Evaluating a Child’s Handwriting: An Inside Look

Handwriting Eval

When I ask a parent to describe their concerns regarding their child’s handwriting, I usually hear one of the following responses:

“It’s messy.”

“You can’t really read it.”

“It doesn’t look as good as his peers.”

While that’s all well and vague, it’s up to me to determine not only what’s wrong with their child’s handwriting, but also what’s fixable. So here is my process…

Step 1: Gather the data.   

I don’t even start off by asking a child to write. I first look at underlying skills related to handwriting. This usually includes clinical observations of motor skills, stability of supporting joints, pencil grasp, hand strength, etc. You have to look at the foundation before you can fully address anything else.

Standardized testing typically starts with The Developmental Test of Visual Motor Integration (AKA the Beery VMI).

I like this test because it is broken down into three subtests which assess the building blocks for writing.

These subtests include:

Visual Motor Integration (Taking in visual information and using it appropriately for motor output such as writing, drawing, throwing a ball, using a utensil, etc.)

This portion of the test involves the child copying various shapes and forms which increase in difficulty.

Visual Perception (The ability to appropriately process visual input.)

This portion of the test focuses on matching two shapes when one is among similar shapes.

Motor Coordination (Skilled control of motor movements.)

This portion of the test requires the child to draw within the guidelines of shapes that also increase in difficulty. They have to demonstrate pencil control to remain inside the lines.

This test is fairly quick, and can offer a lot of insight into areas of difficulty. If concerns are sparked by this test, a therapist can pull out other evaluations to further assess specific areas such as visual perceptual skills or motor coordination, but this is a solid place to start.

There are also several handwriting assessments available, including the ETCH, or The Print Tool. But let’s be honest- I hate these. They take forever to score and don’t give me any real additional insight, except maybe for goal writing and tracking purposes.

I can usually get a sense of legibility issues by watching a child complete a handwriting sample. Sure, parents can bring in a handwriting sample from school, (that usually allows me to see their day to day writing as opposed to the “better than average” sample I usually get in the clinic) but I also want to see the child writing in front of me to assess how they create each character.

Step 2: Analyze the data

If I’ve completed a formal handwriting evaluation then I’ll spend some torturous twenty minutes expertly measuring letter sizes and assessing each stroke and the order in which it was completed.

I mostly see The Print Tool handwriting assessment around other clinics and my own, so I’ll talk about that one in specific. It’s made by Handwriting Without Tears, but each letter is scored based on the specific handwriting program that the child has been instructed in. (See my review of these different handwriting programs here.)

This evaluation measures letter memory, placement on the line, sizing, orientation, start point, and sequence formation. All important components of letter writing, but also observable in a simple handwriting sample.

Here is my main issue with a test like this- Yes, it creates an objective way to measure handwriting skills, but does it truly assess legibility in a functional sense?

For example, let’s say that a child makes a legible letter ‘M’. For complete credit on the assessment, the child has to start at the top, draw a straight line down, and then come back up to the top to finish the strokes. If the child starts at the bottom to make the letter… deductions! What do I say to that? Who. Cares.

There are only a few situations when this would really matter to me:

  1. The letter is completely illegible.
  2. The child is unsure of their letter formations and is starting at the bottom out of sheer confusion.
  3. Their letter habits are slowing them down to a less functional rate in the classroom.
  4. Their irregular letter formations are causing reversals.

Otherwise, it’s basically a stylistic choice, and most likely a HABIT. These handwriting habits are formed early. I have parents come to me with their 10 year olds, saying “I want to fix these handwriting issues while they are still young.”

To that I have to say- it’s a little too late. If a child that age truly needs to change the way they form their letters, they had better be very motivated and their parents had better be ready for lots of practice. It’s essentially learning a completely new habit to replace an old one. I’ve seen it done in children as old as 16, but these guys worked at it, page after page, every day, until these new habits took over.

Think of your own handwriting. There is no way you make each letter exactly as you were instructed in school. Imagine if I said that your perfectly legible R’s are all wrong because you don’t make them according to a specific handwriting program. Now you will be forced to change the way you make them. Think of how hard you would have to think every time you made an R from now on. It might drive you crazy.

Step 3: Recommendations

From all of that data collection, I have to decide whether to recommend therapy or not. Technically, if anything is below average on any of my standardized tests, I can rightfully recommend therapy.

However, I have to think of what I could actually change about a child’s handwriting. As I’ve mentioned in detail, it is a big decision to determine if specific letter formations need to be changed. Issues like spacing and line placement can have a huge impact on legibility, and are easier to address and change. Either way, everyone has to be on board with this process.

An important idea to keep in mind during this process is to decide when therapy will be completed. AKA, when will the child’s handwriting be “good enough” to warrant discharge?

This can be a sticky situation. I’ve had parents swear up and down that their child’s handwriting is still a mess, even when they meet all standardized requirements.

At that point, the children are usually so sensitive to their parents’ criticisms that they begin to hate handwriting in general. This poor little girl I worked with had absolutely beautiful handwriting by my standards. However, her parent was never satisfied with what she saw. It was a lose-lose situation.

Now I know this isn’t the norm for every parent, but I definitely like to sit down with everyone and decide what exactly needs to be changed, and how we will determine when we get to where we need to be.

 

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About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Insider Information, Lessons Learned, Occupational Therapy, Therapy Process and tagged , , , , , , , , . Bookmark the permalink.

34 Responses to Evaluating a Child’s Handwriting: An Inside Look

  1. Pingback: When to “Fix” a Pencil Grasp | The Anonymous OT

  2. Sherry says:

    Re:There are only a few situations when this would really matter to me:

    The letter is completely illegible.
    The child is unsure of their letter formations and is starting at the bottom out of sheer confusion.
    Their letter habits are slowing them down to a less functional rate in the classroom.
    Their irregular letter formations are causing reversals.

    Hear! Hear!

  3. fivescents says:

    Nice info. I also really look at core strength because really, it is all about core : ). But I have seen kids handwriting improve dramatically after improving their core strength. The Kindergarten teachers I work with say that fine motor isn’t nearly the issue it used to be since they began to address core strength/stability through S’Cool Moves activities that they have embedded throughout their curriculum. I agree-what really matters is legibility. I also see that the emphasis on handwriting instruction in the classroom has decreased, at least in the districts I have served.

    • So true: it is all about the core. 🙂 From talking with some of my teacher friends, it seems as if they have so many standards to meet in their classroom that they literally don’t have the time to spend on handwriting instruction. I’m glad to hear that they are incorporating strengthening tasks in the curriculum! Thanks for the comment.

  4. Pingback: Pencil Grip 101 | The Anonymous OT

  5. Debbie says:

    What age do you feel is “too late” to easily changed poorly learned letter formation that contributes to legibility difficulties? Having a parent (or even teachers!) understand that some extreme dedication/follow-through outside of OT time would be required to change such habits is something I’m struggling with as a school OT with only a couple years experience under my belt. (And for the record, I completely agree! I’ve got 8 year olds who just seem unable to “unlearn” poor writing habits. :/

    • Hi Debbie! It is definitely hard to put a specific age limit on this, but I feel like once a child leaves kindergarten they have already established handwriting habits. And then as they get older, the more they solidify these habits, and thus the more practice it will take to change. So obviously the younger they are, the easier it is to change letter formations, but it’s going to take a lot of work regardless. Best of luck to you!! 🙂

      • Debbie says:

        thank you much! 🙂

      • Tara says:

        I learned to write in kindergarten, then moved to a different school district for first grade where they used a different handwriting style. I learned the straight letters (lowercase k being like a capital K, only smaller, etc.) in kindergarten, and my first grade teacher tried to “correct” me into putting tails on my letters and that funky lowercase “k” that is all loopy (like cursive). Once I did learn cursive (in second grade), I got a little more flowy with my handwriting. Now I use a Frankenstein mix of print and cursive. No real rhyme or reason, but they say your handwriting has a lot to do with your personality.

      • I love your description of a “Frankenstein” mix! You are all too correct; each of us uses some sort of hybrid mix. Regardless, I’m sure you ended up with something legible!

  6. Sarah says:

    I have completely enjoyed reading your posts! I am a pediatric OT and could not agree more with this.. The job is really educating those around us (teachers, parents, etc!) to promote functional writing to start with! Thank you for your posts!

  7. Brooke W. says:

    Great breakdown of handwriting components and grasps.
    Thanks for taking the time to write this.
    Brooke

  8. Lauren says:

    I am so with you! So much frustration around this in my district!

    I am curious to know where you draw the line between qualifying for OT Intervention vs needing (targeted but not therpeutic) extra practice in the classroom and at home. I find that ANY handwriting legibility issues are shoved in my lap despite my clinical opinion regarding the reasons behind the difficulties. Students who have legimate visual motor deficits (I find few, really) are lumped in with students whose legibility issues are due to rushing, attention deficits, lack of primary instruction or severe literacy delays (a topic for another day!).

    I also agree that the parent/district threshold for legibility falls in line with antiquated penmanship expectations while the instruction falls far shorts of the old school investment in handwriting.

    Looking forward to your response! Thanks for the article.

    • Oh Lauren, you bring up SO many interesting topics here. I totally agree with your issue in the lumping together of all handwriting issues. I have had many teachers express to me that they simply don’t have the time in their curriculum to extensively teach handwriting; however, the expectations of legibility are so high, and often involve some intangible goals that parents envision in their head. Then all these children end up with us because people associate poor handwriting with an OT referral. I wish I had a line to draw in terms of practice versus intervention. I’ve always tried to back myself up with standardized assessment results. If a parent is very particular about an issue, I’ll do a formal handwriting assessment to give them some hard numbers (These results are often much less terrible than they assume.) to keep in perspective. Plus if there is no VM, sensory, or postural deficit, I might recommend purchasing a HWT workbook or other product and recommend a re-eval if things don’t improve. Regardless, I totally understand this issue you are having!!

  9. Agnes says:

    So what’s your take if a parent goes outside the most common script and tells you that their child has very neat, very small, very slooooowww handwriting? Is well past K age? And does the “death grip on a pencil [with] closed off web space” you showcase on your pencil grasp page (thanks for the post and especially the pictures, that was a fantastic resource)?

  10. Rosie says:

    I happened across your blog today – I really enjoy reading it!

    One tool that I find helpful for handwriting assessment is the McMaster Handwriting Assessment Protocol: http://www.canchild.ca/en/measures/handwritingassessment.asp . It’s Canadian (and so am I) 🙂

    • Emma says:

      What a really awesome tool! Thank you so much for sharing the McMaster Handwriting Assessment Protocol— it gives me concrete tasks to have the kids perform and very solid ways to assess output (and suggest intervention.) Invaluable! 🙂

  11. Janelle says:

    Berry VMI – Composite score vs. subtest scores
    My child recently had a OT eval completed by the school as I expressed concern over motor skills, as evidenced as almost illegible handwriting and continued difficulty tying shoes etc. in a 2nd grader (8yrs old). The first diagnostic completed was the Beery VMI, in which his composite score was in 23rd percentile – and the conclusion was drawn that this is “average” and needs no OT services. However, the subtests were 39% for visual perception and 6% for motor coordination. I have no OT training, but statistically it seems like the one subcategory with a stronger score is normalizing the below average score within the composite VMI. From your viewpoint and practice, are subscores below a standard deviation statistically significant or do you focus on the composite score when analyzing Beery results?

    • michele says:

      This is probably way too late for your information, but … I am a school based OT and first of all, there is no composite for the VMI that I am aware of and I have used it for 12 years! Also, you are correct that a spread between 39%ile and 6%ile between subtests would be too high a discrepancy for a composite to be used.

    • Richard says:

      I am a pediatric OT and I feel very strongly that a low score on either sub test of the VMI is significant and should be looked into further. Each sub test is measuring entirely different skills. Visual Perception is a skill of it’s own. As is Fine Motor control. And the use of these two skills simultaneously–the Visual Motor sub test–is honestly a 3rd skill build of not just the other two skills, but the ability to coordinate them simultaneously. If your child had a 6% in the visual perception sub test that could indicate a significant delay. However, I have an issue with only relying on the VMI alone to test visual perception. The VMI assesses only one type of visual perception–the ability to compare details between two pictures. There are areas of visual perception as well that are highly valuable in our daily life. Spatial orientation, visual memory, figure ground, visual closure, etc.

      If I give a child the VMI (a quick test that to me is more about screening for a deficit) and I see a low score, I try and follow this up with a more in depth test of the same skill. For visual perception, my favorite test is called the MVPT-3. It deals with each visual perceptual skill individually so you can learn specifically which areas are troublesome.

      Visual perception in and of itself is a very important skill in school, careers, and the rest of life. It is not just a “subtest” and if there is a significant deficit in this area, then the services of a skilled OT are a very good idea. In addition, and perhaps even more important, once an OT can identify which types of visual perception are having issues, they can also give you ideas of hobbies (reading music, crafts, drawing, puzzles, LEGO’s, etc.), games (Blokus, connect four, etc.) and other activities (mechanics, bracelet making, coloring, etc.) to naturally help your child build these skills at home.

      There is a good possibility with poor visual perception, that counter intuitive exercises using the whole body (dance, gymnastics, sports, playing instruments, etc.) can improve this skill. Many times, poor visual perception is related to poor awareness of your own body, or a poor coordination of both sides of the brain on a single task. This definitely needs the direction of an OT skilled in this specific type of therapy to assess and treat.

      If your OT is not interested in providing therapy for this, it would be a good idea to get a second opinion. 6% is significant. If the test was given well and this is an accurate representation of your child’s visual perceptual level, then a focused intervention plan is needed. Though it may not need weekly visits to an OT. It may just need an OT to help you determine what to begin involving your child in at home. Then I would suggest a second evaluation in a year to assess her progress in this area.

    • I am a pediatric OT and I feel very strongly that a low score on either sub test of the VMI is significant and should be looked into further. Each sub test is measuring entirely different skills. Visual Perception is a skill of it’s own. As is Fine Motor control. And the use of these two skills simultaneously–the Visual Motor sub test–is honestly a 3rd skill build of not just the other two skills, but the ability to coordinate them simultaneously. If your child had a 6% in the visual perception sub test that could indicate a significant delay. However, I have an issue with only relying on the VMI alone to test visual perception. The VMI assesses only one type of visual perception–the ability to compare details between two pictures. There are areas of visual perception as well that are highly valuable in our daily life. Spatial orientation, visual memory, figure ground, visual closure, etc.

      If I give a child the VMI (a quick test that to me is more about screening for a deficit) and I see a low score, I try and follow this up with a more in depth test of the same skill. For visual perception, my favorite test is called the MVPT-3. It deals with each visual perceptual skill individually so you can learn specifically which areas are troublesome.

      Visual perception in and of itself is a very important skill in school, careers, and the rest of life. It is not just a “subtest” and if there is a significant deficit in this area, then the services of a skilled OT are a very good idea. In addition, and perhaps even more important, once an OT can identify which types of visual perception are having issues, they can also give you ideas of hobbies (reading music, crafts, drawing, puzzles, LEGO’s, etc.), games (Blokus, connect four, etc.) and other activities (mechanics, bracelet making, coloring, etc.) to naturally help your child build these skills at home.

      There is a good possibility with poor visual perception, that counter intuitive exercises using the whole body (dance, gymnastics, sports, playing instruments, etc.) can improve this skill. Many times, poor visual perception is related to poor awareness of your own body, or a poor coordination of both sides of the brain on a single task. This definitely needs the direction of an OT skilled in this specific type of therapy to assess and treat.

      If your OT is not interested in providing therapy for this, it would be a good idea to get a second opinion. 6% is significant. If the test was given well and this is an accurate representation of your child’s visual perceptual level, then a focused intervention plan is needed. Though it may not need weekly visits to an OT. It may just need an OT to help you determine what to begin involving your child in at home. Then I would suggest a second evaluation in a year to assess her progress in this area.

      • Ok, so after sounding so official there, I realized I read your comment wrong and it was the motor sub test that had the 6%. I try to make blunders like that at least ooooh.. 6 times a day. you know….keeps me humble:)

        Anyway! My opinions of how significant this score is remains. The motor control sub test really measures FINE motor control. Along with causing issues with things like handwriting and shoe tying. It effects pretty much anything that requires coordination with your hands and fingers. Buttoning, typing, job skills with assembly requirements (mechanics, carpentry, etc.), and certainly hobbies like crafts or instrument playing. It is a very important skill and is definitely worth addressing if the 6% is an accurate measurement.There are a host of tests that assess fine motor control for this age. My favorite is the BOT-2. It tests fine motor skills in multiple activities. The VMI only assess the ability to control a pencil. It also assess fine motor dexterity (skilled fine motor coordination with speed factored in). It also tests bilateral coordination of the whole body, as well as strength, both of which are usually involved in fine motor coordination delays.

        Once again. I recommend a second opinion with an OT that treats this area commonly and is going to look at the other contributing skills (those other BOT-2 sub tests).

        Hope that was helpful. Certainly more helpful than my first comment!

  12. Ruth says:

    Thank you for your blog! I came across it when I was researching an answer for the NBCOT exam prep. Could I run this question by you and see which answer you would choose? I got it wrong, by the way, and I’m not sure why. The question is:
    An OTR® receives a referral for a child who has difficulty with handwriting. The OTR® wants to determine whether the child has difficulty with the integrated process of handwriting rather than specific components that support the production of handwriting.
    Which of assessment methods would be appropriate to use for this purpose?
    A. Print Tool
    B. Developmental Test of Visual Motor Integration
    C. Canadian Occupational Performance Measure
    D. Child Occupational Self-Assessment

    Thank you!

  13. Jamey Stofko says:

    I have worked in schools for almost 20 years and writing is still a hot topic. I have done a LOT of inservicing, written a teacher’s manual for handwriting and one for addressing sensory issues. While many teachers are receptive, there are still many who just want me to “take the child and fix them”. I have yet to find a good assessment that is not too time consuming (I am level I certified for HWT, but it takes forever to score!) and found your site while looking. Thanks for the good information. I printed it to share with my fieldwork students and fellow OT.

    • Krista Caffey says:

      Jamey, would you mind sharing your teacher’s manuals for handwriting and sensory issues with me? My email is caffeyk@usd320.com Thank you so much, Krista Caffey

    • Heather O says:

      Hi Jameey! I would be really interested to see your teachers manual for handwriting and sensory needs. I am also getting certified in HWT and I want to help those better understand the need for practice versus the need for the quick fix. If you could email me those to Heathr1900@aol.com that would be greatly appreciated 🙂

  14. zaheen says:

    We are a group of researchers at a University in Saudi Arabia…
    Your ideas are helping children worldwide…
    We need some suggestions..
    We have a project in which we have to assess handwriting or signature of our subjects (preferably adults) in two different conditions (eg. with and without chewing, etc).. Can you please suggest us any of your products or scales/other outcome measures (etc..) that can be used as outcome measures in our study?

    Hope for early and positive response…

  15. Lindsey M. says:

    My son Jacob has had horrible handwriting from the get go. He was never interested in coloring or learning to write pre-kindergarten. Then when he did start writing it was awful, almost illegible. Fast forward to sixth grade. He now has issues keeping up with his work as it takes him longer than other kids to write a paragraph. He has to write incredibly slow in order to insure the quality of the penmanship. It has lead to struggles, crying fits and an outright refusal to complete assignments. His teach has decided to let him type everything but, I don’t think that is the answer. He has been through OT already and we were told “he just has weak hand muscles” but I think it’s more than that. His IQ testing revealed 158 verbal with a VMI of 80.

    I’m just wondering if we should pursue yet another (third) OT evaluation and treatment plan for him? (He also has some sensory issues – tags, textures, noise etc. His little sister was just dxed by an OT with Dyspraxia as well).

    So sorry this is all over the place! Your input would be greatly appreciated!

  16. Jenny says:

    No one has mentioned the learning disability dysgraphia. This can be a reason for handwriting difficulties. Is anyone familiar with this learning disability?

  17. Aurora says:

    Hi, my son just started kindergarten and I got this email from his teacher “I noticed he is having a difficult time handwriting. He tries to use both hands. I’ve told him he has to use one hand – the one that feels best. I think he may be left-handed. I tell him to grip the pencil like a crab. I’m sending home a practice sheet. Just have him do a line or two every night if you can. Don’t have him practice too much or he will get too tired and he won’t like writing” I knew he had that problem and I have work with him at home so much because he usually does not want to write or color and if he does he ask for help, he definitely does not like finger painting does not like to get paint on him self. He told me he is sad because there’s a little gril at his table that is calling the teacher on him when he uses both hands but he can’t with one. Please help, your comment will be greatly appreciated.

  18. MaryEllen says:

    Hi, I’m a homeschooling mom. I followed a that lead me to your pencil grip post and that one lead me here.
    My child is starting high school. We started an art class and I noticed she cannot copy a simple design. The lessons are to copy basic shapes of various sizes within a pre-printed square. The things to watch are size variations and spacing.
    After several attempts she got frustrated and quit. So, if this is the problem… where do I go, what do I do, to fix it? Would her doctor be the place to start the ball rolling?

  19. car says:

    hi, i know someone who is interested in becoming a child’s ot but she has a five finger grasp which she has learned to use efficiently over the years. her handwriting is neat and she writes fast without tiring. are all pediatric ot’s required to teach handwriting?

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