The Impact of an Occupational Therapy–Based Handwriting Program for a Preschool Student

The overall purpose of this study was to determine the effectiveness of an occupational therapy handwriting intervention for a pre-kindergarten child. The main areas of handwriting assessed were letter formation and posture, as these areas often hinder children’s occupational performance. The child was given ways to improve foundational skills such as visual motor integration and coordination. Handwriting requires foundational skill development that includes the integration of visual motor coordination, language, executive function, and visual motor integration (Nye & Sood, 2018). During this research, we aim to answer the following question: What impact does an occupational therapy led handwriting curriculum have on letter formation and posture, for a pre-kindergarten student?

This was a single-subject experimental study using AB design. Single-study designs have an impressive legacy in the study of many individualized interventions for persons with disabilities (Barnett et al, 2012). Initial assessments were administered to a pre-kindergarten student. The assessments used included the Peabody Developmental Motor Scales - 2^nd Edition (PDMS-2), Learning Without Tears Check Readiness (LWTCR), and an observation checklist. Pre/post-test measures were conducted using the standardized PDMS-2 grasping and visual motor subtests and the non-standardized LWTCR screening that included an overall score as well as 2 subtests that included (1) printed first name and (2) printed last name. The observational checklist included 17 different components modified from the Handwriting Without Tears® program. Letter formation and posture were the two areas of concern tracked for this student.

The student chosen as the single-subject for this study scored a 1/3 in letter formation and posture on the observation sheet. This student scored in the poor category for the Fine Motor Composite Quotient of the PDMS-2 and within the 2^nd percentile in the grasping subtest measure. An evidence-based handwriting curriculum was implemented to address the foundations of handwriting such as letter formation and posture. Classroom teachers often feel uncomfortable teaching handwriting, as they report either having received little or no training in handwriting instruction (Nye & Sood, 2018). The curriculum was implemented using a collaborative, coaching approach with the teacher during classroom activities. Interventions were provided in the classroom for 16 sessions, for 8 weeks. Each session included an activity focused on the child writing first and last name. Results were recorded at the conclusion of each session on an observation chart on a scale of 0-3 representing number of trials successfully completed out of 3.

The student’s baseline scores for both letter formation and posture were 1/3. The trend indicated overall improvement in both areas over the course of 8 weeks with the student scoring a 3/3 in areas of concern. This was seen in overall improvement in legibility on written assignments. Over the course of the study, collaboration and coaching with the teacher resulted in the implementation of carryover strategies outside of direct services.

In conclusion, an evidence-based handwriting curriculum implemented with a pre-kindergarten student resulted in improvements in letter formation and posture during classroom writing activities. In addition to learning the structure of each letter, through the activities, the child was exposed to a variety of ways to increase fine motor abilities needed for handwriting. The impact of these findings emphasize that a structured, occupational therapy led handwriting program with ongoing collaboration and coaching maximizes student performance.

References

Barnett, S. D., Heinemann, A. W., Libin, A., Houts, A. C., Gassaway, J., Sen-Gupta, S., Resch, A., Brossart, D. F. (2012). Small N designs for rehabilitation research. The Journal of Rehabilitation Research and Development, 49:1, 175–186. doi: 10.1682/jrrd.2010.12.0242

Donica, D. K. (2015). Handwriting Without Tears®: General education effectiveness through a consultative approach. American Journal of Occupational Therapy, 69, 6906180050. http://dx.doi.org/10.5014/ajot.2015.018366

Nye, J. A. and Sood, D. (2018) Teachers’ Perceptions of Needs and Supports for Handwriting Instruction in Kindergarten, The Open Journal of Occupational Therapy, 6:2, Article 6. https://doi.org/10.15453/2168-6408.1411

Randall, B. S. (2018). Collaborative instruction and Handwriting Without Tears®: A strong foundation for kindergarten learning. Journal of Occupational Therapy, Schools, & Early Intervention, 11:4, 374-384. doi: 10.1080/19411243.2018.1476200