Running Head: OPTIMAL HANDWRITING PRACTICE TIME

Optimal Practice Time to Improve Letter Size, Form, and Legibility in Handwriting For

Children Ages 6-10

Ashley Thayn, Rebecca Andlau, & Rebekah Strobel

University of Utah
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Optimal Practice Time to Improve Letter Size, Form, and Legibility in Handwriting for

Children Ages 6-10

“Practice makes perfect” is a commonly used phrase when mastering a new skill.

When it comes to handwriting, just how much practice time is needed? Furthermore, is

there a limit to how much a child should practice handwriting? Perhaps most handwriting

difficulties are simply a result of not practicing enough. These considerations are important

because many children ages 6-10 years old have handwriting challenges. In fact, it is

estimated that 12% of children are labeled as having handwriting difficulties (Roberts,

Siever, & Mair, 2010). It is also estimated that children spend 31-60% of their time at

school handwriting or doing other fine motor tasks (Alhusaini, Melam, & Buragadda, 2016).

For these reasons among others, handwriting is the most common reason school-age

children are referred to occupational therapy services (Schneck & Amundson, 2010).

A study done by Cramm and Egan (2015) identified a knowledge-to-practice gap in

the area of handwriting practice for children. They identified a strong current need for

facilitated practice and the ineffectiveness of developing skills in a “bottom-up” approach to

address handwriting. Currently, much of the literature views handwriting from a “bottom-

up” perspective by studying interventions aimed at improving skills such as hand strength

and visual motor perception in an attempt to address handwriting overall.

The “top-down” approach looks at how a person performs in their occupation and

whether it is functional or dysfunctional. Additionally, it addresses the occupation itself,

instead of task components, in handwriting interventions. This approach is utilized

frequently in occupational therapy, but there is a lack of research of the “top-down”

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method in handwriting interventions. Due to this lack of research, it is important to study

and determine how much time is required to practice handwriting in order to improve

handwriting legibility. We aim to find the optimal practice time, including number of

minutes per day and frequency in days per week. Finding the optimal amount of practice

time will help children with handwriting difficulties know how much time they should and

how frequently in order to increase legibility.

Background

The existing research on children’s handwriting largely focuses on different types of

interventions with varying results. Additionally, existing research aspires to determine the

most effective type of intervention to improve handwriting. Interestingly, Roberts et al.

(2014) found that neither a multisensory nor cognitive intervention worked to improve

handwriting performance and learning, unless both interventions were blended with daily

practice. Additionally, a systematic review conducted by Hoy et al. (2011) found

handwriting interventions to be ineffective with less than a minimum of 20 minutes of

practice, twice a week. However, there is no conclusive evidence that shows how much

practice time and frequency creates the greatest improvement in children’s handwriting.

In the United States, the typical amount handwriting practice is 20-60 minutes.

Interestingly, one school district reported providing less than this typical amount of

handwriting practice, and above average referrals to occupational therapy for handwriting

difficulties (Asher, 2006). This indicates that there is a relationship between handwriting

and practice time; and that not providing enough practice could lead to handwriting

difficulties. Illegible handwriting makes it difficult to succeed in school in areas where

written academic performance is a requirement for success- such as taking notes and
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performing math equations. A lack of success in legible handwriting performance can lead

to handwriting avoidance, a dislike for school, a lack of motivation and engagement in

academics, poor grades, and low self-esteem. Furthermore, lacking a strong foundation in

handwriting can greatly affect reading ability (Karin & Engelhart, 2012); which we believe

could ultimately have long-term effects with limited literacy, having difficulty attaining

higher education, and ultimately acquiring higher level and better paying employment.

Therefore, it appeals to logical reason to study the optimal amount of practice time for

children to make significant improvements in their handwriting, education, and quality of

life.

Effectiveness of existing handwriting programs

Research indicates that a couple of handwriting programs in current use by

occupational therapists are effective in improving children’s confidence in handwriting and

handwriting legibility. Zylstra and Pfeiffer (2016) studied the Handwriting without Tears

intervention and Pfeiffer, Rai, Murray, and Brusilovskiy (2015) studied the Size Matters

Handwriting programs implemented from 45 minutes per week to 90 minutes per week.

They found handwriting legibility improved in children in kindergarten through second

grade.

A few studies focused on the concept of practice in terms of blocked practiced. Block

practice uses repetition by having the child repeat the same exercises with similar

materials for the same amount of time, each session handwriting is practiced. Research

findings suggest that block practice results in increased writing speed and it works better if

the task is simple (Cahill, 2009; Guadagnoli & Lee, 2004). Since handwriting is not a simple
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task for children, block practice is preferred daily for 20 minutes if the child presents

handwriting difficulties.

Handwriting programs combined with other interventions

A systematic review conducted by Hoy and Egan (2011) found that interventions

that did not include practice were useless. In addition, they found that any intervention

with less than 20 practice sessions were ineffective. This systematic review studied

relaxation with and without electromyography, sensory-based training without

handwriting practice, and handwriting-based practice. It is useful to know that handwriting

programs combined with other interventions should include actual handwriting practice or

they prove to be ineffective. A study by Saleem (2017) looked at the combination of

repetitive task practice (the type of practice typically done in schools) with mental practice

or visualization. Students who engaged in this combination of interventions showed

handwriting improvements.

Studies on deliberate practice

While practice has been a focus of many studies, research on deliberate practice in

regards to children’s handwriting is severely lacking. One study looked at the quality of

“grit” in children’s ability to sustain long periods of practice time in general activities and

found that gritter children could endure more practice time and outperformed their peers

(Duckworth, 2011). This study noted the importance of having a mentor, coach, or teacher

provide immediate feedback so the student can quickly learn from their mistakes rather

than practice those mistakes into a habit. Thus, the principles of deliberate practice require

spending quality time practicing correctly to achieve positive gains.

Importance of handwriting on the brain and educational success

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In a study by Karin and Engelhardt (2012), researchers found it was more common

for children to practice typing rather than handwriting in the classroom. This study

reported the effects handwriting has on certain areas of the brain through MRI scanning. It

was found that writing letters of the alphabet is important for early recruitment of letter

processing in certain regions of the brain that are known to interpret symbols and

ultimately determine successful reading. Therefore, success in reading can be directly tied

to a child’s ability to recognize and form letters properly to be able to interpret individual

letters of the alphabet and be able to coordinate letter groupings into comprehensible

words.

Objective

The purpose of our study is to find the optimal amount of practice time to help

children succeed in improving their handwriting legibility. Most research conducted on

improving handwriting in children focuses on the type of intervention used, rather than the

amount of time and frequency practiced. We suspect that handwriting improvement could

be more accurately attributed to the amount and frequency of practice time rather than the

type of intervention used. For this reason, we will focus on studying optimal practice time

rather than optimal intervention. We expect that improving children’s handwriting through

optimal practice time will increase a child’s academic performance in reading, writing, and

math. Additionally, we foresee improvements in increased levels of confidence, higher

grades, and enhanced quality of life. In a broader sense, we also expect to benefit parents,

teachers, and other occupational therapists in effectively setting children up for success in

handwriting improvements with a clearly paved understanding of how much practice time

is most effective to make positive improvements in legibility.

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Method

Participants

Administrators from local school districts will be contacted for permission and help

in recruiting for our research study to determine the optimal amount handwriting practice

time for children in order to improve their legibility. Qualified schools within a chosen

district will be randomly drawn to participate in this study. We aim to obtain a total of 210

eligible participants of boys and girls, ages 6 - 10 years old. Inclusion criteria are (a) the

child must be referred to work with their school-based occupational therapist for

handwriting, (b) be 6 - 10 years of age, (c) speak English, (d) be able to focus on a task for

at least 10 minutes, (e) be enrolled in any school program, and (f) have parental

commitment to follow through with required practice times of up to five days a week, for

12 weeks. Exclusion criteria for this study includes (a) children who are not currently

working with an occupational therapist on handwriting improvement, (b) are outside the

ages of 6 - 10 years old, (c) don’t speak English, (d) children that are unable to focus for at

least 10 minutes, (e) are not enrolled in a school program, and (f) lack parental

commitment to carry out required practice sessions of up to five days a week, for 12 weeks.

Research Design

This study will be a quantitative, exploratory, randomized control trial with pretest

and posttest assessments. It will be a 12-week assessment with 3 groups. The independent

variables in our treatment groups are the number of minutes of daily practice in

combination with the number of days practiced a week. The dependent variable is

handwriting legibility as measured by the ETCH.

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The rationale for our study is based upon our review of past research in discovering

there has been no research yet conducted to determine optimal practice time and

frequency required for children to improve their handwriting legibility. Thus, we plan to

use three different intervention groups that vary practice and frequency to better

understand how much practice is optimal in increasing handwriting legibility.

Measures

Handwriting legibility will be assessed the Evaluation Tool of Children’s

Handwriting (ETCH). The ETCH is a criterion referenced tool that assesses a student’s

speed and legibility of handwriting. The ETCH consists of seven tasks including writing the

alphabet from memory, writing numerals from memory, near-point copying, far-point

copying, manuscript to cursive translation, dictation, and sentence composition that will be

assessed for measurement. Scores from the seven areas are composited to create a score

for total legibility. Higher scores equate to better handwriting proficiency. Additionally, the

ETCH contains observation sections for pencil grasp, pencil management, and classroom

behavior.

Example questions derived from the ETCH are, “(name of the child), write each of

the letters of the alphabet, starting with ‘a’ and ending with ‘z’.” Specific prompts are

allowed, such as “If you make a mistake on a letter, you are only allowed to erase one time.

And, “if you don’t know how to write one of the letters put a dot, like this (therapist

demonstrates) in its place.” Next, the therapist will lead the child in numerical work by

saying “this time write the numbers 1-12, if you make a mistake on a number, you only get

to erase it one time, you will begin here (therapist points).”

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The ETCH was assessed for reliability and validity and is overall considered to be

reliable, valid, and acceptable (Duff & Goyen, 2010).

We are also administering the Likert scale questionnaire to both participants and

parents of participants to gauge satisfaction with school performance as measured by

grades as well as confidence in handwriting performance, and quality of life. An example

question from the Likert scale questionnaire is, “What is your child’s current level of

confidence in handwriting on a scale of 1-5, with 1 being not confident at all and 5 being

extremely confident?”; “ How enjoyable is your life currently on a scale of 1-5, with 1 being

not enjoyable at all and 5 being extremely enjoyable?”

Procedure

To recruit participants, we will take a multi-step approach to invite participants via

their parents, teacher, or occupational therapist via letter, email, phone call, and/or text

message. For children to participate in our study, parents must complete a parental

consent form, detailing the methods of our study.

The participants will be randomly divided into three groups. Group A will practice

10 minutes a day, five days a week; Group B will practice 20 minutes a day, four days a

week; and Group C will practice 30 minutes a day, three days a week. Students will be

randomly assigned to a group intervention. Each participant will complete the pretest of an

observational assessment and the Evaluation Tool of Children’s Handwriting (ETCH). Upon

completion of the 12-week assigned group intervention, each participant will complete the

ETCH a second time, as well as, a structured Likert scale questionnaire to measure self-

esteem, satisfaction with grades, and quality of life; and an observation session. We will use

closed-ended questions in the structured interviews with parents and teachers to evaluate
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their levels of satisfaction with the child’s handwriting; as well as, provide our research

team with a holistic view of the child’s handwriting performance.

Human Participants Protection

We will minimize coercion or undue influence by informing parents and

participants that their participation is voluntary and that they can drop out at any time. We

will obtain IRB approval prior to starting this study. We will obtain consent from parent

and assent from kids prior to beginning treatment.

Data Analysis Plan

Data cleaning, manipulation, and analysis will be conducted using IBM SPSS

Statistics (v. 25). Individual participant data will be paired pretest and posttest and a

repeated measure ANOVA will be run to assess differences in variance between and within

groups. A post hoc analysis will be utilized to determine where group differences are to

make inferences about data.

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References

Asher, A. (2006). Handwriting Instruction in elementary schools. American Journal of

Occupational Therapy, 60, 461-471. doi:10.5014/ajot.60.4.461

Cahill, M. S. (2009). Where does handwriting fit in? Sage Journals, 44(4), 223-228.

doi:10.1177/1053451208328826

Case-Smith, J., Weaver, L., & Holland, T. (2014). Effects of a classroom-embedded

occupational therapist–teacher handwriting program for first-grade students.

American Journal of Occupational Therapy, 68(6), 690-698.

Dixon, R. A., Kurzman, D., & Friesen, I. C. (1993). Handwriting performance in

younger and older adults: Age, familiarity, and practice effects. Psychology and

Aging, 8(3), 360-370. doi:10.1037/0882-7974.8.3.360

Duckworth, A. L., Kirby, T. A., Bernstein, H., & Ericsson, K. A. (2011). Deliberate practice

spells success: Why grittier competitors triumph at the national spelling bee. Social

Psychological and Personality Science, 2(2), 174 -181. doi:

10.1177/1948550610385872

Duff, S., & Goyen, T. (2010). Reliability and validity of the evaluation tool of children’s

handwriting-cursive using the general scoring criteria. American Journal of

Occupational Therapy, 64, 37-46. doi: 10.5014/ajot.64.1.37

Guadagnoli, A. M., & Lee, D. T. (2004). Challenge point: a framework for

conceptualizing the effects of various practice conditions in motor learning. Journal

of Motor Behavior, 36(2), 212-224.

Hoy, M. M.P., Egan, M. Y., & Feder, K. P. (2011). A systematic review of interventions to
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improve handwriting. Canadian Journal of Occupational Therapy, 78(1), 13-25. doi:

10.2182/cjot.2011.78.1.3

Karin, J. H., & Engelhardt, L. (2012). The effects of handwriting experience on the functional

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32-42.

Longcamp, M., Zerbato-Poudou, M., & Vely, J. (2005). The influence of writing practicing on

letter recognition in preschool children: A comparison between handwriting and

typing. Acta Psychologica, 119(1), 67-79. doi:10.1016/j.actpsy.2004.10.019

Pfeiffer, B., Rai, G., Murray, T., & Brusilovskiy, E. (2015). Effectiveness of the size matters

handwriting program. OTJR: Occupation, Participation and Health, 35(2), 110-119.

Roberts, G., Siever, J., & Mair, J. (2010). Effects of kinesthetic cursive handwriting

intervention for grade 4-6 students. American Journal of Occupational Therapy,

64(5), 745-755. doi:10.5014/ajot.2010.08128

Saleem, G. (2017). Mental practice combined with repetitive task practice to rehabilitate

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Schneck, C. M., & Amundson, S. J. (2010). Prewriting and handwriting skills. In J. Case-Smith

& J. C. O'Brien (Eds.), Occupational Therapy For Children (6th ed., pp 555–580).

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Zylstra, S. E., & Pfeiffer, B. (2016). Effectiveness of a handwriting intervention with at-risk

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