Best Practice, Therefore, Supports

Best Practice, Therefore, Supports

Here’s what I found:  

1.Not Effective - Process - Oriented Treatment. Do you have a Sensorimotor emphasis? Making Shaving cream letters? It may be fun, and it may help with the recognition of letters, but not in acquiring legible printing.  

And don’t even bother trying to correct pencil grip after second, even first grade.  First of all, it shows no correlation with legibility.  Secondly, once kids habituate a grip… which they do earlier and younger… you are fighting an uphill battle to change it.  But to what end?  It doesn’t impact legibility anyway!

Kinesthesia training?  Not making the difference you want.  Handwriting is too discrete a skill to be generalized satisfactorily by increasing a child’s conscious awareness of where his body is in space.  Don’t waste your energy. Perceptual-Motor exercises… all those worksheets… Don’t pack them up so quickly though. While they don’t translate to the ability to print neatly, they do correlate with the ability to see whether you got it right or wrong, just not necessary the way to make it right in the first place.

2.Inconclusive - Gross and fine motor warm-up exercises. Darn. I know I did them all the time.

3.Effective… Combinations of Task and Process Oriented approaches. Direct instruction AND biomechanical or neurodevelopmental. High-level cognitive strategies, especially when combined with Multisensory approaches.  

  • But the most effective… a Task-Oriented approach. Direct instruction/Specific Skill Training. Verbal Feedback.  

My time is really valuable. I believe yours is, too. I’m going for MOST EFFECTIVE. Best practice, therefore, supports Motor Learning Theory.

  • Gillian Rai, another doctoral study, did a similar study.  Her research question was?  What is the Effectiveness of a Multisensory Approach compared to a Task-oriented approach in teaching handwriting to elementary school children.

And I should tell you that both Gillian’s and my doctoral papers are included in their entirety on my website if you would like to read them.

  • She reached a similar conclusion… 

Direct Instruction was the most effective approach, accompanied by Embedded handwriting instruction, Parent involvement, supplemental program (like homework), frequent visual cuing, mnemonics, self-instruction, and self-monitoring… curiously, all features of SMHP.

  • But it was Tammy Murray, the third doctoral student who measured: The Impact of the Size Matters Handwriting on Writing Legibility in Kindergarten, First and Second Grade Students.  Tammy was also the site manager for Test Site 1 as well as a test scorer.

So let’s talk about how this looked

  •  In terms of Design…

We had 2 schools.  One was urban, in Worcester Massachusetts.  It was a randomized group consisting of 117 students.  The second was in a rural setting in Otego, NY, outside of Albany.  This was a convenience study of 98 students. In terms of design strength, you should know that a randomized study is considered stronger.  And this was possible in Massachusetts since we had 3 classrooms per grade.  None of the teachers knew until right before the study began which group they would be assigned to.

In NY, we only had 2 classrooms per grade. Going into the experimental stage, we were aware of teachers with professional or personal conflicts that would have made it hard for them to participate or stay with the program for its duration. Because of that, we were deliberate in assigning classrooms to the control or treatment groups. So yes... there were control and treatment groups…one each in Kindergarten, First and Second Grades. IN other words, we had 2 control groups in each grade, one in each setting, and 2 treatment groups in each grade in each setting.

Baseline, Pretesting, and Posttesting was done using 3 different assessments. This was accomplished with the assistance of 15 different scorers from 6 different states. The tests included the VMI.  All 3 grades took the VMI. The Beery-Buktenica Test of Visual-Motor Integration. This is a green booklet in which children imitate or copy a series of designs and shapes.  Satisfactory completion of the first 9 pictures on the VMI has been correlated with printing readiness. In truth, these tests are still being scored and analyzed for the effectiveness as an outcome measure in our study.

All three grades took The Test of Handwriting Skills. This is the only standardized handwriting assessment. All others are norm-referenced. If you are not familiar with this assessment, I will go over it in a minute.

The last test was the Minnesota. Since this is only norm-referenced for the second half of first grade and all of second grade, it was only given to our first and second graders. So let’s take a second to appreciate the magnitude of this study. 200 students given 3 tests. That’s 600 tests to be scored…Once, twice, and then three times. In other words, there were almost 1800 tests administered in this study. This was a huge study.

Data Analysis used the SPSS - Statistical Package for Social Sciences, version 19 prior to Intervention. Specifically, chi-squared and independent sample T-tests were used. 

  1. For each grade level
  2. To examine differences between experimental and control groups
  3. To quantify Demographic characteristics, and
  4. To compare outcome measures

The SPSS-version 19 was again used After Intervention. Specifically, independent sample t-tests were done:

  1. For each grade level
  2. To examine differences between the experimental and control groups, and
  3. To compare change scores from pre-test to post-test
  • This is a breakdown of the demographics.  You can see the exact number of students in each grade and as a percentage of all the students for each grade.  So, despite New York being a much larger state, because we used a rural setting, our class sizes and thus the number of students from NY percentagewise were smaller in each Kindergarten, first and second grade as compared to Massachusetts.

 This is a breakdown of the demographics.

Breakdown of the demographics.


 Essentially though, there was no significant differences between the experimental and control groups for kindergarten, first or second grades regarding:

  1. Age
  2. Sex
  3. Handedness
  4. # of children with pre-existing diagnoses
  5. # children with IEPs, or
  6. # children having a previous history with Occupational Therapy

 And the way that looks in a graph is a follows:  

  1. Most of the Kindergarten students (82%) were 5 years old, some were 6.  
  2. Most of the first graders were 6 years old (81%).  Some were 7.  
  3. Most of the second graders were 7 years old (76%). Some were 8.  

From a statistical standpoint however, there were no significant baseline differences between the experimental and control groups when comparing the entire sample from New York to the sample from Massachusetts.

 Additional analysis revealed no significant baseline differences between the experimental and control groups for any other variables either, including handedness, number of children with IEPs, number of children with a known diagnosis or number of children receiving OT.  In other words, all kindergarten, first and second grade students between the two schools had essentially the same percentage of children who were right-handed, had IEPs, had pre-existing diagnoses and had prior history of OT.

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