

PURPOSE: Typically, handwriting develops between kindergarten and second grade. Handwriting is a predictive factor in determining a composition’s length and quality. MRI studies have shown that paper-and-pencil tasks spike interhemispheric communication. Additionally, handwriting is proven to impact reading. Limited literature is available exploring the effectiveness of handwriting interventions that focus on grouping alphabet letters by size. Therefore, the purpose of this study is to investigate a curriculum-based handwriting intervention that emphasizes the importance of letter size. The research question was, Is the Size Matters Handwriting Program (SMHP) effective in improving the handwriting skills of children in kindergarten and first and second grades?

DESIGN: In this pretest–posttest experimental design study, an equal number of kindergarten and first- and second-grade classrooms were assigned to intervention and control groups. All students were in either a rural New York or an urban Massachusetts regular education elementary school. Both schools included students with disabilities within their classrooms; of these students, some had an individualized education program (IEP) or existing diagnosis and/or were receiving occupational therapy (OT) services. There were no significant differences between the intervention and control groups in age, sex, handedness, number of preexisting diagnoses, number of IEPs, or history of OT between grades or schools.

METHOD: The norm-referenced Minnesota Handwriting Assessment (MHA) was given to first and second graders. The standardized Test of Handwriting Skills–Revised (THS–R) was given to kindergartners, first graders, and second graders. Chi-square and independent-samples t tests examined the differences between groups in demographic characteristics and outcome measures prior to intervention. Within-group differences over time were assessed with paired t tests. Independent-samples t tests compared the groups on changes between pre- and postintervention scores on the measures. Analyses were done separately for each grade level.

RESULTS: At preintervention, there were no significant differences between the intervention and control groups on any measures for the kindergartners and second graders. However, the control group first graders had significantly better preintervention scores on the MHA Size scale. Kindergartners in both groups had significant improvements over time on the THS–R. These improvements were significantly greater in the intervention group. First graders in the intervention group had significant increases on all scales of the MHA and THS–R except the MHA Spacing scale. The MHA Rate scale showed significant decreases postintervention. Intervention group first graders also had significantly greater over-time increases on all subtests except the MHA Rate subtest compared with the control group. Second graders in the intervention group had significant increases on all subtests of the THS–R and MHA except the MHA Rate, Legibility, and Spacing scales, for which there was no change over time. The control group did not report over-time increases on any subtests or scales of the THS–R or MHA.

DISCUSSION: The results indicate that the SMHP serves as an effective intervention for kindergarten and first- and second-grade students. Students’ handwriting improved in size, legibility, form, alignment, and spacing. OT practitioners have a role in directing handwriting curriculum in school-based settings. By emphasizing the importance of letter size, the SMHP helps improve handwriting.

IMPACT STATEMENT: Occupational therapists report that up to 75% of their caseload relates to handwriting. The urgency therefore to identify a proven efficient instructional program is paramount. Since the SMHP is also embeddable, measurable, easy, and fast, evidence of its effectiveness is timely. Additionally, as a concept-driven approach, the SMHP promotes collaboration in the natural environment and the Workload model.