Effectiveness of a Handwriting Intervention

Study Overview
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Brief Summary
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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
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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: 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? 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.

Official Title
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Effectiveness of a Handwriting Intervention With At-Risk Kindergarteners

Conditions
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Developmental Dysgraphia

Intervention / Treatment
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* Other: Size Matters Handwriting Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Kindergartners receiving educational support in the form of IEP and/or RtI tier 2 interventions Must be in a support classroom where services are delivered Exclusion Criteria: Children not in kindergarten Children not receiving IEP or Rtl tier 2 interventions

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Size Matters Handwriting Program<br>All participants were receiving educational support in the form of IEP and/or RtI tier 2 interventions, and were participating in a support classroom where those services where being delivered. The intervention group consisted of 23 kindergarten students comprising all students in two kindergarten support classrooms, one in each of two neighboring schools. All students in the group received the Size Matters Handwriting Program. | Other: Size Matters Handwriting Program<br>* 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.<br>|
| No Intervention: Control<br>All participants were receiving educational support in the form of IEP and/or RtI tier 2 interventions, and were participating in a support classroom where those services where being delivered. The control group consisted of 12 kindergarteners comprising all students in a kindergarten support classroom at a third school. They received no additional interventions. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the Test of Handwriting Skills-Revised (THS-R) after 16 weeks | A standardized assessment of handwriting which can be administered to students ages six to 18 (Milone, 2007). There are ten subtests which include writing letters and numbers from memory, writing letters, numbers and words from dictation, copying letters, copying words, copying short sentences, and writing short words from dictation (Milone, 2007). | Before and after 30 sessions completed twice a week for 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the North Dakota Title I Kindergarten Reading Standards Assessment (Letter Identification Subtest after 16 weeks | The North Dakota Kindergarten Reading Standards Assessment is aligned with North Dakota State Standards and consists of a number of subtests including: letter identification, word recognition, concepts about print, and sentence dictation. The assessment was designed as a tool for teachers and educational in selecting Title I students or assessing student achievement. | Before and after 30 sessions completed twice a week for 16 weeks |