SLIDES – Design, Methodology, Scope and Materials

Over 200 students participated in this very large study.
During the 8 weeks of intervention, teachers in each grade instructed the students in the Size Matters Handwriting Program once a day for 15-20 minutes.
Because the intervention phase was limited to 8 weeks, the scope was limited, too.
Note that only Kindergartners used consumable workbooks. First and second grade classrooms received materials that were one time investments. Even the Adapted Writing Paper can be copied. This is a fiscally responsible and green program.


SLIDES – Data Analysis, Demographics and Pretest Results

To be able to compare similarities or differences between the groups, two separate statistical formulas were applied.
Aside from the fact that there were slightly more children in the Massachusetts sample than in the New York one, both groups showed no significant differences.
Before the study began, scores on the MHA and THS were compared between both NY and MA control and treatment groups. No significant differences were noted.
Interestingly though, both NY and MA first and second grade students (both experimental and control) showed noticeable differences from typical peers before the study even began on the Minnesota Handwriting Assessment.


P < .001

The preliminary results are in.

At this point, the results from the Minnesota Test of Handwriting Skills have been scored, entered into the database and analyzed. Version 19 of the SPSS, the latest edition of the Statistical Package for Social Sciences was used. The findings are awesome!

First and second grade students from schools in New York and Massachusetts had their pretests compared with their posttests after an 8-week intervention program. The treatment groups followed a Fidelity Manual scope and sequence specific to their grades. Since it was a limited amount of time, the first grades were tested and taught just the lower case alphabet. The second grades were tested and taught both upper and lower cases letters.   The control groups for both grades continued with their standard curriculum.

Here’s how the data panned out:

There were NO significant differences in the PRE-TESTS between the control and treatment groups in 5 out of the 6 subtests of the Minnesota.   Interesting, there was a significant difference in means between the control group and the treatment group in the Size subtest with the latter having significantly lower scores in SIZE than the former. That means that the treatment group started off printing a lot worse in terms of letter size. They’d have a lot of catch up to do.

And they did.

In the POST TESTS, there were significant differences between the control and treatment groups in ALL 6 SUBTESTS of the Minnesota Test of Handwriting Skills. In 5 out of the other 6 subtests, the treatment group demonstrated SIGNIFICANTLY HIGHER SCORES than the control group indicating better performance. These subtests included Legibility, Form, Alignment, Size and Space. Curiously, on the Rate subtest, the treatment groups had SIGNIFICANTLY LOWER SCORES than the control group indicating that they completed their writing tasks more slowly than the control group. The site managers at each location reported that the children in the treatment group appeared to be taking care to make their letters ‘star-worthy!’

For SPACING, the difference was significant at the .05 level. RATE differences between the groups were significant at the .01 level. But for FORM, LEGIBILITY, ALIGNMENT AND SIZE, p < .001. That’s huge!!!

You asked for evidence. We deliver!!

More is on the way.

Demographics and Acknowledgements

This has been an event-filled year.

At long last. Research into the effectiveness of The Size Matters Handwriting Program has finally taken place. Here’s the breakdown:

Two school districts, one rural and one urban participated. The first was outside Albany, NY (Otego). The second was west of Boston, MA. In each school, 2 classes each of Kindergarten, first grade and second grade were enrolled. The New York site utilized a convenience assignment of control versus intervention. In Boston, the determination of participation was random. Albany had a total of 98 students on board, Boston 117.

The study spanned a twelve-week period commencing in January 2012. During the first week, baseline data was collected on all students, controlled and intervention. Three different standardized or norm-referenced tests were administered including:

  • The Test of Visual-Motor Integration (VMI)
  • Test of Handwriting Skills-Revised (THS)
  • Minnesota Handwriting Assessment (first and second grade)

By sheer numbers alone, the task ahead was daunting.   The number of students, the grade levels of participants, the diversity of the demographics, and both the validity and reliability of the outcome measure assessments make it one of the largest handwriting studies ever.   Plus each of the tests given on three separate occasions to 215 children meant over 1700 tests had to be administered and scored.

Many thanks to the wonderful therapists who championed this study.   Kelly Poje was the site manager in Albany and one of the earliest early adopters. She attended my debut BER lecture and became a fan of SMHP from then on. Tammy Murray was the site manager in Boston. She came on board as a doctoral student and enlisted a cadre of cohorts (names forthcoming) to assist with the scoring. Her detailed analysis of the procedures, results and conclusions are planned for at least one journal article. Gillian Rai was the other doctoral student. Her literature review will preface a different series of planned publications. Her OT students in West Virginia tackled many of the tests from both sites. Suzanne Warnalis, a tireless therapist, submitted herself to the reliability test twice, the test scorings over a hundred times and the rigors of evidence-based research countless more. She has neither been in pursuit of a degree nor the thrill of personal caseload participation. She is the definition of an altruist. She just wanted to help.

Dr. Beth Pfeiffer became our lead investigator. As an Associate Professor and head of the doctoral program, she identified willing doctoral candidates and campaigned to get IRB approval from Temple University. All data entry and analysis has been conducted at her direction.   In time, she will insure the broadest exposure to the research results through acclaimed professional journals. Look out for our results presentation at AOTA in San Diego in April 2013.

Acknowledgements are necessary too, to the many other therapists who initially volunteered but ultimately had to withdraw for various reasons. I am still humbled by your consideration. Advancing the profession through controlled research requires a commitment of time beyond one’s normally hectic day. It is truly awesome… in the literal sense.

Not to worry, though. There will still be opportunities in the future. Size Matters is in its infancy and trail-blazing, enthusiastic pioneers like you still have time to bring to our profession, our teachers and our students, the most innovative and effective advancement in handwriting instruction in decades.

In upcoming blogs, learn the methodology, results and conclusions. In the meantime, let me know if you’re still interested.

Let me know how I can help you!

Research Update

Hi, everyone.

I’ve received word that graduate students from the Occupational Therapy department at one acclaimed university will be in touch with me shortly about doing research on the Size Matters Handwriting Program. As soon as I have more information, I’ll pass it along.
Meantime, those who volunteered to do Beta Testing should start implementing the
SMHP concepts into your schools. Getting some of the kinks out of your delivery will help make the testing phase smoother. In this way, until the Instruction Manual is in your hands, we’d be able to work through some of your questions beforehand.
Don’t hesitate to contact me.
Help is just an email or phone call away.

Practical Strategies

Thanks to all the people in Albany, Manchester, Chicago and Milwaukee who attended my seminar, Practical Strategies for Increasing the Effectiveness, Efficiency and Impact of your School-based Occupational Therapy practice. Hope you’re enjoying your Alphatrangles. More practical strategies and useful products will be coming soon. Check us out frequently, or better still, write! I’m happy to strategize with you though email to maximize your time and your student’s skills.

Beta Testing

Those interested in Beta Testing… hang in there. We greatly appreciate your enthusiasm and willingness to pilot the Size Matters Handwriting Program in your districts and with your students. Developing a valid research study takes time, but we’ll keep you updated as we get closer to ‘testing time.’ Your help at this ground level will not only be credited and rewarded, but may very well spark a shift in the implementation of realistic therapeutic intervention.