Effectiveness of a Handwriting Intervention
Condition: Developmental Dysgraphia
MeSH terms: Agraphia
Study type: Interventional

Summary: 
      The purpose of the study was to examine the effectiveness of an occupational therapy led
      handwriting intervention for special education and at-risk kindergarten students.
    

Detailed description: 
      In spite of the increased use of computers and tablets by children of younger and younger
      ages, handwriting remains an important skill for school success and continues to be a
      critical skill for elementary school students to acquire. Beginning writers still do most of
      their composing by hand, and difficulties with handwriting can have far-reaching effects on a
      child's self esteem and academic success.

      This study examined the effectiveness of an occupational therapy led handwriting intervention
      for special education and at-risk kindergarten students. There is a tremendous need for
      studies examining the outcomes of handwriting instruction provided to the at-risk population,
      in order to determine whether outcomes are similar to those seen in the typically developing
      population. There is also a need for studies that examine outcomes in "real world" settings,
      in addition to those settings manipulated for experimental research. Such studies may not be
      as "clean" as those in classic experimental research, however it is imperative to examine
      outcomes in the settings that are occurring in today's schools. At-risk children are
      increasingly being provided intensive interventions under an RtI model, and children
      receiving special education services are increasingly being integrated into less restrictive
      settings, thus creating classroom environments with a wide variety of students needs.

      The purpose of this study was to examine the outcomes of a handwriting intervention, the Size
      Matters Handwriting Program (SMHP), provided to kindergarten children currently receiving IEP
      or RtI interventions. This study attempted to answer the following research questions:

        1. Will at-risk kindergarteners (those children receiving IEP or RtI support) participating
           in a 16 week, occupational therapy led handwriting SMHP intervention group demonstrate
           significantly greater improvements in handwriting legibility than children who do not
           receive the intervention?

        2. Will at-risk kindergarteners, participating in a SMHP handwriting intervention, make
           significantly greater gains in the pre-reading skills of letter-name recognition and
           letter-sound recall, than students who do not receive the intervention?

      The study incorporated a two group pre and post-test design. Both groups consisted of
      kindergarten students receiving IEP and/or RtI support. An occupational therapist provided
      biweekly group handwriting instruction using the Size Matters Handwriting Program to students
      in the intervention group (n = 23), while the control group (n=12) received the standard
      handwriting instruction.
    

Intervention name(s): Size Matters Handwriting Program
Intervention type(s): Other
Intervention description(s): The Size Matters Handwriting Program (Moskowitz, 2009) (SMHP) program incorporates principles grounded in motor learning theory, cognitive theory, and motivation theory. Children learn the importance of letter size by learning size 1 (capital and tall letters), size 2 (small letters) and size 3 letters (those that dive below the baseline) at different stages (Moskowitz, 2009). The intervention group received a total of 30 sessions of the SMHP, completed twice weekly over a 16 week period. Sessions lasted 30 minutes, and were led by an occupational therapist with training in the Size Matters Handwriting Program. All interventions were provided within the existing support classrooms. Each child had their own SMHP workbook.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment