A Review of Handwriting A Review of Handwriting AssessmentsAssessments

Presented by:Presented by:

Rachel KirkRachel Kirk

Shannon MunfordShannon Munford

Selena Mehr, BCABASelena Mehr, BCABACaldwell CollegeCaldwell College

HandwritingHandwritingWhy focus heavily on handwriting Why focus heavily on handwriting

skills/remediation?skills/remediation? Record and communicate informationRecord and communicate information Compete in the regular education classroom Compete in the regular education classroom Personal use (class notes, shopping lists)Personal use (class notes, shopping lists) Written communication to others (letters, Written communication to others (letters,

memos)memos) Writing related to seeking employment and Writing related to seeking employment and

job-related skills (applications)job-related skills (applications) To obtain information from others To obtain information from others (Stowitschek et. al., 1989)(Stowitschek et. al., 1989)

HandwritingHandwriting

Poor Handwriting can “cause”:Poor Handwriting can “cause”:

Teachers place importance on clear, concise, good Teachers place importance on clear, concise, good handwriting. Poor handwriting in the early grades handwriting. Poor handwriting in the early grades linked to poor academic performance in the future. linked to poor academic performance in the future. (Harvey and Henderson 1997)(Harvey and Henderson 1997)

Some develop mind-set that they cannot write and give Some develop mind-set that they cannot write and give up. (Berninger 1998)up. (Berninger 1998)

Lack of confidence then leads to stress, poor self-Lack of confidence then leads to stress, poor self-esteem, poor career prospects. (Sassoon 1997)esteem, poor career prospects. (Sassoon 1997)

HandwritingHandwriting

Reason for Assessment:Reason for Assessment: Standardized or systematic procedures Standardized or systematic procedures

are seldom used are seldom used Poor letter formation skills are evident in Poor letter formation skills are evident in

the handwriting of many studentsthe handwriting of many students Few special or general educators have Few special or general educators have

been trained to teach and remediate been trained to teach and remediate handwritinghandwriting

Distinguish between student ability and Distinguish between student ability and actual handwriting performanceactual handwriting performance

(Stowitschek et. al., 1989)(Stowitschek et. al., 1989)

MHAMHAThe Minnesota HandwritingThe Minnesota Handwriting

AssessmentAssessment

Developed by:Developed by:

Judith Reisman (1993) Judith Reisman (1993)

Development of MHT:Development of MHT:

MHA is a way:MHA is a way: to assist school-based occupational therapists in the to assist school-based occupational therapists in the

identification of children with writing difficulties/assess identification of children with writing difficulties/assess treatment.treatment.

A more sophisticated alternative to the “rating scales.”A more sophisticated alternative to the “rating scales.” MHA can determine: MHA can determine:

Speed, accuracy, letter size, spacing, and can show where Speed, accuracy, letter size, spacing, and can show where students difficulties are.students difficulties are.

(Reisman 1993)(Reisman 1993)

MHAMHA

Designed forDesigned for: : 11stst and 2 and 2ndnd graders graders

Age Range:Age Range:(5 to 7 years)(5 to 7 years)

Administration:Administration:Individual or Group- 5 to 10 minutes; 10 to 30 minutes to score Individual or Group- 5 to 10 minutes; 10 to 30 minutes to score

Test is used to identify how students are performing in Test is used to identify how students are performing in relationship to their peers. relationship to their peers.

(Reisman 1993)(Reisman 1993)

MHA: MaterialsMHA: Materials Complete kit:Complete kit:

Includes manual, 1 manuscript and 1 D'Nealian Pad, Includes manual, 1 manuscript and 1 D'Nealian Pad, 25 sheets25 sheets

Additional copies of materials:Additional copies of materials:

Manuscript Print Pads, pack of 4 pads (25 sheets per Manuscript Print Pads, pack of 4 pads (25 sheets per pad) D'Nealian Print Pads, pack of 4 pads (25 sheets pad) D'Nealian Print Pads, pack of 4 pads (25 sheets

per padper pad))

MHA: FormatMHA: Format Rate score (writing speed): # of letters completed during the Rate score (writing speed): # of letters completed during the

timed portion.timed portion. More time given:More time given:

1.1. LegibilityLegibility

2.2. FormForm

3.3. AlignmentAlignment

4.4. SizeSize

5.5. SpacingSpacing The total maximum point scored on the The total maximum point scored on the

test is 170.test is 170.(Reisman 1993)(Reisman 1993)

MHAMHAProcedure:Procedure: Sentence is given in jumbled form Sentence is given in jumbled form

Ex: “the quick brown fox jumped over the lazy dog”Ex: “the quick brown fox jumped over the lazy dog” Small triangles: starting point.Small triangles: starting point. Write for a timed period (2 ½ minutes)Write for a timed period (2 ½ minutes)

(Reisman 1991) used 2.5 minutes made after pilot test with 1(Reisman 1991) used 2.5 minutes made after pilot test with 1stst and 2 and 2ndnd graders graders

timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes. timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes. 67% of the 267% of the 2ndnd graders finished at least 31 of the 34 sample letters in graders finished at least 31 of the 34 sample letters in

2.5 minutes. 2.5 minutes. Stop and circle last letter writtenStop and circle last letter written Then finish the sentenceThen finish the sentence(Feder & Majnemer 2003)(Feder & Majnemer 2003)

MHAMHA Legibility/ScoringLegibility/Scoring::

Letter is recognizable out of context (dots on letters i/j)Letter is recognizable out of context (dots on letters i/j) Complete with all strokes presentComplete with all strokes present Contains no reversals (letter k) Contains no reversals (letter k)

34 maximum points34 maximum points Scoring is Scoring is discontinueddiscontinued if the students writing is illegible. if the students writing is illegible. This rule was adopted b/c:This rule was adopted b/c:

It is impossible to obtain reliable measurements for the It is impossible to obtain reliable measurements for the other categories if a letter is illegibleother categories if a letter is illegible

(Reisman 1993)(Reisman 1993)

MHAMHA

2.2. Form/Scoring:Form/Scoring: Measures letter qualityMeasures letter quality Lines: curved or Lines: curved or

pointed in certain parts pointed in certain parts of the letter.of the letter.

no gaps or overlaps no gaps or overlaps greater than 1/16” greater than 1/16” between letter partsbetween letter parts

Maximum 34 pointsMaximum 34 points

3.3. Alignment/Scoring:Alignment/Scoring: Position of the Position of the

letters on the line.letters on the line. Letters within 1/16” Letters within 1/16”

of the solid of the solid baseline.baseline.

Maximum 34 pointsMaximum 34 points

MHAMHA

4.4. Size/Scoring:Size/Scoring: Measures all Measures all

other parts of other parts of the letter to the the letter to the midline, upper midline, upper and lower lines.and lower lines.

Maximum Maximum points 34points 34

5.5. Spacing/Spacing/Scoring:Scoring:

Correct letter Correct letter and word and word spacingspacing

““daylight” daylight” between letters.between letters.

Maximum points Maximum points 3434

ResearchResearchReisman, J.E., (1993). Development and Reliability of the Research Version Reisman, J.E., (1993). Development and Reliability of the Research Version

of the Minnesota Handwriting Testof the Minnesota Handwriting Test.. Physical and Occupational Therapy in Physical and Occupational Therapy in Pediatrics, 13Pediatrics, 13(2), 41-55.(2), 41-55.

6 raters trained in 3 sessions6 raters trained in 3 sessions 11stst session: Brief explanation of the scoring rules. session: Brief explanation of the scoring rules.

Took an average of 2 hours to scoreTook an average of 2 hours to score After 1After 1stst session: discussion b/w Reisman and the raters. session: discussion b/w Reisman and the raters. 22ndnd session: repeated the process. session: repeated the process. After 2After 2ndnd session: errors made raters was very small. session: errors made raters was very small. 33rdrd session: repeated the process. session: repeated the process.

Took an average of 25 minutes to scoreTook an average of 25 minutes to score Reliability increased to 95%.Reliability increased to 95%.

Manual for the MHA: 3 sets of 10 handwriting samples, can Manual for the MHA: 3 sets of 10 handwriting samples, can be compared to Reismans grading of the samples.be compared to Reismans grading of the samples.

Explains scoring procedure as in the study. Explains scoring procedure as in the study.

Research con’t:Research con’t: Cornhill, H., Case-Smith, J. (1996). Factors that relate to good and Cornhill, H., Case-Smith, J. (1996). Factors that relate to good and

poor handwriting. poor handwriting. American Journal of Occupational Therapy, American Journal of Occupational Therapy, 56(3),56(3), 305-312. 305-312.

48 typical 148 typical 1stst graders identified as either good or poor handwriters. graders identified as either good or poor handwriters. Motor accuracy test, visual-motor integration test and 2 in-hand Motor accuracy test, visual-motor integration test and 2 in-hand

manipulation tests.manipulation tests. All test scores significantly higher for students with good All test scores significantly higher for students with good

handwriting.handwriting. Then given the MHA.Then given the MHA. ResultsResults::

Eye-hand coordination, visual-motor integration and in-hand Eye-hand coordination, visual-motor integration and in-hand manipulation have a direct association to handwriting skillsmanipulation have a direct association to handwriting skills

MHA is a valid tool that accurately shows a students current MHA is a valid tool that accurately shows a students current handwriting skillshandwriting skills

Research con’t:Research con’t:

Owens, L.L (2004). Owens, L.L (2004). The Effects of the Handwriting Without The Effects of the Handwriting Without Tears Program on the Handwriting of Students in Inclusion Tears Program on the Handwriting of Students in Inclusion Classrooms.Classrooms. Master’s Thesis. Virginia Commonwealth Master’s Thesis. Virginia Commonwealth University, Richmond, Virginia.University, Richmond, Virginia.

2 Experimental groups(41 students)- received HWT method2 Experimental groups(41 students)- received HWT method 2 Comparison groups(40 students)- general handwriting 2 Comparison groups(40 students)- general handwriting

instruction.instruction. Handwriting performance measured using MHA.Handwriting performance measured using MHA. Pretest scores: no difference b/w both groupsPretest scores: no difference b/w both groups Posttest scores: experimental classes showed improvement in Posttest scores: experimental classes showed improvement in

the areas of size (.008) and spacing (.014).the areas of size (.008) and spacing (.014).

MHA: MHA: Individualization/ModificationIndividualization/Modification The initial MHA evaluation shows handwriting illegibility.The initial MHA evaluation shows handwriting illegibility.

The teacher could customizes the MHA test by:The teacher could customizes the MHA test by:

1.1. Teaching specific commonly used letters. Teaching specific commonly used letters. Example: e, a, h, f, t, i, r, d, s, y.Example: e, a, h, f, t, i, r, d, s, y.

2.2. Combining these letters into words.Combining these letters into words. Example: “The first day.”Example: “The first day.”

3.3. Practice writing these words.Practice writing these words.

4.4. Take MHA using the learned letters, words and phrases.Take MHA using the learned letters, words and phrases.

5.5. Contriving this procedure until all the letters have been used Contriving this procedure until all the letters have been used and evaluated.and evaluated.

MHAMHAProsPros Reinforce/teach hand dexterity (kinesthetic)Reinforce/teach hand dexterity (kinesthetic) knowledge (cognitive) is motivationalknowledge (cognitive) is motivational Helps with perception/motor skillsHelps with perception/motor skills Easy to scoreEasy to score Easy to administerEasy to administer Clear, easy to understand manualClear, easy to understand manual Reisman: “MHA can be administered to children with Reisman: “MHA can be administered to children with

a variety of disabilities.” a variety of disabilities.”

MHAMHA

ConsCons Test is relatively newTest is relatively new No extensive clinical trials or researchNo extensive clinical trials or research Children who can not read are at a disadvantage in Children who can not read are at a disadvantage in

the timing portion.the timing portion. Write letter by letterWrite letter by letter Some pre-req: hold a pencil, see, concentrate and Some pre-req: hold a pencil, see, concentrate and

understand.understand. Can be difficult for many developmentally disabled Can be difficult for many developmentally disabled

childrenchildren

DRHPDRHPThe The DDiagnosis and iagnosis and

RRemediation of emediation of

HHandwriting andwriting PProblemsroblems

Authors:Authors:Denis H. Stott, Fred A. Moyes, and Denis H. Stott, Fred A. Moyes, and

Sheila E. Henderson (1985)Sheila E. Henderson (1985)

DRHPDRHP

According to Stott et. al. (1987)…According to Stott et. al. (1987)…

Purpose:Purpose: Systematically identify and classify Systematically identify and classify

handwriting problemshandwriting problems To be used as a clinical toolTo be used as a clinical tool Advance research in handwritingAdvance research in handwriting Provide remedial materials for Provide remedial materials for

teacher educationteacher education

DRHPDRHP

According to Stott et. al. (1987)…According to Stott et. al. (1987)…

Population Intended to Assess:Population Intended to Assess: Children with two years experience Children with two years experience

handwritinghandwriting

(3(3rdrd grade) grade) Adults who have loss skill of Adults who have loss skill of

handwriting due to brain injuryhandwriting due to brain injury

DRHPDRHP

Materials Materials Manual Manual Scoring templates for size and slantScoring templates for size and slant 3 pictures/comic strips3 pictures/comic strips Student’s Writing SheetStudent’s Writing Sheet Diagnostic Record Form Diagnostic Record Form

DRHPDRHP

Manual Content:Manual Content: Sections on direction Sections on direction

useuse Directions for ScoringDirections for Scoring Scorer trainingScorer training Single reliability Single reliability

studystudy Issues relative to the Issues relative to the

measurement of measurement of handwritinghandwriting

Handwriting in left-Handwriting in left-handershanders

Monitoring Monitoring handwriting handwriting standards in the standards in the classroomclassroom

Guidelines for Guidelines for remediationremediation

Remedial programsRemedial programs

DRHPDRHP

Categories of AssessmentCategories of Assessment

Part 1. Faults of Concept and Style Part 1. Faults of Concept and Style (poor teaching or failure to benefit from (poor teaching or failure to benefit from

teaching)teaching)

Section A. Letters incorrectly formed Section A. Letters incorrectly formed and/or joinedand/or joined

Section B. Spacing ErrorsSection B. Spacing Errors

Section C. Stylistic DistractorsSection C. Stylistic Distractors

Section D. SlurringSection D. Slurring

DRHPDRHP

Categories of AssessmentCategories of Assessment

Part 2. Faults of Motor ControlPart 2. Faults of Motor Control1.1. Inconsistency of slantInconsistency of slant

2.2. Inconsistency of letter sizeInconsistency of letter size

3.3. Irregular word alignmentIrregular word alignment

4.4. Random Letter DistortionRandom Letter Distortion

5.5. TremorTremor

DRHPDRHP

Categories of AssessmentCategories of Assessment

Part 3. Concurrent ObservationsPart 3. Concurrent ObservationsSection A. Posture of handling paper and Section A. Posture of handling paper and

penpen

Section B. Faulty ways of addressing taskSection B. Faulty ways of addressing task

Section C. Physical Disadvantages Section C. Physical Disadvantages (poor motor control)(poor motor control)

DRHPDRHP

Administration:Administration: Individually or in a groupIndividually or in a group Student is given a comic book style Student is given a comic book style

series of 3 pictures with word cues series of 3 pictures with word cues provided in “balloons” in each pictureprovided in “balloons” in each picture

Student is given “Student’s Writing Student is given “Student’s Writing Sheet” containing ten lines to write onSheet” containing ten lines to write on

Test is not timed but authors suggest Test is not timed but authors suggest no more than 20 minutesno more than 20 minutes

DRHPDRHP

Scoring:Scoring: Only Part 1 and 2 are numerically scoredOnly Part 1 and 2 are numerically scored Quantitative measuresQuantitative measures

Scoring templates or mechanical aids for Scoring templates or mechanical aids for consistency of slant, spacing, and letter size consistency of slant, spacing, and letter size difference are useddifference are used

These transparent diagnostic templates are These transparent diagnostic templates are applied to writing slant and alignment or deviation applied to writing slant and alignment or deviation from the writing base linefrom the writing base line

Measurement of word spacing is taken but Measurement of word spacing is taken but dependent on the scorer’s accuracy and decision dependent on the scorer’s accuracy and decision when making numerical awardswhen making numerical awards

DRHPDRHP

Scoring:Scoring: Qualitative measuresQualitative measures

Examiner’s determination of whether an Examiner’s determination of whether an error occurrederror occurred

When examiner judgment needed refer When examiner judgment needed refer to the operationally defined termsto the operationally defined terms

All of Section 3 (Observations)All of Section 3 (Observations) Higher Scores: high number of Higher Scores: high number of

errors and higher writing errors and higher writing impairmentimpairment

DRHPDRHP

Scoring:Scoring: Use scores from part 1 & 2 with Use scores from part 1 & 2 with

observations from part 3 (not scored) to observations from part 3 (not scored) to provide basis for diagnostic analysisprovide basis for diagnostic analysis

Overall score/sum were not intended to Overall score/sum were not intended to be used but you can total the scores if be used but you can total the scores if needed for research purposesneeded for research purposes

Use of a two-scorer system provided for Use of a two-scorer system provided for reliabilityreliability

DRHPDRHP

Limitations:Limitations: Complex to ScoreComplex to Score

No scores or score range guidelines for No scores or score range guidelines for interpretation; necessary for development interpretation; necessary for development generalizabilitygeneralizability

IOA: 61-65% for 150 samples (Stott et. al., 1987)IOA: 61-65% for 150 samples (Stott et. al., 1987) Scores are dependent on examiner’s accuracy and Scores are dependent on examiner’s accuracy and

judgment judgment No demographic information regarding the samplesNo demographic information regarding the samples No descriptive data for scorer reliability training No descriptive data for scorer reliability training

provided in the study (Alston & Taylor, 87)provided in the study (Alston & Taylor, 87) No validity studies doneNo validity studies done

Authors do identify need for validity and further Authors do identify need for validity and further reliability studies (Alston & Taylor, 87)reliability studies (Alston & Taylor, 87)

DRHPDRHPLimitations:Limitations: Learner must have prerequisite of writing Learner must have prerequisite of writing

complete sentences and writing/reading complete sentences and writing/reading comprehension.comprehension.

Suggests no room for Suggests no room for individualization/modificationindividualization/modification Could change the pictures/balloons to accommodate the Could change the pictures/balloons to accommodate the

learners academic repetiorelearners academic repetiore Remedial materials and teacher education aspects Remedial materials and teacher education aspects

are limited to brief sections are limited to brief sections A brief review or introduction to an area is not A brief review or introduction to an area is not

sufficient information to plan and carry out sufficient information to plan and carry out handwriting programming (Daniels, 1988)handwriting programming (Daniels, 1988)

Advantages:Advantages: Easy to administer (Daniels, 1988)Easy to administer (Daniels, 1988)

DRHPDRHP

Conclusion:Conclusion: Not a valid/reliable tool in assessing Not a valid/reliable tool in assessing

handwriting problemshandwriting problems With clarification in scoring methods DRHP With clarification in scoring methods DRHP

could be…could be… Useful tool for occupational therapists and Useful tool for occupational therapists and

behavioral therapists in assessing/teaching behavioral therapists in assessing/teaching handwriting problemshandwriting problems

Not a useful approach to assessing Not a useful approach to assessing handwriting for lower skilled individuals handwriting for lower skilled individuals since there is a need for writing/reading since there is a need for writing/reading comprehension.comprehension.

ETCHETCH

EEvaluation valuation TTool of ool of CChildren’s hildren’s HHandwritingandwriting

Author:Author: Susan J. Amudson Ph.D. OTR/L, Susan J. Amudson Ph.D. OTR/L,

FAOTAFAOTAPublication-1995Publication-1995

ETCHETCH

Who is using it?Who is using it?• Public Schools Public Schools • Pediatric occupational therapy Pediatric occupational therapy

agencies agencies • Children’s Hospitals Children’s Hospitals • Child SpecialistsChild Specialists

ETCHETCH

Purpose:Purpose:Evaluate:Evaluate:

• Global legibility Global legibility • Speed Speed

Target Population:Target Population: • Mild developmental delaysMild developmental delays• Learning disabilities Learning disabilities • Mild muscular impairment Mild muscular impairment

ETCHETCH

Prerequisite Skills:Prerequisite Skills:

• First or Second grade levelFirst or Second grade level• Composition Composition

ETCHETCH

DesignDesign Task 1- Alphabet Task 1- Alphabet

Task 2- NumbersTask 2- Numbers

Task 3- Near point Task 3- Near point

Task 4- Far point Task 4- Far point

Task 5- Dictation Task 5- Dictation

Task 6- Sentence composition Task 6- Sentence composition

ETCHETCH

Example:Example:

ETCHETCH

How is the test scored?How is the test scored?Legibility Legibility • subtract the illegible letter, word or subtract the illegible letter, word or

numbers from the possible total.numbers from the possible total. Speed-Speed-TasksTasks 3, 4 &63, 4 &6• Minutes are divided by the number of Minutes are divided by the number of

letters written within the time given.letters written within the time given.

ETCHETCH

Diekema et al. (1998)Diekema et al. (1998)

Test-retest reliability of the ETCH-MTest-retest reliability of the ETCH-M

• Examined the test-retest reliability with Examined the test-retest reliability with • 31 First and second graders31 First and second graders• Tested twice with one week between testing Tested twice with one week between testing Results:Results: total letter legibility =.77 total letter legibility =.77 total word legibility =.71total word legibility =.71Individual letter legibility ranged from .20-.76 Individual letter legibility ranged from .20-.76

ETCHETCHSudsawad et al. (2000)Sudsawad et al. (2000)

The Relationship Between the ETCH and The Relationship Between the ETCH and teachers’ perception of handwriting teachers’ perception of handwriting

LegibilityLegibility • 45 first grade students 45 first grade students • Teacher rated students Teacher rated students • ETCHETCH• Compared the ETCH scores to the teacher questionnaireCompared the ETCH scores to the teacher questionnaire

Results:

Legability Legability Items:Items:

ETCHETCH Teacher Teacher

Questionnaire Questionnaire

NumbersNumbers m=76.3m=76.3 m= -1.3m= -1.3

Near Point Near Point m= 61.8m= 61.8 m= -1.8m= -1.8

Far PointFar Point m=45.8m=45.8 m=-2.0m=-2.0

Dictation Dictation m=42.2 m=42.2 m=1.7m=1.7

ETCHETCH

ETCHETCH

Pros:Pros:• Examiner is proficient Examiner is proficient • Scoring criteriaScoring criteria• Score sheets Score sheets • Includes diagramsIncludes diagrams• Total score reliabilityTotal score reliability• Tasks are relevantTasks are relevant• Cons:Cons:• Individual score reliability Individual score reliability • Insufficient validity studiesInsufficient validity studies• VariabilityVariability• Writing Quality Writing Quality

ETCHETCH

Limitations:Limitations: SubjectiveSubjective Handwriting changes Handwriting changes Combined with other methods Combined with other methods Unable to account for the differences Unable to account for the differences

in in handwriting qualityhandwriting quality

ETCHETCH

How can this be modified?How can this be modified?

Latency and durationLatency and duration

Operational definitionOperational definition

legibility legibility

speedspeed

Pretest/Post-test Pretest/Post-test

ReferencesReferencesAlston, J., & Taylor, J. (1987). Alston, J., & Taylor, J. (1987). Handwriting: Theory, Handwriting: Theory,

research and practiceresearch and practice. London, UK: Croom Helm.. London, UK: Croom Helm.Berninger, V., & Graham, S. (1998). Language by hand: A Berninger, V., & Graham, S. (1998). Language by hand: A

synthesis of a decade of research on handwriting. synthesis of a decade of research on handwriting. Handwriting ReviewHandwriting Review 12: 11-25. 12: 11-25.

Cornhill, H., & Case-Smith, J. (1996). Factors that relate to Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. good and poor handwriting. American Journal of American Journal of Occupational Therapy, 56(3),Occupational Therapy, 56(3), 305-312. 305-312.

Daniels, L.E. (1988). The diagnosis and remediation of Daniels, L.E. (1988). The diagnosis and remediation of handwriting problems: An analysis. handwriting problems: An analysis. Physical & Physical & Occupational Therapy in PediatricsOccupational Therapy in Pediatrics, 8(1), 61-67., 8(1), 61-67.

Diekema, S.M., Deitz, L., & Amundson, S.J. (1998). Test-retest reliability of the Evaluation Tool of Children’sHandwrting-Manuscript. American Journal of Occupational Therapy, 52, 248-255.

Feder, K., & Majnemer, A. (2003). Children’s Handwriting Feder, K., & Majnemer, A. (2003). Children’s Handwriting Evaluation Tools and Their Psychometric Properties. Evaluation Tools and Their Psychometric Properties. Physical and Occupational Therapy in Pediatrics, 23(3Physical and Occupational Therapy in Pediatrics, 23(3), ), 65-83.65-83.

ReferencesReferencesHarvey, C. & Henderson, S. (1997). Children’s Harvey, C. & Henderson, S. (1997). Children’s

handwriting in the first three years of school: handwriting in the first three years of school: Consistency over time and its relationship to Consistency over time and its relationship to academic achievement. academic achievement. Handwriting ReviewHandwriting Review 11: 8-25. 11: 8-25.

Owens, L.L (2004). The Effects of the Handwriting Owens, L.L (2004). The Effects of the Handwriting Without Tears Program on the Handwriting of Without Tears Program on the Handwriting of Students in Inclusion Classrooms. Students in Inclusion Classrooms. Master’s ThesisMaster’s Thesis. . Virginia Commonwealth University, Richmond, Virginia Commonwealth University, Richmond, Virginia. Virginia.

Reisman, J.E., (1991). Reisman, J.E., (1991). Poor handwriting: Who is Poor handwriting: Who is referred? American Journal of Occupational Therapy, referred? American Journal of Occupational Therapy, 4545, 849-852., 849-852.

Reisman, J.E., (1993). Development and Reliability of Reisman, J.E., (1993). Development and Reliability of the Research Version of the Minnesota Handwriting the Research Version of the Minnesota Handwriting TestTest.. Physical and Occupational Therapy in Physical and Occupational Therapy in Pediatrics, 13Pediatrics, 13(2), 41-55.(2), 41-55.

Sassoon, R. (1997). Dealing with adult handwriting Sassoon, R. (1997). Dealing with adult handwriting problems. problems. Handwriting ReviewHandwriting Review 11: 69-74. 11: 69-74.

ReferencesReferencesStott, D.H., Henderson, S.E., & Moyes, F.A. (1987). Stott, D.H., Henderson, S.E., & Moyes, F.A. (1987).

Diagnosis and remediation of handwriting problems. Diagnosis and remediation of handwriting problems. Adapted Physical Education QuarterlyAdapted Physical Education Quarterly, 4, 134-147., 4, 134-147.

Stott, D.H., Moyes, F.A., & Henderson, S.E. (1985). Stott, D.H., Moyes, F.A., & Henderson, S.E. (1985). Diagnosis and Remediation of Handwriting ProblemsDiagnosis and Remediation of Handwriting Problems . . Fairwater, Cardiff, Whales. DRAKE Educational Fairwater, Cardiff, Whales. DRAKE Educational Associates.Associates.

Stowitschek, C.E., Stowitschek, J.J., Hendrickson, J.M., Stowitschek, C.E., Stowitschek, J.J., Hendrickson, J.M., Gable, R.A. (1989). Diagnosis and remediation of Gable, R.A. (1989). Diagnosis and remediation of handwriting errors. handwriting errors. Multidisciplinary Diagnostic and Multidisciplinary Diagnostic and Training Program,Training Program, 22. 22.

Sudsawad, P.,Trombly, C.A., Henderson, A., Tickle-Degnen, L (2000). The relationship between the Evaluation Tool of Children’s Handwriting and teachers perceptions of handwriting legibility. American Journal of Occupational Therapy, 55 518-523.