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Journal of Occupational Therapy,

Schools, & Early Intervention
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A Comparison of the Handwriting

without Tears Program and Peterson
Directed Handwriting Program on
Handwriting Performance in Typically
Developing First Grade Students
a b
Joyce Salls OTD OTR/L , Jeryl D. Benson EdD OTR/L , Mary A.
c d e
Hansen PhD , Kari Cole MS OTR/L & Amanda Pielielek MS OTR/L
a
Occupational Therapy, Chatham University , Pittsburgh , PA
b
Occupational Therapy Department , Duquesne University ,
Pittsburgh , PA
c
School of Education and Social Sciences , Robert Morris University ,
Coraopolis , PA
d
The Watson Institute , Sewickley , PA
e
Caring Heights Community Care & Rehabilitation Center ,
Pittsburgh , PA
Published online: 16 Aug 2013.

To cite this article: Joyce Salls OTD OTR/L , Jeryl D. Benson EdD OTR/L , Mary A. Hansen PhD ,
Kari Cole MS OTR/L & Amanda Pielielek MS OTR/L (2013) A Comparison of the Handwriting without
Tears Program and Peterson Directed Handwriting Program on Handwriting Performance in Typically
Developing First Grade Students, Journal of Occupational Therapy, Schools, & Early Intervention, 6:2,
131-142, DOI: 10.1080/19411243.2013.810958
To link to this article: http://dx.doi.org/10.1080/19411243.2013.810958

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 Journal of Occupational Therapy, Schools, & Early Intervention, 6:131–142, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1941-1243 print / 1941-1251 online
DOI: 10.1080/19411243.2013.810958

A Comparison of the Handwriting without Tears

Program and Peterson Directed Handwriting
Program on Handwriting Performance in Typically
Developing First Grade Students

JOYCE SALLS, OTD, OTR/L,1 JERYL D. BENSON, EdD,

OTR/L,2 MARY A. HANSEN, PhD,3 KARI COLE, MS, OTR/L,4
Downloaded by [Chulalongkorn University] at 06:19 09 January 2015

AND AMANDA PIELIELEK, MS, OTR/L5

1
Occupational Therapy, Chatham University, Pittsburgh, PA
2
Occupational Therapy Department, Duquesne University, Pittsburgh, PA
3
School of Education and Social Sciences, Robert Morris University,
Coraopolis, PA
4
The Watson Institute, Sewickley, PA
5
Caring Heights Community Care & Rehabilitation Center, Pittsburgh, PA

The purpose of this study was to compare the results of two handwriting curricula
on handwriting performance in typically developing first grade students. Each class-
room implemented a different handwriting curriculum throughout the school year as
part of the regular first grade curriculum. One classroom implemented the Handwriting
Without Tears program, while the other used the Peterson Directed Handwriting cur-
riculum. Handwriting skills were assessed at the beginning, middle, and end of the
school year. Student handwriting performance improved for both classrooms over the
course of the school year. This suggests that for typically developing first grade students,
implementation of a structured curriculum may be key to developing good handwriting
skills.

Keywords Handwriting, curriculum, occupational therapy, school based practice,

printing skills

Handwriting is a primary occupation for school-age children. Children are required to

engage in pencil-and-paper tasks and record responses during a variety of school subjects
including math, social studies, science, and reading. It has been estimated that 30% to 60%
of a child’s school day is spent engaging in fine-motor tasks, with handwriting (including
writing, copying, and drawing) identified as the most common fine-motor activity (McHale
& Cermak, 1992). A study of kindergarten children found that 42% of students’ school days
involved pencil-and-paper activities (Marr, Cermak, Cohn, & Henderson, 2003). Writing
is used for taking notes, completing homework assignments, recording responses to test
questions, and creative expression. According to Bonney (1992), handwriting is a func-
tional activity that allows people to express themselves in a creative manner, increase their
satisfaction, and have greater success in the academic aspect of their lives. With the recent

Received: 8 May 2012; accepted: 5 March 2013.

Address correspondence to Joyce Salls, Occupational Therapy Department, Woodland Rd.,
Chatham University, Pittsburgh, PA 15232, USA. E-mail: [email protected]

131
 132 J. Salls et al.

change to the College Board SAT test (2005) requiring students to handwrite the essay
portion of the test, the ability to write legibly remains an important skill beyond the ele-
mentary school years. Children with poor or illegible writing may experience a variety of
academic challenges, including inability to complete written assignments in a timely man-
ner, lower grades due to illegibility, and producing shorter creative writing assignments due
to writing fatigue (Chase, 1986; Graham, 1980; Tseng & Cermak, 1993).
Prior studies have noted that handwriting is a leading area of referrals for school-based
occupational therapists (Asher, 2006; Marr & Cermak, 2002) and therefore a major focus
of intervention (Hammerschmidt & Sudsawad, 2004; Hoy, Egan, & Feder, 2011). It has
been estimated that 98% of school-based occupational therapy referrals are related to issues
with handwriting (Tait, 1998; Marr & Dimeo, 2006). Although teachers are the primary
instructors of handwriting in the elementary school curriculum, when children experience
difficulties with handwriting, they are frequently referred to occupational therapy for
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remediation. In a study exploring handwriting instruction in a school district, Asher

(2006) found teachers using a variety of curricula, with some reporting a lack of a formal
teaching method for handwriting. In a national survey of teachers, only 12% reported
adequate training in handwriting instruction (Graham et al., 2007). With the growing
emphasis on providing services that are evidence-based, it is important for educators and
occupational therapists to base their recommendations and interventions on methods that
are grounded in research. The Individuals with Disabilities Education Improvement Act
of 2004 (IDEIA) states that special education services for children should be based, to the
greatest extent possible, on peer-reviewed research (Pub. L. 108-446). Additionally, the
No Child Left Behind Act of 2001 (NCLB; Pub. L. 107-110) states that teaching methods
for school children should be based on scientifically based research (Pub. L. No. 107-110,
115 Stat.1425). Recent changes to school curricula have lessened the amount of time
and practice allotted for handwriting, while studies have shown that handwriting methods
for all children that include at least two practice sessions per week for a minimum of
20 sessions are most effective (Hoy et al., 2011).
Handwriting is taught through numerous programs that were developed to aid in the
process of increasing legibility (Zwicker & Harris, 2009). Zaner-Bloser, D’Nealian, and
the Peterson Directed Handwriting curricula are common traditional handwriting curricula
implemented in schools (Cahill, 2009; Nelson, 2006; Hammerschidt & Sudsawad, 2004;
Wallace & Schomer, 1994).
Each handwriting program is unique in its own manner, by introducing and teaching
handwriting differently. Combinations of approaches, such as kinesthetic, sensorimotor,
and/or ergonomic factors, were integrated into the programs. However, no evidence has
been found regarding the effectiveness of using one handwriting program over another
(Cahill, 2009; Sheffield, 1996).
Handwriting without Tears (HWT), a developmentally based, multisensory handwrit-
ing curriculum, is frequently used by occupational therapists and has been adopted by many
school districts throughout the United States (Olsen, 2003). It was developed by an occupa-
tional therapist and is designed for students from pre-kindergarten through the sixth grade.
The curriculum includes instruction for both printing and cursive writing and is grounded
in the assumption that children learn best through a multi-sensory approach. Lessons are
presented from a developmental sequence, with letters with similar formation taught in
groupings. Visual, auditory, tactile, and movement tools are included to reinforce letter for-
mation, size, and alignment. Due to the multisensory nature of the program and the use
of simple, child-friendly language, HWT is often used to teach handwriting to children
with special needs (Olsen, 2003). There is currently no published research regarding the
effectiveness of the HWT Program as compared to other handwriting curricula.
 Comparison of Two Handwriting Curricula 133

The Peterson Directed Handwriting Method is a handwriting curriculum based on prin-

ciples of motor learning theory. It is designed to help children develop handwriting that
is legible, fluid, and automatic. Directed lesson activities focus on movement sequence
and rhythm, with the goal of helping students to internalize movement patterns for writing
automaticity. The curriculum uses a “We Write to Read” method to illustrate a connection
between reading and writing fluency and focuses on the principles of “Develop, Practice,
and Apply.” Instructional tools include lessons to develop internalization of movement
patterns, practice to improve control and rhythm, and application of learning to facilitate
using rhythm as a tool (Nelson, 2006). To date, there are no research studies regarding the
effectiveness of the Peterson Program.
Multiple handwriting curricula are available; however, there is little evidence to sup-
port one program or method of intervention over another (Hoy et al., 2011; Cahill,
2009; Weintraub, Yinon, Hirsch, & Parush, 2009; Zwicker & Hadwin, 2009). Evidence
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to support a reliable and efficient method of instruction could provide the practitioner
with the documentation needed to support professional reasoning. The purpose of this
study was to compare two handwriting curricula, Handwriting Without Tears (HWT)
and the Peterson Directed Handwriting Program, on handwriting performance in typ-
ically developing first grade students. Specifically, the research question under study
was, For typically developing first graders, is there a difference between handwrit-
ing performance in first grade students who receive instruction in the HWT versus
the Peterson Directed Handwriting Program, as measured by three different instru-
ments?

Methods

Design and Participants

The study used a two-group repeated-measures design and was approved by the
Institutional Review Board of Chatham University. A total of 31 students from two first
grade classrooms in a suburban school district in Pittsburgh, Pennsylvania participated in
the study. Parental consent and student assent were received for all participants prior to ini-
tiation of the project. Students receiving special education or occupational therapy services
were excluded from the study.
The classrooms were located in two different elementary schools in the same dis-
trict. These classrooms were chosen since each was implementing a different handwriting
curriculum. One classroom implemented the HWT curriculum, while the other used
the Peterson Directed Handwriting Program. Time allocated to in-classroom instruction,
in-school practice, and handwriting homework was consistent between the two curricula.
Table 1 provides student demographics for the two classrooms. The sample sizes for
the two classrooms were similar. Age ranges for the children in both classes were also
similar with ages ranging from 6 years, 0 months to 7 years, 1 month. The percentage of
boys in the Peterson classroom was slightly higher than the corresponding percentage in the
HWT classroom, and the overwhelming majority of children in both classrooms were right-
handed. Both elementary schools were located in a middle-class suburban school district.

Instruments
Several instruments were utilized in the current study to measure various aspects of
handwriting quality of students in the two classrooms, including the Print Tool, the
 134 J. Salls et al.

Table 1
Student Demographics by School

Right- Left-
Total Male Female Handed Handed Age
Curriculum n n % n % n % n % m Range
Peterson 17 11 64.7 6 35.3 16 94.1 1 5.9 6.6 6.0–7.1
HWT 14 6 42.9 8 57.1 12 85.7 2 14.3 6.5 6.0–6.11

Developmental Test of Visual-Motor Integration (5th edition; VMI), and the Minnesota
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Handwriting Assessment (MHA; Reisman, 1999). The Print Tool instrument is used for
evaluating use of capitals, lowercase letters, and numbers for children in grades K to 4
(Olsen & Knapton, 2006). With the Print Tool, eight basic printing skills are assessed:
memory, orientation, placement, size, start, sequence, control, and spacing. Four scores are
available from the Print Tool: the total percent correct, the capital total percent correct,
the lowercase total percent correct, and the number total percent correct. The second mea-
sure used to assess handwriting in the current study was the Beery Test of Visual Motor
Integration (VMI). The VMI is a widely used pencil-and-paper test that requires the child
to copy a series of geometric forms from a test booklet. Graphic responses are scored using
the criterion listed in the manual. The VMI is a norm-referenced standardized assessment
and has been shown to have high reliability and validity (Beery & Beery, 2006). Both scale
scores and standard scores from the VMI were used in the current study. The third tool
utilized in the study to assess handwriting was the Minnesota Handwriting Assessment
(MHA). This norm-referenced standardized tool is used to analyze the handwriting skills
of first and second grade students. It addresses standard manuscript and D’Nealian styles of
print. Students are instructed to copy a sample sentence that contains eight words. Scores
are based on rate and on quality, as indicated by five subscales (legibility, form, align-
ment, size, and spacing). Inter-rater reliability is high (r = .98), and test-retest reliability is
moderate (r = .72; Feder & Majnemer, 2003).

Procedure
A sample of two first grade classrooms was chosen based on the handwriting curriculum
being implemented. In one classroom, the teacher was trained in the Peterson Directed
Handwriting curriculum. The Peterson Directed Handwriting curriculum is based on
the principles of motor learning utilizing a cognitive approach to letter formation with
reinforcement rooted in directed practice and repetition (Nelson, 2006). In the other class-
room, the teacher was trained to implement the HWT program. The HWT Program is a
sensorimotor-based curriculum engaging the children in learning tasks that reinforce letter
formation via multiple sensory systems (Olsen, 2003). Both teachers had prior experience
with the programs they were teaching. The children were assigned a number based on a
classroom roster and were tested on all three measures (Print Tool, VMI, and MHA) at
the beginning, midpoint, and end of the school year. The evaluators were eight occupa-
tional therapy graduate students who were trained by the first two authors to administer and
score each of the three instruments. Training for the tools consisted of administration and
scoring of the tool until intra-rater reliability exceeded 95% for each evaluator. Training
 Comparison of Two Handwriting Curricula 135

to address reliability between evaluators consisted of discussion on all items where there
was disagreement until consensus was reached. Evaluators began data collection after 100%
agreement was reached on three separate trials. During data collection, each instrument was
scored independently by two evaluators. When there was disagreement in the scoring, the
evaluators and the second author reviewed the scoring together until 100% agreement was
reached. All evaluators were blinded to the curriculum of the children they were testing.

Data Analysis
To compare the effectiveness of the two handwriting curricula, two-way repeated-measures
analyses of variance (ANOVA) were run, with type of instruction as the between-groups
independent variable having two levels (HWT and Peterson), and time as the within-groups
independent variable having three levels (baseline, midpoint, and final). Repeated-measures
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ANOVAs were run using several dependent variables, including total score, capital score,
lowercase score, and number score from the Print Tool; raw score, scale score, standard
score, and percentile from the VMI; and rate, legibility, form, alignment, size, and spacing
scores from the MHA. A variety of instruments were used to measure several aspects of
handwriting in the study, because corresponding results across instruments would provide
stronger evidence of the effectiveness of one handwriting curriculum over the other than
would results based on only one instrument. Additionally, the instruments chosen for use
in the study measure different aspects of handwriting.

Results

Print Tool
Table 2 shows the means and standard deviations for each of the Print Tool scores for the
classrooms using the HWT and Peterson curricula at each time point. Scores on the Print
Tool were similar at each time point for the two classrooms.

Table 2
Print Tool Descriptive Statistics and Significance Levels for Tests of Simple Effects

Print Tool Base Print Tool Mid Print Tool Final

HWT Peterson HWT Peterson HWT Peterson
Print Tool
Scale M (SD) M (SD) p M (SD) M (SD) p M(SD) M (SD) p
Total 74.2 77.5 .28 84.6 82.2 .37 84.8 84.6 .92
(9.6) (6.8) (6.4) (7.7) (6.1) (4.6)
Capital 73.8 77.6 .21 82.9 81.2 .55 79.4 82.1 .32
(10.9) (5.2) (7.5) (8.1) (7.9) (6.5)
Lower 73.5 73.8 .91 86.0 82.2 .25 87.8 84.1 .19
(7.1) (8.4) (6.8) (10.5) (6.4) (8.6)
Number 76.8 76.8 1 84.3 85.1 .83 84.9 85.5 .87
(14.0) (11.1) (11.0) (8.5) (9.5) (10.0)
 136 J. Salls et al.

Repeated-measures ANOVA results based on the Print Tool showed that Mauchly’s
Sphericty assumption was met for Print Tool Total (p = .10), Print Tool Capital (p =
.15), Print Tool Lowercase (p = .08), and Print Tool Number (p = .18). Therefore, the
univariate approach to repeated-measures ANOVA was utilized, as the univariate tests are
more powerful than their multivariate counterparts when the sphericity assumption is met.
Results showed that there were no significant interactions between handwriting method
and time for Print Tool Total scores (F(2, 58) = 1.91, p = .16, η2 = .06), Print Tool
Capital scores (F(2, 58) = 1.46, p = .24, η2 = .05), Print Tool Lowercase (F(2, 58) =
1.75, p = .18, η2 = .06), or Print Tool Number (F(2, 58) = 0.02, p = .98, η2 = .00). With
no significant interaction effects, the main effects for handwriting curricula and time were
investigated.
Repeated-measures ANOVA results showed that there were no significant between-
group main effects for any of the Print Tool scores, indicating that the differences in
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handwriting as measured by the Print Tool were not statistically significant for the class-
rooms receiving the HWT versus Peterson curricula. Specifically, the between-group
differences were not significant for the Print Tool Total (F(1, 29) = .02, p = 90, η2 = .00),
Print Tool Capital (F(1, 29) = 0.62, p = .44, η2 = .02), Print Tool Lowercase (F(1, 29) =
0.88, p = .34, η2 = .03), or Print Tool Number (F(1, 29) = 0.02, p = .89, η2 = .00). Again,
these results suggest that there is little difference in the effect on handwriting, as measured
by the Print Tool, of the HWT versus Peterson curricula.
There was a significant main effect for time for each of Print Tool scores, indicating
that, as would be expected during the course of a school year, scores increased over time.
Specifically, the within-group differences for time were significant for the Print Tool Total
(F(2, 58) = 21.91, p = .00, η2 = .43), Print Tool Capital (F(2, 58) = 7.94, p = .00, η2 =
.22), Print Tool Lowercase (F(2, 58) = 54.56, p = .00, η2 = .65), and Print Tool Number
(F(2, 58) = 12.07, p = .00, η2 = .29). As measured by the Print Tool, the groups receiv-
ing the two handwriting curricula saw similar and statistically significant gains over time.
In order to investigate further whether there were differences between the two curricula at
any individual time point, tests of simple effects were carried out. As is seen in Table 2, the
differences between HWT and Peterson classrooms were not significant at any time point,
with each p-value in Table 2 being larger than .05. Therefore, both curricula seem to be
equally effective as measured by the Print Tool.

VMI Results
Table 3 presents descriptive statistics and tests of simple effects for the VMI Raw, Standard,
Scale and percentile scores for the classrooms receiving the HWT and Peterson curricula
at the baseline, midpoint, and final time points.
Mauchly’s test showed that the sphericity assumption was met for VMI Raw (p =
.711), VMI Standard (p = .51), VMI Scale (p = .61), and VMI Percentile scores (p =
.35). Repeated-measures ANOVA results showed that there were no significant interactions
between handwriting method and time for VMI raw scores (F(2, 58) = 1.02, p = .37,
η2 = .03), VMI standard scores (F(2, 58) = 1.55, p = .22, η2 = .05), VMI scale scores
(F(2, 58) = 1.95, p = .15, η2 = .06), or VMI percentile scores (F(2, 58) = 1.93, p = .16,
η2 = .06). With no significant interaction effects, the main effects for handwriting curricula
and time on the VMI scores were investigated.
Repeated-measures ANOVA results showed that there were significant between group
main effects for the VMI standard scores (F(1, 29) = 4.48, p = .04, η2 = .13), VMI scale
scores (F(1, 29) = 4.34, p = .045, η2 = .13), and VMI Percentile scores (F(1, 29) = 5.21,
 Comparison of Two Handwriting Curricula 137

Table 3
VMI Descriptive Statistics and Significance Levels for Tests of Simple Effects

VMI Base VMI Mid VMI Final

HWT Peterson HWT Peterson HWT Peterson
Time M (SD) M (SD) p M (SD) M (SD) p M (SD) M (SD) p
Raw 19.0 18.2 .32 20.7 18.8 .06 21.4 19.8 .11
(2.4) (2.1) (2.2) (3.1) (2.4) (2.8)
Standard 104.9 100.5 .31 109.6 98.9 .03∗ 109.4 100.2 .04∗
(12.4) (11.3) (9.3) (15.0) (10.7) (12.7)
Scale 10.9 10.1 .36 12.0 9.7 .02∗ 11.9 10.1 .049∗
(2.5) (2.3) (1.8) (3.1) (2.2) (2.6)
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Percentile 59.4 50.5 .33 71.6 47.5 .01∗ 69.4 49.9 .03∗
(24.4) (25.2) (19.1) (30.0) (19.5) (26.7)

p = .03, η2 = .15); however, effect sizes for each of these scores were small. Between-group
differences for the VMI raw scores were statistically significant at the alpha = .10 level of
significance (F(1, 29) = 3.3, p = .08, η2 = .10). These results show that differences between
handwriting of students receiving the HWT versus the Peterson curricula were statistically
significant as measured by the VMI. Effect sizes were small indicating that, while results
were statistically significant, there is little practical significance between the two curricula.
There were significant main effects for time for only the VMI raw scores (F(2, 58) =
12.66, p = .00, η2 = .30) indicating that the raw scores increased over time. Further, there
were no significant changes in VMI standard scores (F(2, 58) = 0.67, p = .52, η2 = .02),
VMI scale scores (F(2, 58) = 1.13, p = .33, η2 = .04), or VMI percentiles (F(2, 58) =
0.89, p = 42, η2 = .03) over time. These results indicate, counter to results for the Print
Tool, that VMI scores were relatively stable over time, showing little increase for students
receiving both handwriting curricula.
With no main effects for time for these three standardized scores, it was important
to investigate simple effects, which show (1) whether there are differences in performance
across the three time points for either handwriting curricula and (2) whether there are differ-
ences at any single time point between the groups receiving the two different handwriting
curricula.
Figure 1 shows the VMI raw scores and standard scores for the two groups at each time
point. Similar patterns to the VMI standard scores are seen in the VMI scale scores and VMI
percentiles, so those values are not plotted. Supporting the means shown in Table 3, there
are differences between the VMI standard scores between the two schools, which were not
significantly different at Time 1 (p = .36) but were statistically significant at Time 2 (p =
.02) and Time 3 (p = .05). The differences at all time points were small. Figure 3 also shows
that students following the HWT curriculum showed larger gains in raw scores and standard
scores than students following the Peterson curriculum, and at Time 2, the standard scores
for the Peterson group decreased. Again, the differences between students receiving each
curricula at Times 2 and 3 were statistically significant, but those differences have little
practical meaning. Therefore, as seen by the VMI scores, there is little difference between
the two curricula, and VMI scores were relatively stable over time.
 138 J. Salls et al.

Peterson
25 VMI Raw
Score
21.4
20.7
19.0 HWT VMI
20
Raw Score
19.8
18.8
18.2
Scores

15 Peterson
VMI
12.0 11.9 Standard
10.9 Score
10 HWT VMI
10.1 10.1 Standard
9.7
Score
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5
Baseline Midpoint Final

Figure 1. VMI raw and standard scores.

Minnesota Handwriting Assessment Results

Table 4 presents descriptive statistics for the Minnesota Handwriting Assessment Rate,
Legibility, Form, Alignment, Size, and Spacing subscales for each curriculum at each time
point.
Analyses similar to those presented for the Print Tool and VMI were conducted for
each of the MHA subscales. First, tests of the sphericity assumption were carried out for
each subscale, which showed that the sphericity assumption was not violated for rate (p =
.73), legibility (p = .053), form (p = .21) but was violated for alignment (p = .00), space
(p = .00), and size (p = .00). Second, interaction effects between handwriting curriculum
and time were carried out, followed by tests of main effects and simple main effects. For
cases where the sphericity assumption was violated, Wilks’ Lambda was used.
There were no significant interaction effects for any of the subscales. Specifically,
the statistics for each subscale were rate (F(2, 58) = 1.86, p = .17, η2 = .06), legibility
(F(2, 58) = 0.28, p = .76, η2 = .01), form (F(2, 58) = 2.44, p = .01, η2 = .08), alignment
(2, 28) = 0.62, p = .55, η2 = .04), spacing (F(2, 28) = 0.66, p = .53, η2 = .05), and size
(F(2, 28) = 1.36, p = .27, η2 = .09).
Further, there were no main effects for students receiving each handwriting curriculum
as measured by the rate (F(1,29) = .53, p = .47, η2 = .02), legibility (F(1,29) = 1.09, p =
.31, η2 = .04), form (F(1,29) = .74, p = .38, η2 = .03), alignment (F(1,29) = 2.80, p = .11,
η2 =.09), spacing (F(1,29) = 1.07, p = .31, η2 = .04), or size (F(1,29) = 3.71, p = .06,
η2 = .11) subscales. Therefore, supporting the results found using the other instruments,
there were not significant differences between students receiving the different handwriting
curricula on any of the MHA subscales. In looking at simple effects or the differences
between means of the two handwriting groups at individual time points, Table 4 shows
that the only significant differences were at the final time point, for the alignment (p =
.02) and size (p = .02) subscales, where the HWT produced higher scores than the Peterson
curriculum.
There were significant main effects for time for several of the subscales, indicating that
scores for the rate (F(2,58 = 46.4, p = 0.00, η2 = .62), alignment (F(2,58) = 11.7, p =
 Comparison of Two Handwriting Curricula 139

Table 4
MHA Subscale Descriptive Statistics and Significance Levels for Tests of Simple Effects

Baseline Midpoint Final

HWT Peterson HWT Peterson HWT Peterson
MSA
Subscale M (SD) M (SD) p M (SD) M (SD) p M (SD) M (SD) p
Rate 17.2 16.2 .71 23.8 28.2 .06 31.2 31.1 .94
(6.4) (8.0) (7.2) (5.5) (4.0) (6.5)
Legibility 32.9 31.7 .27 33.0 32.6 .71 32.6 32.1 .47
(1.1) (3.7) (2.7) (2.5) (1.6) (2.6)
Form 30.8 31.2 .70 31.6 31.3 .67 32.3 30.5 .07
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(3.0) (2.5) (1.8) (1.8) (1.4) (3.4)

Alignment 29.5 28.1 .44 32.4 31.4 .24 33.1 31.1 .02∗
(4.5) (5.6) (2.6) (2.0) (1.4) (2.8)
Size 29.9 28.2 .39 33.3 31.4 .06 32.9 29.5 .02∗
(5.4) (5.3) (1.1) (3.5) (2.1) (4.8)
Spacing 32.4 31.1 .18 32.2 32.0 .77 32.3 31.7 .51
(1.5) (3.2) (2.1) (1.9) (2.2) (2.6)

0.00, η2 = .29), and size (F(2,58) = 9.7, p = 0.00, η2 = .25) subscales increased over time
for students using both curricula. Time was not a significant factor for legibility (F(2,58) =
57, p = .57, η2 = .02), form (F(2,58) = .46, p = .63, η2 = .02), or spacing (F(2,58) = .43,
p = .67, η2 = .01), indicating that the scores on those subscales remained consistent over
time.
Results for the MHA subscales are similar for the two classrooms. Statistical tests
showed few significant differences between the two groups receiving the two curricula.
The data shown in Table 4 indicate that scores for students receiving HWT are slightly
higher than scores for students receiving the Peterson curriculum on most subscales, but
most of these differences are not statistically significant.
In order to further explore the data, differences between the performance of boys and
girls on each of the instruments were examined. The sample sizes in the two classrooms
did not allow for valid statistical comparisons of gender between the two curricula, but
exploratory independent samples t-tests indicated that there were no statistically significant
differences between the genders on any of the instruments at alpha = .01. Therefore, the
study indicated that the performance by gender was similar.

Discussion and Conclusions

School-based occupational therapists play a key role in helping children develop the skills
necessary for handwriting efficiency. However, studies have been inconclusive regarding
which handwriting curricula or intervention strategies are most effective (Hoy et al., 2011;
Weintraub et al., 2009). The current study compared the use of two handwriting curric-
ula, HWT and Peterson, on students in two first grade classrooms who were exposed to
the respective curriculum for an entire school year. At baseline, the two groups of children
scored equally on all tests and were therefore considered to be comparable in handwriting
 140 J. Salls et al.

skills. Three different handwriting instruments, each measuring different aspects of hand-
writing, were utilized. Overall, students receiving the two different handwriting curricula
performed similarly on each measure and subscale. Generally, students in the HWT class-
room showed higher gains sooner on several measures, but in most cases, the differences
were not statistically significant. For most instances when differences occurred, scores in
the HWT classroom were higher. The initial higher gains may be attributed to the vari-
ety, novelty, and multisensory nature of the materials presented in the HWT curriculum,
leading to increased motivation. It is also possible that these differences may have been
greater with a larger sample size. Additionally, it was noted that VMI scores remained rel-
atively stable over the course of the school year for both groups. It is possible that the VMI
is not sensitive enough to detect the changes that occur in handwriting during a 9-month
time period whereas the other two measures used did reveal changes in scores during the
same period of time. Although the VMI has been cited as a good predictor for learning the
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beginning skills of writing letters in kindergarten (Daly, Kelley, & Krauss, 2003; Weil &
Cunningham Amundson, 1994), there is no evidence that it predicts handwriting ability in
first grade. Overvelde and Hulstijn (2011) found that the VMI was not an appropriate tool
for assessing handwriting ability in children in grades 2 and 3.
The findings of this study support the use of either curriculum in teaching typically
developing children the essential skills of handwriting. What appears to be most important
is the implementation of a formal curriculum that allows for ongoing handwriting instruc-
tion and practice. Hoy et al. (2011), in an extensive review of the literature, supported that
effective handwriting interventions require meeting at least twice a week for 20 sessions,
and improvements in handwriting speed require even more practice. This is consistent with
the motor learning theory, which emphasizes the role of practice and experience in improv-
ing skilled movement (Zwicker & Harris, 2009). Zwicker and Hadwin (2009), in a study
comparing a multisensory approach to handwriting to a cognitive approach in a group of
first and second grade students, found no significant differences between the two groups.
This could support the idea that implementation of any formal handwriting curriculum with
typically developing children may improve handwriting skills. However, with the growing
number of children with special needs who are receiving occupational therapy services
due to handwriting deficits, it may be beneficial to implement a multisensory program that
can be effective in both environments. Additionally, use of the HWT program may sup-
port inclusion, providing students with special needs the opportunity to learn and reinforce
handwriting skills in the regular classroom setting. Finally, occupational therapists can play
a key role in handwriting instruction through early intervention services, including response
to intervention. This could include providing consultation to school administrators and staff
regarding the importance of handwriting curricula, screening children, and support to class-
room teachers on evidenced-based handwriting instructional methods that would benefit
all students. Benson, Salls, and Perry (2010) suggest collaboration between teachers and
occupational therapists for curriculum selection and implementation.
One limitation to the design of the current study was the fact that a control group,
which did not implement a handwriting curriculum, was not utilized. However, a control
group was not considered necessary as current literature already supports that handwriting
improves with instruction (Shimel, Candler, & Neville-Smith, 2009). In addition, with-
holding handwriting instruction from a group of first graders for an entire school year was
deemed unethical. Therefore, this limitation to the design is seen as a positive aspect of
the current study, since students in both classrooms were able to receive formal handwrit-
ing instruction. Another limitation is the small sample size, limiting generalizability of the
study. Post hoc power analyses given the smaller sample sizes utilized in the study indicate
 Comparison of Two Handwriting Curricula 141

that the current study had low power. However, the study served as a pilot study for the dis-
trict in question, as they utilized the results of the study in determining which handwriting
curriculum to implement. The setting in which the study was conducted, a suburban middle-
class school district, further limits generalizability. Finally, this study compared only two
handwriting curricula. Future studies could compare the effectiveness of other commercial
handwriting programs as well as the efficacy of these curricula in improving handwriting
performance in students with special needs.

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